Laparoscopic simulator performance: Harrier fighter pilots versus medical and non-medical undergraduates.
Tsim P, Carty H-M, Baxendale B, Ferguson E and Maxwell-Armstrong CA. Bulletin of the Royal College of Surgeons of England 2010, 92(2) 58-61.

Will laparoscopic simulation training help to substitute the number of hours not spent in surgical training reduced by EDTW? Should we recruit new trainees wishing to undertake minimal access surgery modules by testing their aptitude and therefore not needing so many hours of training? These are some questions that this interesting study may stimulate.

This study was of undergraduate medical students of University of Nottingham and of Harrier jet pilots from RAF Wittering. All undergraduates and Harrier fighter pilots were invited based on their availability for the study. The hypothesis stated that the Harrier fighters will do the best.

Four tasks were set for performance assessment: appendicectomy, bean drop, bile duct cannulation and block move. None of the participants had previous laparoscopic or surgical experience.

Although the medical, non-medical students and Harrier pilots were tested at different centres and using different equipment, the authors believed that the data for all participants were directly comparable. All the data was adjusted for multiple comparisons.

The Harrier fighter pilots took less than a third of the mean time taken by the medical undergraduates to perform the appendicectomy (28.7 vs. 95.5 minutes); took half the time to perform a block move (15.1 vs. 21.3 minutes) but about as long as other groups, to perform a bean drop!

Results also showed that Harrier pilots made fewer errors. It is suggested that extensive simulation experience [typically up to 500 hours] and selection by aptitude are the reason for the outstanding performance of Harrier pilots. In the current situation of reduced training hours, the parallel system of selection by aptitude may be a quicker way to achieve competence. Further studies are needed to examine implication of aptitude on learning curve in laparoscopy by medical trainees and patient safety.