Transfer of Laparoscopic Skills From Box Trainer Simulation to Real Life: A Bi-Center Study in Pakistan

Rabia Aftab,1 Syed Moin Ali,2 Aun Ali,3 Nadia Shahid,4 Sateesh B Arja,5 Muhammad Ahmed,3 Rubab Nafees,3 Madeeha Shahid6 1Department for Educational Development and Anesthesiology, Aga Khan University, Karachi, Pakistan; 2Department for Educational Development, Aga Khan University, Karachi, Pakistan; 3Department for General Surgery, Fazaia Ruth Pfau Medical College, Karachi, Pakistan; 4Department for General Surgery, Ziauddin University, Karachi, Pakistan; 5Medical Education Department, Avalon University School of Medicine, Willemstad, Curacao; 6Department for General Surgery, Niazi Medical and Dental College, Sargodha, PakistanCorrespondence: Rabia Aftab, Department for Educational Development and Anesthesiology Aga Khan University, Karachi, Pakistan, Tel +923002036450, Email [email protected]: Laparoscopic surgery is growing in importance, and laparoscopic training is being incorporated into surgical residency programs in Pakistan, despite limited access to training centers. This study emphasizes the need for residents to acquire essential psychomotor skills through simulation tools like Box Trainers (BTs), which are cost-effective and proven to improve laparoscopic performance. However, gaps remain in standardizing laparoscopic training, and the effectiveness of simulation in skill transfer to real-life surgery is still uncertain. The study aims to evaluate the transferability of skills acquired via BTs and gather residents’ perceptions of their usefulness at two medical centers in Karachi.Methods: The authors used a quasi-experimental design to assess the effect of a three-month laparoscopic skills simulation training course on surgical and gynecology residents’ surgical performance. The total sample size is 41, and the study was conducted for 13 months. The residents were provided with structured step-by-step training in a hierarchical order of four tasks for three months. The task includes ball transfer, ring transfer, cutting pieces of paper, and suturing and Knotting. A duly qualified surgery faculty member observed all the residents using the Global Operative Assessment of Laparoscopic Skills (GOALS) as an assessment tool at the end of training and in a real-life setting after training. The perceptions were taken via questionnaires.Results: This study’s findings indicate no significant difference in the scores of residents when shifting from simulation to real-life tasks for ball transfer (p-value of 0.32) and ring transfer (p-value of 0.47). This lack of significant difference suggests that simulation training for these tasks effectively prepared the residents for real-life application. In other words, the skills learned in simulation were successfully translated to real-life scenarios for these tasks. Also, findings reveal a significant improvement in scores from simulation to real-life for precision cutting, simple suturing, and knot tying. This improvement suggests that while residents may initially perform at a similar level in both settings for some tasks, there is an observable enhancement in their ability to perform more complex tasks when transitioning from simulation to real-life.Discussion: The postgraduate residents demonstrated significant improvements across all tasks, highlighting the productivity of the simulation-based practical training in enhancing and transferring laparoscopic skills.Keywords: simulation, transfer, laparoscopic skills, residents, surgical education, training box