Simulator training to automaticity leads to improved skill transfer compared with traditional proficiency-based...

Area of Science:

• Surgical Education
• Medical Simulation
• Skill Acquisition

Background:

• Simulator training enhances surgical skills, but skill transfer to the operating room is often incomplete.
• Secondary task metrics can assess multitasking ability (automaticity) and indicate learning completion.
• Automaticity training may improve performance assessment and skill transfer in surgical simulation.

Purpose of the Study:

• To test the hypothesis that novices achieve better operating room performance after simulator training to automaticity compared to traditional proficiency-based training.
• To evaluate the effectiveness of secondary task metrics in assessing surgical skill automaticity.

Main Methods:

• A randomized controlled trial enrolled 30 novices, randomized into intervention (n=20) and control (n=10) groups.
• The intervention group underwent simulator suturing training to proficiency, then to automaticity using a secondary task, with retesting on an operating room model.
• Performance scores were compared between groups during testing sessions on a live porcine fundoplication model.

Main Results:

• Intervention participants achieved proficiency in 54 ± 14 repetitions and automaticity in an additional 109 ± 57 repetitions.
• Operating room performance scores were significantly higher after automaticity training (345) compared to proficiency-based training (220; P < 0.001).

Conclusions:

• Simulator training to automaticity, while time-consuming, is superior to proficiency-based training for surgical skill acquisition and transfer.
• Implementing secondary task metrics for automaticity assessment in simulator training can enhance learning and skill transfer.
• Automaticity training is a more effective paradigm for surgical skill development than traditional proficiency-based methods.