DEVELOPMENT OF A MODEL FOR TRAINING AND EVALUATION OF LAPAROSCOPIC SKILLS

BACKGROUND: Interest in the training and evaluation of laparoscopic sk ills is extending beyond the realm of the operating room to the use of laparoscopic simulators, The purpose of this study was to develop a s eries of structured tasks to objectively measure laparoscopic skills. This model was then used to test for the effects of level of training and practice ore performance. METHODS: Forty-two subjects (6 each of s urgical residents PGY1 to PGY5, 6 surgeons who practice laparoscopy an d 6 who do not) were evaluated, Each subject viewed a 20-minute introd uctory video, then was tested performing 7 laparoscopic tasks (peg tra nsfers, pattern cutting, clip and divide, endolooping, mesh placement and fixation, suturing with intracorporeal or extracorporeal knots), P erformance was measured using a scoring system rewarding precision and speed. Each candidate repeated all a tasks and was rescored. Data wer e analyzed by linear regression to assess the relationship of performa nce with level of residency training for each task, and by ANOVA with repeated measures to test for effects of level of training, of repetit ion, and of the interaction between level of training and repetition o n overall performance. Student's t test was used to evaluate differenc es between laparoscopic and nonlaparoscopic surgeons and between each of these groups and the PGY 5 level of surgical residents. RESULTS: Si gnificant predictors of overall performance were (a) level of training (P = 0.002), (b) repetition (P < 0.0001), and (c) interaction between level of training and practice (P = 0.001). There was also a signific ant interaction between level of training and the specific task on per formance scores (P = 0.006). When each task was evaluated individually for the 30 residents, 4 of the 7 tasks (tasks 1, 2, 6, 7) showed sign ificant correlation between PGY level and score. A significant differe nce in performance scores between laparoscopic and nonlaparoscopic sur geons was seen for tasks 1, 2, and 6. CONCLUSIONS: A model was develop ed to evaluate laparoscopic skills. Construct validity was demonstrate d by measuring significant improvement in performance with increasing residency training, and with practice. Further validation will require correlation of performance in the model with skill in vivo. (C) 1998 by Excerpta Medica, Inc.