Emphasizing the growing popularity of motion metrics are the majority of available virtual
reality simulators and some newer hybrid models that offer motion tracking for performance
assessment. A popular hybrid model (PROMIS) allows training with regular laparoscopic
instruments in a box-trainer while automatically recording task duration and movement
efficiency (pathlength and smoothness) that are immediately offered as feedback to trainees.
Despite the increasing availability of simulators that track motion, our knowledge of the
impact those metrics have on trainee learning is severely limited. We do not know if it is
more important to use speed, accuracy, motion efficiency or a combination thereof for
performance assessment and how these metrics impact skill transfer to the OR.
Based on sound educational principles we have developed a proficiency-based laparoscopic
suturing simulator curriculum. This curriculum focuses on deliberate and distributed
practice, provides trainees with augmented feedback and sets expert-derived performance goals
based on time and errors. We have previously demonstrated that this curriculum leads to
improved operative performance of trainees compared to controls.
To measure operative performance and determine transferability, we will use a live porcine
Nissen fundoplication model. Instead of placing actual patients at risk, the porcine model is
preferable for this purpose as it offers objective metrics (targets are established,
distances measured, knots are disrupted for slippage scoring), complete standardization, and
allows multiple individuals to be tested on the same day.
We hypothesize that proficiency-based simulator training in laparoscopic suturing to
expert-derived levels of speed and motion will result in better operative performance
compared to participants training to levels of speed or motion alone. The study is powered to
detect an at least 10% performance difference between the groups.
1. Compare whether any performance differences between the groups persist long-term
2. Assess whether the groups demonstrate differences in safety in the operating room by
comparing the inadvertent injuries in the animal OR between the groups
3. Identify the training duration required by novices to reach proficiency in laparoscopic
suturing based on speed, motion efficiency, or a combination of these metrics
4. Identify any baseline participant characteristics that may predict individual