34th Annual Scientific Meeting proceedings

Review of learning theories, latest teaching models and technology utilized to train human and veterinary laparoscopic surgeons. Inclusion of relevant literature updates.

• Passive- reading, watching online, watching in person
• Active- online activities, assisting in surgery, advanced training
• Solidifying skills- research, teaching of others

How and when is proficiency achieved?

Important to define proficiency which will vary for different techniques. Attempt to quantify in veterinary medicine. Approximately 14 hours of basic skills training increased veterinary students' confidence level in performing laparoscopic ovariectomy.

• Levi O, Kass PH, Lee LY, et al. J Am Vet Med Assoc 2015;247:1279–1288 Comparison of the ability of veterinary medical students to perform laparoscopic versus conventional open ovariectomy on live dogs. 

Perceptions of MIS and training

Most view that use of training models will improve confidence and capability. Limitations of training programs, time, money, and standardization. Shift away from cadaver and live animal training.

• Fidelity: how realistic the model looks and feels (engineering fidelity) and how well the steps required to complete the task on the model align with the steps on the live animal (psychological fidelity)
  • Appears low fidelity may be as effective as high fidelity on learning outcomes
• If learner participates in deliberate practice with feedback, the learner will continuously improve in skill level, and models facilitate deliberate practice

What psychomotor skills are required?

• ambidexterity
• hand-eye coordination
• instrument targeting accuracy- long instrument fulcrum
• recognition of cues to provide a sense of depth despite the monocular camera view

How does skills training translate to live surgery?

• Extensive simulation training including suturing may contribute toward surgery residents being able to perform complex laparoscopic procedures
• The CLVTS showed a good preliminary acceptance (4.7/5) in terms of the usefulness and adequacy of the exercises that, in the participants' opinion, are appropriate and are related to the difficulty of the TLG. 
• Both experienced and intermediate surgeons gave high marks (4.5/5) to the feeling of realism, design, and practicality. 
• Front Vet Sci. 2022; Development and validation of a composed canine simulator for advanced veterinary laparoscopic training Carlos A. Oviedo-Peñata et al

Formal task training- Designed by Dr. Boel Fransson- University of Washington

• General
• Simulation training
• Training in operating room
• Training in animal models
• Box Trainer basic manual skills checklist VALS program
• Virtual reality (VR)

VLAS and ACVS MIS Fellowship

• Designed to provide a standardized program for veterinary MIS training
• 18 small animal and 16 large animal founding fellows
• Approved training centers
• Effectiveness of training programs
  • All participants reached the predefined proficiency level on the Fundamentals of Laparoscopic Surgery intracorporeal suture task
  • The average number of repetitions required to reach proficiency was 18 ± 7, and there was significant improvement in both time to completion (seconds) and scores from pretraining to final testing (P = .005)
• Kilkenny JJ, White K, Singh A. Evaluating veterinary student skill acquisition on a laparoscopic suturing exercise after simulation training. Vet Surg. 2019; 48(S1): O66-O73

Conclusions

• BEST TIPS FOR SUCCESS:
• Structured curriculum,
• Validated tasks
• Clear training goals
• Combine
  • Didactics and practical training
  • Reading and video materials