1. Comparing Performance on the Virtual Laparoscopic and Robotic Simulators Among Medical Students Pursuing Surgical versus Non-surgical Residencies Amanda Bunton, M.D., James Barrow, M.D., Michelle Finch, M.S., Nick Stringer, M.D., Ben Thompson, M.D. Department of Obstetrics & Gynecology, Louisiana State University Health Sciences Center-Shreveport, LA 71130 USA Abstract Acceptance of medical school graduates into surgical training programs is currently not based on tangible indicators of technical skills, as these skills are not evaluated either before or during the selection process. In this study, we sought to compare the learning curves on the virtual laparoscopic and robotic trainers between medical students pursuing surgical versus non-surgical residency specialties to determine if the technical skill levels of surgical residency applicants exceeds those of non-surgical residency applicants. We hypothesized that there would be no significant difference in performance between the two groups. Fifty-six medical students with no prior laparoscopic or robotic experience performed five repetitions of two comparable tasks on each of the trainers. In addition, they also completed a post-test questionnaire that allowed them to rate their subjective perception of improvement across trials and trainers using a 4 point Likert scale. Paired and independent t-tests were used to analyze the data. This study showed that significant improvement was observed over the five repetitions on all four tasks on the laparoscopic and robotic trainers. There was no significant difference in improvement in performance from trial 1 to trial 5 on either trainer between the two groups. This data indicates that there is no self-selection of applicants for surgical residency based on actual surgical skills. ResultsMaterials and Methods The study enrolled 56 medical students with no prior laparoscopic or robotic experience. The study population included 51.8% male participants and 48.2% female participants ranging in age from 23-32. Approximately 30% desired to pursue a surgical residency. All participants performed five repetitions of two comparable tasks on each of the trainers: a camera targeting task and a coordination task. Performance was measured by time to complete each task. They also completed a post-test questionnaire that allowed them to rate their subjective perception of improvement across trials and trainers using a 4 point Likert scale The objective dependent variable was time to complete each task. The subjective dependent variable was improvement on laparoscopic/robotic trainer. We counterbalanced which trainer was used first in order to control for practice effects. Conclusions This study showed that significant improvement was observed over the five repetitions on all four tasks on the laparoscopic and robotic trainers. There was no significant difference in improvement in performance from trial 1 to trial 5 on either trainer between the two groups. This data indicates that there is no self-selection of applicants for surgical residency based on actual surgical skills. Furthermore, using technical skills as selection criteria for surgical training may not better discriminate those applicants with an aptitude for a surgical specialty. The subjective data from this study suggested more significant improvement on the robotic trainer tasks versus the laparoscopic trainer tasks. Objective data demonstrated significant improvement on all four tasks over the five trials and suggested that the learning curves are similar between trainers and that participants improved more on the laparoscopic trainer. Comparable learning curves between trainers suggest that a similar skills based curriculum may be developed for both systems. Introduction There is a premium on maximizing efficiency in surgical training. Surgical skills are more difficult to teach and master in the operating room these days. Reasons for this include the new 80 hour work week, development of new surgical technology and techniques and increased complexity of surgical patients. Requirements for surgical graduates have become more stringent. As such, alternatives to intraoperative training in the form of simulation labs have been developed. It has been recognized that successful completion of the FLS (Fundamentals of Laparoscopic Surgery) program correlates well with improved performance in the operating room. Furthermore, completion of this program has recently been mandated by ACGME as a prerequisite for eligibility of all graduates of general surgery residency programs for the American Board of Surgery exam. Despite the fact that requirements for surgical graduates have become more stringent, acceptance of medical school graduates into surgical training programs is currently not based on tangible indicators of technical skills, as these skills are not evaluated either before or during the selection process. Most candidate rankings rely on assessment of structured tests of knowledge and academic achievement, the quality of letters of recommendation, and subjective impressions during a brief interview process. In this study, we sought to compare the learning curves on the virtual laparoscopic and robotic trainers between medical students pursuing surgical versus non-surgical residency specialties to determine if the technical skill levels of surgical residency applicants exceeds those of non-surgical residency applicants. Since mastery of laparoscopic skills is a highly important area of training, one would assume that program directors would also be interested in recruiting the most technically skilled applicants possible in their program. Further testing and expansion of this field could be used in the residency application and selection process. It can potentially serve as a discriminating factor when trying to select between two applicants with otherwise very similar credentials. In addition, knowing the baseline skill set of applicants at the onset of residency may allow tailoring of training based on individual needs. Discussion For the laparoscopic trainer camera navigation task, there was a significant difference in the improvement from trial 1 to trial 5 for all of the participants (t=7.18, p<0.001) as well as for the surgical group (t=3.59, p<0.05) and non-surgical group (t=6.48, p<0.001) independently. There was a significant difference in the improvement from trial 1 to trial 5 for the surgical group (t=12.1, p<0.001) and non-surgical group (t=6.3, p<0.001) independently for the laparoscopic trainer coordination task. For the robotic trainer camera navigation task, there was a significant difference in the improvement from trial 1 to trial 5 for all of the participants (t=6.06, p<0.001) as well as for the surgical group (t=5.78, p<0.01) and non-surgical group (t=4.89, p<0.01) independently. There was a significant difference in the improvement from trial 1 to trial 5 for all of the participants (t=6.07, p<0.001) as well as for the surgical group (t=5.53, p<0.01) and non-surgical group (t=4.15, p<0.01) independently for the robotic trainer coordination task. When comparing surgical to non-surgical groups, there was not a significant difference in the improvement from trial 1 to trial 5 for any of the four tasks. Participants reported significantly greater improvement on the robotic trainer than on the laparoscopic trainer (p<0.01). However, there was more improvement between run 1 and run 5 on the laparoscopic trainer than on the robotic trainer camera navigation tasks (33.9s improvement versus 19.3s improvement) as well as the coordination tasks (45.2s improvement versus 20.7s improvement). Learning curves were overall similar on the laparoscopic and robotic trainers. Camera Navigation Exercises Overall Camera Navigation-Surgical Group Camera Navigation-Non-Surgical Group Coordination Exercises Overall Coordination-Surgical Group Coordination-Non-Surgical Group Subjective Improvement Results Results, cont.