Design and implementation of a proficiency-based, structured endoscopy course for medical students applying for a surgical specialty

Abstract

Background: Surgical simulation is becoming increasingly important in surgical education. Despite the important work done on simulators, simulator model development, and simulator assessment methodologies, there is a need for development of integrated simulators in the curriculum. In this paper, we describe the design of our evidence-based preclinical training program for medical students applying for a surgical career at the Centre for Surgical Technologies.

Methods: Twenty-two students participated in this training program. During their final months as medical students, they received structured, proficiency-based endoscopy training. The total amount of mentored training was 18 hours and the training was organized into three training blocks. The first block focused on psychomotor training, the second block focused on laparoscopic stitching and suturing, and the third block on laparoscopic dissection techniques and hemostasis. Deliberate practice was allowed and students had to show proficiency before proceeding to the next training block. Students' psychomotor abilities were tested before the course and after each training block. At the beginning of their careers as surgical registrars, their performance on a laparoscopic suturing task was compared with that of registrars from the previous year who did not have this training course. Student opinions about this course were evaluated using a visual analog scale.

Results: All students rated the training course as useful and their psychomotor abilities improved markedly. All students performed deliberate practice, and those who participated in this course scored significantly (P < 0.0001) better on the laparoscopic suturing task than first year registrars who did not participate in this course.

Conclusion: Organization of a structured preclinical training program in laparoscopy for final year medical students is feasible, attractive, and successful.

Keywords: curriculum development; laparoscopy training; proficiency based; surgical skill evaluation.

Figure 1

Design of the preclinical training program at the Centre for Surgical Technologies. Notes: Every training block starts with online instructions which the student can prepare at home. Every training block consists of four daily training sessions each of 1.5 hours. At the end of each training block, the students have the opportunity to enhance their skills with performing deliberate practice. Two weeks later, the skills acquired are tested. If proficiency is reached, the trainee can continue with the next training block.

Figure 2

Laparoscopic psychomotor skills training and testing model. (A) E1, camera navigation. (B) E2, hand-eye coordination. (C) E3 bimanual coordination. Note: Springer and Gynecological Surgery. Campo R. A valid model for testing and training laparoscopic psychomotor skills. Gynecol Surg. 2010;7(2):133-141. With kind permission from Springer Science and Business Media.

Figure 3

Pulsatile organ perfusion model of bleeding.

Figure 4

Improvement of Southwestern drills between different training sessions. Notes: Results on Southwestern drills before training, during evaluation of block 1 (psychomotor training), and during the final evaluation, after block 2 (suturing) and block 3 (dissection, tissue feeling, and hemostasis). There is a significant decrease in time needed to complete all three drill exercises after the first training block (P < 0.0001). The second and third training block do not decrease the time needed further (P > 0.05).

Figure 5

Course evaluation by students’ visual analog score.

Figure 6

(A) At the beginning of surgical residency, the preclinical trained students outperformed the registrars from the previous year on suturing a pig aorta, a task that none of the trainees had performed before (P < 0.0001, t-test). (B) However, when the suturing evaluation for students who completed the preclinical training program at the Centre for Surgical Technologies after block 2 (suturing chicken skin) was compared with the more complex suturing evaluation at the start of their residency (suturing pig aorta), a marked skill decay is seen (P = 0.0055, paired t-test).