88 Chapter 3 three interven-tion groups. This shows the exposure to the robotic surgery skills simulator alone could possibly be sufficient to achieve the required dexterity skills when approaching RAS. This could indicate that novice surgeons have little use of proctoring or training by use of simulation guided exercises be-cause they are too focussed on learning the basic skills needed for performing robot-assisted sur-gery. This result could be an indication of cognitive overload in the participants. Cognitive overload is the point in which the complexity of the task or the combination of external input (proctoring or added feedback from the simulator) with the task its self puts too much strain (cognitive load) on the learner.18 This cognitive overload could be detrimental to the learning process of novice sur-geons.18,19 A study by Andersen et al. shows cognitive overload could lead to an inhibition of the learning process itself.19 Our observations may therefore indicate that the exercise selected is less suited to the included trainee’s experience and further basis skills training is required before em-barking on an advanced simulation exercises as the VU anastomosis exercise. The notion is sup-ported by the fact that none of the trainees passed all threshold criteria set by Harrison et al during the post-intervention exercise.13 Another explanation could be the difference between the groups could lie in other factors not measured by the simulator. It is possible analysis of the videos of the simulation exercises could result in different findings for example a difference in depth perception, efficiency, force sensitivity and robotic control. (3) The influence of the intervention on the participant’s satisfaction of novice robotic surgeons Based on the evaluation of the participant’s satisfaction the proctor guided group felt more like they were actually performing a surgical step compared to the non-intervention group, this could also be the effect of the proctoring, as novice doctors are used to someone proctoring them during surgery in order to be taught the specific step of the surgery, it could be that having someone next to them doing the same during simulation exercises helps create a similar atmosphere as in the operating room. The learning goals were less clear to the non-intervention group compared to the proctor guided group which could also be an effect of added explanation by the proctor during the intervention. (4) The effect of participants’ characteristics (i.e. age, gender, laparoscopic surgery experience, sur-gical experience, etc.) on the learning curve of novice surgeons. The univariate analysis of the effect of the baseline characteristics on the change in simulation scores shows there is no relation between the change in surgical skills after the intervention and the individual baseline characteristics, these results are in
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