Abstract

Introduction:

Post graduate surgical skill training has significantly changed over the last few years. A number of drivers for this include COVID-19 pandemic – which has reduced training opportunities available (1), a shift in focus on maintaining patient safety (2) and the importance of assessing skills before they are done on patients (3). Simulation is felt to be an acceptable technique to recreate part of the clinical environment, in which clinical skills can be taught and assessed without exposing patient to risks (4). In this project we assessed how confidence changed for both surgical and obstetric trainees following practicing laparoscopic skills on a task trainer.

Methodology:

2 laparoscopic skills training sessions were set up 6 months apart, for junior doctors of all levels from various surgical specialities. Trainees were able to practice various skills according to their grade.

5 laparoscopic task trainers of low fidelity (3 Inovus and 2 EO-sim) connected to a monitor were set up. Skills ranged from grasping and manipulating tissues (moving polo mints and stacking dice), tying and placing extracorporeal roeder knots, cutting (various shapes from gloves) and suturing (normal, under tension and suturing in a straight line). Data was collected looking at how confidence changed before and after the course in each of the above domains.

Doctors graded their confidence level from NA, very poor, poor, average, reasonable and good. Qualitative data was also collected about what trainees thought about the course.

Results:

21 trainees in total. 15 general surgeons and 6 obstetric and gynaecology doctors.
Trainee Grade: Fy1 to registrars (PGY1-Fellows).

For manipulation and grasping; there was a 58% improvement in confidence and a mode shift from average to reasonable. For cutting; there was an 85% improvement in confidence and the mode shifted from poor to reasonable. For tying and placing intra-corporeal roeder knots; there was a 13% improvement in confidence and the mode remained at reasonable. For suturing; there was a 54% improvement in confidence and the mode shifted from poor to average.

Conclusion:

Limitation of the study is that the sample size is small.
However, this data shows the importance of practicing laparoscopic skills in a safe environment. Utilising the laparoscopic trainers is a safe method to achieve this. The skills obtained can be repeated to build confidence. It is cost effective and can be replicated over several different sessions easily to allow trainees to practice thus enhancing learning. These results are promising and with further research and a larger sample size we would be able to validate this as an integral component of surgical training.

References: 

1. Zheng, J. et al., 2020. General Surgery chief residents’ perspective on surgical education during the coronavirus disease 2019 (COVID-19) pandemic. Surgery, 168(2), pp. 222-225.
2. GMC, 2015. GMC, Promoting excellence: standards for medical education and training
3. Fried, M. P. et al., 2004. Identifying and reducing errors with surgical simulation. Qual Saf Health Care, 13(1), pp. 19-26.
4. Maran, N. J. & Glavin, R. J., 2003. Low- to high-fidelity simula