Abstract
We expect to be treated by competent doctors when we need surgery. Competence is a combination of knowledge, technical skills, decision-making, communication, and leadership, and can be learned. Feedback is decisive to achieve good learning.
The aim of the three studies included in the Thesis was to evaluate the feasibility and effect of a systematic training program for laparoscopic hysterectomy.
We developed and validated a procedure-specific assessment tool for hysterectomy. Participants with different surgical experience performed a hysterectomy, and the surgical performance was evaluated using both this tool and an assessment tool for general laparoscopic skills. Both tools showed statistically significant different mean score for participants with different surgical experience. This indicated that the validated assessment tools could be useful for evaluation of effect of training.
A scoring system for laparoscopic skills and proficiency levels for tasks on a virtual reality simulator were developed and validated. Experienced gynaecologists performed the tasks, and defined the proficiency levels. Less experienced participants were included and performed the same tasks. There was significant different mean score between the experienced and the inexperienced participants in four out of five tasks.
The tasks on the simulator and a multiple-choice test defined the first two steps of the training program. When the participants reached the pre-set proficiency levels for each task, they were signed in to step 3, the hysterectomy. The surgical procedures were video recorded and evaluated with the validated assessment tools. Participants with training achieved a higher score compared to participants in a control group of trainees without a structured training program.
The results indicate that systematic virtual reality simulator training improve surgical competence, and that pre-set proficiency levels on the simulator can be used to “sign-in” trainees to surgery.