title: Comprehensive simulation-enhanced training curriculum for an advanced minimally invasive procedure: a randomized controlled trial.
abstract: BACKGROUND
  There is no comprehensive simulation-enhanced training curriculum to address cognitive, psychomotor, and nontechnical skills for an advanced minimally invasive procedure.
  
  
  OBJECTIVE
  1) To develop and provide evidence of validity for a comprehensive simulation-enhanced training (SET) curriculum for an advanced minimally invasive procedure; (2) to demonstrate transfer of acquired psychomotor skills from a simulation laboratory to live porcine model; and (3) to compare training outcomes of SET curriculum group and chief resident group.
  
  
  METHODS
  University.
  
  
  METHODS
  This prospective single-blinded, randomized, controlled trial allocated 20 intermediate-level surgery residents to receive either conventional training (control) or SET curriculum training (intervention). The SET curriculum consisted of cognitive, psychomotor, and nontechnical training modules. Psychomotor skills in a live anesthetized porcine model in the OR was the primary outcome. Knowledge of advanced minimally invasive and bariatric surgery and nontechnical skills in a simulated OR crisis scenario were the secondary outcomes. Residents in the SET curriculum group went on to perform a laparoscopic jejunojejunostomy in the OR. Cognitive, psychomotor, and nontechnical skills of SET curriculum group were also compared to a group of 12 chief surgery residents.
  
  
  RESULTS
  SET curriculum group demonstrated superior psychomotor skills in a live porcine model (56 [47-62] versus 44 [38-53], P<.05) and superior nontechnical skills (41 [38-45] versus 31 [24-40], P<.01) compared with conventional training group. SET curriculum group and conventional training group demonstrated equivalent knowledge (14 [12-15] versus 13 [11-15], P = 0.47). SET curriculum group demonstrated equivalent psychomotor skills in the live porcine model and in the OR in a human patient (56 [47-62] versus 63 [61-68]; P = .21). SET curriculum group demonstrated inferior knowledge (13 [11-15] versus 16 [14-16]; P<.05), equivalent psychomotor skill (63 [61-68] versus 68 [62-74]; P = .50), and superior nontechnical skills (41 [38-45] versus 34 [27-35], P<.01) compared with chief resident group.
  
  
  CONCLUSIONS
  Completion of the SET curriculum resulted in superior training outcomes, compared with conventional surgery training. Implementation of the SET curriculum can standardize training for an advanced minimally invasive procedure and can ensure that comprehensive proficiency milestones are met before exposure to patient care.
authors.affiliation: Department of Surgery, University of Toronto, Toronto, Canada. Electronic address: boris.a.zevin@gmail.com.
authors.forename: Boris
authors.initials: B
authors.lastname: Zevin
authors.affiliation: Institute of Medical Science, University of Toronto, Toronto, Canada.
authors.forename: Nicolas J
authors.initials: NJ
authors.lastname: Dedy
authors.affiliation: Institute of Medical Science, University of Toronto, Toronto, Canada.
authors.forename: Esther M
authors.initials: EM
authors.lastname: Bonrath
authors.affiliation: Department of Surgery, University of Toronto, Toronto, Canada; Division of General Surgery, St. Michael׳s Hospital, Toronto, Canada.
authors.forename: Teodor P
authors.initials: TP
authors.lastname: Grantcharov
mesh_terms: D000328:Adult; D000818:Animals; D050110:Bariatric Surgery / Q000193:education* / Q000592:standards; D002983:Clinical Competence / Q000592:standards; D000066491:Clinical Decision-Making; D003142:Communication; D003479:Curriculum; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D007400:Interprofessional Relations; D007582:Jejunostomy / Q000193:education / Q000592:standards; D010535:Laparoscopy / Q000193:education* / Q000592:standards; D008297:Male; D023421:Models, Animal; D011446:Prospective Studies; D011597:Psychomotor Performance / Q000502:physiology; D000066908:Simulation Training / Q000379:methods*; D016037:Single-Blind Method; D013552:Swine; D055815:Young Adult
keywords: Simulation-enhanced training; advanced minimally invasive surgery; bariatric surgery; comprehensive curriculum