Laparoscopic Skills Laboratories: Current Assessment and a Call for Resident Training Standards

1. Laparoscopic Skills Laboratories: Current Assessment and a Call for Resident Training Standards James R. Korndorffer, Jr., MD, Dimitris Stefanidis, MD, Daniel J. Scott, MD

2. Background • Training in laparoscopic skills laboratories has been shown to transfer to real operations1-4 • Prior study showed 80% of programs had laparoscopic surgery labs5 • However, perceived slow adoption to the use of labs in residency training programs 1 Korndorffer Jr. JR, et al. Surg Endosc (2005) 19: 161-167 2 Seymour NE, et al. Ann Surg (2002) 263: 458 - 463 3 Scott DJ, et al. J Am Coll Surg (2000) 191: 272-283 4 Fried GM. et al. Surg Endosc (1999) 13: 1077 – 1081 5 Marks JM, et al. Surg Endosc (2001) 15: 1011-1015

3. Purpose • Believed benefitof laparoscopic skills labs • Prevalence • Composition of the “average lab”

4. Purpose“average” skills Lab

5. Purpose • Believed valueof laparoscopic skills labs • Prevalence • Composition of the “average lab” • Utilization • Costs

6. Methods • Survey: mailed to all surgical residency program directors • Unique identifier • All non-responders contacted by e-mail • Remaining no-responders again contacted by mail

7. Methods

8. Results • 64% response rate (162) • University programs 62% • University affiliated/Community 64% • Community 72% • Graduate 647 residents • 42 have laparoscopic fellowships

9. ResultsPerceivedValue 78% 88% Improves OR Performance Efficient Method 55% 75% Have Skills Labs Recruitment Aid

10. ResultsEquipment 3.9 / lab (range 1 -15)

11. ResultsEquipment • Mirror Type • 33% (range 0 - 6) • TV Type • 60% (range 0 - 6) • Trainer Box andLaparoscope • 55% (range 0 - 10) • Free Standing • 31 % (range 0 - 5)

12. ResultsEquipment 3.8 / lab (range 1 - 15) 1.7 / lab (range 1 - 7)

13. ResultsEquipment • MIST-VR • 61% (range 0 - 3) • Endoscopy • 34 % • Other • 37% (range 0 – 3)

14. ResultsUtilization -Basic Skills

15. ResultsUtilization -Basic Skills

16. ResultsUtilizationBasic Skills

17. ResultsUtilizationBasic Skills ? ? ? ? ?

18. ResultsUtilization -SuturingSkills 100% 90% 80% 70% 60% ? 50% 40% 30% 20% 10% 0% "Our own" Endostitch Intracorporeal Extracorporeal Suture Assistant

19. ResultsUtilization - resident time • Mean time in lab 50 min/week • Range 0 - 5 hrs / wk • 48 % less than 1 hr / wk • Required training 55 % • Range “one session”/ year - 5 hrs/week

20. ResultsCosts • Staffing • 1.7 People/lab (range 0 - 5) • MD - 79 % • Fellow/resident - 43 % • Other - 21 % • Monetary • Set up $133,000 ($300 - 1 mil) • Annual budget $11,000 ($0 - 50,000) • Source of Funds 43 % corporate 26 % department 13 % hospital 14 % other 3 % government

21. Summary • Benefits proven and accepted by most • Small majority have labs • “Average Lab” • 0.7 mirror trainers • 1.2 TV trainers • 1.4 Box Trainers • 0.5 free standing trainers • 0.3 MIST - VR • 0.2 Endoscopic VR • 0.3 Other VR • 0.8 hrs/week • 1.7 people for staffing • $133.000 set up

22. Conclusion • Impediments to implementation • What to use and how to use it • Curriculum • Resident motivation • Program director involvement • Where to find time in the 80 hr work-week • Need to be creative • Accessible • Costs

23. Conclusion Significant variability of equipment and training practices exist in currently available labs. Strategies are needed for more widespread implementation of skills labs, and standards should be developed to facilitate uniform adoption of validated curricula that reliably maximize training efficiency and educational benefit.

24. Laparoscopic Skills Laboratories: Current Assessment and a Call for Resident Training Standards James R. Korndorffer, Jr., MD, Dimitris Stefanidis, MD, Daniel J. Scott, MD