Promoting Residents’ Motivation to Develop Laparoscopic Skills Through Simulation

OBJECTIVE: To evaluate the engagement of general surgery residents in a pilot simulation-based education curriculum promoting intrinsic motivation to develop laparoscopic technical skills. DESIGN: A pilot study of an 8-week simulation-based education curriculum to develop laparoscopic technical skills by fostering intrinsic motivation aligned to self-determination theory (SDT). The design followed Kern's 6 steps to curriculum development for medical education. The curriculum addressed the basic psychological needs of autonomy, competence, and relatedness, explained in SDT, to promote intrinsic motivation. Participation, satisfaction, learning of procedural knowledge and competence were assessed using Moore's expanded outcomes framework. Data were analyzed using quantitative and qualitative methods. SETTING: Tertiary university hospital in New Zealand. The study used the portable eoSim (Limbs & Things Ltd, Bristol, United Kingdom) laparoscopic box simulators with associated SurgTrac objective performance measurement software, exercises and biotissue models delivered at convenient locations in the hospital close to residents' daily activities. PARTICIPANTS: Department of general surgery residents were the primary target. Attendings, fellows and medical students were also able to participate in the curriculum. RESULTS: There were 25 participants, with 37% (15/41) of residents participating. The median number of sessions attended was 1, with a range of 1 to 9. The median time practicing on the simulator was 46 minutes, mean 119 minutes, ranging from 29 minutes to 9 hours and 38 minutes. Most junior residents and medical students reported a gain in procedural knowledge, and senior residents were able to demonstrate competence and performance. Forty percent of participants responded to the evaluation survey, and all stated that the curriculum was either useful or very useful for developing their laparoscopic technical skills. CONCLUSIONS: A pilot simulation-based education curriculum aligned with self-determination theory (SDT) was able to intrinsically motivate a proportion of general surgery residents to develop their laparoscopic technical skills. Additional strategies to promote residents' autonomous motivation to engage in learning and skill development are required.