Advanced training in laparoscopic suturing (ATLAS): developing multicenter expert-derived proficiency scores and assessing workload

The advanced training in laparoscopic suturing (ATLAS) program was developed by a working group within the Association for Surgical Education (ASE) simulation committee and is commercially available as of 2022. This study aimed to develop updated multicenter expert-derived proficiency scores for this proficiency-based training curriculum.

Four laparoscopic suturing experts were identified through their affiliation with the ASE simulation committee, training in minimally invasive surgical techniques, and earlier work in developing the ATLAS project. After a brief optional warmup period on each task, each expert performed five consecutive repetitions which an independent observer scored. After each task, experts completed ratings using the NASA Task Load Index (TLX) scale across six domains (6–126; higher scores indicate increased workload). Outliers (± 2 standard deviations [SD]) were removed from the data sets; trimmed means and the new SD were used to create proficiency levels.

Six of 120 data points were trimmed after identifying 0–2 outliers per task. Per group consensus, a tiered approach was taken to create multiple proficiency levels suitable for learners at various stages. Workload ratings ranged low to moderate for all tasks. Temporal (81 ± 23) and mental (76 ± 24) demand had the highest ratings and varied considerably among experts, whereas performance (44 ± 9) was consistently rated as favorable.

We developed multicenter proficiency levels for the updated commercially available ATLAS curriculum using established methodology. Workload ratings reflected the rigorous nature of the ATLAS tasks. We anticipate that the Basic, Advanced, and Expert levels will facilitate longitudinal training for learners.