Abstract
As the practice of surgery evolves, the modalities by which future surgeons are trained must also develop. Traditionally, surgical trainees have learned through a mentorship model, with the majority of cognitive motor learning for surgical skill being initiated and practiced within the operating room. This, however, is no longer the ideal environment in which to acquire surgical skills and, subsequently, many surgical training programs are incorporating the use of other surgical models within their curricula. Training on simulators, ranging from low-fidelity bench models to complex, high-fidelity virtual reality models, seems to be transferable and might prove to be a crucial supplement to the traditional curriculum. Models that are reliable and valid, coupled with objective instruments that measure technical skill, might prove to be useful for evaluation. For a simulator to provide a good assessment of competency, it should either correlate to or predict the person's technical performance in the operating room. More research is, therefore, needed regarding the validity and transferability of various training models, particularly if they are to become a form of assessment for certification or licensure.
Key Points
-
The traditional model of apprenticeship alone for training in surgical skill might no longer be appropriate
-
Many surgical training programs are incorporating the use of surgical models within their curricula
-
Many modalities of simulators for teaching new surgical skills are available, including bench models, animal models, cadavers and computer software-based virtual reality simulators
-
It seems that skills learned on a simulator are transferable to the clinical setting
-
Simulators might also prove useful for evaluation of the surgical proficiency of a trainee
-
Future use of simulators could be incorporated into a high-stakes assessment, but this is controversial
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Wanzel KR et al. (2002) Teaching the surgical craft: from selection to certification. Curr Probl Surg 39: 583–659
Wanzel KR et al. (2002) Teaching technical skills: training on a simple, inexpensive, and portable model. Plast Reconstr Surg 109: 258–264
Kopta JA (1971) The development of motor skills in orthopedic education. Clin Orthop 75: 80–85
Schmidt RA (1975) A schema theory of discrete motor skill learning. Psychol Rev 82: 225–260
Collins A et al. (1989) Cognitive apprenticeship: teaching the crafts of reading, writing, and mathematics. In Knowing, Learning, and Instruction: Essays in Honor of Robert Glaser, 453–494 (Eds Glaser R and Resnick LB) Hillsdale, NJ: Lawrence Erlbaum Associates
Ericsson KA (1996) The acquisition of expert performance: an introduction to some of the issues. In The Road to Excellence: The Acquisition of Expert Performance in the Arts and Sciences, Sports, and Games, 1–50 (Ed Ericsson KA) Mahwah, NJ: Lawrence Erlbaum Associates
Hamdorf JM and Hall JC (2000) Acquiring surgical skills. Br J Surg 87: 28–37
Matsumoto ED (2007) Low-fidelity ureterscopy models. J Endourol 21: 248–281
Bridges M and Diamond DL (1999) The financial impact of teaching surgical residents in the operating room. Am J Surg 177: 28–32
Anastakis DJ et al. (1999) Assessment of technical skills transfer from the bench training model to the human model. Am J Surg 177: 167–170
Leape LL (1994) Error in medicine. JAMA 272: 1851–1857
Nuland SB (2004) Mistakes in the operating room: error and responsibility. N Engl J Med 351: 1281–1283
Hamstra SJ et al. (2006) Teaching technical skills to surgical residents. Clin Orthop Relat Res 449: 108–115
Ericsson KA (2004) Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Acad Med 79 (Suppl): S70–S81
Krummel TM (1998) Surgical simulation and virtual reality: the coming revolution. Ann Surg 228: 635–637
Undre S and Darzi A (2007) Laparoscopy simulators. J Endourol 21: 274–279
McDougall EM (2007) Validation of surgical simulators. J Endourol 21: 244–247
Grober ED et al. (2004) The educational impact of bench model fidelity on the acquisition of technical skill. Ann Surg 240: 374–381
Matsumoto ED et al. (2002) The effect of bench model fidelity on endourologic skills: a randomized controlled study. J Urol 167: 1243–1247
Fried GM (2005) The Steinberg–Bernstein Centre for Minimally Invasive Surgery at McGill University. Surg Innov 12: 345–348
Fried GM et al. (1999) Comparison of laparoscopic performance in vivo with performance measured in laparoscopic simulator. Surg Endosc 13: 1077–1082
Naik VN et al. (2001) Fiberoptic orotracheal intubation on anesthetized patients: do manipulation skills learned on a simple model transfer into the operating room? Anesthesiology 95: 343–348
Scott DJ et al. (2000) Laparoscopic training on bench models: better and more cost effective than operating room experience? J Am Coll Surg 191: 272–283
Seymour NE et al. (2002) Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann Surg 236: 458–464
Martin JA et al. (1997) Objective structured assessment of technical skill (OSATS) for surgical residents. Br J Surg 84: 273–278
Reznick R et al. (1997) Testing technical skill via an innovative “bench station” examination. Am J Surg 173: 226–230
Reznick RK (1993) Teaching and testing technical skills. Am J Surg 165: 358–361
Regehr G et al. (1998) Comparing the psychometric properties of checklists and global rating scales for assessing performance on an OSCE-format examination. Acad Med 73: 226–230
Guillonneau B (2005) Should we consider testing for skill in surgery? Eur Urol 47: 480–481
Haluck RS and Krummer TM (2000) Computers and virtual reality for surgical education in the 21st century. Arch Surg 135: 786–792
Watterson JD and Denstedt JD (2007) Ureteroscopy and cystoscopy simulation in urology. J Endourol 21: 263–269
Brehmer M and Swartz R (2002) Validation of a bench model for endoscopic surgery in the upper urinary tract. Eur Urol 42: 175–180
Knoll T et al. (2005) Validation of computer-based training in ureterorenoscopy. BJU Int 95: 1276–1279
Knudsen BE et al. (2006) A randomized, controlled, prospective study validating the acquisition of percutaneous renal collecting system access skills using a computer based hybrid virtual reality surgical simulator: phase I. J Urol 176: 2173–2178
Matsumoto ED et al. (2001) A novel approach to endourological training: training as the surgical skills center. J Urol 166: 1261–1266
Park S et al. (2006) Face, content and construct validity testing on a percutaneous renal access simulator. J Endourol 20 (Suppl 1): A4
Rassweiler J et al. (2007) Mechanical simulators for training for laparoscopic surgery in urology. J Endourol 21: 252–262
Wilson MS et al. (1997) A virtual reality trainer for laparoscopic surgery assesses performance. Ann R Coll Surg Engl 79: 403–404
Taffinder N et al. (1998) Validation of virtual reality to teach and assess psychomotor skills in laparoscopic surgery: results from randomized controlled studies using the MIST VR laparoscopic simulator. Stud Health Technol Inform 50: 124–130
Larsson A (2001) An open and flexible framework for computer aided surgical training. Stud Health Technol Inform 81: 263–265
Sherman V et al. (2005) Assessing the learning curve for the acquisition of laparoscopic skills on a virtual reality simulator. Surg Endosc 19: 678–682
Schijven MP and Jakismowicz J (2003) Introducing the Xitact LS500 laparoscopy simulator: toward a revolution in surgical education. Surg Technol Int 11: 32–36
Schijven M and Jakinowicz J (2003) Construct validity. Experts and novices performing on the Xitact LS500 laparoscopy simulator. Surg Endosc 17: 803–810
Rolfsson G et al. (2002) Training and assessment of laparoscopic skills using a haptic simulator. Stud Health Technol Inform 85: 409–411
Schijven M and Jakismowicz J (2003) Virtual reality surgical laparoscopic simulators. Surg Endsoc 17: 1943–1950
Corica FA et al. (2005) Construct validity of the LapMentor laparoscopic simulator. J Endourol 19 (Suppl 1): A183
Verdaasdonk EGG et al. (2007) Construct validity and assessment of the learning curve for the SIMENDO endoscopic simulator. Surg Endosc 21: 1406–1412
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing financial interests.
Rights and permissions
About this article
Cite this article
Wong, J., Matsumoto, E. Primer: cognitive motor learning for teaching surgical skill—how are surgical skills taught and assessed?. Nat Rev Urol 5, 47–54 (2008). https://doi.org/10.1038/ncpuro0991
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1038/ncpuro0991
This article is cited by
-
A comprehensive review on learning curve associated problems in endoscopic vein harvesting and the requirement for a standardised training programme
Journal of Cardiothoracic Surgery (2016)
-
The educational value of disaster victim identification (DVI) missions—transfer of knowledge
Forensic Science, Medicine, and Pathology (2012)
-
Significant transfer of surgical skills obtained with an advanced laparoscopic training program to a laparoscopic jejunojejunostomy in a live porcine model: feasibility of learning advanced laparoscopy in a general surgery residency
Surgical Endoscopy (2012)
-
Assessment and maintenance of competence in urology
Nature Reviews Urology (2010)