Development and Validation of a Comprehensive Curriculum to Teach an Advanced Minimally Invasive Procedure: A Randomized Controlled Trial

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Objective:To develop and validate a comprehensive ex vivo training curriculum for laparoscopic colorectal surgery.Background:Simulators have been shown to be viable systems for teaching technical skills outside the operating room; however, integration of simulation training into comprehensive curricula remains a major challenge in modern surgical education. Currently, no curricula have been described or validated for advanced laparoscopic procedures.Methods:This prospective, single-blinded randomized controlled trial allocated 25 surgical residents to receive either conventional residency training or a comprehensive training curriculum for laparoscopic colorectal surgery. The curriculum consisted of proficiency-based psychomotor training on a virtual reality simulator, cognitive training, and participation in a cadaver lab. The primary outcome measure in this study was surgical performance in the operating room. All participants performed a laparoscopic right colectomy, which was video recorded and assessed using 2 previously validated assessment tools. Secondary outcome measures were knowledge relating to the execution of the procedure, assessed with a multiple-choice test, and technical performance on the simulator.Results:Curricular-trained residents demonstrated superior performance in the operating room compared with conventionally trained residents (global score 16.0 [14.5–18.0] versus 8.0 [6.0–14.5], P = 0.030; number of operative steps performed 16.0 [12.5–17.5] versus 8.0 [6.0–14.5], P = 0.021; procedure-specific score 71.1 [54.4–81.6] versus 51.1 [36.7–74.4], P = 0.122). Curricular-trained residents scored higher on the multiple-choice test (10 [9–11] versus 7.5 [5.3–7.5], P = 0.047), and outperformed conventionally trained residents in 7 of 8 tasks on the simulator.Conclusions:Participation in a comprehensive ex vivo training curriculum for laparoscopic colorectal surgery results in improved technical knowledge and improved performance in the operating room compared with conventional residency training. Reg. ID#NCT 01371136.

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