Introduction of a Comprehensive Training Curriculum in Laparoscopic Surgery for Medical Students: A Randomized Trial. N Gawad, EM Bonrath, NJ Dedy, B Zevin,

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Introduction of a Comprehensive Training Curriculum in Laparoscopic Surgery for Medical Students: A Randomized Trial. N Gawad, EM Bonrath, NJ Dedy, B Zevin, M Louridas, TP Grantcharov St. Michael’s Hospital, University of Toronto

Background “Surgery departments need to rededicate themselves to education to effectively address the learning needs of medical students...Also, students need to develop technical proficiency in clinical sills laboratories” – American Surgical Association Blue Ribbon Committee Report on Surgical Education 2004 Recent initiatives to increase medical student interest in surgical careers 1 Structured simulation curricula exist in resident education 2 Prevalence of minimally invasive techniques in many surgical subspecialties 1. Cloyd J et al. J Surg Educ Palter VN et al. Ann Surg

Curriculum Framework Pre-Development Analysis Cognitive Component Team-based Component Technical Component Evaluation and Improvement Curriculum Maintenance of Training Zevin B et al. J Am Coll Surg

Methods 24 pre-clerkship medical students Pre-Intervention Assessment: 1.Demographic Questionnaire 2.Baseline Cognitive MCQ Test 3.Baseline T-TAQ 4.Baseline Technical Skills a)Peg Transfer b)Intracorporeal Suture c)VR Simulator Control GroupCurriculum Group 8 hours of self-directed learning Introduction to Laparoscopy Curriculum 1.Cognitive 2.Team-based training 3.Technical skills Post-Intervention Assessment 1.Cognitive MCQ Test 2.T-TAQ 3.Technical Skills Test Technical Skills Retention Assessment 5 weeks Randomization

Methods Technical Skills Peg Transfer Intracorporeal Suture Virtual Reality Simulator Grasping Cutting Clipping

Results: Cognitive Component P = 0.03

Results: Technical Skills Component P-values TaskMeasurement BLPTRTBL vs. PTPT vs. RT Virtual Reality (LapSim) Score – Grasping2 (0-24)77 (70-90)68 (60-71)< Score – Cutting20 (18-36)80 (56-89)58 (38-72).001NS Score – Clipping0 (0-0)66 (43-80)55 (30-63)<.0001NS Peg TransferTime372 ( )56 (46-63)99 (90-165)<.0001 Intracorporeal Suture Time600 ( )264 ( )352 ( )< Curriculum Group Control Group P-values TaskMeasurement BLPTRTBL vs. PTPT vs. RT Virtual Reality (LapSim) Score – Grasping0 (0-10)73 (55-92)60 (21-73) Score – Cutting21 (18-26)85 (36-91)54 (35-69).006NS Score – Clipping0 (0-0)30 (22-57)33 (14-44)<.0001NS Peg TransferTime312 ( )78 (65-96)100 (90-129) Intracorporeal Suture Time600 ( )283 ( )457 ( ) (22-57) 66 (43-80) P = (46-63) 78 (65-96) P = (30-63) 33 (14-44) P = 0.04

Results P=0.31

Summary & Conclusion Curriculum results: Significantly improved cognitive and technical performance No difference in attitudes towards team-based skills Greater homogeneity and fewer dropouts Self-directed learning results: Significantly improved cognitive and technical performance Variability between participants An introductory curriculum for medical students should be delivered in a structured and standardized fashion in order to maintain motivation and enhance learning.