Presentation
SE3 - Identifying Self-Reported Strategies to Acquire Proficiency in Laparoscopic Surgery Training Simulation
SessionPoster Session 2
DescriptionIntroduction: Medical trainees face many challenges in acquiring the skills required for laparoscopic surgery. One major obstacle is the indirect visual feedback from the computer monitor, which affects the surgeon’s field of view and depth perception compared to the natural environment. Additionally, the limited degrees of freedom in manipulating laparoscopic instruments, combined with motion inversion caused by the “fulcrum effect,” further complicates the development of dexterity and eye-hand coordination. The Fundamentals of Laparoscopic Surgery (FLS) program has been established to ensure medical trainees to be equipped with basic knowledge and skills in overcoming these challenges prior to apprenticing in actual surgeries under attending surgeons. The FLS program prescribed simulation-based, self-training with a trainer box to simulate core aspects of laparoscopic procedures, such as hand-eye coordination, depth perception, and bimanual dexterity. The effectiveness and efficiency of self-training depend on whether trainees are provided with or can discover effective practice strategies. Some might quickly reach proficiency, while others might struggle despite extended practice. Effective training strategies are crucial to reduce training time, lower costs, and enhance resource allocation in healthcare.
This study aims to identify the challenges encountered and strategies used by individuals self-training to achieve proficiency in the FLS peg transfer task. Specifically, this study employs interview data in a longitudinal experiment to uncover potential approaches that can optimize training efficiency and effectiveness for medical students. The findings will provide practical guidance for designing targeted training interventions, ultimately improving skill acquisition in laparoscopic surgery programs.
Method - (1) Data Collection: The study recruited twenty-nine college students with no prior experience in laparoscopic surgery. The Virginia Tech Institutional Review Board (IRB) has reviewed and approved the study (VT 23-265).
The experiment adopted a longitudinal within-subject design. Participants engaged in multiple self-practice sessions until they either met the FLS passing criteria or completed a maximum of six practice sessions for the peg transfer task. Each session lasted one hour, during which participants practiced the peg transfer task as many times as possible, with a 2-minute break every 10 minutes. Upon reaching proficiency – defined as completing the task within 48 seconds without dropping any object outside the field of view for 10 non-consecutive trials – a short debriefing interview was conducted to gather feedback on their learning experience.
During these interviews, researchers asked participants about their overall experience, the practice process, the feedback they received, and the strategies they developed throughout the experiment. The researchers took notes and recorded the entire interview. In total, debriefing interview data was collected from 16 participants.
Method - (2) Analysis: The thematic analysis to systematically identify patterns and themes in the interviews of 16 participants is currently in progress. The research team has transcribed the audio recordings and will be coding the transcripts to identify the dominant challenges and practice strategies reported by the participants. A preliminary coding scheme, based on previous literature on common challenges such as controlled instrument movement, movement efficiency, ambidexterity, depth perception, and hand-eye coordination, will serve as a foundation for identifying these themes. As the coding process unfolds, the scheme will be refined to ensure that all relevant task challenges and practice strategies mentioned by participants are captured accurately.
Expected and Preliminary Result: As the coding of the transcripts, and thus the formal analysis, is still ongoing, we can only present preliminary insights based on a cursory review of transcripts from three interviews for this abstract submission. The most commonly reported challenges included (1) holding/dropping objects, (2) using the non-dominant hand for transfers, and (3) achieving a completion time threshold or consistent speed. Participants also shared several self-reported strategies: (1) reducing movement speed to minimize the frequency of dropping objects, (2) adjusting the grabbing location to improve success in picking up objects, (3) angling the tool while grasping objects, and (4) dual-tasking with both hands to increase efficiency, such as using one tool to grasp an object while the other tool is simultaneously dropping off another.
Discussion: The findings from this study may highlight challenges and practice strategies that can be integrated into FLS training to prepare trainees for potential obstacles and provide self-training guidelines. Speed and accuracy are the two main criteria for evaluating participants’ performance in laparoscopic training simulations. For example, three participants mentioned the challenge of dropping objects, which is expected to emerge as a major theme in the formal analysis. Dropping objects not only increases completion time but also disqualifies an examination trial from reaching proficiency. As a result, participants focused on this challenge in their practice, identifying it as a key factor in achieving proficiency.
One self-reported strategy by two participants involves reducing movement speed to maintain high accuracy, especially at the start of their practice sessions. Once they were able to control their movements consistently, they shifted their focus toward improving speed. One participant expected that by focusing on accuracy, their completion times would naturally improve. Another participant adopted a different approach, reporting strategies such as optimizing tool paths, adjusting the grasp location, and angling the tool, without specifically mentioning movement speed. The formal analysis is expected to reveal more on speed-control strategies adopted by the participants.
Preliminary findings on three participants already indicate multiple strategies in overcoming challenges in acquiring laparoscopic surgery skills. The research team will continue coding and analyzing the interview transcripts using thematic analysis to reveal more about self-reported challenges and strategies in relation to speed and accuracy. Further investigation is needed to determine which of these strategies is more effective for enhancing performance. The thematic analysis findings will be presented at the conference. These findings could help improve laparoscopic surgery training by informing more targeted training interventions to better prepare trainees for real-world surgical tasks.
The limitation of this research is that participants were all college students with neither general surgery nor laparoscopic surgery experience. Thus, the challenges and strategies may be different from medical students or residents. Future work includes adopting natural language processing, such as topic modeling, to analyze the transcripts from a computation perspective for comparison to findings based on coding by the research team.
This study aims to identify the challenges encountered and strategies used by individuals self-training to achieve proficiency in the FLS peg transfer task. Specifically, this study employs interview data in a longitudinal experiment to uncover potential approaches that can optimize training efficiency and effectiveness for medical students. The findings will provide practical guidance for designing targeted training interventions, ultimately improving skill acquisition in laparoscopic surgery programs.
Method - (1) Data Collection: The study recruited twenty-nine college students with no prior experience in laparoscopic surgery. The Virginia Tech Institutional Review Board (IRB) has reviewed and approved the study (VT 23-265).
The experiment adopted a longitudinal within-subject design. Participants engaged in multiple self-practice sessions until they either met the FLS passing criteria or completed a maximum of six practice sessions for the peg transfer task. Each session lasted one hour, during which participants practiced the peg transfer task as many times as possible, with a 2-minute break every 10 minutes. Upon reaching proficiency – defined as completing the task within 48 seconds without dropping any object outside the field of view for 10 non-consecutive trials – a short debriefing interview was conducted to gather feedback on their learning experience.
During these interviews, researchers asked participants about their overall experience, the practice process, the feedback they received, and the strategies they developed throughout the experiment. The researchers took notes and recorded the entire interview. In total, debriefing interview data was collected from 16 participants.
Method - (2) Analysis: The thematic analysis to systematically identify patterns and themes in the interviews of 16 participants is currently in progress. The research team has transcribed the audio recordings and will be coding the transcripts to identify the dominant challenges and practice strategies reported by the participants. A preliminary coding scheme, based on previous literature on common challenges such as controlled instrument movement, movement efficiency, ambidexterity, depth perception, and hand-eye coordination, will serve as a foundation for identifying these themes. As the coding process unfolds, the scheme will be refined to ensure that all relevant task challenges and practice strategies mentioned by participants are captured accurately.
Expected and Preliminary Result: As the coding of the transcripts, and thus the formal analysis, is still ongoing, we can only present preliminary insights based on a cursory review of transcripts from three interviews for this abstract submission. The most commonly reported challenges included (1) holding/dropping objects, (2) using the non-dominant hand for transfers, and (3) achieving a completion time threshold or consistent speed. Participants also shared several self-reported strategies: (1) reducing movement speed to minimize the frequency of dropping objects, (2) adjusting the grabbing location to improve success in picking up objects, (3) angling the tool while grasping objects, and (4) dual-tasking with both hands to increase efficiency, such as using one tool to grasp an object while the other tool is simultaneously dropping off another.
Discussion: The findings from this study may highlight challenges and practice strategies that can be integrated into FLS training to prepare trainees for potential obstacles and provide self-training guidelines. Speed and accuracy are the two main criteria for evaluating participants’ performance in laparoscopic training simulations. For example, three participants mentioned the challenge of dropping objects, which is expected to emerge as a major theme in the formal analysis. Dropping objects not only increases completion time but also disqualifies an examination trial from reaching proficiency. As a result, participants focused on this challenge in their practice, identifying it as a key factor in achieving proficiency.
One self-reported strategy by two participants involves reducing movement speed to maintain high accuracy, especially at the start of their practice sessions. Once they were able to control their movements consistently, they shifted their focus toward improving speed. One participant expected that by focusing on accuracy, their completion times would naturally improve. Another participant adopted a different approach, reporting strategies such as optimizing tool paths, adjusting the grasp location, and angling the tool, without specifically mentioning movement speed. The formal analysis is expected to reveal more on speed-control strategies adopted by the participants.
Preliminary findings on three participants already indicate multiple strategies in overcoming challenges in acquiring laparoscopic surgery skills. The research team will continue coding and analyzing the interview transcripts using thematic analysis to reveal more about self-reported challenges and strategies in relation to speed and accuracy. Further investigation is needed to determine which of these strategies is more effective for enhancing performance. The thematic analysis findings will be presented at the conference. These findings could help improve laparoscopic surgery training by informing more targeted training interventions to better prepare trainees for real-world surgical tasks.
The limitation of this research is that participants were all college students with neither general surgery nor laparoscopic surgery experience. Thus, the challenges and strategies may be different from medical students or residents. Future work includes adopting natural language processing, such as topic modeling, to analyze the transcripts from a computation perspective for comparison to findings based on coding by the research team.
Event Type
Poster Presentation
TimeTuesday, April 14:45pm - 6:15pm EDT
LocationFrontenac Foyer