Skill retention following proficiency-based laparoscopic simulator training

Background. Proficiency-based curricula using both virtual reality (VR) and videotrainer (VT) simulators have proven to be efficient and maximally effective, but little is known about the retention of acquired skills. The purpose of this study was to assess skill retention after completion of a validated laparoscopic skills curriculum. Methods. Surgery residents (n = 14) with no previous VR or VT experience were enrolled in an Institutional Review Board-approved protocol and sequentially practiced 12 Minimally Invasive Surgical Trainer-VR and 5 VT tasks until proficiency levels were achieved. One VR (manipulate diathermy) and 1 VT (bean drop) tasks were selected for assessment at baseline, after training completion (posttest), and at retention. Results. All residents completed the curriculum. Posttest assessment occurred at 13.2 ± 11.8 days and retention assessment at 7.0 ± 4.0 months. After an early performance decrement at posttest (17%-45%), the acquired skill was maintained up to the end of the follow-up period. For VR, scores were 81.5 ± 23.5 at baseline, 33.3 ± 1.8 at proficiency, 48.4 ± 9.2 at posttest, and 48.4 ± 11.8 at retention. For VT, scores were 49.4 ± 12.5 at baseline, 22.0 ± 1.4 at proficiency, 25.6 ± 3.6 at posttest, and 26.4 ± 4.2 at retention. Skill retention was better for VT, compared with VR (P < .02). The extent of skill deterioration did not correlate with training duration or resident level. Conclusions. Although residents do not retain all acquired skills (more so for VR than for VT) according to simulator assessment, proficiency-based training on simulators results in durable skills. Additional studies are warranted to further optimize curriculum design, investigate simulator differences, and establish training methods that improve skill retention.