Barriers and facilitators to deliberate practice using take-home laparoscopic simulators

Vivienne I Blackhall* (Corresponding Author), Jennifer Cleland, Philip Wilson, Susan J Moug, Kenneth G Walker

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

20 Citations (Scopus)
5 Downloads (Pure)


Several regions in the UK and Ireland have delivered home-based laparoscopic simulation programmes in an attempt to progress surgical trainees’ skills through deliberate practice. However, engagement with these programmes has been poor. This study aims to uncover the barriers to engagement with home-based simulation, with a view to developing an improved programme.

This was a qualitative study using focus groups with key stakeholders including junior surgical trainees, consultants/attendings and simulation faculty. Data were collected across four regions in three countries. Data were audio-recorded, transcribed and a thematic analysis was performed using NVivo software.

Sixty-three individuals were interviewed in 12 focus groups (43 trainees, 20 trainers). Trainees cited competing commitments as a barrier to engaging with home-based simulation. They tended to focus on scoring ‘points’ towards career progression rather than viewing tasks as interesting, or associated with personal development. Their view was that this approach is perpetuated by the training system, which rewards trainees for publications and exams, but not for operative skill. Trainees were unsatisfied with metric feedback and wanted individual feedback from consultants (attendings). Trainees perceived consultants as lacking interest in the programmes and training in general. However, some consultants were unaware of the programmes being delivered and others felt lacking in confidence to deliver the necessary training.

Scheduled simulation sessions which provide trainees with the opportunity for consultant feedback may improve engagement. Tackling the ‘point-scoring’ culture is more challenging. This could be addressed by modified assessment structures, greater recognition and accountability for trainers, and recognition and funding of simulation strategies including in-house skills sessions
Original languageEnglish
Pages (from-to)2951–2959
Number of pages9
JournalSurgical Endoscopy
Issue number9
Early online date19 Nov 2018
Publication statusPublished - Sept 2019

Bibliographical note

This research was funded by The Association for the Study of Medical Education and the UK General Medical Council (Excellent Medical Education Joint Award).
Open Access via Springer Compact Agreement


  • deliberate practice
  • simulation
  • surgical training
  • laparoscopy


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