Is there a proof of transferability of laparoscopic psychomotor skills from the Lab to the OR
Competency can be achieved with proper training but aiming to do so during actual live surgeries is tedious, lengthy and might even be considered unethical. Hence other modalities for training have been sought, including and not limited to dry lab training which would allow for rehearsal of skill without time constraint and without patient safety issues. This can be either done via traditional video box trainer or via virtual reality simulators and validation studies (Aggarwal 2006 ) have shown that the skills needed to perform simulation tasks are actually similar to those needed during surgery i. e. proven “construct validity” (Nagendran et al , 2014), with the simulator being more effective than the traditional box trainer as it allows for a more complete surgical experience ( as opposed to the limited tasks performed on the box trainer) and for the metrics to be analyzed thus offering an objective assessment and providing feedback to the trainee.
The assessment methods in the exclusion and inclusion criteria included, pass/fail score, procedure and errors, time to complete and patient discomfort. Nagendran et al (2014) study only considered the randomized clinical trials irrespective of publication, language or blinding status excluding quasi randomized studies. The study’s participants included surgical trainees that had limited laparoscopic experience. the interventions used were trials that compared virtual reality training and other training methods like in job training and traditional training, Results Studies showing differences in time and speed Cristina et al (2014) shows that Sixteen RCT examining skills transfer from the simulated setting an operative setting was suitable for being included in the study. They compared the performance of two groups prior to simulation training and after intervention.
Likewise, two RCT and an observational study showed that simulated trained groups members managed to complete endoscopic task/ procedures in less time compared to those in control groups. One study revealed that participants with simulator training managed to perform upper gastrointestinal endoscopy faster compared to the control group participants. Performance Score According to Christina et al, three studies evaluated performances on the basis of the formula incorporating accuracy and time. Fried et al calculated differences in performance score and revealed that participants in trained groups scored higher compared to control groups. The study also revealed that there was a significant improvement in trained groups compared to control groups. Despite the lack of analyzing the formal subgroups, the decline in the operating time seems to be pronounced in the trials in which trainees got trained on the anomatical models compared to trials that surgical trainees trained in basic task only.
Additionally, it is also vivid that simulation training increases the operative appearances compared with the supplementary training. Dawe et al (2014) also shows that there are various benefits that could be derived from successful acquisition of skills in surgical simulation training setting. High level transfer improves patient safety as well as procedure efficiency and cost savings. From Dawe’s et al study, does support the hypothesis showing that simulation-based training has various advantages. Notably, from the review of the existing literature, it is vivid that virtual reality training or simulation training is of great significance compared to other training methods. Studies have shown that it reduces performs errors, increase performance scores as well as the performance time. However, other studies have alleged that tis training technique is similar to other training techniques and it has no advantage over other training techniques.
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