Closing the Gap in Operative Performance Between Novices and Experts: Does Harder Mean Better for Laparoscopic Simulator Training?

BACKGROUND: We have previously shown that reaching expert performance on an fundamentals of laparo-scopic surgery (FLS)-type simulator model for laparoscopic suturing results in measurable improvement during an actual operation; trained novices, however, demonstrate inferior oper-ative performance compared with experts.We hypothesized that simulator training under more difficult and realistic conditions would enhance the operative performance of novices. STUDY DESIGN: Medical students (n! 32) participated in an IRB-approved, randomized, controlled trial. All participants were pretested in laparoscopic suturing on a previously validated porcine Nissen model and were randomized into three groups: group I (n! 6) received no training, group II (n! 13) trained on the FLS videotrainer model until a previously published proficiency score (512) was achieved on 2 consecutive and 10 additional attempts, group III (n! 13) trained to the same goal but had to practice in a constrained space, with a shorter suture, starting with a dropped needle, and listening to operating room noise. Training workload was measured with the validated NASA-TLX (Task Load Index) questionnaire after each training session. All groups were posttested on the porcine model. Results were compared using ANOVA; p " 0.05 was considered significant