The Role of Deconstructive Teaching in the Training of Laparoscopy

Abstract

Background and objectives: Skills-lab training is crucial for the development of advanced laparoscopic skills. In this study, we examined whether a systematic deconstructive and comprehensive tutoring approach improves training results in laparoscopic suturing and intracorporeal knot tying.

Methods: Sixteen residents in obstetrics and gynecology participating in structured skills-lab laparoscopy training were randomized in 2 equal-sized groups receiving 1-on-1 tutoring either in the traditional method or according to the Peyton's 4-step approach, involving an additional training step, with the trainees instructing the tutor to perform the exercises. A validated assessment tool (revised Objective Structured Assessment of Technical Skills) and the number of completed square knots per training session and the mean time per knot were used to assess the efficacy of training in both groups.

Results: Trainees in Peyton's group achieved significantly higher revised Objective Structured Assessment of Technical Skills scores (28.6 vs 23.9 points; P = .05) and were able to improve their scores during autonomous training repetitions, in contrast to the trainees not in Peyton's group (difference +4.75 vs -4.29 points, P = .02). Additionally, they seemed to be able to perform a greater number of successful knots during the exercise and to complete each knot quicker with the later observations failing to reach the threshold of statistical significance.

Conclusion: Peyton's 4-step approach seemed to be superior for teaching laparoscopic skills to obstetrics and gynecology residents in the skills-lab setting and can be therefore proposed for training curricula.

Keywords: Laparoscopic training; Pelvitrainer; Peyton's 4-step approach.

Figure 1.

OSATS scores before and after training repetitions for all trainees, regardless of tutoring method: The training does not improve the score. Results are displayed as means ± standard deviations. The dots represent outliers (P = 0.64).

Figure 2.

OSATS scores before (dark) and after (bright) the autonomous training repetitions: In the Peyton tutoring group, there is an improvement of the qualitative score. Results are displayed as mean ± standard deviation. The dots represent outliers (P = .05).

Figure 3.

Difference in OSATS score during the autonomous training for each tutoring method. Peyton group trainees present an increase and non-Peyton trainees present a decrease in their OSATS score. Results are displayed as mean ± standard deviation (P = .02).

Figure 4.

Number of successful knots during the 5 repetitions. In both groups, the number of knots is increasing, but the Peyton group trainees perform more knots (P = .11). Results are displayed as mean ± standard deviation.

Figure 5.

Average time in seconds needed for the completion of one successful knot during each training repetition in both tutoring groups. Both groups present a nonsignificant improvement during repetitions.