I read with much interest the article entitled “Effectiveness of repeated video feedback in the acquisition of a surgical technical skill” by Backstein and associates (Can J Surg 2005;48:195–9). I appreciated very much the method of repeated video feedback associated with the bench training investigated by the authors.
Unfortunately, the models used for training do not allow any apprenticeship or opportunity to gain technical skill.1 In our experience of training courses on subfascial endoscopic perforator surgery (SEPS) we employed a 3-step apprenticeship, starting from the mechanical simulator, then use of an ad hoc animal model to reach the clinical setting. The models were used in the development of a fundamental sequence of drills to objectively evaluate the video-assisted procedure performances.
It is notable that, in evaluating the effect of training, the final registered times and scores of performance showed that the models (mechanical leg and abdomen of swine1) were useful for acquiring skills in surgeons familiar with laparoscopic techniques and by surgeons or residents with little experience in endoscopic techniques.2 Our data, which are statistically significant, showed the importance of exercise in improving skill, not only on the simulator and on the animal model, but even in the clinical setting.
Whether performance in the training box or on the animal model may be equivalent to a real surgical performance is always difficult to assess,2 but our study seemed to confirm it. Obviously, SEPS is a simple technique easy to teach, learn and evaluate since its technical steps can be readily measured.