Design and implementation of a proficiency-based, structured endoscopy course for medical students applying for a surgical specialty

Gunter De Win,^1,2 Siska Van Bruwaene,¹ Christopher Allen,³ Dirk De Ridder<sup>2

1</sup>Centre for Surgical Technologies, ²Department of Urology, University Hospitals, KU Leuven, Leuven, Belgium; ³School of Arts and Sciences, University of Pennsylvania, PA, USA

Background: Surgical simulation is becoming increasingly important in surgical education. Despite the important work done on simulators, simulator model development, and simulator assessment methodologies, there is a need for development of integrated simulators in the curriculum. In this paper, we describe the design of our evidence-based preclinical training program for medical students applying for a surgical career at the Centre for Surgical Technologies.
Methods: Twenty-two students participated in this training program. During their final months as medical students, they received structured, proficiency-based endoscopy training. The total amount of mentored training was 18 hours and the training was organized into three training blocks. The first block focused on psychomotor training, the second block focused on laparoscopic stitching and suturing, and the third block on laparoscopic dissection techniques and hemostasis. Deliberate practice was allowed and students had to show proficiency before proceeding to the next training block. Students’ psychomotor abilities were tested before the course and after each training block. At the beginning of their careers as surgical registrars, their performance on a laparoscopic suturing task was compared with that of registrars from the previous year who did not have this training course. Student opinions about this course were evaluated using a visual analog scale.
Results: All students rated the training course as useful and their psychomotor abilities improved markedly. All students performed deliberate practice, and those who participated in this course scored significantly (P < 0.0001) better on the laparoscopic suturing task than first year registrars who did not participate in this course.
Conclusion: Organization of a structured preclinical training program in laparoscopy for final year medical students is feasible, attractive, and successful.

Keywords: laparoscopy training, proficiency based, surgical skill evaluation, curriculum development