Education Clinical Trial
Official title:
A National, Prospective,Randomised, Single Blinded Controlled Trial of Proficiency- Based Simulation Training for General Surgical Trainees
The hypothesis of this trial is to demonstrate that training junior surgeons on a virtual
reality (VR) simulator in addition to didactic teaching will improve their intraoperative
performance compared to those trainees who receive the traditional teaching paradigm (i.e,
operating under the guidance and instruction of a consultant general surgeon).
We anticipate that the VR trained group will make less critical intraoperative errors and
will perform faster than their traditionally trained colleagues.
Other study questions include:
1. Does objective assessment of fundamental abilities (FA) such as visuo-spatial ability
predict intra-operative performance?
2. Do FA predict rate of learning to reach proficiency?
We plan to assess up to 30 junior surgical trainees from training hospitals nationwide. All
will have baseline assessment of fundamental abilities (FA) such as psychomotor,
visuospatial and perceptual abilities. The trainees will then be randomised to one of two
groups:
Group A-will receive the 'traditional' training programme; i.e. will receive whatever
clinical training on a patient their supervising consultant deems appropriate. This is the
way junior surgeons are currently trained. They will also receive the standard didactic
teaching on the School for Surgeons e-learning resource.
Group B-will be assigned to the 'proficiency-based progression' training programme. These
trainees will be required to train on the virtual reality (VR) simulator (Lap Simâ„¢) for a
laparoscopic cholecystectomy (LC). Trainees will have objectively set goals to reach on the
simulator and will have to demonstrate proficiency before they are permitted to progress to
the next, more challenging level. These supervised sessions will last no longer than one
hour at a time. The proficiency measures will be predetermined errors, economy of instrument
movement and economy and safety of diathermy usage.
The benchmark or 'gold standard' of proficiency will be established from the objectively
assessed performance of expert consultant surgeons.
Group B will also receive the standard School for Surgeons instruction but, unlike Group A,
they will have to demonstrate proficiency on the didactic module before they progress to the
operating theatre.
Trainees in both the VR and traditional group will then each perform five video-recorded
laparoscopic cholecystectomies at their respective training hospitals. The first three will
be carried out early in the trainees rotation and the last two towards the end of the
rotation. Each trainee will be supervised by a consultant surgeon for all procedures; the
consultant will be ready to take over the procedure should the trainee run into
difficulties.
The video recordings will be forwarded to the National Surgical Training Centre and will be
assessed by two consultant surgeons blinded to the training status of the trainee.
The LC will be divided into 3 distinct phases, exposure of the cystic duct and artery plus
clip placement on these structures, tissue division and finally diathermy excision of the
gallbladder from the liver-bed. The different phases of the procedure will be marked, using
a scoring system which will enable the observers to record whether the event or a
pre-described error had or had not occurred. Senior surgeon takeover events will also be
scored as errors.
;
Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Single Blind (Outcomes Assessor)
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