Module Based Training Improves Performance in Laparoscopic Surgery: A Nationwide Randomized Controlled Trial

Objectives: New working time directives reduce the available training hours for futuresurgeons. Laparoscopic training must be more efficient, and deliberate clinical operative training within a short time-frame (module based training) might help achieve this goal. This study set out to measure the effect of such a module based training programme for surgical trainees applied to laparoscopic cholecystectomy. Method: Randomized controlled trial in Danish surgical training hospitals. Thirty-five Danish surgical specialty trainees (registrars) were randomized to either module based training including performance of 20 procedures within 4-8 weeks or standard clinical training. The laparoscopic cholecystectomies were videotaped and blindly rated by three professors/consultants using the validated tool: Global Objective Assessment of Laparoscopic Skills (GOALS). Results: Data show a significant effect of the module based training program on technical skills compared to standard training at one year follow-up despite equal number of performed procedures in the two groups (p=0.010). Due to a large number of drop-outs only ten participants completed the study with the required number of videotaped operations. Inter-rater reliability showed Cronbach’s alpha=0.37. Conclusions: Only few trainees completed the study and inter-rater reliability was low, which highlight some of the challenges in educational randomized studies. Despite this, module based training showed promising effect as an efficient method in clinical skills training of surgical registrars.