Psychomotor Testing Predicts Rate Of Skill Acquisition For Proficiency Based Laparoscopic Skills Training

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Introduction: Laparoscopic simulator training translates into improved operative performance. Proficiency-based curricula maximize efficiency by tailoring training to meet the needs of each individual; however, because rates of skill acquisition vary widely, such curricula may be difficult to implement. We hypothesized that baseline psychomotor testing may be useful in predicting training duration.

Methods: Residents (R1, n=20) were enrolled in an IRB-approved prospective study at the beginning of the academic year. All completed 1) a background information survey, 2) a battery of 14 innate ability measures (4 visual, 4 motor, and 6 visual-spatial), and 3) baseline testing on 3 validated simulators (5 videotrainer (VT) tasks, 12 virtual reality (MIST-VR) tasks, 2 camera navigation (LCN) tasks). Participants trained during 1-hour weekly sessions until previously reported expert-derived proficiency levels were achieved for all tasks. Post-testing included 3 repetitions of each task. Spearman’s correlation was used for statistical analysis.

Results: No test correlated with baseline simulator ability. Curriculum implementation required 347 man-hours (6 person team) and $795,000 of capital equipment. With an attendance rate of 75%, 19 of 20 residents (95%) completed the curriculum by the end of the academic year. To complete training, a mean of 11.8 hrs (range 5.5 - 21), and 345 repetitions (range171 - 782) were required. Simulator score improvement was 72% ± 23%. Training duration and repetitions correlated with 2 past experience variables, 3 innate ability measures, and 1 baseline simulator score. (see table).

Conclusions:Proficiency-based laparoscopic simulator training provides improvement in performance and can be effectively implemented as a routine part of resident education but may require significant resources. Interestingly, psychomotor tests do not predict baseline performance but rather, in part, predict the rapidity of skill acquisition. These tests may be useful in optimizing curricular design and may ultimately prove useful in selecting residency candidates.



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