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Mastery learning simulation-based curriculum for laparoscopic TEP inguinal hernia repair.

Benjamin Zendejas1, David A Cook, Roberto Hernández-Irizarry

  • 1Department of Surgery, College of Medicine, Mayo Clinic, Rochester, MN, USA.

Journal of Surgical Education
|February 28, 2012
PubMed
Summary

Simulation training accelerates mastery of laparoscopic totally extraperitoneal (TEP) inguinal herniorrhaphy. Surgical trainees achieved expert-level technical skills in simulated TEP repairs, indicating readiness for operating room training.

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Area of Science:

  • Surgical Education
  • Minimally Invasive Surgery
  • Medical Simulation

Background:

  • Mastering laparoscopic totally extraperitoneal (TEP) inguinal herniorrhaphy traditionally requires 250 repairs.
  • Simulation-based training offers a potential method to expedite the learning curve for TEP procedures.
  • This study details the creation and validation of a TEP mastery learning curriculum.

Purpose of the Study:

  • To develop and evaluate a mastery learning curriculum for TEP inguinal herniorrhaphy using simulation.
  • To assess the effectiveness of simulation training in accelerating surgical skill acquisition for TEP repairs.
  • To determine if trainees can achieve expert-level performance on a TEP simulator.

Main Methods:

  • A two-stage curriculum was designed, incorporating online modules and simulator practice (Guildford-MATTU TEP trainer).

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  • Learners progressed upon demonstrating mastery, assessed by a knowledge test and procedure time benchmarked against experienced surgeons.
  • Individualized feedback and proctoring were provided until mastery time was achieved.

    • Main Results:

    • All participants successfully met knowledge and skills mastery endpoints.
    • Trainees required a median of 69 minutes and 16 simulated repairs to achieve mastery.
    • Training time and number of attempts varied significantly by experience level, with more experienced residents requiring less time and fewer attempts.

    Conclusions:

    • Simulation-based mastery learning enables surgical trainees to acquire TEP repair skills to an expert level under artificial conditions.
    • Trainees successfully completing the simulation curriculum are deemed ready for advanced training in the operating room.
    • This approach can potentially reduce the time and number of repairs needed to achieve TEP surgical proficiency.