Skill retention following proficiency-based laparoscopic simulator training Dimitrios Stefanidis, MD, PhD, James R. Korndorffer Jr, MD, Rafael Sierra, MD, Cheri Touchard, BS, J. Bruce Dunne, PhD, and Daniel J. Scott, MD, New Orleans, La Background. Proficiency-based curricula using both virtual reality (VR) and videotrainer (VT) simulators have proven to be efficient and maximally effective, but little is known about the retention of acquired skills. The purpose of this study was to assess skill retention after completion of a validated laparoscopic skills curriculum. Methods. Surgery residents (n = 14) with no previous VR or VT experience were enrolled in an Institutional Review Board–approved protocol and sequentially practiced 12 Minimally Invasive Surgical Trainer-VR and 5 VT tasks until proficiency levels were achieved. One VR (manipulate diathermy) and 1 VT (bean drop) tasks were selected for assessment at baseline, after training completion (posttest), and at retention. Results. All residents completed the curriculum. Posttest assessment occurred at 13.2 ± 11.8 days and retention assessment at 7.0 ± 4.0 months. After an early performance decrement at posttest (17%-45%), the acquired skill was maintained up to the end of the follow-up period. For VR, scores were 81.5 ± 23.5 at baseline, 33.3 ± 1.8 at proficiency, 48.4 ± 9.2 at posttest, and 48.4 ± 11.8 at retention. For VT, scores were 49.4 ± 12.5 at baseline, 22.0 ± 1.4 at proficiency, 25.6 ± 3.6 at posttest, and 26.4 ± 4.2 at retention. Skill retention was better for VT, compared with VR (P < .02). The extent of skill deterioration did not correlate with training duration or resident level. Conclusions. Although residents do not retain all acquired skills (more so for VR than for VT) according to simulator assessment, proficiency-based training on simulators results in durable skills. Additional studies are warranted to further optimize curriculum design, investigate simulator differences, and establish training methods that improve skill retention. (Surgery 2005;138:165-70.) From the Tulane Center for Minimally Invasive Surgery, Tulane University School of Medicine THE TEACHING of operative skills in the clinical setting is constrained by the complexity of proce- dures, medicolegal and ethical concerns, fiscal and time limitations (especially in the 80-hour work- week), and has created the need for formal train- ing outside the operating room. 1-3 Moreover, the increased incidence of complications that was observed as a result of the undisciplined introduc- tion of laparoscopic techniques in the early 1990s 4 has raised public awareness and resulted in an outcry for safety. 5 Loss of depth perception 6 and haptic feedback, the fulcrum effect, and the use of instruments with limited range of motion 7 make laparoscopic tasks difficult and introduce new skill sets that must be mastered. Acquisition of laparo- scopic skills using both virtual reality (VR) and videotrainer (VT) simulators can help overcome the learning curve of new, complex, and difficult tasks, and lead to improved operative perfor- mance. 8-12 Moreover, proficiency-based curricula have proven to be maximally effective and effi- cient. 12-14 Besides skill acquisition, skill retention is vitally important 15,16 but has not been well studied for surgical motor tasks. Contrary to the nonsurgi- cal literature, in which many publications have investigated skill retention, 15,17-24 only a handful of surgical papers have addressed this issue. 25-27 In addition, there are no studies that compare the durability of skill between VR and VT simulators, which have previously demonstrated distinct learn- ing characteristics. 28 The purpose of this study was to investigate the durability of skill that surgery Presented at the 66th Annual Meeting of the Society of University Surgeons, Nashville, Tennessee, February 9-12, 2005. Reprint requests: Daniel J Scott, MD, Associate Professor of Surgery, Director, TulaneCenter for Minimally Invasive Surgery, Department of Surgery, SL-22, 1430 Tulane Ave, New Orleans, LA 70112-2699. E-mail: dscott@tulane.edu. 0039-6060/$ - see front matter Ó 2005 Mosby, Inc. All rights reserved. doi:10.1016/j.surg.2005.06.002 SURGERY 165