Pediatric urology training: performance-based assessment using the fundamentals of laparoscopic surgery

Despite the proven utility of laparoscopy in pediatric urology, widespread adoption of the surgical approach has been limited. The Fundamentals of Laparoscopic Surgery (FLS) is a reliable teaching mode for surgeons. Our study objective was to evaluate the effectiveness of a laparoscopic training course via a performance based assessment of participants' technical skills on the FLS module.

The laparoscopic pediatric urology course, administered to 18 fellows, consisted of a 6-h didactic session and a full d practice on a live porcine model. FLS skills were practiced prior to and immediately following the course, and included peg transfer, precision pattern cutting, securing a ligating loop, and intracorporeal suturing. Written exams were used to evaluate participants' cognitive knowledge about laparoscopic procedures. Pretest and post-test performances were compared using paired t-tests. Previous laparoscopic caseload was addressed as a potential predictor of performance using two separate Pearson correlations between total caseload and performance scores.

Participation in the course led to significant improvements in FLS and written exam scores. Laparoscopic caseload was correlated with pretest performance (R = 0.53, P < 0.05) though this correlation was not significant at post-test (R = 0.41, P > 0.05). However, the improvement from pretest to post-test (i.e., difference score) was significantly related to the participants' pediatric laparoscopic caseload (R = -0.47, P < 0.05).

Operative experience is instrumental in attaining laparoscopic skills. However, intensive simulation-based training improves technical performance and cognitive knowledge competence, especially for novice trainees. Long-term assessment of trainees is required to ascertain the effectiveness of this approach to laparoscopic training.