Validation of a Training Model for Performing Laparoscopic Knots and Stitches in a Simulation Environment

Abstract

Abstract: Introduction: To evaluate the progression of competence, learning curve and degree of satisfaction with the training model of medical students undergoing training to perform laparoscopic knots in a simulator. Methods: This was a prospective, longitudinal, interventional study, carried out from April 2016 to July 2017, with the participation of 52 students from the Centro Universitário Christus, Fortaleza, Brazil, from the first to the third year of medical school, undergoing theoretical practical, systematic, and methodized training, with progression of skills to perform laparoscopic knots in a simulation environment in four stages, with a total duration of 16 hours. It was established the task of performing laparoscopic stitches, with five simple knots, in the beginning and in the end, in a suture mold, in an abdominal cavity simulator, in 18 minutes. The main outcomes were time and quality of performance. The students were evaluated before the first and after all stages of the training regarding the quantity and quality of the knots or the subject of the stage and satisfaction with the training model. ANOVA and Student’s t tests were performed for the independent samples and the chi-square test for the categorical variables. For variables with serial measurements, general linear models were used. Univariate binomial models were used in the evaluation variables of the training model. P values <0.05 were considered significant. Results: The values of the medians were analyzed between the first and last stages of the training; of the number of simple knots (0.0 and 15.0) and laparoscopic knots (0.0 and 3.0), the adequacy of the sizes of the suture tail ends (0.0 and 11.0), the number of adjusted initial simple knots ( 0.0 and 3.0) and adjusted sequential ones (0.0 and 24.0). There was statistical significance in all evaluated parameters (p< 0.001). The learning curve showed that 99.1% of the students attained competence. The degree of satisfactory evaluation of the training model was considered good or great in 97% or more, with statistical relevance in 8 of the 10 evaluated statements. Conclusions: The study demonstrated that the students showed competence progression and learning curve evolution. The degree of student satisfaction in relation to the training model stages was very significant.