Date of Award

11-23-2009

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Andrew J. Duffy, MD

Abstract

A NOVEL VIRTUAL REALITY-BASED CURRICULUM IMPROVES LAPAROSCOPIC SKILL IN NOVICES. Michael Joel Martinez, Andrew John Duffy. Department of Surgery, Yale School of Medicine, New Haven, CT. Surgical skills training, facing work hours restrictions and increasing numbers of procedural skills to master, requires an innovative approach to ensure success. We developed a novel basic laparoscopic skill, virtual reality-based simulator curriculum on the LapSim (Surgical Science, Goteborg, Sweden), with a training module and a skills exam enabling trainees to develop a minimum skill level. We hypothesize that unskilled trainees laparoscopic skills performance will improve when compared to controls. Also, those who are able to successfully complete our training curriculum and pass the exam will demonstrate higher skills levels compared to non-passers during the training period. We anticipate that skills will begin to degrade after a period 30 days without repetitive training. We expect that individual trainee performance will correlate with past experience with video games, sports, or musical instruments. Thirty-two novice, pre-clinical medical students were randomized to various training schedules. All students trained on the curriculum with the goal of completing the practice drills and passing the skills exam. Students laparoscopic skills were assessed at baseline and at monthly intervals using two tasks from the Fundamentals of Laparoscopic Surgery (FLS) curriculum that are known to correlate with operative laparoscopic skill. Additional FLS testing was performed after a one month layoff to evaluate short-term skill degradation. Objective skill FLS scores were compared between training and non-training groups, and between passing and non-passing groups at the completion of the study. All participants prior experiences with video games, sports and musical instruments were correlated with study performance. Training improved FLS performance for all participants. There was significantly greater skill development in passers versus non-passer (p<0.05). Skills did not degrade after a 30 day layoff but continued to improve for all participants even reaching a statistically significant improvement on one task. Performance was not correlated with past video game, sports, or musical instrument experience. Trainees who successfully completed the our curriculum demonstrated significantly higher laparoscopic skills. These skills should translate to improved operative performance. Skills were retained after the last training session and demonstrated improvement at 30 days. We demonstrated no performance correlation with prior video game, sports or musical experience.

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