Simulator Training to Automaticity Leads to Improved Skill Transfer Compared With Traditional Proficiency-Based Training

TLDR

Simulator training improves surgical skill, but transfer to the operating room remains incomplete, and secondary task metrics that assess multitasking ability may better indicate when learning is complete. The study tested whether training novices to automaticity on a simulator results in superior operating‑room performance compared with standard proficiency‑based training. In a blinded, randomized controlled trial, 30 novices were assigned to an intervention group that practiced the FLS suturing task until proficiency, then until automaticity, and were retested on a live porcine model, while a control group received only testing sessions. Participants who achieved automaticity performed significantly better in the operating room (median 345 vs 220, P < 0.001), demonstrating that automaticity training improves skill acquisition and transfer; secondary task metrics should be incorporated into simulator training.

Abstract

We hypothesized that novices will perform better in the operating room after simulator training to automaticity compared with traditional proficiency based training (current standard training paradigm).Simulator-acquired skill translates to the operating room, but the skill transfer is incomplete. Secondary task metrics reflect the ability of trainees to multitask (automaticity) and may improve performance assessment on simulators and skill transfer by indicating when learning is complete.Novices (N = 30) were enrolled in an IRB-approved, blinded, randomized, controlled trial. Participants were randomized into an intervention (n = 20) and a control (n = 10) group. The intervention group practiced on the FLS suturing task until they achieved expert levels of time and errors (proficiency), were tested on a live porcine fundoplication model, continued simulator training until they achieved expert levels on a visual spatial secondary task (automaticity) and were retested on the operating room (OR) model. The control group participated only during testing sessions. Performance scores were compared within and between groups during testing sessions.: Intervention group participants achieved proficiency after 54 ± 14 and automaticity after additional 109 ± 57 repetitions. Participants achieved better scores in the OR after automaticity training [345 (range, 0-537)] compared with after proficiency-based training [220 (range, 0-452; P < 0.001].Simulator training to automaticity takes more time but is superior to proficiency-based training, as it leads to improved skill acquisition and transfer. Secondary task metrics that reflect trainee automaticity should be implemented during simulator training to improve learning and skill transfer.