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Introduction of a Virtual Reality-Based Laparoscopic Skills Training Program into Surgical Residency

David B Earle, Jay Kuhn, Neal E Seymour
Baystate Medical Center, Springfield, MA

Although technical skills training is a vital component of surgical education, it is largely pursued in a nonstructured fashion during actual patient care.
Objectives:
In a medium-sized surgical residency, a technical skills curriculum was instituted. Blocked training time on a virtual reality laparoscopic trainer was started with the intention of increasing resident technical skills.
Methods:
After initial survey of prior laparoscopic experience, 10 postgraduate year 1-2 trainees received mentored instruction on training tasks by a surgical teacher over 2-4 1-hour sessions, and were instructed to return for self-directed practice. If no practice sessions occurred over a 4 week period, residents were contacted and instructed to resume training.
Results:
There were no significant differences in number of prior laparoscopic procedures among residents by PGY level at onset of training. Over 4 months residents undertook 13 ± 4 training sessions (range 4-28) including those under supervision. 4 residents achieved expert levels of performance relative to experienced laparoscopic surgeons. These residents had higher initial scores on an index task than those who did not achieve these levels (p < 0.05). All residents demonstrated improvement in error frequency and economy of instrument use.
Conclusions:
Mandated use of a virtual reality trainer resulted in a variable level of actual usage among trainees. Rate of skill acquisition is predicted by initial performance, but all trainees improved with practice. On the basis of these observations, strategies to improve individual compliance and verify improved clinical skills have been implemented.

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