Frequent practice using a laparoscopic simulator is known to improve subsequent operating skills. Achieving automation of motor movements prior to live training frees the trainee’s atention for higher skills. Despite this, trainees generally do not avail themselves of opportunity for practice. To address this, we incentivised frequent laparoscopic practice within the two Scottish Core Surgical Training (CST) programmes.

Twenty-seven CST’s in their first general/urology or paediatric surgery post were given a take-home laparoscopic simulator (fig1) with instrument tracking software and assigned six online modules (fig 2) to complete. Metric measurements of distance, speed, acceleration, motion smoothness, percentage time offscreen and handedness were measured. Support was provided via social media and a helpdesk. Achievement of pre-defined metric targets and uploading specified data merited an e-Certificate. On production of this, supervisors were asked to progress trainees from camera-holding to operating (the incentive). Trainee views of the intervention and laparoscopic practice were assessed by questionnaire.

Metric results showed improvement across all domains (motion smoothness, acceleration, speed, distance between instruments, percentage time off screen and time to completion) for those who completed one or more modules. Trainee self-rated anxiety of laparoscopic operating was reduced post-study (p<0.05). 94% of participants thought simulator practice was worthwhile. 76% would recommend the programme. 88% reported improved confidence and motor skills.

However only 41% of participants completed >1 module; only 19% completed all modules. Comments indicated reasons for this including the need to integrate simulation into curricular structures.

The message from this feasibility study, the first to “incentivise” laparoscopic practice, is that simply incentivising practice with 24/7 access to simulators and targets does not result in frequent deliberate practice by trainees, though performance does improve in those who do engage. However, using the simulator reduced anxiety in laparoscopic operating. Trainee feedback suggests that, to engage trainees, laparoscopic practice must be fully integrated into training programmes and measured. Future incentives must be tangible and seen as realistic by trainees. Innovations must be seen as a core part of surgical training and subject to assessment to guarantee uptake.

Funding for this study gratefully received from RCSed, RCPSG and NHS Highland

1 Nagendran M, Toon CD, Davidson BR, Gurusamy KS; (2014) Laparoscopic surgical box model training for surgical trainees with no prior laparoscopic experience; Cochrane Database Syst Rev. Jan 17;1:CD010479
2 Dawe SR, et al. (2014) A Systematic Review of Surgical Skills Transfer After Simulation-Based Training Laparoscopic Cholecystectomy and Endoscopy; Annals of Surgery Vol 259; No2.
3 Zapf MA, Uiiki MB,; (2015) Surgical resident evaluations of portable laparoscopic box trainers incorporated into a simulation-based minimally invasive surgery curriculum; Surg Innov; Feb;22(1):83-7