High-Fidelity Simulated Teaching Cases Improve Resident Confidence Performing Laparoscopic Cholecystectomy Procedures

Abstract

Introduction

To assess if performing a high-fidelity simulated laparoscopic cholecystectomy in a teaching case format improves junior residents’ operative confidence or senior residents’ comfort in coaching.

Methods

This is a prospective observational study including categorical general surgery residents across all postgraduate levels (1-5) from a program based in New York, NY. Randomly paired junior and senior residents performed a laparoscopic cholecystectomy teaching case on a high-fidelity laparoscopic simulator. Residents answered pre- and post-simulation survey questions regarding operative experience, laparoscopic surgery comfort, biliary anatomy knowledge, confidence coaching, and impressions of the exercise.

Results

The study included n = 30 residents. Juniors reported significant improvements in confidence obtaining a critical view with and without anatomic variants, placing trocars, and detecting their instruments on-screen (P < .05). Seniors experienced non-statistically significant improvements in coaching confidence (P > .05). On a scale of 1-5, seniors felt these exercises should be completed by both seniors (3.47, SD 1.20) and juniors (3.67, SD 0.94) before their first teaching cholecystectomy. There were no significant associations found between survey responses and simulator performance metrics (instrument path length or number of collisions) on regression analysis. In free responses, junior residents emphasized the benefits of having a senior mentor with real-life operative experience to provide nuanced guidance and tailored real-time feedback.

Discussion

These findings suggest that junior residents’ technical comfort improved after performing a simulated teaching laparoscopic cholecystectomy. By implementing coached simulation in early training, residents will enter the operating room with enhanced confidence to become more autonomous.