Feasibility of Learner-Led Model Building for Simulation-Based Training in Open Inguinal Hernia Repair: A Randomized Controlled Trial

OBJECTIVES: (1) To establish the feasibility of novice learners building inguinal hernia models for simulation-based training in open inguinal hernia repairs (IHR). (2) To examine the associations between participation in model building and learners' self-reported confidence in understanding of the inguinal canal anatomy, the anatomic accuracy of learner-constructed models, and technical performance during a simulated open IHR. We hypothesized that learner-led model construction is feasible, supports acquisition of relevant anatomy knowledge, and improves performance in some steps of a simulated open IHR. DESIGN: Prospective randomized controlled trial. SETTING: Queen's University, Kingston, Ontario, Canada; institutional academic training environment. PARTICIPANTS: Forty-eight novice learners (second-year medical students) with minimal prior exposure to open or laparoscopic IHR were enrolled and randomly assigned to a didactic lecture-only group (control) or to a didactic lecture and learner-led model-building group (intervention). All study participants were then asked to complete a simulated open IHR procedure. Self-reported confidence in understanding of the 3-dimensional anatomy of the inguinal canal, as well as procedural and executional errors were assessed. RESULTS: Learner-constructed models were anatomically accurate and suitable for use in simulation-based training, and participants rated the model-building activity positively. Participants in the model-building (intervention) group demonstrated greater gains in self-reported confidence in the understanding of the 3-dimensional anatomy of the inguinal canal compared to participants in the control group (p = 0.004). Participants in the model-building (intervention) group committed fewer executional errors during external oblique aponeurosis exposure (p = 0.03), fewer procedural errors during wound closure (p = 0.05), and were more likely to complete hernia sac resection within the allotted time (p = 0.04). CONCLUSIONS: Learner-led construction of simulated models is a feasible, low-cost approach for simulation-based training in open IHR. This intervention improves learners' self-reported understanding of the inguinal canal anatomy and is associated with improved performance in some steps of a simulated open IHR, while requiring minimal materials and instructional resources.