The Impact of a Self-Directed, Low-Cost Laparoscopic Simulation-Based Training Model Among Surgical Trainees in Cameroon.

Abstract

Learning laparoscopic surgery in LMICs is hindered by the dearth of technically skilled surgeons. A self-directed, low-cost simulation-based training could bridge this gap. To evaluate the effectiveness of such a program, we assessed the differences in knowledge, laparoscopic skills, and self-ratings between simulation-trained and simulation-naive residents. This study involved Cameroonian surgery residents from a program with 3 years of laparoscopic simulation training on the ALL-SAFE platform (Group A) and residents from another training program without simulation exposure (Group B). All participants completed cognitive and psychomotor portions of a novel case-based laparoscopic cholecystectomy module. We used Kruskal-Wallis tests to compare the groups' pre- and post-training test scores, confidence and competence, time to task, and psychomotor skill via checklist and global assessments of submitted videos. Twenty-six participants, including 14 in Group A and 12 in Group B, completed the module. Both groups reported similar pre-course confidence (p ≥ 0.63) and competence (p ≥ 0.21). They also had similar pretest scores, but Group A's posttest scores were improved (M = 89.29 and p = 0.005) over B's (M = 77.50 and p = 0.28). Group B checklist scores trended slightly lower (p = 0.22) and significantly lower on global assessment (p < 0.001). Group A's mean task completion time was 28.46 (12.00) minutes whereas group B's was 51.83 (16.36); p < 0.001, and d = 1.41. Group B self-ratings were higher than peers' ratings, whereas Group A self-ratings were similar or lower; p = 0.02, and r = 0.35. Long-term simulation-based training improved cognitive and psychomotor skills, suggesting that a self-directed, low-cost simulation-based training may help learners develop proficiency in laparoscopy.