A randomized trial evaluating a cognitive simulator for laparoscopic appendectomy


  • B. P. T. Loveday MBChB; G. V. Oosthuizen FCS (SA); B. S. Diener PhD; J. A. Windsor MD FRACS.

  • This work was presented at the Royal Australasian College of Surgeons 76th Annual Scientific Congress on 7 May 2007, and published in abstract form in the proceedings of the meeting (J. A. Windsor, B. Loveday, G. Oosthuizen, S. Diener. The validity of an integrated clinical simulator for learning laparoscopic appendicectomy. ANZ Journal of Surgery 2007;77:A77-A77). This study received financial support from the Royal Australasian College of Surgeons. Professor J. A. Windsor and Dr G. Oosthuizen were on the Board of Directors for SIMTICS. Dr S. Diener was Educational Advisor to SIMTICS.

Professor John A. Windsor, Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1023, New Zealand. Email: j.windsor@auckland.ac.nz


Background:  The Integrated Cognitive Simulator (ICS) is a software application that integrates text, anatomy, video and simulation for training clinical procedures. The aim of this randomized controlled trial was to determine the usability of the ICS laparoscopic appendectomy module, and to determine its effectiveness in training the cognitive skills required for the procedure.

Methods:  Junior surgical trainees were randomized into control and intervention groups. The latter had access to the ICS. Participants had three assessments: a pre-study questionnaire to determine demographics, 20 multiple choice questions to assess procedural knowledge (training effectiveness) after 2 weeks, and a questionnaire to assess usability after 4 months.

Results:  Fifty-eight trainees were randomized. The overall response rate was 57%. The median scores for interface, functionality, usefulness and likelihood of utilization (usability) were 5/7 or higher. In the multiple choice questions (training effectiveness), first-year trainees in the intervention group scored higher than the control group (14.9 versus 12.1, P= 0.04), but second-year trainees did not. Use of the ICS did not alter the participants' perceived need for intra-operative guidance.

Conclusions:  The ICS is considered highly usable by trainees. The ICS is effective for training cognitive skills for laparoscopic appendectomy among first-year surgical trainees. Training cognitive skills alone does not increase confidence in the ability to perform motor tasks.