A Randomised Controlled Trial Evaluating the Effects of a Structured Training Program on the Learning Curve of Residents in the Field of Laparoscopic Surgery (STAR Trial)

2. Background and clinical significance 2.1 Background The use of simulated training has been popularized for surgical techniques as it provides spatial and task oriented training which is vital for surgery. As more and more junior residents are performing laparoscopic appendectomy under supervision by registrars, the concern of patient safety of such early exposure without a prior structured training program is questioned. Furthermore, as these procedures are performed after office hours in our center, performance of this procedure by junior doctors may result in higher conversion rates according to a retrospective study done in our center.1 A recent leading article by Kordowicz et al stated the challenges and the importance of having validated simulator training for individual centers.2

2.2 Potential clinical significance The investigators propose that a validated training program will allow a safer training environment for junior residents. This will help to provide a standard laparoscopic training program that can be used for the training of future batches of surgical trainees coupled with improved learning curves and surgical techniques.

Studies done both locally and overseas have also shown that the presence of junior doctors in such operations can potentially increase operating time and poor surgical outcomes.3,4 Therefore, investigators also hope that with a validated training program for the residents, this can translate to improved patient outcomes and safety.

2.3 Potential benefits to the participants Direct benefit to the subjects include provision of a structured training program for participants randomized to Group A. Subjects in both groups will also receive critical assessment and feedback on their laparoscopic skills, thus contributing to the development of their surgical skills.

3. Methods Approach 3.1 Methodology A randomized controlled trial for junior surgical residents with less than 10 laparoscopic appendectomies' experience as first surgeon will be recruited. They will be randomized to either Group A or Group B (control).