What is the ideal interval between training sessions during proficiency-based laparoscopic simulator training?

BACKGROUND: The aim of this study was to identify the ideal interval between training sessions in a proficiency-based laparoscopic suturing simulator curriculum. METHODS: We analyzed performance data from 3 randomized controlled trials of novices (n = 66) who followed a similar proficiency-based simulator curriculum in laparoscopic suturing on the Fundamentals of Laparoscopic Surgery model. The change in performance and intertraining interval were correlated. RESULTS: Overall participant performance improved from 530 +/- 58 seconds at baseline to 81 +/- 14 seconds at training completion (P < .001). Intertraining intervals ranged from 1 to 43 days and performance change between training sessions varied widely. There was no correlation of performance change with intertraining interval (r = .05, P = .30). Performance deterioration was similar at different intertraining intervals. Shorter intervals were associated, however, with shorter training duration (r = .35, P = .005). CONCLUSIONS: No association was found between intertraining interval and change in performance during proficiency-based laparoscopic simulator training but shorter intervals were associated with improved skill acquisition. Further study is needed to confirm these findings.

Do novices display automaticity during simulator training?

BACKGROUND: The objective of this study was to investigate whether novices improve their ability to develop multitask (ie, automaticity) with accumulating experience on a simulated laparoscopic task. METHODS: In this prospective study, novices (12 premed students) trained for 4 months in laparoscopic suturing. Simultaneously with suturing, participants performed a visual-spatial secondary task to assess their spare attentional capacity. Trainees were required to achieve expert-derived levels in both suturing (520 score) and the secondary task (target 73%). Their performance was assessed with objective scores, and their ability to multitask during training was examined. RESULTS: After 10 +/- 5 hours and 84 +/- 41 repetitions, participants demonstrated improvements in their suturing (70%, P < 0.001) and secondary-task performance (16%, P = 0.08) compared with their baseline scores. During the study period, 11 of 12 participants achieved suturing proficiency, but no one achieved secondary-task proficiency. Longer training times correlated with higher secondary-task scores (r = .68, P < 0.02), and participants who performed >100 repetitions (n = 4) achieved higher secondary-task scores (P < 0.03). COMMENTS: This study provides evidence for improved automaticity at advanced stages of simulator training. Although novices achieve simulator proficiency after relatively short training durations, the attainment of automaticity requires substantially longer training periods. Further study of this concept is warranted and is currently underway.