Incorporation of proficiency criteria for basic laparoscopic skills training: how does it work?

BACKGROUND: It is desirable that surgical trainees are proficient in basic laparoscopic motor skills (eye-hand coordination). The present study evaluated the use of predefined proficiency criteria on a basic virtual reality (VR) simulator in preparation for a laparoscopic course on animal models.
METHODS: Twenty-eight surgical trainees who enrolled for a basic laparoscopic course were trained on a basic (VR) simulator until their performance met predefined criteria. Two different criteria were defined, based on the performance of experienced laparoscopic surgeons on the simulator. In the first group (n = 10), the criteria were set at the 75th percentile of the laparoscopic surgeons' performance on the simulator and in the second group, at the 50th percentile (n = 18). Training time and number of attempts needed until the performance criteria were met were measured.
RESULTS: In the first group, training time needed to pass the test ranged from 29 to 77 min (median: 63 min) with a range of 43-90 attempts (median 61 attempts). In the second group, training time ranged from 38 to 180 min (median 80 min) with a range of 55-233 attempts (median 95 attempts). Experience with assisting or performing laparoscopic procedures varied widely and was not correlated with the training time and number of attempts needed to pass the criteria.
CONCLUSIONS: The performance criteria for training laparoscopic motor skills on a (VR) simulator resulted in wide variation between surgical trainees in time and number of attempts needed to pass the criteria. This demands training courses with a flexible time span tailored to the individual level of the trainee.