An "intermediate curriculum" for advanced laparoscopic skills training with virtual reality simulation

STUDY OBJECTIVE: To estimate face and construct validity for a novel curriculum designed for intermediately skilled laparoscopic surgeons on a virtual reality simulator. It consists of 5 exercises that focus on training precision and coordination between both hands. DESIGN: Prospective study (Canadian Task Force II-2). SETTING: Three university hospitals and 4 teaching hospitals in the Netherlands. SUBJECTS: Residents, consultants, and laparoscopic experts (n = 69) in the fields of general surgery, gynecology, and urology participated. Participants were divided into 4 groups on the basis of their level of laparoscopic experience: resident, years 1-3 (n = 15); resident, years 4-6 (n = 17); consultant (n = 19); and laparoscopic experts (n = 18). INTERVENTIONS: Participants completed 3 runs of 5 exercises. The first run was an introduction, and the second and third runs were used for analysis. The parameters time, path length, collisions, and displacement were compared between groups. Afterward the participants completed a questionnaire to evaluate their laparoscopic experience and identify issues concerning the simulator and exercises. MEASUREMENTS AND MAIN RESULTS: The expert group was significantly faster (p <.05) than other groups in 4 of 5 exercises. The parameter displacement demonstrated a significant difference between the expert group and other groups in 2 of the 4 exercises in which this parameter was relevant (p <.05). In the questionnaire (n = 68), training capacity of the curriculum was scored with a median of 4 points on a 5-point Likert scale. Of all participants, 92.6% indicated that this curriculum is suitable as an addition to a basic skills module within their residency program. CONCLUSION: Face and construct validity were estimated for an advanced virtual reality curriculum for intermediately skilled laparoscopic surgeons. The results indicate that the curriculum is suitable for training of residents and consultants and to assess and maintain their laparoscopic skills.