16 Simulator training at home improves laparoscopic skills of novice surgical trainees

Introduction Enhances in technology have meant that minimally invasive surgical techniques are commonplace and used across the surgical specialities. As a novice, the skills required for laparoscopic surgery can be transferred to all minimally invasive techniques. The changing landscape of the NHS and the impact of the working European Working Time Directive have meant that alternative training methods must be adopted. Simulation offers one solution to this, but to be effective must be readily available for repeated deliberate practice and offer feedback. Method First year Core Surgical Trainees were given access to innovative ‘at home’ laparoscopic trainers that provide an online curriculum and 5 specific tasks to perform for 5 months. The programme is supported by software that track instrument movements and gives immediate technical feedback to the trainee and allows video links to be sent to a trainer for further feedback. Trainees were encouraged to complete each task 10 times before submitting a final video for assessment and grading before proceeding to the next task. Results from the instrument measurements were recorded and sent to the assessor for analysis. Results 24 trainees were invited to be part of the programme and 22 trainees completed the programme. On average each task has been performed 9 (1–25) times before final submission. The number of attempts was higher for the first three tasks (13) than the later ones (6). Overall, significant improvements were identified in time taken to complete the task (p = 0.001), total distance travelled (p = 0.022), smoothness of the instruments (p = 0.01) and time off screen (0.03). Conclusion At home surgical simulators are used by Core Surgical Trainees and show significant improvements in the technical skills associated with performing set tasks. Further work is required to identify if this improvement is sustained and whether it can be associated with clinical performance.