Procedure-to-Procedure Transfer in Laparoscopic Simulator Training: Results from a Randomized Trial

INTRODUCTION: Laparoscopic simulation has become a standard component of surgical training, but there is limited knowledge regarding skills transfer between procedural tasks. The objective of this trial was to investigate the specificity of proficiency-based procedural simulator training. METHODS: A randomized single-center educational superiority trial. Surgical novices (n=102) practiced basic skills on a laparoscopic virtual reality simulator. Those who reached proficiency for the basic skills were randomized. The intervention group practiced 2 procedures on the simulator to proficiency (first an appendectomy followed by a salpingectomy); the control group trained only 1 procedure (a salpingectomy). The outcomes were number of repetitions and training time to proficiency for the second procedure (the salpingectomy). Multivariable analyses were used. RESULTS: Ninety-six participants were randomized in the trial; 74% were women, and median age was 26 years. The intervention group made significantly fewer attempts to reach the proficiency level for the second procedure (median 22 attempts [interquartile range (IQR) 17-34] vs median 32 attempts [IQR 26-41], corresponding to 24.1% [95% CI, 8.5-36.9, p=0.004] fewer attempts). For the secondary outcome, the intervention group spent significantly less time to reach proficiency (median of 88 minutes [IQR 63-127] vs 131 minutes [IQR 101-153], corresponding to a difference of 31.1 minutes [95% CI, 14.0-48.3, p=0.001]). CONCLUSIONS: Practicing 2 procedures, compared with only 1 procedure, reduces the number of attempts and the time to reach proficiency for the second procedure. Skills transfer is seen between 2 procedural tasks in laparoscopic simulator training; however, task specificity is still present when practicing procedural tasks.