SAGES UNIVERSITY Mastery versus the standard proficiency target for basic laparoscopic skill training: effect on skill transfer and retention Nicoleta O. Kolozsvari • Pepa Kaneva • Chantalle Brace • Genevieve Chartrand • Marilou Vaillancourt • Jiguo Cao • Daniel Banaszek • Sebastian Demyttenaere • Melina C. Vassiliou • Gerald M. Fried • Liane S. Feldman Received: 3 March 2011 / Accepted: 19 April 2011 / Published online: 26 May 2011 Ó Springer Science+Business Media, LLC 2011 Abstract Background Little evidence exists to guide educators in the best way to implement simulation within surgical skills curricula. This study investigated whether practicing a basic Fundamentals of Laparoscopic Surgery (FLS) simu- lator task [peg transfer (PT)] facilitates learning a more complex skill [intracorporeal suturing (ICS)] and compared the effect of PT training to mastery with training to the passing level on PT retention and on learning ICS. Methods For this study, 98 surgically naı ¨ve subjects were randomized to one of three PT training groups: control, standard training, and overtraining. All the participants then trained in ICS. The learning curves for ICS were analyzed by estimating the learning plateau and rate using nonlinear regression. Skill retention was assessed by retesting par- ticipants 1 month after training. The groups were compared using analysis of variance (ANOVA). Effectiveness of skill transfer was calculated using the transfer effectiveness ratio (TER). Data are presented as mean ± standard deviation (p \ 0.05). Results The study was completed by 77 participants (28 control, 26 standard, and 23 overtrained subjects). The ICS learning plateau rose with increasing PT training (452 ± 10 vs. 459 ± 10 vs. 467 ± 10; p \ 0.01). Increased PT training was associated with a trend toward higher initial ICS scores (128 ± 107 vs. 127 ± 110 vs. 183 ± 106; p = 0.13) and faster learning rates (15 ± 4 vs. 14 ± 4 vs. 13 ± 4 trials; p = 0.10). At retention, there were no differences in PT scores (p = 0.5). The PT training took 20 ± 10 min for standard training and 39 ± 20 min for overtraining (p \ 0.01). Overtrained participants saved 11 ± 5 min in ICS training compared with the control subjects (p = 0.04). However, TER was 0.165 for the overtraining group and 0.160 for the standard training group, suggesting that PT overtraining took longer than the time saved on ICS training. Conclusion For surgically naı ¨ve subjects, part-task train- ing with PT alone was associated with slight improvements in the learning curve for ICS. However, overtraining with PT did not improve skill retention, and peg training alone was not an efficient strategy for learning ICS. Keywords FLS  Learning curve  Part-task training  Proficiency-based training  Retention Although considerable interest is focused on the use of simulation for the acquisition of fundamental surgical skills through goal-directed practice in a safe environment, little evidence guides educators on the establishment of simu- lator training goals. The identification of an optimally effective and efficient training strategy for simulator-based laparoscopic skills training is important for both practicing surgeons and trainees. A recent Delphi process led by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) ranked the question ‘‘What methods of Presented at the SAGES 2011 Annual Meeting, March 30–April 2, 2011, San Antonio, TX. Self-Assessment CME credit will be available for SAGES members for this article at SAGES University, coming this Summer. Visit www.sages.org for more information. N. O. Kolozsvari  P. Kaneva  C. Brace  G. Chartrand  M. Vaillancourt  D. Banaszek  S. Demyttenaere  M. C. Vassiliou  G. M. Fried  L. S. Feldman (&) Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, 1650 Cedar Avenue, Room E19-117, Montreal, QC H3G 1A4, Canada e-mail: liane.feldman@mcgill.ca J. Cao Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, BC, Canada 123 Surg Endosc (2011) 25:2063–2070 DOI 10.1007/s00464-011-1743-9