Cognitive learning versus practical "hands-on" training for acquisition of laparoscopic surgical skills: an optimal
Amila Cizmic1, Nils Schwabe2, Frida Häberle2
1Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
Background:
Most minimally invasive surgery (MIS) training curricula involve practical training (PT) and cognitive learning (CL) to different extents. It has been proven that acquiring and training specific skills through CL can improve MIS skills. This study aimed to discover the most efficient combination of these two approaches and examine their effects on acquiring MIS skills in novices.
Methods:
Sixty medical students without MIS experience participated in this randomized controlled study and were divided into three groups. The first group received the same amount of PT (50%) as CL (50%). The second group focused on PT (75%) compared to the CL (25%). The third group focused more on CL (75%), with less PT implemented (25%). Before and after training, participants performed an ex vivo laparoscopic cholecystectomy (LCHE). Objective Structured Assessment of Technical Skills (OSATS) and Global Operative Assessment of Laparoscopic Skills (GOALS) scores were used for MIS skill evaluation.
Results:
Group 1 improved all four performance assessments (global GOALS 14.3 vs. 18.0, p < 0.001, LCHE-specific GOALS 5.9 vs. 6.9, p = 0.016, global OSATS 19.4 vs. 26.4, p < 0.001, LCHE-specific OSATS 37.9 vs. 46.5, p = 0.004). Group 2 and Group 3 improved three of four performance scores (Group 2: global GOALS 15.0 vs. 18.4, p < 0.001, LCHE-specific GOALS 7.0 vs. 7.7, p = 0.115, global OSATS 19.6 vs. 25.8, p < 0.001, LCHE-specific OSATS 41.3 vs. 50.7, p = 0.001; Group 3: global GOALS 13.8 vs. 17.9, p < 0.001, LCHE-specific GOALS 5.8 vs. 6.6, p = 0.148, global OSATS 18.9 vs. 25.5, p < 0.001, LCHE-specific OSATS 36.8 vs. 43.5, p = 0.034).
Conclusions:
A balanced combination of PT and CL seems to offer the most effective training compared to predominantly PT or CL training. All three training modes improved MIS skills in novices.
Related Concept Videos
01:26Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
01:21Cognitive Learning
E. C. Tolman's theory of purposive behavior emphasizes that much behavior is goal-directed. He argued that to understand behavior, we must look at the entire sequence of actions leading to a goal. For instance, high school students study hard, not just due to past reinforcement but also to achieve the goal of getting into a good college.
Tolman introduced the idea that behavior is influenced by...
01:27Associative Learning
Classical conditioning, also known...