Role of instruction method in novices' acquisition of minimally invasive surgical basic skills.

INTRODUCTION: We investigated the impact of instruction method on novices' acquisition of minimally invasive surgical (MIS) basic skills. MATERIALS AND METHODS: One hundred five novice medical students underwent text-based (TB), video-based (VB), or faculty-tutored (FT) single-session instruction in three basic MIS skill tasks on a box trainer. Pre- and postsession, participants completed a 12-item, 5-point Likert-type scale (1=Not confident at all, 5=Completely confident) of self-efficacy for performing basic MIS skills and had performances on each task recorded. Four raters evaluated every video performance of one task, a two-handed peg transfer, using a 16-cm visual analog measurement (VAM). Inter-rater reliability was good (intra-class correlation coefficient=0.82). The relationship between instruction method, self-efficacy mean score change, and mean VAM change was examined using ANOVA analysis. RESULTS: Eighty-five participants (TB=32, VB=24, FT=29) had valid matched data. Mean scores in self-efficacy and task performance increased from pre- to postsession for every instruction method: (1) Δ self-efficacy=1.04±0.64 (TB), 1.36±0.69 (VB), and 1.41±0.82 (FT); (2) Δ VAM=3.77±2.87 (TB), 3.82±2.35 (VB), and 2.57±2.60 (FT). Analysis of variance revealed no relationship between instruction method and self-efficacy (P=.10) or VAM mean score change (P=.14). CONCLUSIONS: Self-directed instruction methods (e.g., TB and VB) for novices' acquisition of MIS basic skills offer flexible, learner-centered, and cost-effective alternatives to the more expensive FT method.

Hand-eye dominance and depth perception effects in performance on a basic laparoscopic skills set.

OBJECTIVES: Our study determined whether depth perception defects and hand-eye dominance affect an individual's ability to perform laparoscopic skills. METHODS: The study cohort comprised 104 third-year medical students from LSU School of Medicine who completed a questionnaire including information on handedness and were tested for eye dominance and depth perception by using standardized methods. Training sessions involved an initial recorded performance, a 20-minute practice session, followed by a final recorded performance. Recorded sessions were randomized and rated by using a visual analog scale (maximal possible score = 16) based on overall performance (OPS) and depth perception (DPS). A general linear model was used to correlate depth perception defects and hand-eye dominance with assessment scores for OPS and DPS. RESULTS: Students with depth perception defects scored significantly lower on their initial performance than did those with normal depth perception (OPS, 4.80 vs. 7.16, P=0.0008; DPS, 5.25 vs. 6.93, P=0.0195). After training, the depth perception defect group continued to have lower scores compared with the normal depth perception group. However, the 2 groups showed similar increases in pre- to posttraining performance scores (OPS, 3.84 vs. 3.18, P=0.0732). Hand-eye dominance did not significantly affect scores. CONCLUSIONS: Depth perception defects appear to compromise an individual's ability to perform basic laparoscopic skills. Individuals with defects can improve their skills by a proportion comparable to that of people with uncompromised depth perception. Differences in hand-eye dominance do not correlate with performance differences in basic laparoscopic skills. Although further research is necessary, the findings indicate that training can be tailored for individuals with depth perception defects to improve laparoscopic performance.

Relationship among age, race, medical funding, and cervical cancer survival.

OBJECTIVE: To examine the impact of age, race, and medical funding on cervical cancer survival. MATERIALS AND METHODS: Study design was a retrospective chart review of cervical cancer patients. Charts were abstracted for demographic characteristics, Pap smear history, clinical presentation, treatment, and survival. Descriptive studies, Spearman correlation, and Cox's proportional hazards regression model were performed. RESULTS: One hundred-twenty-five cervical cancer patients were included. Mean age at diagnosis was 46.1 +/- 13.2 years, and median survival time from cervical cancer was 31 months; 11.2% of the study population was aged greater than 65 years; 63.4% were African American; and 44.6% had no medical funding. Diagnosis at age of at least 65 years was significantly correlated with suboptimal cervical cancer screening pattern (r = 0.36, p = .0003). Women aged at least 65 years old had a 3.39 time increased hazard of death compared to younger patients (p = .02; OR, 3.39; 95% CI, 1.20-9.56) after adjusting for advanced stage of disease and treatment modality. There was no significant association between medical funding or race on cervical cancer screening pattern, stage at diagnosis, or survival. CONCLUSION: Age at diagnosis (> or = 65 years), but not medical funding or race, was correlated with suboptimal cervical cancer screening pattern and poor survival.