Aim: To optimise the role and place of Box Training (BT), Virtual Reality Simulation (VRS) and Mental Training (MT) in technology enhanced learning of laparoscopic skills.Methodology: Medical students were trained in two randomized controlled studies on to determine which training models produced the best outcome. The first study N=41 was carried out to identify the best initial method and the second study N=64 the best additional training method. Similar assessment on VRS and BT of time, precision, accuracy and overall performance was performed in both studies.Results: In both studies VRS produced fast performers excelling at VRS assessment but fairly poor on BT assessment. MT outcomes were worst as a stand-alone but were the most effective when used as an adjunct to BT or VRS. Groups incorporating MT were the most homogenous, showing fewer inter-individual differences versus non-MT adjunct groups. Box free training: VT+MT were worse in all domains. VRS remains a convenient and reliable tool for assessment of physically and mentally acquired skills.Conclusion: The most effective learning method for novices is by primary skill acquisition on the box trainer combined with additional skills enhancement by mental training.
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