Can everyone achieve proficiency with the laparoscopic technique? Learning curve patterns in technical skills acquisition

Abstract 

Background

The study was carried out to determine the learning curve patterns for basic laparoscopic technical skills.

Methods

Thirty-seven surgical residents with limited laparoscopic experience performed 10 repetitions of 6 tasks on a virtual-reality trainer (MIST-VR) with standardized distribution of practice. Assessment was based on time, errors, and economy of motion as measured by MIST-VR. Proficiency levels were established by testing experienced laparoscopic surgeons.

Results

Four learning curve patterns were determined. Surgeons in group 1 (5.4%) demonstrated proficiency from the beginning; group 2 (70.3%) achieved predefined expert criteria between 2 and 9 repetitions; group 3 (16.2%) demonstrated improvement but was unable to achieve proficiency within 10 repetitions. Group 4 (8.1%) underperformed and showed no tendency of skills improvement, reflecting a group of subjects who probably are unable to learn laparoscopic technique.

Conclusions

The results indicated that a group of subjects could not reach proficiency in the psychomotor skills relevant for laparoscopy. We believe that this is an important issue that should be addressed in future research.

Keywords: Assessment, Certification, Laparoscopic surgery, Learning curves, Training, Proficiency, Selection