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Performance variables and professional experience in simulated laparoscopy: a two-group learning curve study
Jan-Maarten Luursema1, Maroeska M Rovers2, Marleen Groenier3
1Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Department of Operating Rooms, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Objective:
Virtual reality simulators are increasingly used in laparoscopy training. Such simulators allow objective assessment of performance. However, both low-level variables and overall scores generated by the simulator can be hard to interpret. We present a method to generate intermediate performance variables and show how the resulting variables can be used to investigate the development of laparoscopic skills.
Design:
A beginner group (n = 16) and a group with intermediate laparoscopic experience (n = 9) participated in a 5-session, basic skills training course hosted by the Department of Technical Medicine at the University of Twente. Multiple simulator-generated variables were aggregated into 4 performance variables: duration, left-hand motion, right-hand motion, and damage. Differences in performance were analyzed in relation to proficiency values.
Results:
Damage performance differentiated the most between groups and proficiency values; motion performance variables differentiated the least. The more experienced group outperformed the beginner group at damage by the end of the course.
Conclusions:
Differentiating between duration, left-hand motion, right-hand motion, and damage is a useful way to investigate laparoscopic performance development. Different performance variables follow different trajectories toward expertise. Valid and reliable clinical damage parameters are needed to investigate the relation of real-world damage to simulator damage.
