Mastery learning simulation-based curriculum for laparoscopic TEP inguinal hernia repair

Benjamin Zendejas, David A. Cook, Roberto Hernndez-Irizarry, Marianne Huebner, David R. Farley

Research output: Contribution to journalArticlepeer-review

33 Scopus citations


Background: The laparoscopic totally extraperitoneal (TEP) inguinal herniorrhaphy requires 250 repairs to master. Simulation training could potentially accelerate this process. We describe the development, evaluation and implementation of a TEP mastery learning curriculum. Design: We developed a 2-stage curriculum comprising online knowledge modules and skills practice on a simulator (the Guildford-MATTU TEP trainer; Limbs & Things, Ltd, Bristol, UK). Learners demonstrated mastery at each stage before advancing. The knowledge endpoint was a multiple-choice test. The skills endpoint was procedure time, as established by timing 5 experienced staff surgeons. Participants were proctored individually, receiving personalized feedback after each attempt until mastery time was achieved. The times to perform a simulated repair, number of attempts, and training time to reach mastery were compared between groups. Results: The mastery time was established at 2 minutes. Nine medical students, 36 general surgery residents (PGY 1-5), and 3 surgery fellows participated as learners. All learners achieved the knowledge and skills mastery endpoints. For the skill endpoint, participants required a median of 69 minutes (range, 13-193 minutes) and 16 simulated repairs (range, 7-27 repairs). The mean number of attempts and total training time to reach mastery varied by group (p < 0.001); more experienced residents required fewer attempts and less time to reach mastery. Conclusions: When training with a mastery learning-type simulation-based curriculum, surgical trainees can achieve the technical skill required to perform key portions of the TEP repair under artificial conditions with a performance similar to that of an expert, and are ready to move to the next phase of training in the operating room.

Original languageEnglish (US)
Pages (from-to)208-214
Number of pages7
JournalJournal of Surgical Education
Issue number2
StatePublished - Mar 2012


  • education
  • laparoscopic inguinal hernia repair
  • mastery learning
  • simulation
  • training
  • validity

ASJC Scopus subject areas

  • Surgery
  • Education


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