Take-home laparoscopic simulators to develop surgical skills: Analysing attitudes to, and barriers and enablers of, their use in gynaecology training

Introduction: Providing specialty trainees with take-home laparoscopic simulators may overcome known barriers to simulation-based surgical training such as limited time and access to equipment; however, programs utilising these simulators have reported suboptimal engagement from trainees. The purpose of this study was to understand factors influencing the use of take-home laparoscopic simulators and make suggestions to optimise engagement in future programs.

Methods: We interviewed 10 of the 16 gynaecology trainees who participated in a take-home laparoscopic box trainer simulation program. Interview transcripts were analysed and themes sorted using the Theoretical Domains Framework. Articulation of these domains with the Behaviour Change Wheel directed the formulation of targeted interventions.

Results: Trainees had positive attitudes towards simulation training; however, they experienced numerous under-recognised barriers to training. Trainees found their professional role, duties and competing life priorities limited time for training. Trainees experienced feelings of inertia and did not train as much as they anticipated. They were disengaged from training by a lack of real operating, a perceived poor relationship between training tasks and surgery and difficulties with equipment set-up. Self-directed practice, goal setting, task deadlines, perceived supervision, a recognition of personal skill development and an understanding of the need for simulation enabled training. Interventions were proposed to address the barriers to training.

Conclusions: Trainee attitudes towards simulation and take-home trainers were positive, yet numerous barriers prevented them from training. Following a theory-driven process, we were able to devise targeted, evidence-based interventions, which may be incorporated into future versions of the program.