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Does the Rate of Achieving Competency on simulated Laparoscopy Training Programs Predict Actual Skill in
Performing Laparoscopic Cholecystectomy?
Warren D. Widmann, MD Mark A. Hardy, MD, Nancy Hogle, RN, MS, Akuezunkpa O. Ude, MD, and Dennis Fowler, MD
New York Presbyterian Hospital, Columbia CampusColumbia University College of Physicians and Surgeons
New York, New York
LapSim®
LapSim® Basic Skills
Camera Navigation Instrument Navigation
Coordination Grasping
Lifting and Grasping Cutting
Clip Applying
Global Operative Assessment of Laparoscopic Skill
GOALS
• depth perception
• bimanual dexterity
• efficiency
• tissue handling
• overall competence
Protocol
• 21 PGY1 residents
• All PGY1residents performed a laparoscopic cholecystectomy in a pig after minimal training; performance evaluated by skilled laparoscopic surgeons using GOALS
• 10 of the group trained to competency on the LapSim® • All 21 PGY1 residents again performed laparoscopic
cholecystectomies on pigs; performance evaluated by skilled laparoscopic surgeons using GOALS
Results
• Baseline scores, untrained, experimental group of residents 2.18/5
• Baseline scores, untrained, control
group of residents 2.05/5
Results
• Baseline scores, untrained, experimental group of residents 2.18/5
Scores after training 2.77/5
• Baseline scores, untrained, control
group of residents 2.05/5
Scores w/o training 2.24/5
Results
• Baseline scores, untrained, experimental group of residents 2.18/5 2.77– Time to complete training varied from 73 to
242 minutes
• Baseline scores, untrained, control
group of residents 2.05/5 2.24
Results
• Baseline scores, untrained, experimental group of residents 2.18/5 2.77 Time to complete training varied from
73 to 242 minutes
• Baseline scores, untrained, control group of residents 2.05/5 2.24
Time to complete later training varied from 60 to 239 minutes
Conclusion
LapSim® training of novices improves the performance of a
cholecystectomy in a pig
Conclusion
LapSim® training improves the performance of a cholecystectomy in a pig by an
untrained novice
Not very surprising—LapSim® training has face validity, construct validity, and
predictive validity
Where do we go from here?
Do residents who learn quickly on a LapSim® program perform better
than residents who learn at a slower rate??
• We looked at the change in scores of the 4 fastest learners, baseline vs retesting after lapsim® competency
Δ .75/5 in pigs• The 4 slowest learners showed
Δ .45/5 in pigs
Things Do Not Look So Good for the Slow Learners
• Have we truly tested for predictive validity in the clinical setting?
• Our model was the pig, our testing was done early in the PGY1 year
Let’s take a look at actual performance when the now trained residents operated on patients during the next 12 months
Method
• Data was collected on 6 PGY1 categorical residents who performed 28 cholecystectomies during their PGY 1 year. Case loads varied from 2-10 per resident
• All were evaluated by skilled laparoscopic surgeons using the GOALS criteria
Results
• Fast Learners
(68-79 minutes)
2.39/5
• Slow Learners
(123-239 minutes)
2.53/5
Results
• Fast Learners(68-79 minutes)
2.39/5
• Slow Learners(123-239 minutes)
2.53/5
How come???
Characteristics of the LearnersPrior Video Game Habit
Time Ever > 3 hrs/wk Current user
Pig Person
68
73
79
123
195
239
Yes
Yes
Yes
Yes
No
No
Yes
No
Yes
Yes
No
No
No
No
No
Yes
No
No
2.6
3.2
2.6
2.6
1.2
1.4
1.96
2.61
2.59
2.83
2.56
2.20
Conclusions
• Slow learners on the LapSim® were naïve gamers
• All residents learned to competency on LapSim®—some took appreciably longer than others
• The rate of learning and achieving competency on the LapSim® predicted performance on the pig early in the PGY1 year
• The rate of learning on the LapSim® failed to predict clinical performance throughout the rest of the PGY1 year
Characteristics of the Best Clinical Performer
Time Ever > 3 hrs/wk Current user
Average GOALS
68
73
79
123
195
239
Yes
Yes
Yes
Yes
No
No
Yes
No
Yes
Yes
No
No
No
No
No
Yes
No
No
1.96
2.61
2.59
2.83
2.56
2.20
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