Validation of a Training Model for Performing Laparoscopic Knots and Stitches in a Simulation Environment

Costa, Grijalva Otávio Ferreira da; Rocha, Hermano Alexandre Lima; Carvalho, Cândida Mayara Rodrigues; Moura Junior, Luiz Gonzaga de; Medeiros, Francisco das Chagas

doi:10.1590/1981-5271v44.2-20190160.ING

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ORIGINAL ARTICLE • Rev. bras. educ. med. 44 (2) • 2020 • https://doi.org/10.1590/1981-5271v44.2-20190160.ING copy

Validation of a Training Model for Performing Laparoscopic Knots and Stitches in a Simulation Environment

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

Introduction:

To evaluate the progression of competence, learning curve and degree of satisfaction with the training model of medical students undergoing training to perform laparoscopic knots in a simulator.

Methods:

This was a prospective, longitudinal, interventional study, carried out from April 2016 to July 2017, with the participation of 52 students from the Centro Universitário Christus, Fortaleza, Brazil, from the first to the third year of medical school, undergoing theoretical practical, systematic, and methodized training, with progression of skills to perform laparoscopic knots in a simulation environment in four stages, with a total duration of 16 hours. It was established the task of performing laparoscopic stitches, with five simple knots, in the beginning and in the end, in a suture mold, in an abdominal cavity simulator, in 18 minutes. The main outcomes were time and quality of performance. The students were evaluated before the first and after all stages of the training regarding the quantity and quality of the knots or the subject of the stage and satisfaction with the training model. ANOVA and Student’s t tests were performed for the independent samples and the chi-square test for the categorical variables. For variables with serial measurements, general linear models were used. Univariate binomial models were used in the evaluation variables of the training model. P values <0.05 were considered significant.

Results:

The values of the medians were analyzed between the first and last stages of the training; of the number of simple knots (0.0 and 15.0) and laparoscopic knots (0.0 and 3.0), the adequacy of the sizes of the suture tail ends (0.0 and 11.0), the number of adjusted initial simple knots ( 0.0 and 3.0) and adjusted sequential ones (0.0 and 24.0). There was statistical significance in all evaluated parameters (p< 0.001). The learning curve showed that 99.1% of the students attained competence. The degree of satisfactory evaluation of the training model was considered good or great in 97% or more, with statistical relevance in 8 of the 10 evaluated statements.

Conclusions:

The study demonstrated that the students showed competence progression and learning curve evolution. The degree of student satisfaction in relation to the training model stages was very significant.

Keywords:
Laparoscopic Surgery; Simulation Training; Medical Education; Suture

Demographic data		Mean/n	SD/%
Age	years	21.1	2.0
Gender	Female	29	55.8%
Gender	Male	23	44.2%
Dominant hand	Right	46	88.5%
Dominant hand	Left	6	11.5%
Skilled at typing on cell phone		51	98.1%
Skilled at typing on computer keyboards		49	94.2%
Desire to perform surgical activities		49	94.2%
Experience in surgery		18	34.6%
Musical instrument practice		13	25.0%
Video game practice three or more hours a week		12	23.1%
Experience in video-assisted surgery		7	13.5%

Statements	Scores	Total	%	p
1. The theoretical activities contributed to the understanding of the cognitive elements of the practice of skills.	4	25	16.0	0.010
	5	130	83.3
2. The materials/equipment were demonstrated and provided adequate conditions for the development of skills.	4	18	8.7	0.001
	5	190	91.3
3. The practical demonstrations decisively contributed to the development of skills.	4	16	7.7	0.001
	5	192	92.3
4. The performance of the instructor / monitor decisively contributed to the learning and development of skills.	4	32	15.4	0.107
	5	170	81.7
5. The feedback provided decisively contributed to the learning and development of skills.	4	22	10.6	0.002
	5	185	88.9
6. The number of repetitions of the exercises and the division into subcomponents in the practical activities were adequate.	4	6	2.9	0.001
	5	202	97.1
7. The activities were effective and allowed the proposed practices to be executed without mistakes.	4	55	26.4	0.014
	5	151	72.6
8. The applied teaching methodology with progressive complexity stations is adequate for learning.	4	8	3.8	0.001
	5	200	96.2
9. The simulation environment was adequate for learning and developing the skills.	4	8	3.8	0.014
	5	197	94.7
10. The previous stage contributed to the current one for the development of the skills domain.	4	7	4.5	0.057
	5	146	93.6

	1^st Stage	2^nd Stage	3^rd Stage	4^th Stage
N	Med (Max-Min)	Med (Max-Min)	Med (Max-Min)	Med (Max-Min)	p
Half-knots	0.0 (7.0 - 0.0)	3.0 (10.0 - 0.0)	9.0 (25.0 - 0.0)	15.0 (32.0 - 3.0)	<0.001
Stitches	0.0 (2.0 - 0.0)	0.0 (2.0 - 0.0)	1.0 (4.0 - 0.0)	3.0 (6.0 - 0.0)	<0.001
FPMS	0.0 (4.0 - 0.0)	1.0 (4.0 - 0.0)	3.0 (9.0 - 0.0)	6.0 (12.0 - 0.0)	<0.001
Adequate suture tail ends	0.0 (2.0 - 0.0)	0.0 (3.0 - 0.0)	1.0 (6.0 - 0.0)	3.0 (11.0 - 0.0)	<0.001
Adjusted initial half-knots	0.0 (2.0 - 0.0)	1.0 (2.0 - 0.0)	2.0 (5.0 - 0.0)	3.0 (7.0 - 0.0)	<0.001
Adjusted seq. half-knots	0.0 (5.0 - 0.0)	1.0 (8.0 - 0.0)	6.0 (13.0 - 0.0)	12.0 (24.0 - 1.0)	<0.001

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[1] CORRESPONDING ADDRESS
Hermano Alexandre Lima Rocha. Centro Universitário Christus, Rua João Adolfo Gurgel, 133, Cocó, Fortaleza, CE, Brasil. CEP: 60190-060. E-mails: hermano@ufc.br,