Simulation-based mastery learning improves patient outcomes in laparoscopic inguinal hernia repair: a randomized...

Area of Science:

• Surgical Education
• Minimally Invasive Surgery
• Medical Simulation

Background:

• Establishing the clinical benefits of simulation-based training for surgical skills like operative time and error reduction remains challenging.
• Laparoscopic totally extraperitoneal (TEP) inguinal hernia repair requires specialized technical proficiency.

Purpose of the Study:

• To assess the effectiveness of a mastery learning, simulation-based curriculum for TEP inguinal hernia repair.
• To determine if simulation training improves surgical performance and patient outcomes.

Main Methods:

• General surgery residents were randomized to either a mastery learning (ML) or standard practice (SP) group after a baseline TEP repair.
• The ML group underwent web-based modules and simulator training until expert performance was achieved.
• Operative time, performance scores, and patient outcomes were compared between groups, adjusting for confounding factors.

Main Results:

• ML residents achieved significantly faster operative times (34 vs. 48 minutes) and higher performance scores (21.9 vs. 18.3) post-training compared to SP residents.
• The ML group experienced fewer intraoperative complications (e.g., peritoneal tear, conversion), postoperative complications (e.g., urinary retention, seroma), and reduced need for overnight stays.
• Mastery learning required a median of 16 simulated repairs to achieve expert performance.

Conclusions:

• A simulation-based mastery learning curriculum effectively reduces operative time and enhances trainee performance in laparoscopic TEP inguinal hernia repair.
• This training methodology leads to improved patient safety, evidenced by decreased intra- and postoperative complications and shorter hospital stays.
• Simulation-based mastery learning represents a valuable tool for surgical skill acquisition in minimally invasive procedures.