Can everyone achieve proficiency with the laparoscopic technique? Learning curve patterns in technical skills acquisition

• Published in: The American journal of surgery Vol. 197; no. 4; pp. 447 - 449
• Main Authors: Grantcharov, Teodor P., Funch-Jensen, Peter
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.04.2009; Elsevier; Elsevier Limited
• Subjects: Accreditation; Assessment; Biological and medical sciences; Certification; Clinical Competence; Clinical medicine; Competency-Based Education; Computer Simulation; Curricula; Digestive system. Abdomen; Educational Measurement - methods; Endoscopy; Female; General aspects; Health education; Humans; Investigative techniques, diagnostic techniques (general aspects); Laparoscopic surgery; Laparoscopy; Laparoscopy - standards; Laparoscopy - statistics & numerical data; Learning; Learning curves; Male; Medical personnel; Medical residencies; Medical sciences; Proficiency; Psychomotor Performance; Selection; Skills; Statistical analysis; Studies; Surgeons; Surgery; Surgical Procedures, Operative - education; Surgical Procedures, Operative - statistics & numerical data; Training; Virtual reality; United States > US; Chicago Illinois; Training; Proficiency; Learning curves; Selection; Assessment; Laparoscopic surgery; Certification; Endoscopic surgery; Curve; Laparoscopy; Acquisition; Learning; Medicine; Treatment; Vocational aptitude; Endoscopy; Technique
• ISSN: 0002-9610; 1879-1883; 1879-1883
• DOI: 10.1016/j.amjsurg.2008.01.024

The study was carried out to determine the learning curve patterns for basic laparoscopic technical skills. Thirty-seven surgical residents with limited laparoscopic experience performed 10 repetitions of 6 tasks on a virtual-reality trainer (MIST-VR) with standardized distribution of practice. Assessment was based on time, errors, and economy of motion as measured by MIST-VR. Proficiency levels were established by testing experienced laparoscopic surgeons. Four learning curve patterns were determined. Surgeons in group 1 (5.4%) demonstrated proficiency from the beginning; group 2 (70.3%) achieved predefined expert criteria between 2 and 9 repetitions; group 3 (16.2%) demonstrated improvement but was unable to achieve proficiency within 10 repetitions. Group 4 (8.1%) underperformed and showed no tendency of skills improvement, reflecting a group of subjects who probably are unable to learn laparoscopic technique. The results indicated that a group of subjects could not reach proficiency in the psychomotor skills relevant for laparoscopy. We believe that this is an important issue that should be addressed in future research.