The impact of innate ability and objective scoring methods on proficiency based training in minimally invasive surgery.

Background: The attainment of technical competence and accurate performanceassessment of surgical trainees for surgical procedures are the fundamentalcomponents of a proficiency-based surgical training programme. We hypothesised thataptitude may directly affect one’s ability to successfully complete the learning curve forminimally invasive procedures.

Aim: The principle aim of this thesis was evaluate the impact of innate ability upon therate at which a surgical novice can achieve proficiency in index and advancedlaparoscopic procedures. Our secondary aim was to develop new objective methods oftechnical skills assessment for a proficiency-based programme.

Materials & Methods: We tested medical students (surgical novices) with disparateaptitude consecutively until they achieved proficiency in laparoscopic appendicectomyand laparoscopic suturing using objective and subjective scoring methods. Wedeveloped objective scoring methods by designing a new zone metric to assesslaparoscopic suturing and also a mathematical formula to provide meaningful metrics scores on the laparoscopic simulator ProMIS.

Results: The results demonstrated that surgical novices with low aptitude took twice as long to reach proficiency targets. Aptitude predicted superior baseline performance in medical students. There is a group of surgical candidates who are unable to achieve proficiency despite repeated practice. It was shown that a new zone metric could be used to assess laparoscopic suturing. Finally we successfully developed a scoring method, which provides meaningful user scores on the ProMIS simulator.

Conclusion: High aptitude is directly related to a rapid attainment of proficiency. It is likely that surgical trainees self select in surgery based on innate ability. The new zone metric and formulated scoring systems are valid tools for assessing laparoscopic tasks and provide meaningful scores. These findings have implications for developing a proficiency based training system according to a trainees natural ability.