1. Laparoscopic Skills Laboratories: Current Assessment and a Call for Resident Training Standards James R. Korndorffer, Jr., MD, Dimitris Stefanidis, MD, Daniel J. Scott, MD

2. Background Background Training in laparoscopic skills laboratories has been shown to transfer to real operations 1-4 Training in laparoscopic skills laboratories has been shown to transfer to real operations 1-4 Prior study showed 80% of programs had laparoscopic surgery labs 5 Prior study showed 80% of programs had laparoscopic surgery labs 5 However, perceived slow adoption to the use of labs in residency training programs However, perceived slow adoption to the use of labs in residency training programs 1 Korndorffer Jr. JR, et al. Surg Endosc (2005) 19: 161-167 2 Seymour NE, et al. Ann Surg (2002) 263: 458 - 463 3 Scott DJ, et al. J Am Coll Surg (2000) 191: 272-283 4 Fried GM. et al. Surg Endosc (1999) 13: 1077 – 1081 5 Marks JM, et al. Surg Endosc (2001) 15: 1011-1015

3. Purpose Purpose Believed benefit of laparoscopic skills labs Believed benefit of laparoscopic skills labs Prevalence Prevalence Composition of the “average lab” Composition of the “average lab”

4. Purpose “ average” skills Lab Purpose “ average” skills Lab

5. Purpose Purpose Believed value of laparoscopic skills labs Believed value of laparoscopic skills labs Prevalence Prevalence Composition of the “average lab” Composition of the “average lab” Utilization Utilization Costs Costs

6. Methods Survey: mailed to all surgical residency program directors Survey: mailed to all surgical residency program directors Unique identifier Unique identifier All non-responders contacted by e-mail All non-responders contacted by e-mail Remaining no-responders again contacted by mail Remaining no-responders again contacted by mail

7. Methods

8. Results 64% response rate (162) 64% response rate (162) University programs 62% University programs 62% University affiliated/Community 64% University affiliated/Community 64% Community 72% Community 72% Graduate 647 residents Graduate 647 residents 42 have laparoscopic fellowships 42 have laparoscopic fellowships

9. Results Perceived Value Improves OR Performance Efficient Method Recruitment Aid Recruitment Aid Have Skills Labs 88% 78% 75% 55%

10. Results Equipment 3.9 / lab (range 1 -15)

11. Results Equipment Mirror Type Mirror Type 33% (range 0 - 6) 33% (range 0 - 6) TV Type TV Type 60% (range 0 - 6) 60% (range 0 - 6) Trainer Box and Laparoscope Trainer Box and Laparoscope 55% (range 0 - 10) 55% (range 0 - 10) Free Standing Free Standing 31 % (range 0 - 5) 31 % (range 0 - 5)

12. Results Equipment 3.8 / lab (range 1 - 15) 1.7 / lab (range 1 - 7)

13. Results Equipment MIST-VR MIST-VR 61% (range 0 - 3) 61% (range 0 - 3) Endoscopy Endoscopy 34 % 34 % Other Other 37% (range 0 – 3) 37% (range 0 – 3)

14. Results Utilization - Basic Skills

16. Results Utilization Basic Skills

17. ? ? ? ? ?

18. Results Utilization - Suturing Skills 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Intracorporeal Extracorporeal Endostitch Suture Assistant "Our own" ?

19. Results Utilization - resident time Mean time in lab 50 min/week Mean time in lab 50 min/week Range 0 - 5 hrs / wk Range 0 - 5 hrs / wk 48 % less than 1 hr / wk 48 % less than 1 hr / wk Required training 55 % Required training 55 % Range “one session”/ year - 5 hrs/week Range “one session”/ year - 5 hrs/week

20. Results Costs Staffing Staffing 1.7 People/lab (range 0 - 5) 1.7 People/lab (range 0 - 5) MD - 79 % MD - 79 % Fellow/resident - 43 % Fellow/resident - 43 % Other - 21 % Other - 21 % Monetary Monetary Set up $133,000 ($300 - 1 mil) Set up $133,000 ($300 - 1 mil) Annual budget $11,000 ($0 - 50,000) Annual budget $11,000 ($0 - 50,000) Source of Funds Source of Funds 43 % corporate 26 % department 43 % corporate 26 % department 13 % hospital 14 % other 13 % hospital 14 % other 3 % government 3 % government

21. Summary Benefits proven and accepted by most Benefits proven and accepted by most Small majority have labs Small majority have labs “Average Lab” “Average Lab” 0.7 mirror trainers 0.7 mirror trainers 1.2 TV trainers 1.2 TV trainers 1.4 Box Trainers 1.4 Box Trainers 0.5 free standing trainers 0.5 free standing trainers 0.3 MIST - VR 0.3 MIST - VR 0.2 Endoscopic VR 0.2 Endoscopic VR 0.3 Other VR 0.3 Other VR 0.8 hrs/week 0.8 hrs/week 1.7 people for staffing 1.7 people for staffing $133.000 set up $133.000 set up

22. Conclusion Impediments to implementation Impediments to implementation What to use and how to use it What to use and how to use it Curriculum Curriculum Resident motivation Resident motivation Program director involvement Program director involvement Where to find time in the 80 hr Where to find time in the 80 hr work-week work-week Need to be creative Need to be creative Accessible Accessible Costs Costs

23. Conclusion Significant variability of equipment and training practices exist in currently available labs. Strategies are needed for more widespread implementation of skills labs, and standards should be developed to facilitate uniform adoption of validated curricula that reliably maximize training efficiency and educational benefit. Significant variability of equipment and training practices exist in currently available labs. Strategies are needed for more widespread implementation of skills labs, and standards should be developed to facilitate uniform adoption of validated curricula that reliably maximize training efficiency and educational benefit.

24. Laparoscopic Skills Laboratories: Current Assessment and a Call for Resident Training Standards James R. Korndorffer, Jr., MD, Dimitris Stefanidis, MD, Daniel J. Scott, MD