Document Type : Original Article

Authors

1 Shaukat Khanum Memorial Cancer Centre, Lahore, Pakistan

2 Department of Surgery, Aga Khan University, Karachi, Sindh, Pakistan

Abstract

BACKGROUND: The traditional model of teaching surgical skills on “real” patients using graded 
responsibility is being seriously questioned, and there is a paradigm shift toward exploiting simulators. 
There is a lack of clarity on the impact of using simulation as a teaching strategy in novice learners. 
The purpose of our study was to determine if the number and duration of training sessions influence 
the acquisition and retention of laparoscopic skills in naïve learners. There are some data to suggest 
that distributed training programs might have better outcomes, but the results are inconclusive. We 
designed a controlled trial at Aga Khan University, Karachi, with the hypothesis that students trained 
using the distributed method may have enhanced learning outcomes.
MATERIALS AND METHODS: 100 medical students were assigned in a 1:1 ratio to one of two groups. 
Group A underwent a single orientation and supervised practice session of 3 h duration. Group B 
underwent distributed teaching with three learning sessions of 1 h each spread over 3 consecutive 
weeks. Participant scores were analyzed before and after the intervention and at 3‑ and 6‑month 
intervals using repeat measures of ANOVA.
RESULTS: Pretest and immediate posttest scores were comparable between the two groups. The 
3‑month interval test showed significantly higher scores in Group B (difference = −2.90, P < 0.001). 
The 6‑month interval test showed no differences in scores between the two groups (P = 0.178).
CONCLUSIONS: Distributed teaching resulted in significantly enhanced scores at 3‑month 
assessment. However, similar scores at 6 months suggest the need for repeated intervention.

Keywords

1. Agha RA, Fowler AJ. The role and validity of surgical simulation. 
Int Surg 2015;100:350‑7.
2. Isik B, Kaya H. The effect of simulation software on learning 
of psychomotor skills and anxiety level in nursing education. 
Procedia Soc Behav Sci 2014;116:3864‑8.
3. Ellis SM, Varley M, Howell S, Trochsler M, Maddern G, Hewett P,
et al. Acquisition and retention of laparoscopic skills is different 
comparing conventional laparoscopic and single‑incision 
laparoscopic surgery: A single‑centre, prospective randomized 
study. Surg Endosc 2016;30:3386‑90.
4. Gallagher AG, Jordan‑Black JA, O’Sullivan GC. Prospective, 
randomized assessment of the acquisition, maintenance, and loss 
of laparoscopic skills. Ann Surg 2012;256:387‑93.
5. Bellows CF, Smith AA. Laparoscopic skills training of surgical 
residents: A comparison of two proficiency‑based independent 
approaches. Minim Invasive Surg 2017;1:126‑32.
6. Gostlow H, Marlow N, BabidgeW, Maddern G. Systematic review 
of voluntary participation in simulation‑based laparoscopic skills 
training: Motivators and barriers for surgical trainee attendance. 
J Surg Educ 2017;74:306‑18.
7. Orlando MS, Thomaier L, Abernethy MG, Chen CC. Retention 
of laparoscopic and robotic skills among medical students: 
A randomized controlled trial. Surg Endosc 2017;31:3306‑12.
8. Sant'Ana GM, Cavalini W, Negrello B, Bonin EA, Dimbarre 
D, Claus C, et al. Retention of laparoscopic skills in naive 
medical students who underwent short training. Surg Endosc. 
2017;31(2):937-944. [doi: 10.1007/s00464-016-5063-y].
9. Cavalini WL, Claus CM, Dimbarre D, Cury Filho AM, Bonin EA, 
Loureiro Mde P, et al. Development of laparoscopic skills in medical students naive to surgical training. Einstein (Sao Paulo) 
2014;12:467‑72.
10. Bjerrum F, Sorensen JL, Thinggaard J, Strandbygaard J, Konge L. 
Implementation of a cross‑specialty training program in basic 
laparoscopy. JSLS 2015;19:e2015.00059.
11. Vassiliou MC, Feldman LS, Andrew CG, Bergman S, 
Leffondré K, Stanbridge D, et al. A global assessment tool for 
evaluation of intraoperative laparoscopic skills. Am J Surg 
2005;190:107‑13.
12. IBM Corp. IBM SPSS Statistics for Windows. Ver. 20.0. Armonk, 
NY: IBM Corp; 2011.
13. Ou Y, McGlone ER, Camm CF, Khan OA. Does playing video 
games improve laparoscopic skills? Int J Surg 2013;11:365‑9.
14. Quillin RC 3rd, Cortez AR, Pritts TA, Hanseman DJ, Edwards MJ, 
Davis BR. Surgical resident learning styles have changed with 
work hours. J Surg Res 2016;200:39‑45.
15. Kim RH, GilbertT. Learning style preferences of surgical residency 
applicants. J Surg Res 2015;198:61‑5.
16. Spruit EN, Band GP, Hamming JF. Increasing efficiency of surgical 
training: Effects of spacing practice on skill acquisition and retention 
in laparoscopy training. Surg Endosc 2015;29:2235‑43.
17. StefanidisD, HenifordBT. The formula for a successful laparoscopic 
skills curriculum. Arch Surg 2009;144:77‑82.
18. Sugihara T, Yasunaga H, Matsui H, Ishikawa A, Fujimura T, 
Fukuhara H, et al. A skill degradation in laparoscopic surgery 
after a long absence: Assessment based on nephrectomy case. 
Mini Invasive Surg 2018;2:11.
19. Bonrath EM, Weber BK, Fritz M, Mees ST, Wolters HH, 
Senninger N, et al. Laparoscopic simulation training: Testing for 
skill acquisition and retention. Surgery 2012;152:12‑20.
20. Alnassar S, Alrashoudi AN, Alaqeel M, Alotaibi H, Alkahel A, 
Hajjar W, et al. Clinical psychomotor skills among left and right 
handed medical students: Are the left‑handed medical students 
left out? BMC Med Educ 2016;16:97.
21. Nieboer TE, Sari V, Kluivers KB, Weinans MJ, Vierhout ME, 
Stegeman DF. A randomized trial of training the non-dominant 
upper extremity to enhance laparoscopic performance. 
Minim Invasive Ther Allied Technol. 2012;21(4):259-64. [doi: 
10.3109/13645706.2011.614256].
22. Glassman D, Yiasemidou M, Ishii H, Somani BK, Ahmed K, 
Biyani CS. Effect of playing video games on laparoscopic skills 
performance: A systematic review. J Endourol 2016;30:146‑52.
23. White C, Rodger MW, Tang T. Current understanding of learning 
psychomotor skills and the impact on teaching laparoscopic 
surgical skills. Obstet Gynaecol 2016;18:53‑63.
24. White MT, Welch K. Does gender predict performance of novices 
undergoing fundamentals of laparoscopic surgery (FLS) training? 
Am J Surg 2012;203:397‑400.
25. Kolozsvari NO, Andalib A, Kaneva P, Cao J, Vassiliou MC, 
Fried GM, et al. Sex is not everything: The role of gender in early 
performance of a fundamental laparoscopic skill. Surg Endosc 
2011;25:1037‑42.