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Background: Laparoscopic camera navigation is vital to laparoscopic surgery, yet often falls to the most junior member of the surgical team who has limited laparoscopic operating experience. Previously published reports on simulation models fail to address qualitative scoring of movement, method of communication and correct physician location with respect to patient position. The purpose of this study was to develop and evaluate a novel laparoscopic camera navigation simulation model that addresses these deficiencies.Methods: A novel, low-cost laparoscopic camera navigational maze was constructed from pliable foam for use in a standard laparoscopic surgery box trainer. Participants (n = 37) completed a camera navigation exercise by following a pre-recorded set of verbal instructions using correct anatomic terminology that is used in the operating room, to simulate an actual operating room experience of receiving verbal cues from senior surgeons. The sample group consisted of participants at various levels of Obstetrics and Gynecology training, representing novice to expert laparoscopists. Each trial was recorded with a multi-channel video camera. Performances were scored by a blinded evaluator for excess gross and fine camera movements as well as overt errors, including camera collisions and failure to follow directions.Results: Our model demonstrated evidence of validity by discriminating performance by level of laparoscopic experience with a statistically significant decrease in number of movements and errors in experts compared to novices. A trend emerged toward improvement with each additional year of training, with reduced variability among performances in more experienced participants.Conclusions: This novel, low-cost box-trainer simulation model for laparoscopic camera navigation offers a mechanism for assessment of laparoscopic camera operation skills. Moreover, this model closely replicates operating room logistics and communication. Given the necessity for improved laparoscopic camera operation education, our model represents a unique, complementary tool to other laparoscopic simulation curricula. [ABSTRACT FROM AUTHOR]

Background: This study aimed to quantify learner reactions manifesting from a realistic contextual stressor while training with a laparoscopic simulator, and to identify learner-derived stress-modifying behaviors. Stress factors are known to affect cognitive and psychomotor performance. Simulation-based medical training typically occurs in environments that are relatively stress free compared with the applied context. Training is most effective when it occurs in a highly faithful context, so the inclusion of typical clinical stressors in simulated laparoscopic learning environments may be beneficial. Methods: Preclinical medical students (N = 27) completed tasks using a laparoscopic simulator under the following 2 conditions: faculty direct observation (stressor) and unobserved (no stressor). The data included simulator performance, blood pressure, real-time heart rates, videotaped behavior, and pre/post surveys of latent anxiety and stress factors associated with participating in the research (eg, STAI 9). Results: Physiologic and behavioral manifestations of stress were observed for all participants during the stressor condition and during poor performance on simulator tasks. Stress was highest during periods of poor performance under the stressor condition. Focusing on the task itself mitigated stress reactions and improved performance on the simulator. Conclusion: Stress reactions can be induced in a laboratory setting where simulation-based training occurs. Stressors imposed on the learner during simulation-based training may help support the acquisition of stress management skills that are necessary in the applied clinical setting. A ramped-up sequence of acquiring technical skills and clinical decision making, followed by stress management techniques, may lead to a more efficient transfer of learning from the simulated context to the clinical area. [Copyright &y& Elsevier]

Abstract: Background: Computer-aided simulators may increase the safety and efficiency of training in laparoscopic surgery. Before implementation of the Immersion LapSim (Gaithersburg, MD) simulator in our training curriculum, we wished to determine its construct validity (ie, whether the simulator could differentiate laparoscopic novices from trainees with greater experience). Methods: Subjects were medical students (MS), residents (RES), and laparoscopic faculty (FAC). Subjects performed 10 repetitions of 6 LapSim tasks. The LapSim measured performance in 6 to 10 parameters per task, and performance was compared between groups. Post hoc t tests were used to make pair-wise comparisons among the 3 groups using the Bonferroni technique. Statistical significance was set at P < .05. Results: The degree of prior laparoscopic experience was reflected in performance on at least 1 parameter for each task. Several patterns of performance between MS, RES, and FAC were observed. Conclusions: The LapSim has performance parameters that reliably differentiate between subjects with varying laparoscopic experience. However, some performance parameters do not differentiate between groups. To accurately measure a trainee’s skill level, only parameters that sensitively measure the true level of performance should be used. [Copyright &y& Elsevier]