ABSTRACT
PURPOSE: Difficulties at the beginning of the learning curve in minimally invasive surgery (MIS) can well be overcome by simulation outside the operating room. Despite a great number of available devices, standardized, structured, and validated training curricula for video simulators are scarce. METHODS: The Lübeck Toolbox (LTB) video trainer provides six training modules and online video tutorials. Proficiency levels for the tasks were defined by performance analysis of MIS experts (n = 15). Mean values of the best performed repetitions were set as benchmarks for a validation study with n = 30 MIS novices and the learning curves calculated. The novices performed a cholecystectomy on a pig organ model before and after the curriculum which were analyzed using the GOALS score. RESULTS: Benchmarks defined by expert performance for the task Nos. 1 to 6 were 72 s (± 8) (Pack Your Luggage), 49 s (± 9) (Weaving), 66 s (± 10) (Chinese Jump Rope), 89 s (± 28) (Triangle Cut), 138 s (± 44) (Hammer Cut), and 98 (± 22) (Suturing). The median numbers of required repetitions by the novices to reach the proficiency level were n = 42 (7-80), n = 26 (9-55), n = 32 (14-77), n = 44 (15-59), n = 19 (6-68), and n = 26 (15-60). These values were all located at the beginning of the plateau phase of the learning curves. GOALS score improved significantly after completion of the curriculum (18.0 (± 2.6) vs. 10.9 (± 1.6), p < 0.0001). CONCLUSION: The LTB curriculum constitutes a new highly standardized and proficiency level-based training program for basic skills in MIS. Transferability of the task content to a (sub)-realistic environment could be demonstrated. Still, future trials will have to further validate the effectiveness of the LTB curriculum.
Subject(s)
Cholecystectomy, Laparoscopic/education , Clinical Competence , Minimally Invasive Surgical Procedures/education , Simulation Training/methods , Academic Medical Centers , Animals , Curriculum , Education, Medical, Graduate/methods , Germany , Humans , Prospective Studies , Statistics, Nonparametric , SwineABSTRACT
BACKGROUND: Simulation-based training has become increasingly relevant in minimally invasive surgery (MIS). It is unclear whether or not the established Lübeck Toolbox (LTB) Curriculum for the acquisition of basic MIS skills can be implemented to supplement standard undergraduate education in surgery and how it would be accepted. MATERIALS UND METHODS: Since 04/2015, students at the medical school of the University of Lübeck have had the option to complete the highly standardized and validated LTB Curriculum. It consists of six subsequent tasks with pre-defined learning goals. Video tutorials allow for a self-educating approach. The individual training progress is documented continuously as scheduled by the curriculum. The program was evaluated in a standardized manner using an established online platform for the evaluation of university courses at the University of Lübeck. RESULTS: Between 04/2015 and 07/2016, 63 students completed the LTB Curriculum. The general interest in a surgical specialty rose from an average of 1.61 (SD 0.78) before to 1.12 after the curriculum. The numbers of required repetitions for the training tasks 1â-â6 were median 24 (6â-â79), 23 (5â-â61), 7 (5â-â33), 15 (5â-â59), 16 (5â-â50), and 18 (7â-â48), respectively. None of the 63 students terminated the curriculum prematurely. On average, 4.35 (SD 1.58) hours per week were spent training with an overall duration of 4.1 (SD 1.2) weeks required to go through the LTB Curriculum. Evaluation results showed an overall rating of 1.0 (SD 0.17). The average learning progress, didactics and structure of the curriculum were rated as 1.0 (SD 0.24), 1.14 (SD 0.36), and 1.0 (SD 0.24), respectively. The relevance for the following study years and the future professional activity was reported to be 1.2 (SD 0.45) on average. CONCLUSION: As an addition to the regular undergraduate program, the Lübeck Toolbox Curriculum was well accepted by many students. Evaluation showed exceedingly positive results. Furthermore, the data suggest that the LTB Curriculum may increase the interest in a surgical specialty among medical students. This aspect seems to be relevant in times where surgeons should make every effort to recruit young doctors for surgical residency.
