Mastery learning simulation-based curriculum for laparoscopic TEP inguinal hernia repair

Background: The laparoscopic totally extraperitoneal (TEP) inguinal herniorrhaphy requires 250 repairs to master. Simulation training could potentially accelerate this process. We describe the development, evaluation and implementation of a TEP mastery learning curriculum. Design: We developed a 2-stage curriculum comprising online knowledge modules and skills practice on a simulator (the Guildford-MATTU TEP trainer; Limbs & Things, Ltd, Bristol, UK). Learners demonstrated mastery at each stage before advancing. The knowledge endpoint was a multiple-choice test. The skills endpoint was procedure time, as established by timing 5 experienced staff surgeons. Participants were proctored individually, receiving personalized feedback after each attempt until mastery time was achieved. The times to perform a simulated repair, number of attempts, and training time to reach mastery were compared between groups. Results: The mastery time was established at 2 minutes. Nine medical students, 36 general surgery residents (PGY 1-5), and 3 surgery fellows participated as learners. All learners achieved the knowledge and skills mastery endpoints. For the skill endpoint, participants required a median of 69 minutes (range, 13-193 minutes) and 16 simulated repairs (range, 7-27 repairs). The mean number of attempts and total training time to reach mastery varied by group (p < 0.001); more experienced residents required fewer attempts and less time to reach mastery. Conclusions: When training with a mastery learning-type simulation-based curriculum, surgical trainees can achieve the technical skill required to perform key portions of the TEP repair under artificial conditions with a performance similar to that of an expert, and are ready to move to the next phase of training in the operating room.