Effects of Repetition and Inactivity on Laparoscopic Skills Training

Abstract

Study objective: To describe the impact of task repetition and time between practice sessions on time to complete a surgical task using a high-fidelity laparoscopic simulator.

Design: An Institutional Review Board-approved retrospective cohort study of 33 obstetrics/gynecology residents with unlimited access to a high-fidelity laparoscopic simulator over a period of 12 months. Canadian Task Force design classification II-2.

Setting: Academic medical center and obstetrics/gynecology residency training program.

Participants: Obstetrics/gynecology residents.

Interventions: Participation in a high-fidelity laparoscopic training exercise.

Measurements: Residents completed a standardized peg transfer exercise with data collected on the time to completion of the exercise, number of the attempt, and interval since the last day of practice. Data were analyzed using Spearman correlation coefficients and mixed-effects linear regression.

Main results: A total of 33 residents participated during the 12-month period, completing 484 peg transfer exercises (mean, 16.2 per resident). Each repetition was correlated with a mean decrease in time to completion of 2.28 seconds (p < .0001). This correlation was most dramatic in the first 9 completed exercises, in which each repetition correlated with a decrease in time to complete of 7.98 seconds (p ≤ .0001). The lapse in practice preceding the exercise correlated with a negligible change in time to completion of 0.003 second (SD, 0.06; p = .90).

Conclusion: The number of previous completed exercises was significantly correlated with decreased time to completion of this standardized exercise. Lapses in practice did not correlate with slower times to completion, suggesting that repetitive exposure to a simple surgical task has a greater impact on efficiency than lapse in practice.

Keywords: Laparoscopy; Resident education; Simulation.