What is Transferred and How Much is Retained? A Simulation Study of Complex Surgical Skills

Studies indicate that learning surgical skills on low-fidelity models is equally beneficial to learning on high-fidelity models in terms of skills retention and transfer. However, it is unclear how low-fidelity simulation training impacts retention and transfer in novice learners, particularly on complex surgical tasks that incorporate multiple challenging skills. This study explores the capacity of complete novices to learn and transfer complex surgical skills from a low-fidelity model to a high-fidelity simulation after a delay.

Task-naïve medical and nonmedical undergraduate students (n = 62) participated in a three-phase prospective double-arm randomized (2:1) experimental study. Participants completed two skills training sessions (end-to-side anastomosis) on a low-fidelity bench model. After a 4-week delay, participants completed the task again either using the low-fidelity model or a high-fidelity model (cadaver) and were assessed using a validated checklist.

There was a significant time × fidelity group interaction (P = 0.004). Simple effects analysis indicated the high-fidelity group (M_diff = 4.18, P < 0.001) performed significantly worse (P = 0.003) in phase 3 relative to phase 2 compared to the low-fidelity group (M_diff = 0.75, P = 0.39). Post hoc logistic regression analysis indicated that radial suturing technique and economy of motion skills were less likely to be completed correctly for those in the high-fidelity group.

These findings suggest that for novice populations, relying on low-fidelity simulation training as a source of teaching complex skills may not provide a reliable transfer to high-fidelity models and in turn clinical settings.