A Structured Four-step Curriculum in Basic Laparoscopy: Development and Validation

Objective: The objective of this study was to develop a four-step curriculum in basic laparoscopy consisting of validated modules integrating a cognitive component, a practical component and a procedural component.

Design: A four-step curriculum was developed. The methodology was different for each step. Step 1: A 1-day course in basic laparoscopy developed on the background of a regional needs analysis. Step 2: A multiple-choice test, developed and validated through interviews with experts in laparoscopy and subsequently through a Delphi audit involving regional chief physicians. Step 3: A procedural training task (a salpingectomy) on a validated virtual reality simulator. Step 4: An operation on a patient (a salpingectomy) with following formative assessment based on a validated assessment scale.

Setting: University hospital, Copenhagen, Denmark.

Population: Fifty-two first-year residents in obstetrics and gynecology from 2009 to 2011.

Method: Observational cohort study.

Main Outcome Measure: Completion rate.

Results: All participants completed step 1 and improved post-course test scores compared with pre-course test scores, p = 0.001. Step 2 was completed by 75% (37/52); all improved test scores after 6 months, p = 0.001. Step 3 was completed by 75%. Participants used 238 min (range 75-599) and 38 repetitions (range 8-99) to reach proficiency level on a virtual reality simulator. Step 4 was completed by 55%. There was no correlation between test scores and simulator training time. Protected training time was correlated with increasing completion rate.

Conclusion: A four-step curriculum in basic laparoscopy is applicable in residency training. Protected training time correlated with increasing completion rate.