Incentivising laparoscopic deliberate practice in core surgical training

Introduction: Frequent practice using a laparoscopic simulator is known to improve subsequent live operating skills. Achieving automation of motor movements prior to live training frees the trainee’s attention for higher skills. Despite this, trainees don’t avail themselves of opportunity for practice. We incentivised frequent laparoscopic practise within two Core Surgical Training (CST) programmes. Method: 27 CST’s in their first general/urology/paediatric post were given a take-home laparoscopic simulator with instrument tracking software and assigned 6 online modules. Support was provided via social media and a helpdesk. Achievement of metric targets and uploading specified data merited an eCertificate. On production of this certificate, supervisors progressed trainees from camera-holding to operating (the incentive). Trainee views of the intervention and laparoscopic practice were assessed by questionnaires. Results: Metric results show improvement across all domains for those who completed 1 or more modules (presented graphically). Trainee self-rated anxiety of laparoscopic operating was reduced post-study. 94% of participants thought simulator practise was worthwhile, 76% would recommend the programme. 88% reported improved confidence and motor skills. 41% of participants completed >1 modules. 19% completed all. Comments indicated reasons for this, including the need to integrate simulation into curricular structures. Metric results showed improvement in 5 domains Motion smoothness, acceleration, speed, distance between instruments,% time off screen + time to completion. Conclusion: The message from this feasibility study, the first to “incentivise” laparoscopic practice, indicates that simply incentivising practice with 24/7 access to simulators and targets, doesn't result in frequent deliberate practice by trainees, though performance improves in those who do engage. Trainee feedback provides clear indicators of what to address to maximise uptake. It would suggest that to fully engage trainees, laparoscopic practice must be fully integrated into training and progress assessed within training.