title: Training or non-surgical factors-what determines a good surgical performance? A randomised controlled trial.
abstract: BACKGROUND
  Acquiring laparoscopic skills is a necessity for every young surgeon. Whether it is a talent or a non-surgical skill that determines the surgical performance of an endoscopic operation has been discussed for years. In other disciplines aptitude testing has become the norm. Airlines, for example, have implemented assessments to test the natural aptitude of future pilots to predict their performance later on. In the medical field, especially surgery, there are no similar comparable tests implemented or even available. This study investigates the influence of potential factors that may predict the successful performance of a complex laparoscopic operation, such as the surgeon's age, gender or learning method.
  
  
  METHODS
  This study focussed 70 surgical trainees. It was designed as a secondary analysis of data derived from a 2 × 2 factorial randomised controlled trial of practical training and/or multimedia training (four groups) in an experimental exercise. Both before and then after the training sessions, the participating trainees performed a laparoscopic cholecystectomy in a pelvitrainer. Surgical performance was then evaluated using a modified objective structured assessment of technical skills (OSATS). Participants were classified as 'Skilled' (high score in the pre-test), 'Good Learner' (increase from pre- to post-test) or 'Others' based on the OSATS results. Based on the results of the recorded performance, the training methods as well as non-surgical skills were eventually evaluated in a univariate and in a multivariate analysis.
  
  
  RESULTS
  In the pre-training performance 11 candidates were categorised as 'Skilled' (15.7%), 35 participants as 'Good Learners' (50.0%) and 24 participants were classified as 'Others'. The univariate analysis showed that the age, a residency in visceral surgery, and participation in a multimedia training were significantly associated with this grouping. Multivariate analyses revealed that residency in visceral surgery was the most predictive factor for the 'Skilled' participants (p = 0.059), and multimedia training was most predictive for the 'Good Learner' (p = 0.006). Participants in the group of 'Others' who were neither 'Skilled' nor improved in the training phase were younger (p = 0.011) and did not receive multimedia (p < 0.001) or practical (p = 0.025) training.
  
  
  CONCLUSIONS
  The type of learning method has been shown to be the most effective factor to improve laparoscopic skills, with multimedia training proving to be more effective than practical training.
authors.affiliation: Department for General, Abdominal and Thoracic Surgery, Clinic Gummersbach, Academic Hospital, University of Cologne, Wilhelm-Breckow-Allee 20, 51643, Gummersbach, Germany. colilo@web.de.
authors.forename: Cornelia
authors.identifier: http://orcid.org/0000-0001-9950-8362
authors.initials: C
authors.lastname: Lindlohr
authors.affiliation: Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, Cologne, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Lefering
authors.affiliation: Department for General, Abdominal and Thoracic Surgery, Clinic Gummersbach, Academic Hospital, University of Cologne, Wilhelm-Breckow-Allee 20, 51643, Gummersbach, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Saad
authors.affiliation: Department for Abdominal, Vascular and Transplant Surgery, Cologne-Merheim Medical Centre, University of Witten/Herdecke, Cologne, Germany.
authors.forename: M M
authors.initials: MM
authors.lastname: Heiss
authors.affiliation: Department for General and Abdominal Surgery, Protestant Hospital, Cologne-Weyertal, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Pape-Köhler
mesh_terms: D000328:Adult; D000367:Age Factors; D001076:Aptitude; D017081:Cholecystectomy, Laparoscopic / Q000193:education*; D002983:Clinical Competence; D003194:Computer-Assisted Instruction; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D018794:Problem-Based Learning; D012737:Sex Factors
keywords: Aptitude; Multimedia training; Non-surgical skills; OSATS; Surgical performance; Surgical training