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Review
. 2022 Dec;36(12):8726-8736.
doi: 10.1007/s00464-022-09408-2. Epub 2022 Jul 18.

Optimizing laparoscopic training efficacy by 'deconstruction into key steps': a randomized controlled trial with novice medical students

A Widder #  1 , J Backhaus #  2 , A Wierlemann  3 , I Hering  3 , S Flemming  3 , M Hankir  3 , C-T Germer  3 , A Wiegering  3 , J F Lock  3 , S König  4 , F Seyfried  3
Affiliations
Review

Optimizing laparoscopic training efficacy by 'deconstruction into key steps': a randomized controlled trial with novice medical students

A Widder et al. Surg Endosc. 2022 Dec.

Abstract

Background: Simulator training is an effective way of acquiring laparoscopic skills but there remains a need to optimize teaching methods to accelerate learning. We evaluated the effect of the mental exercise 'deconstruction into key steps' (DIKS) on the time required to acquire laparoscopic skills.

Methods: A randomized controlled trial with undergraduate medical students was implemented into a structured curricular laparoscopic training course. The intervention group (IG) was trained using the DIKS approach, while the control group (CG) underwent the standard course. Laparoscopic performance of all participants was video-recorded at baseline (t0), after the first session (t1) and after the second session (t2) nine days later. Two double-blinded raters assessed the videos. The Impact of potential covariates on performance (gender, age, prior laparoscopic experience, self-assessed motivation and self-assessed dexterity) was evaluated with a self-report questionnaire.

Results: Both the IG (n = 58) and the CG (n = 68) improved their performance after each training session (p < 0.001) but with notable differences between sessions. Whereas the CG significantly improved their performance from t0 -t1 (p < 0.05), DIKS shortened practical exercise time by 58% so that the IG outperformed the CG from t1 -t2, (p < 0.05). High self-assessed motivation and dexterity associated with significantly better performance (p < 0.05). Male participants demonstrated significantly higher overall performance (p < 0.05).

Conclusion: Mental exercises like DIKS can improve laparoscopic performance and shorten practice times. Given the limited exposure of surgical residents to simulator training, implementation of mental exercises like DIKS is highly recommended. Gender, self-assessed dexterity, and motivation all appreciably influence performance in laparoscopic training.

Keywords: Deconstruction into key steps; Laparoscopic course; Laparoscopic skills; Teaching methods.

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Conflict of interest statement

Priv.-Doz. Dr. med. Florian Seyfried´s basic scientific research is founded by the German research foundation DFG SE 2027/5–1. Prof. Dr. med. Armin Wiegering´s basic scientific research is founded by the German research foundation DFG WI-5037/1–4. Dr. rer. nat. Mohamed Hankir´s basic scientific research is founded by the German research foundation DFG HA 8213/3–1. Dr. med. Sven Flemming´s basic scientific research is founded by the German research foundation in DFG FL 870/2–2. Prof. Dr. med. Christoph-Thomas Germer, Prof. Dr. med. Sarah König, Priv.-Doz. Dr. med. Johan Friso Lock, Ilona Hering, Dr. med. Alexander Wierlemann, Joy Backhaus and Anna Widder have no conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
Study design and training for students in pairs
Fig. 2
Fig. 2
The checklist CAT to assess the laparoscopic performance
Fig. 3
Fig. 3
Internal validation. Increase in performance of students in the control group (CG) and intervention group (IG) compared to surgical residents and attending surgeons regarding the categories “quality” and “quantity”
Fig. 4
Fig. 4
Increase in performance given as the normalized gain of “quality” and “quantity” *p-value ≤ 0,05
Fig. 5
Fig. 5
Quantitative and qualitative performance at t0, t1 and t2 by a gender, b self-assessed dexterity and c self-assessed motivation, *p ≤ 0,05; **p ≤ 0,001
Fig. 6
Fig. 6
Simplified version of a latent difference model
See this image and copyright information in PMC

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