Mandatory completion of a box trainer curriculum prior to laparoscopic apprenticeship in the OR for surgical residents: A Before and After study.

INTRODUCTION: Training on laparoscopic box trainer (BT) improves surgical skills in the operating room (OR). Despite a large consensus on the educational value of the BT, its use is currently left up to local initiatives among French residency programs. This study evaluated the impact of a requirement to complete the Fundamentals of Laparoscopic Surgery (FLS) curriculum before starting companionship in the OR.

METHODS: This was a "Before and After" study conducted in two French academic hospitals in 2015-2017. Gynaecology and urology residents were given open access to a FLS BT during a six-month surgical rotation. Residents in the first group (Before group) trained on the BT while receiving classic companionship. Residents in the second group (After group) had to complete the FLS curriculum before they were allowed to participate in laparoscopic procedures as a primary operator. Outcomes measures were the time to curriculum completion and the intracorporeal suturing performances based on two validated assessment tools (FLS and GOALS scores).

RESULTS: Twenty-one surgical residents were included. All but two residents in the Before group completed the curriculum. The time to curriculum completion was longer in the Before group than the After group (69.5 days versus 28 days, P=0.001). Post-curriculum performances were lower in the Before group than in the After group for the FLS scores (452.5 versus 496, P=0.01) and the GOALS scores (14.5 versus 18, P=0.01).

DISCUSSION: The mandatory completion of a BT curriculum prior to receiving active companionship in the OR is beneficial to residents in reducing time to curriculum completion and in enhancing laparoscopic skills on the BT.