The Use of a “Hybrid” Trainer in an Established Laparoscopic Skills Program

OBJECTIVESTabletop inanimate trainers have proven to be a safe, inexpensive, and convenient platform for developing laparoscopic skills. Historically, programs that utilize these trainers rely on subjective evaluation of errors and time as the only measures of performance. Virtual reality simulators offer more extensive data collection capability, but they are expensive and lack realism. This study reviews a new electronic proctor (EP), and its performance within the Rosser Top Gun Laparoscopic Skills and Suturing Program. This "hybrid" training device seeks to capture the strengths of both platforms by providing an affordable, reliable, realistic training arena with metrics to objectively evaluate performance. METHODSAn electronic proctor was designed for use in conjunction with drills from the Top Gun Program. The tabletop trainers used were outfitted with an automated electromechanically monitored task arena. Subjects performed 10 repetitions of each of 3 drills: "Cup Drop," "Triangle Transfer," and "Intracorporeal Suturing." In real time, this device evaluates for instrument targeting accuracy, economy of motion, and adherence to the rules of the exercises. A buzzer and flashing light serve to alert the student to inaccuracies and breaches of the defined skill transference parameters. RESULTSBetween July 2001 and June 2003, 117 subjects participated in courses. Seventy-three who met data evaluation criteria were assessed and compared with 744 surgeons who had previously taken the course. The total time to complete each task was significantly longer with the EP in place. The Cup Drop drill with the EP had a mean total time of 1661 seconds (average, 166.10) with 54.49 errors (average, 5.45) vs. 1252 seconds (average, 125.2) without the EP (P = 0.000, t = 6.735, df = 814). The Triangle Transfer drill mean total time was 556 seconds (average, 55.63) and 167.57 errors (average. 16.75) (EP) vs. 454 seconds (non-EP) (average. 45.4) (P = 0.000, t = 4.447, df = 814). The mean total times of the suturing task was 1777 seconds (average, 177.73) and 90.46 errors (average. 9.04) (EP) vs. 1682 seconds (non-EP) (average, 168.2) (P = 0.040, t = 1.150, df = 814). When compared with surgeons who had participated in the Top Gun course prior to EP, the participants in the study collectively scored in the 18.3th percentile with the Cup Drop drill, 22.6th percentile with the Triangle Transfer drill, and 36.7th percentile with the Intracorporeal Suturing exercise. When penalizing for errors recorded by the EP, participants scored collectively in the 9.9th, 0.1th, and 17.7th percentile, respectively. No equipment failures occurred, and the agenda of the course did not have to be modified to accommodate the new platform. CONCLUSIONSThe EP utilized during the Top Gun Course was introduced without modification of the core curriculum and experienced no device failures. This hybrid trainer offers a cost-effective inanimate simulator that brings quality performance monitoring to traditional inanimate trainers. It appears that the EP influenced student performance by alerting them to errors made, thus causing an increased awareness of and focus on precision and accuracy. This suggests that the EP could have internal guidance capabilities. However, validation studies must be done in the future

Conservation tillage systems for cotton advance in the San Joaquin Valley

Cotton production in the San Joaquin Valley has traditionally relied heavily on tillage for its presumed benefits to plant establishment, yields and insect management. Research in the 1960s and 1970s demonstrated the potential of precision or zone tillage, which foreshadowed the introduction of a variety of minimum tillage implements in the early 1990s. During a 3-year comparison study from 2001 to 2003, cotton yields in strip tillage plots matched or exceeded yields of standard tillage plots in all 3 years. In a 12-year study from 1999 to 2011, tillage costs were lowered an average of $70 per acre in 2011 dollars using no-tillage compared to standard tillage while achieving statistically comparable yields, provided that adequate crop stands were achieved. If bottom-line profitability can be maintained, conservation tillage may become increasingly attractive to cotton producers in the San Joaquin Valley

Conservation tillage systems for cotton advance in the San Joaquin Valley

Cotton production in the San Joaquin Valley has traditionally relied heavily on tillage for its presumed benefits to plant establishment, yields and insect management. Research in the 1960s and 1970s demonstrated the potential of precision or zone tillage, which foreshadowed the introduction of a variety of minimum tillage implements in the early 1990s. During a 3-year comparison study from 2001 to 2003, cotton yields in strip tillage plots matched or exceeded yields of standard tillage plots in all 3 years. In a 12-year study from 1999 to 2011, tillage costs were lowered an average of $70 per acre in 2011 dollars using no-tillage compared to standard tillage while achieving statistically comparable yields, provided that adequate crop stands were achieved. If bottom-line profitability can be maintained, conservation tillage may become increasingly attractive to cotton producers in the San Joaquin Valley

Conservation tillage systems for cotton advance in the San Joaquin Valley

Cotton production in the San Joaquin Valley has traditionally relied heavily on tillage for its presumed benefits to plant establishment, yields and insect management. Research in the 1960s and 1970s demonstrated the potential of precision or zone tillage, which foreshadowed the introduction of a variety of minimum tillage implements in the early 1990s. During a 3-year comparison study from 2001 to 2003, cotton yields in strip tillage plots matched or exceeded yields of standard tillage plots in all 3 years. In a 12-year study from 1999 to 2011, tillage costs were lowered an average of $70 per acre in 2011 dollars using no-tillage compared to standard tillage while achieving statistically comparable yields, provided that adequate crop stands were achieved. If bottom-line profitability can be maintained, conservation tillage may become increasingly attractive to cotton producers in the San Joaquin Valley

Transition to conservation tillage evaluated in San Joaquin Valley cotton and tomato rotations

We compared standard tillage (ST) and conservation tillage (CT) for tomato and cotton production systems, with winter cover crops (CC) and without (NO), in Five Points, Calif., from 1999 to 2003. Conservation tillage reduced tractor trips across the field by 50% for tomatoes and 40% for cotton compared to standard tillage. When averaged over the 2001 to 2003 period (when the conservation tillage systems were established), tomato yields in CTNO were 6 to 8 tons per acre higher than the other treatments. In cotton, the STNO cotton yields during this period were the highest of all treatments and were 276 pounds per acre higher than the CTNO system. In-field dust concentrations were also significantly reduced by conservation tillage. Our results suggest that conservation tillage may be a viable alternative for managing tomato and cotton crops in the San Joaquin Valley, but that fine-tuning of the systems is needed

Transition to conservation tillage evaluated in San Joaquin Valley cotton and tomato rotations

We compared standard tillage (ST) and conservation tillage (CT) for tomato and cotton production systems, with winter cover crops (CC) and without (NO), in Five Points, Calif., from 1999 to 2003. Conservation tillage reduced tractor trips across the field by 50% for tomatoes and 40% for cotton compared to standard tillage. When averaged over the 2001 to 2003 period (when the conservation tillage systems were established), tomato yields in CTNO were 6 to 8 tons per acre higher than the other treatments. In cotton, the STNO cotton yields during this period were the highest of all treatments and were 276 pounds per acre higher than the CTNO system. In-field dust concentrations were also significantly reduced by conservation tillage. Our results suggest that conservation tillage may be a viable alternative for managing tomato and cotton crops in the San Joaquin Valley, but that fine-tuning of the systems is needed