Achieving engagement with a Deliberate Practice programme using portable laparoscopy simulators - “Incentivised Laparoscopy Practice”
Authors: Walker Kenneth G , Cleland Jennifer , Brennan Paul M , Blackhall Vivienne I , Nicol Laura G , Shah Adarsh , Yalamarthi Satheesh , Vella Mark 
Published: November 2020

Background

The transfer validity of portable laparoscopy simulation is well established. However, attempts to integrate take-home simulation into surgical training have met with inconsistent engagement, as reported in our 2014-15 study of an Incentivised Laparoscopy Practice (ILP) programme. Our subsequent multi-centre study examined barriers and facilitators, informing revisions of the programme for 2018-20. We now report engagement with the revised versions.

Methods

In ILP v2.1 and 2.2, two consecutive year-groups of new CSTs (n= 48 and 46) were loaned portable simulators. The 6-month programme included induction, technical support, and intermittent feedback. Six tasks were prescribed, with video instruction and charting of metric scores. Video uploads were required and scored by faculty. A pass resulted in an eCertificate, expected at Annual Review. ILP was set within a wider reform, “Improving Surgical Training”.

Results

ILP v2.1 and 2.2 saw pass rates of 94% and 76% (45/48 and 35/46 trainees respectively), compared with only 26% (7/27) in v1, despite the v2.1 and v2.2 groups having less electronic gaming experience. In the ILP v2.2 group, 73% reported their engagement was adversely affected by COVID19 redeployments.

Conclusions

Simply providing kit, no matter how good, is not enough. To achieve trainee engagement with take- home simulators, as in ILP v2, a whole programme is required, with motivated learning, individual and group practice, intermittent feedback, and clear goals and assessments. ILP is a complex intervention, best understood as a “reform within a reform, within a context.” This may explain why trainee engagement fell away during early pandemic conditions.

WHAT IS ALREADY KNOWN ON THIS SUBJECT

Attaining automation of motor skills is essential to free up operating surgeons’ attention for higher cognitive functions.

Laparoscopic operating skills can transfer from simulation to the operating room, and deliberate practice is the most important variable in the development of expertise.

Simply providing take-home portable simulators to surgical trainees, even with online training programmes, is insufficient to facilitate consistent deliberate practice by more than a minority of trainees.

WHAT THIS STUDY ADDS

A package of evidence-based reforms transformed participation of Core Surgical trainees in a 6-month programme of practice using take-home portable simulators, resulting in near- 100% engagement.

Such reforms are complex, including motivators for learning, individual and group practice, intermittent feedback, clear goals and assessments, and adoption into a wider curriculum reform called “Improving Surgical Training”.

The improved engagement with this form of remote simulation-based training did not continue in the face of a national “lockdown” for the COVID19 pandemic, where there was widespread redeployment of trainees.