Educational system based on the TAPP checklist improves the performance of novices: a multicenter randomized trial

Enhancing surgical skills through telesimulation: A multicenter randomized controlled trial on laparoscopic inguinal hernia repair

BACKGROUND

Telesimulation has been shown to be effective for teaching simple surgical techniques; however, its usefulness for teaching advanced skills remains unclear. The aim of this randomized controlled trial was to investigate the impact of a telesimulation program on training for laparoscopic inguinal hernia repair.

METHODS

Novice trainees were randomly assigned to the intervention group or control group using a permuted block design. Intervention group participants received a 1-hour didactic telelecture and three 1-hour telesimulation sessions with a hernia specialist, whereas control group participants engaged in self-directed training using the same simulator and materials. Trainees' procedural videos, recorded before and after training, were assessed using the transabdominal preperitoneal checklist and the Global Operative Assessment of Laparoscopic Skills-Groin Hernia. Pre- and post-training tests were performed to evaluate knowledge of inguinal hernias and self-confidence in transabdominal preperitoneal procedures.

RESULTS

Forty-three participants from 16 institutions in Japan were enrolled, with 22 and 19 in the intervention group and control group, respectively, completing the final analysis. Median post-test transabdominal preperitoneal checklist scores were 16 (interquartile range: 15-18.5) in the intervention group and 11 (interquartile range: 8.5-14.5) in the control group; intervention group participants significantly outperformed their counterparts (P < .001). However, comparison of pre- and post-test scores showed skill improvements in both groups (P < .001). Both groups also showed increased knowledge and confidence.

CONCLUSION

The telesimulation program effectively enhanced the surgical skills of novice trainees in learning laparoscopic inguinal hernia repair, demonstrating superiority over self-directed learning.

Development of a systematic telesimulation curriculum for laparoscopic inguinal hernia repair

Purpose

Telesimulation, whereby learners telecommunicate and use simulator resources to receive education at an off-site location, has been used to educate surgical trainees about how to perform basic surgical procedures. However, it has not yet been used for advanced surgical procedures. We aimed to develop a telesimulation curriculum to teach a common laparoscopic procedure called transabdominal preperitoneal (TAPP) repair and to explore the feasibility of its use.

Methods

Learning objectives were created to develop a telesimulation curriculum that included didactic telelecture and telesimulation training. Pre-tests and post-tests to assess the didactic materials were developed and assessed among surgeons with various experiences. We assessed the feasibility of the telelecture and telesimulation separately. Pre-tests, post-tests, and questionnaires were used to assess the telelectures. We created a TAPP repair telesimulation system and checked for problems during training. Trainees were assessed to determine their skill improvement using previously published assessment tools and questionnaires.

Results

A didactic telelecture was developed based on the learning objectives using an expert consensus and pilot-tested among five participants. After the lecture, their test scores improved and they expressed positive opinions about the usefulness of telelectures. The TAPP repair telesimulation training was pilot-tested among three trainees. No technical problems occurred during training. All trainees improved their skills after the telesimulation training and agreed that the training was useful for learning the TAPP repair procedure.

Conclusions

We systematically developed a telesimulation curriculum for the TAPP repair procedure and demonstrated its feasibility among learners.

Identifying the Essential Portions of the Skill Acquisition Process Using Item Response Theory

OBJECTIVE

Item response theory (IRT) was originally developed to make performance assessments more accurate. However, IRT analysis of the intraoperative performance of surgical trainees could help identify the elements that the trainees find difficult during the skill acquisition process. The aim of this study was to identify the essential portions of the skill acquisition process of a surgical procedure using the IRT.

DESIGN

The 24-item assessment checklist was used to evaluate a recorded intra-operative performance of a laparoscopic inguinal hernia repair. The scores were analyzed using IRT to calculate the difficulty and discrimination level of each item.

SETTING

Fifteen institutes.

PARTICIPANTS

Thirty surgical trainees.

RESULTS

A total of 123 assessments were analyzed. The item analysis showed the procedure specific item "traction of peritoneum (difficulty: -0.45; discrimination: 19.37)" and generic items "instrument handling (difficulty: -0.59; discrimination: 3.82)" and "flow of procedure (difficulty: 0.09; discrimination: 3.27)" to be key elements in the skill acquisition process of the procedure.

CONCLUSIONS

Key elements in the skill acquisition process of the procedure were quantitatively identified by applying the IRT analysis. This could lead to the use of IRT in designing and developing a more effective training curriculum.