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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,

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

1 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

2 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. 2008. 2. Palter VN et al. Ann Surg. 2012.

3 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. 2012.

4 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

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

6 Results: Cognitive Component P = 0.03

7 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)<.0001.007 Score – Cutting20 (18-36)80 (56-89)58 (38-72).001NS Score – Clipping0 (0-0)66 (43-80)55 (30-63)<.0001NS Peg TransferTime372 (280-428)56 (46-63)99 (90-165)<.0001 Intracorporeal Suture Time600 (600-600)264 (213-378)352 (252-600)<.0001.027 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).004.014 Score – Cutting21 (18-26)85 (36-91)54 (35-69).006NS Score – Clipping0 (0-0)30 (22-57)33 (14-44)<.0001NS Peg TransferTime312 (189-405)78 (65-96)100 (90-129).002.027 Intracorporeal Suture Time600 (600-600)283 (230-368)457 (286-600).004.012 30 (22-57) 66 (43-80) P = 0.04 56 (46-63) 78 (65-96) P = 0.001 55 (30-63) 33 (14-44) P = 0.04

8 Results P=0.31

9 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.

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