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Incentivising practice with take-home laparoscopic simulators in two UK Core Surgical Training programmes
  1. Laura G Nicol1,
  2. Kenneth G Walker1,
  3. Jennifer Cleland2,
  4. Roland Partridge3,
  5. Susan J Moug4
  6. On behalf of the Scottish Surgical Simulation Collaborative, including Royal College of Surgeons of Edinburgh, Royal College of Physicians and Surgeons of Glasgow, NHS Education for Scotland
  1. 1Highland Surgical Research Unit, NHS Highland, Centre for Health Science, Inverness, UK
  2. 2Division of Medical & Dental Education, University of Aberdeen, Aberdeen, UK
  3. 3Department of Surgery, Royal Hospital for Sick Children Edinburgh, NHS Lothian, Edinburgh, UK
  4. 4Department of General Surgery, Royal Alexandra Hospital, NHS Greater Glasgow and Clyde, Paisley, UK
  1. Correspondence to Laura G Nicol, Highland Surgical Research Unit, NHS Highland, Centre for Health Science, Inverness, UK; Laura.nicol1{at}


Introduction Practice using simulators has been validated as a mean for surgical trainees to improve basic laparoscopic skills and free their attention for higher cognitive functions. However, mere provision of equipment does not result in frequent practice. This study assesses one approach to incentivising practice within core surgical training programmes and leads to further recommendations.

Methods 30 core surgical trainees (CST) starting laparoscopic-based specialties were recruited from East and West of Scotland CST programmes and given take-home laparoscopic simulators, with six training modules. Attainment of target metric scores generated an eCertificate, to be rewarded by progression in the live theatre. Questionnaires assessed confounding variables and explored CSTs’ anxieties about laparoscopy.

Results 27 trainees (90%) agreed to participate (mean age 28 years, range 24–25; 17 males). 13 CSTs (48%) were in the first year of surgical training. 11 (41%) had no previous simulation experience and 7 (32%) CSTs played video games >3 hours/week. 12 of 27 trainees (44%) completed ≥1 task and 7 completed all (26%).

Performances improved in some participants, but overall engagement with the programme was poor. Reasons given included poor internet connectivity, busy rotations and examinations. CSTs who engaged in the study significantly reduced their anxiety (mean 4.96 vs 3.56, p<0.05).

Conclusions The provision of take-home laparoscopic simulators with accompanying targets did not successfully incentivise CSTs to practise. However, the subgroup who did engage with the project reported performance improvements and significantly reduced anxiety. Proposals to overcome barriers to practising in simulation, including obligatory simulation-based assessments, are discussed.

  • Simulation
  • Laparoscopic
  • Incentivised
  • Frequent Practice
  • Surgery

Statistics from


  • Contributors LGN conducted the research project, distributed simulators and took participant consent; she was the primary point of contact for educational supervisors and trainees during the project and was responsible for the write-up of the project. KGW supervised the project as well as the invention of the original study design and its implementation; he was responsible for final draft editing. JC designed the qualitative aspect of the study and aided with this part of the write-up. RP provided simulators and demonstrated them around the country with groups of trainees; and he invented and trialled the simulator tasks specific to the study. SJM assisted with the quantitative aspect of the study including statistical analysis and editing of the write-up.

  • Funding This work was funded by the Royal College of Surgeons of Edinburgh, the Royal College of Physicians and Surgeons of Glasgow and NHS Highland Research, Development and Innovation department.

  • Competing interests RP is a surgical trainee and has taken steps to address the poor access to surgical simulation tools by designing and manufacturing take-home simulation equipment. He established a company ‘eoSurgical Ltd’ ( to achieve this. RP is a shareholder in eoSurgical. The ‘eoSim’ take-home laparoscopic simulator used in this study is manufactured by eoSurgical (eoSurgical, Edinburgh, UK). The ‘InsTrac’ software, also used in this study, was developed in conjunction with a separate company ‘Peekabu Studios’ (Peekabu Studios, Edinburgh, UK) and was marketed by eoSurgical. The ‘InsTrac’ software has since been superseded by an updated version called ‘SurgTrac’.

  • Ethics approval NHS Highland Research Ethics Committee & University of Stirling.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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