Study on the Application of Progressive Training Method Combined with Imagery Training Method in Laparoscopic Suturing Skills Training for Resident Physicians

Study on the Application of Progressive Training Method Combined with Imagery Training Method in Laparoscopic Suturing Skills Training for Resident Physicians | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Study on the Application of Progressive Training Method Combined with Imagery Training Method in Laparoscopic Suturing Skills Training for Resident Physicians Wenxue Lin, Rizeng Li, Jian Yu, Xiaoping Peng, Jianfu Xia, Bingchen Huang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5272100/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 12 Mar, 2025 Read the published version in BMC Medical Education → Version 1 posted 4 You are reading this latest preprint version Abstract Objective This study aims to explore an efficient teaching method to improve laparoscopic suturing skills in resident physicians by combining the progressive training method with the imagery training method. Methods This study used a randomized controlled trial methodology. The experimental group received training utilizing a combination of the progressive training method and the imagery training method In contrast, the control group followed the traditional teaching method of practicing continuous complete actions. Both groups were trained in intracorporeal suturing and knot-tying under laparoscopy. The training effects of the two groups were compared and analyzed before and after the training, including LS-CAT scores and suturing time. Results In the second test, the experimental group had much higher LS-CAT scores than the control group, as well as a considerably lower number of operation errors. In the experimental group, 88.9% of the trainees were proficient, compared to only 28.6% in the control group. There was no significant difference in suturing time between the two groups. In the third test, all trainees met proficiency standards, and the total LS-CAT scores were not significantly different between the two groups. However, the experimental group outperformed the control group in terms of LS-CAT scores in tissue handling and operation mistakes. Conclusion The combination of the progressive training method and the imagery training method significantly improved resident physicians’ laparoscopic suturing skills. This method greatly enhanced the efficiency and quality of learning laparoscopic suturing and knot-tying skills among surgical and gynecological resident doctors. Laparoscopic suturing skills Intracorporeal suturing and knot-tying Progressive training method Imagery training method Resident physicians Laparoscopic simulation training Introduction A well-known and considerable positive correlation exists between laparoscopic simulation training and intraoperative performance [1]. Laparoscopic suturing skills are one of the core competencies required of surgeons and represent a challenging element of laparoscopic simulation training. Traditional teaching methods for laparoscopic suturing skills usually involve instructing and practicing continuous, complete actions. This approach results in high learning difficulty, causing trainees to experience learning stagnation at critical points, leading to low training efficiency and limited learning outcomes. Beginners often confront a step learning curve to overcome the bottleneck in laparoscopic suturing skills. Additionally, the extended learning curve for laparoscopic surgeons can prolong patient surgery times, increase the risk of surgical complications [2], and place a greater strain on public finances [3]. The progressive training method-based approach to teaching laparoscopic suturing skills involves breaking surgical skills down into smaller steps, allowing learners to master each skill step by step gradually. This method enables learners to continually drill individual challenging points, boosting overall proficiency and accuracy. In China, Jin Yang and colleagues applied the progressive training method to simulated training for laparoscopic pancreatojejunostomy and achieved significant results [4]. In Japan, Mizota T and Kurashima Y successfully applied this method in basic laparoscopic skills training [5]. The imagery training method involves mental training in which students repeatedly simulate the skill operation process in their minds, thereby deepening their memory and understanding of the skills. This method also encourages learners to quickly reflect on and adjust their operations, continuously improving their skill level. The imagery training method has been widely employed in sports training, such as golf putting training, where two action states are simulated to achieve cognitive adaptation and skill progress [6]. This study aims to explore a more efficient teaching method by combining progressive training with imagery training to enhance laparoscopic suturing skills in resident physicians. Materials and Methods 1. Ethical Considerations: This randomized controlled trial was approved by Wenzhou Central Hospital’s Medical Ethics Committee（no.202402270046000397799） All participants were given detailed explanations about the study and submitted written informed consent. 2. Equipment and Materials: The study utilized laparoscopic simulation training boxe with internal high-definition camera ( GD/W-200 laparoscopic surgery simulation training systems from Shanghai Honglian Medical Technology Group ). Suture modules with silicone simulation skin and suture lines with needles ("3-0", 15 cm) were used. 3. Study Design: This study adopted a randomized controlled design. The study subjects were 16 resident doctors from the 2202 cohort of the standardized training program for surgical and obstetrics-gynecology bases at Wenzhou Central Hospital, along with one newly employed surgical resident. Before the implementation of the study, all enrolled trainees had not received any simulation training in laparoscopic suturing skills. The researchers randomly assigned the participants to two groups: the experimental group, comprising 9 participants who used the progressive training method combined with the imagery training method, and the control group, comprising 8 participants who used the comprehensive training method. One trainee in the control group adjusted their training plan due to conflicts between work and study schedules, and the final analysis did not include their data. Experimental Protocol: The study’s training skill was the intracorporeal suturing and knot-tying skill based on the Fundamentals of Laparoscopic Surgery (FLS) [7]. During the study, the researchers held training sessions once a week for over 3 weeks, each lasting 100 minutes, totaling 300 minutes. Researchers tested the trainees' intracorporeal suturing and knot-tying skills before, during (at 150 minutes into the training), and after (300 minutes after) the training. Each test was recorded using the simulation box’s built-in video recording function, with a designated person in charge of collecting the videos. 4.1 The experimental group utilized a training method combining the progressive and imagery training methods.. In the lectures and subsequent training sessions, the teacher broke down each decomposed action step by step for the learners to practice, based on the level of difficulty. They moved on to continuous laparoscopic suturing training after completing the practice of all decomposed actions. Throughout the training process, researchers imcorporated the imagery training method to enhance the effectiveness of the practice. Under the progressive training method, the complete suturing process was divided into six decomposed actions: handling the suture, adjusting the needle, inserting and withdrawing the needle, knot-tying 1 (clamping the suture and looping), knot-tying 2 (pulling the suture to tighten the knot), and cutting the suture. Under the imagery training method, the instructor led the trainees through a sequence of full-body relaxation exercises, had them close their eyes slightly, and had them imagine themselves performing the correct intracorporeal suturing operation. During each two-minute imagery training session, the instructor gave suggestive cues, followed by the trainees practicing intracorporeal suturing with the instructor's guidance and corrections. 4.2 The control group used traditional teaching methods, practicing continuous and complete intracorporeal suturing and knot-tying techniques during the instructor's lectures and subsequent training sessions. 4.3 Outcome Assessment: Two experts evaluated and rated the videos using the Laparoscopic Suturing Competency Assessment Tool (LS-CAT) [8]. Throughout the grading process, the experts were kept unware of the participants’ identities. The LS-CAT grading system featured four task areas: needle handling and adjustment, needle insertion and withdrawal through tissue margins, correctly tying the first surgical knot, and knot-tying. Each task area included instrument and tissue handling scores, for a total of eight independent items. Each independent item had four scoring regions, with a maximum possible score of 8 points. A lower LS-CAT score indicated a more proficient technical operation. Additionally, there were 16 error-scoring items, with fewer operation faults indicating better suturing quality. An LS-CAT score of 16 points or fewer (equal to 75% or above on a percentile scale) was regarded as the standard for technical proficiency. Additionally, we also recorded how long it took to complete the intracorporeal suturing and knot-tying. Furthermore, we used the Likert scale to collect data on trainees' confidence levels, involvement in imagery training, and self-perceived ability to perform imagery actions before and after training. Data on trainees' learning experiences with the progressive training method, skill improvement, the effectiveness of the imagery training method, and overall teaching satisfaction were also collected. 4.4 Statistical Analysis ： All data were analyzed using SPSS 24.0. The researchers assessed baseline characteristics of the participants with Fisher's exact test and the Mann-Whitney U test, and they used the Kruskal-Wallis H test to compare LS-CAT scores and error counts across the three tests. The Mann-Whitney U test was used to compare changes in medical confidence, action imagery, and participation in imagery training before and after training, as well as differences in LS-CAT scores and operation error counts between the two groups. Medians (interquartile range, IQR) are used to express quantitative values. P-values <0.05 were considered statistically significant. Results 17 surgical and obstetrics-gynecology resident doctors participated in this study. One trainee adjusted their training plan due to conflicts between work and study schedules, and their data were not included in the study. Researchers randomly assigned sixteen participants to the experimental group and the control group. There were no significant differences in baseline characteristics between the two groups. See Table 1 . All trainees’s LS-CAT scores and operation error counts were compared in the first, second, and third tests. The results showed significant improvements in all trainee’s laparoscopic LS-CAT scores and operation error counts in the second and third tests. See Table 2 . In the second test, the experimental’s LS-CAT scores and operation error counts were significantly lower than those of the control group. In the third test, the experimental group's LS-CAT scores and operation error counts in tissue handling were also significantly lower than those of the control group. See Table 3 . The surgical confidence scores of trainees in the experimental group significantly improved after training, and the imagery training participation scores of the experimental group also showed a significant increase. See Table 4 . Table 1 Baseline Characteristics of Participants Characteristic Experimental Group (n = 9) Control Group (n = 7) P Value Number of Participants 9 7 Male (n) 5 3 1 Female (n) 4 4 Bachelor's Degree (n) 6 6 0.585 Master's Degree (n) 3 1 Age (years) 28 (26.5, 29) 27 (26, 27) 0.142 BMI 20 (18.6, 22.7) 20.9 (18.6, 24.5) 0.47 First Test LS-CAT Total Score (points) 24 (22, 25.5) 24 (22, 25) 0.837 Table 2 LS-CAT Scores and Operation Error Counts of Participants Group Category First Test Second Test Third Test H P Experimental Group Total Score (points) 24.0 (22, 25.5) 13.0 (12, 14) 11.0 (9, 12) 21.2 < 0.001 Instrument Handling 12.0 (11, 13) 7.0 (6, 7) 6.0 (5, 6) 20.5 < 0.001 Tissue Handling 12.0 (11, 12.5) 7.0 (6, 7) 5.0 (4, 6) 21.3 < 0.001 Error Count (times) 5.0 (4, 5.5) 1.0 (1, 3) 1.0 (1, 1.5) 19.3 < 0.001 Control Group Total Score (points) 24.0 (22, 25) 18.0 (16, 19) 11.0 (10, 15) 16.3 < 0.001 Instrument Handling 12.0 (12, 13) 9.0 (8, 10) 6.0 (5, 7) 16.9 < 0.001 Tissue Handling 12.0 (10, 12) 9.0 (8, 10) 6 (5, 8) 14.9 0.001 Error Count (times) 4.0 (4, 5) 4.0 (3, 4) 3.0 (2, 3) 11.4 0.003 Table 3 Comparison of LS-CAT Scores Between Experimental and Control Groups Category Test z P LS-CAT Total Score (points) Second Test 2.68 0.005 LS-CAT Instrument Handling Score Second Test 2.596 0.008 LS-CAT Tissue Handling Score Second Test 2.824 0.003 Operation Error Count (times) Second Test 3.134 0.001 LS-CAT Total Score (points) Third Test 1.345 0.21 LS-CAT Instrument Handling Score Third Test 0.671 0.536 LS-CAT Tissue Handling Score Third Test 2.136 0.042 Operation Error Count (times) Third Test 2.824 0.003 Table 4 Comparison of Confidence and Imagery Scores Before and After Training Group Category Before Training After Training z P Experimental Group Surgical Confidence Score (points) 26.0 (20.5, 34.5) 36.0 (30.5, 40) 2.4 0.014 Action Imagery (points) 24.0 (19.5, 25) 28.0 (22.5, 30) 1.6 1.36 Imagery Training Participation (points) 20.0 (18, 23.5) 24.0 (22, 25) 2.2 0.031 Control Group Surgical Confidence Score (points) 27 (23, 29) 29 (26, 31) 1.3 0.209 Discussion Laparoscopic surgical skills training has long been a global medical education and surgical research focus. Studies have shown that standardized laparoscopic surgical simulation training can reduce surgical complications and the risk of conversion to open surgery [9,10]. Among these skills, intracorporeal suturing and knot-tying under laparoscopy are recognized as one of the most challenging aspects of laparoscopic surgical simulation training. Traditional teaching methods involve instructing and practicing continuous, complete actions. However, resident physicians often experience learning stagnation at critical points due to high learning difficulty, leading to low training efficiency and prolonged learning curves. Additionally, the current equipment and funding for laparoscopic training are limited [11]. In light of increasing hospital operating costs, finding ways to help trainees focus on training steps suitable for their skill levels, thereby smoothly overcoming learning bottlenecks, improving the learning outcomes and efficiency of laparoscopic suturing skills, and saving training costs, has become an urgent issue. This study compared the differences in learning outcomes and efficiency of laparoscopic suturing skills between this new teaching method, which combines the progressive and imagery training with traditional teaching methods. After 150 minutes of training, the trainees in the experimental group had significantly higher LS-CAT score than those in the control group (Experimental group: 13.0 (12, 14) vs. Control group: 18.0 (16, 19); p = 0.005). Additionally, the operation error counts in the experimental group were significantly lower than those in the control group (Experimental group: 1.0 (1, 3) vs. Control group: 4.0 (3, 4); p = 0.001). In the experimental group, 88.9% of the trainees achieved proficiency, compared to only 28.6% in the control group. However, the two groups had no significant difference regarding total suturing time. The result indicates that the new teaching method can more effectively help trainees acquire intracorporeal suturing and knot-tying skills under laparoscopy. Although there was no significant difference in total suturing time between the two groups, the experimental group’s LS-CAT scores and operation error counts were significantly lower than those in the control group. The above result demonstrates that the new teaching method significantly improves the learning efficiency and suturing quality of laparoscopic suturing skills. In surgery, the quality of suturing is crucial. If the suturing quality is inadequate or inconsistent, having the ability to suture quickly becomes meaningless. The progressive training method breaks down the complex laparoscopic suturing operations into simple, manageable segments, allowing trainees to advance progressively from simple to complex tasks and to repeatedly practice specific challenging points. This approach helps trainees adapt to high-difficulty operations, gradually building complete skills, and significantly improves learning efficiency. The progressive training method has been widely applied in related surgical fields such as laparoscopy and colonoscopy [12–14]. In Japan, Tomoko Mizota and colleagues found that a step-by-step training method with remote guidance for laparoscopic suturing skills training could more effectively utilize the time of both trainees and trainers [15]. Further studies by Chen HA and Huang SW confirmed that medical students and surgical trainees who used the progressive training method improved their laparoscopic suturing skills [16] significantly. These findings are consistent with the results of this study. Additionally, this study introduced the imagery training method. This method uses psychological training to repeatedly simulate the skill operation process in the learner's mind, thereby deepening the memory and understanding of the skills. The imagery training method emphasizes the close connection between mental and physical states. Psychological simulation can improve motor skills and strategies. The training process includes image formation, multi-sensory integration, repeated simulation, increasing complexity, and combining with actual operations. Moreover, this method encourages learners to reflect on their operations promptly, continually improving and enhancing their skill levels. Reflective learning is a crucial skill in clinical practice, aiding healthcare practitioners in developing professional skills and lifelong learning abilities [17]. The findings of this study revealed that the combination of the progressive training method and the imagery training method in the training of the challenging skill of intracorporeal suturing and knot-tying under laparoscopy can significantly enhance the efficiency of resident doctors in learning laparoscopic suturing skills in a short period of time while also improving the quality of suturing operations. After 300 minutes of training, all trainees have met the proficiency standard. Although there was no significant difference in the total LS-CAT scores, the experimental group had significantly fewer operation error counts than those in the control group (Experimental group: 1.0 (1, 3) vs. Control group: 4.0 (3, 4); p = 0.003). Additionally, the experimental group's LS-CAT scores for tissue handling were significantly better than those of the control group (Experimental group: 5.0 (4, 6) vs. Control group: 6.0 (5, 8); p = 0.042). The above result indicates that while both teaching methods can enable trainees to achieve proficiency in intracorporeal suturing skills under laparoscopy given sufficient training time, the combination of the progressive training method and imagery training methods significantly improves intracorporeal suturing quality. In Japan, a study by Tomoko Mizota and colleagues showed that all trainees finally achieved proficiency using either a step-by-step training method with remote guidance or a method that involved practicing complete laparoscopic suturing and knot-tying tasks. Their self-practice times showed no significant difference (Step-by-step training group: 202.5 (113.8, 267.5) minutes vs. Comprehensive group: 252.5 (117.5, 357.5) minutes). However, the total instructor time was significantly lower in the step-by-step training group, demonstrating the advantage of the progressive training method. In this study, researchers increased the total practice time to 300 minutes. After 300 minutes of training, all trainees reached the proficiency standard, and the operation error counts in the experimental group were significantly lower than those in the control group. Compared to the Japanese study, this research further proves that extending the total practice time ensures trainees achieve proficiency while significantly reducing operation errors and improving suturing quality using progressive and imagery training methods. However, more evidence is needed to support these conclusions due to differences in study subjects and evaluation metrics between the two studies. Additionally, the surgical confidence scores and imagery training participation scores of the trainees in the experimental group were significantly higher after training compared to before training. This indicates that the new training method not only improves the trainee’s surgical skills but also enhances their confidence. Moreover, the imagery training method received positive recognition and participation from the trainees in practical application. Conclusion In summary, this project significantly improved the laparoscopic suturing skills of resident physicians through the innovative combination of progressive and imagery training methods. It greatly enhanced the efficiency and quality of learning intracorporeal suturing and knot-tying skills for surgical and obstetrics-gynecology residents. This method shortened the time required for resident doctors to reach proficiency and high-quality standards in laparoscopic suturing, and reduced the consumption of training resources. Proficiency in laparoscopic suturing skills helps to reduce surgery time and the incidence of complications, thereby significantly improving the safety and success rates of surgeries, directly benefiting patients. Moreover, this study provides new ideas and methods for training laparoscopic skills in resident physicians, contributing to the reform and innovation of medical education. Declarations Ethical approval was given, by whom and the relevant Judgement ’ s reference number The study was reviewed and approved by Wenzhou Central Hospital’s Medical Ethics Committee（no.202402270046000397799） And the study was in accordance with Helsinki Declaration of 1964 and later versions. Sources of funding for the research This article is supported by Basic Public Welfare Research Project of Wenzhou Science and Technology Bureau（no.Y20240713） Clinical trial number: not applicable Author Contribution Wenxue Lin: Data curation, Writing original draft, ConceptualizationJian Yu : Software, ValidationRizeng Li : Writing Review&Editing, Conceptualization，MethodologyXiaoping Peng: Data curation，visualizationJianfu Xia: Quality Control, Formal AnalysisBingchen Huang: Resource，project management Data Availability Data is provided within the manuscript or supplementary information files References McCluney AL, Vassiliou MC, Kaneva PA, et al. FLS simulator performance predicts intraoperative laparoscopic skill. Surgical Endoscopy. 2007;21:1991–1995. Deziel DJ, Millikan KW, Economou SG, et al. Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,604 cases. The American Journal of Surgery. 1993;165(1):9–14. 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IJgosse WM, Leijte E, Ganni S, et al. Competency assessment tool for laparoscopic suturing: development and reliability evaluation. Surgical Endoscopy. 2020;34:2947–2953. Junjun Ma, Minhua Zheng. Cultivation and Development of Laparoscopic Surgical Techniques for Colorectal Surgeons. Colorectal and Anal Surgery. 2021;27(1):1–4. Coffin SJ, Wrenn SM, Callas PW, Abu-Jaish W. Three decades later: investigating the rate of and risks for conversion from laparoscopic to open cholecystectomy. Surgical Endoscopy. 2018;32:923–929. Armbrust L, Lenz M, Elrod J, et al. Factors influencing performance in laparoscopic suturing and knot tying: a cohort study. European Journal of Pediatric Surgery. 2023;33(02):144–151. Iacopini F, Bella A, Costamagna G, et al. Stepwise training in rectal and colonic endoscopic submucosal dissection with differentiated learning curves. Gastrointestinal Endoscopy. 2012;76(6):1188–1196. Yamada S, Shimada M, Imura S, et al. Effective stepwise training and procedure standardization for young surgeons to perform laparoscopic left hepatectomy. Surgical Endoscopy. 2017;31:2623–2629. Imai K, Hotta K, Yamaguchi Y, et al. Preoperative indicators of failure of en bloc resection or perforation in colorectal endoscopic submucosal dissection: implications for lesion stratification by technical difficulties during stepwise training. Gastrointestinal Endoscopy. 2016;83(5):954–962. Mizota T, Kurashima Y, Poudel S, et al. Step-by-step training in basic laparoscopic skills using two-way web conferencing software for remote coaching: a multicenter randomized controlled study. The American Journal of Surgery. 2018;216(1):88–92. Chen HA, Huang SW, Shen SC, et al. Stepwise training program: A novel practice schedule for laparoscopic suturing. Heliyon. 2023;9(12). Lane AS, Roberts C. Contextualised reflective competence: a new learning model promoting reflective practice for clinical training. BMC Medical Education. 2022;22(1):71. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 12 Mar, 2025 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 23 Oct, 2024 Editor assigned by journal 22 Oct, 2024 Submission checks completed at journal 22 Oct, 2024 First submitted to journal 15 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5272100","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":369449016,"identity":"323027c4-fddd-476a-85f8-f8a1697553e8","order_by":0,"name":"Wenxue Lin","email":"","orcid":"","institution":"Department of surgical oncology, The Dingli Clinical College of Wenzhou Medical University (Wenzhou Central Hospital),","correspondingAuthor":false,"prefix":"","firstName":"Wenxue","middleName":"","lastName":"Lin","suffix":""},{"id":369449017,"identity":"d3ed3bb6-f136-4f41-9f8e-45aa1e94fd92","order_by":1,"name":"Rizeng Li","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0UlEQVRIiWNgGAWjYBACNv7m45///rPhYWNmPnDgww8itPBJHEtj4GFLk+FjZ0s8OLOHCC1yDDlmQC2HbOT4eYwPc7AR4zCGY2kPJHgOAB3G8+EwAw+DPL/YAQJamJuPGxhI3AFq4d1wuMCCwXDm7ASCtiRIJBg8g2iZwcOQYHCboJYcA4kDCYdBDnsAJInTYibZcACshYFILRLHko0ZG9KAWtgMgIEsQdgv8v3NBx8zNtjYy/cffvzhww8beX5pAlrQgQRpykfBKBgFo2AUYAcAHPQ+zF40tloAAAAASUVORK5CYII=","orcid":"","institution":"Department of General Surgery, The Dingli Clinical College of Wenzhou Medical University (Wenzhou Central Hospital)","correspondingAuthor":true,"prefix":"","firstName":"Rizeng","middleName":"","lastName":"Li","suffix":""},{"id":369449018,"identity":"f8f083d7-22bc-4961-a115-efdd7bf3c8a7","order_by":2,"name":"Jian Yu","email":"","orcid":"","institution":"Department of General Surgery, The Dingli Clinical College of Wenzhou Medical University (Wenzhou Central Hospital)","correspondingAuthor":false,"prefix":"","firstName":"Jian","middleName":"","lastName":"Yu","suffix":""},{"id":369449019,"identity":"a8dbeced-e7b7-4b49-9b7c-7220a158ffd9","order_by":3,"name":"Xiaoping Peng","email":"","orcid":"","institution":"Department of Surgery, The Dingli Clinical Institute of Wenzhou Medical University,","correspondingAuthor":false,"prefix":"","firstName":"Xiaoping","middleName":"","lastName":"Peng","suffix":""},{"id":369449020,"identity":"a092d9ea-02d0-4ee6-8363-c410a1a21e49","order_by":4,"name":"Jianfu Xia","email":"","orcid":"","institution":"Department of General Surgery, The Dingli Clinical College of Wenzhou Medical University (Wenzhou Central Hospital)","correspondingAuthor":false,"prefix":"","firstName":"Jianfu","middleName":"","lastName":"Xia","suffix":""},{"id":369449021,"identity":"dea9bafb-0c35-4786-82d1-d1abc24338cf","order_by":5,"name":"Bingchen Huang","email":"","orcid":"","institution":"Clinical Skill Center，The Dingli Clinical College of Wenzhou Medical University (Wenzhou Central Hospital)","correspondingAuthor":false,"prefix":"","firstName":"Bingchen","middleName":"","lastName":"Huang","suffix":""}],"badges":[],"createdAt":"2024-10-16 02:53:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5272100/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5272100/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12909-025-06928-y","type":"published","date":"2025-03-12T15:56:55+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":78688820,"identity":"fd522280-1a96-40fa-a432-eb9d826d6db8","added_by":"auto","created_at":"2025-03-17 16:01:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":623566,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5272100/v1/8321ad9c-36e7-4937-ab06-f1d54b030155.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Study on the Application of Progressive Training Method Combined with Imagery Training Method in Laparoscopic Suturing Skills Training for Resident Physicians","fulltext":[{"header":"Introduction","content":"\u003cp\u003eA well-known and considerable positive correlation exists between laparoscopic simulation training and intraoperative performance [1]. Laparoscopic suturing skills are one of the core competencies required of surgeons and represent a challenging element of laparoscopic simulation training. Traditional teaching methods for laparoscopic suturing skills usually involve instructing and practicing continuous, complete actions. This approach results in high learning difficulty, causing trainees to experience learning stagnation at critical points, leading to low training efficiency and limited learning outcomes. Beginners often confront a step learning curve to overcome the bottleneck in laparoscopic suturing skills.\u003c/p\u003e \u003cp\u003eAdditionally, the extended learning curve for laparoscopic surgeons can prolong patient surgery times, increase the risk of surgical complications [2], and place a greater strain on public finances [3]. The progressive training method-based approach to teaching laparoscopic suturing skills involves breaking surgical skills down into smaller steps, allowing learners to master each skill step by step gradually. This method enables learners to continually drill individual challenging points, boosting overall proficiency and accuracy.\u003c/p\u003e \u003cp\u003eIn China, Jin Yang and colleagues applied the progressive training method to simulated training for laparoscopic pancreatojejunostomy and achieved significant results [4]. In Japan, Mizota T and Kurashima Y successfully applied this method in basic laparoscopic skills training [5].\u003c/p\u003e \u003cp\u003eThe imagery training method involves mental training in which students repeatedly simulate the skill operation process in their minds, thereby deepening their memory and understanding of the skills. This method also encourages learners to quickly reflect on and adjust their operations, continuously improving their skill level. The imagery training method has been widely employed in sports training, such as golf putting training, where two action states are simulated to achieve cognitive adaptation and skill progress [6].\u003c/p\u003e \u003cp\u003eThis study aims to explore a more efficient teaching method by combining progressive training with imagery training to enhance laparoscopic suturing skills in resident physicians.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003e1. Ethical Considerations:\u0026nbsp;\u003c/strong\u003eThis randomized controlled trial was approved by Wenzhou Central Hospital\u0026rsquo;s Medical Ethics Committee（no.202402270046000397799）\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;All participants were given detailed explanations about the study and submitted written informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. Equipment and Materials:\u0026nbsp;\u003c/strong\u003eThe study utilized laparoscopic simulation training boxe with internal high-definition camera ( GD/W-200 laparoscopic surgery simulation training systems from Shanghai Honglian Medical Technology Group ). Suture modules with silicone simulation skin and suture lines with needles (\u0026quot;3-0\u0026quot;, 15 cm) were used.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3. Study Design:\u0026nbsp;\u003c/strong\u003eThis study adopted a randomized controlled design. The study subjects were 16 resident doctors from the 2202 cohort of the standardized training program for surgical and obstetrics-gynecology bases at Wenzhou Central Hospital, along with one newly employed surgical resident. Before the implementation of the study, all enrolled trainees had not received any simulation training in laparoscopic suturing skills. The researchers randomly assigned the participants to two groups: the experimental group, comprising 9 participants who used the progressive training method combined with the imagery training method, and the control group, comprising 8 participants who used the comprehensive training method. One trainee in the control group adjusted their training plan due to conflicts between work and study schedules, and the final analysis did not include their data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExperimental Protocol:\u0026nbsp;\u003c/strong\u003eThe study\u0026rsquo;s training skill was the intracorporeal suturing and knot-tying skill based on the Fundamentals of Laparoscopic Surgery (FLS) [7]. During the study, the researchers held training sessions once a week for over 3 weeks, each lasting 100 minutes, \u0026nbsp;totaling 300 minutes. Researchers tested the trainees\u0026apos; intracorporeal suturing and knot-tying skills before, during (at 150 minutes into the training), and after (300 minutes after) the training. Each test was recorded using the simulation box\u0026rsquo;s built-in video recording function, with a designated person in charge of collecting the videos.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.1\u003c/strong\u003e The experimental group utilized a training method combining the progressive and imagery training methods.. In the lectures and subsequent training sessions, the teacher broke down \u0026nbsp;each decomposed action step by step for the learners to practice, based on the level of difficulty. \u0026nbsp;They moved on to continuous laparoscopic suturing training after completing the practice of all decomposed actions. Throughout the training process, researchers imcorporated the imagery training method to enhance the effectiveness of the practice. Under the progressive training method, the complete suturing process was divided into six decomposed actions: handling the suture, adjusting the needle, inserting and withdrawing the needle, knot-tying 1 (clamping the suture and looping), knot-tying 2 (pulling the suture to tighten the knot), and cutting the suture. Under the imagery training method, the instructor led the trainees through a sequence of full-body relaxation exercises, had them close their eyes slightly, and had them imagine themselves performing the correct intracorporeal suturing operation. During each two-minute imagery training session, the instructor gave suggestive cues, followed by the trainees practicing intracorporeal suturing with the instructor\u0026apos;s guidance and corrections.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.2\u0026nbsp;\u003c/strong\u003eThe control group used traditional teaching methods, practicing continuous and complete intracorporeal suturing and knot-tying techniques during the instructor\u0026apos;s lectures and subsequent training sessions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.3 Outcome Assessment:\u0026nbsp;\u003c/strong\u003eTwo experts evaluated and rated the videos using the Laparoscopic Suturing Competency Assessment Tool (LS-CAT) [8]. Throughout the grading process, the experts were kept unware of the participants\u0026rsquo; identities. The LS-CAT grading system featured four task areas: needle handling and adjustment, needle insertion and withdrawal through tissue margins, correctly tying the first surgical knot, and knot-tying. Each task area included instrument and tissue handling scores, for a total of eight independent items. Each independent item had four scoring regions, with a maximum possible score of 8 points. A lower LS-CAT score indicated a more proficient technical operation. Additionally, there were 16 error-scoring items, with fewer operation faults indicating better suturing quality. An LS-CAT score of 16 points or fewer (equal to 75% or above on a percentile scale) was regarded as the standard for technical proficiency.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAdditionally, we also recorded how long it took to complete the intracorporeal suturing and knot-tying. Furthermore, we used the Likert scale to collect data on trainees\u0026apos; confidence levels, involvement in imagery training, and self-perceived ability to perform imagery actions before and after training. Data on trainees\u0026apos; learning experiences with the progressive training method, skill improvement, the effectiveness of the imagery training method, and overall teaching satisfaction were also collected.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.4 Statistical Analysis\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data were analyzed using SPSS 24.0. The researchers assessed baseline characteristics of the participants with Fisher\u0026apos;s exact test and the Mann-Whitney U test, and they used the Kruskal-Wallis H test to compare LS-CAT scores and error counts across the three tests. The Mann-Whitney U test was used to compare changes in medical confidence, action imagery, and participation in imagery training before and after training, as well as differences in LS-CAT scores and operation error counts between the two groups. Medians (interquartile range, IQR) are used to express quantitative values. P-values \u0026lt;0.05 were considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e17 surgical and obstetrics-gynecology resident doctors participated in this study. One trainee adjusted their training plan due to conflicts between work and study schedules, and their data were not included in the study. Researchers randomly assigned sixteen participants to the experimental group and the control group. There were no significant differences in baseline characteristics between the two groups. See Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eAll trainees\u0026rsquo;s LS-CAT scores and operation error counts were compared in the first, second, and third tests. The results showed significant improvements in all trainee\u0026rsquo;s laparoscopic LS-CAT scores and operation error counts in the second and third tests. See Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eIn the second test, the experimental\u0026rsquo;s LS-CAT scores and operation error counts were significantly lower than those of the control group. In the third test, the experimental group's LS-CAT scores and operation error counts in tissue handling were also significantly lower than those of the control group. See Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe surgical confidence scores of trainees in the experimental group significantly improved after training, and the imagery training participation scores of the experimental group also showed a significant increase. See Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline Characteristics of Participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExperimental Group (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl Group (n\u0026thinsp;=\u0026thinsp;7)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of Participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBachelor's Degree (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.585\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaster's Degree (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (26.5, 29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (26, 27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.142\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (18.6, 22.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.9 (18.6, 24.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst Test LS-CAT Total Score (points)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (22, 25.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (22, 25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.837\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLS-CAT Scores and Operation Error Counts of Participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFirst\u003c/p\u003e \u003cp\u003eTest\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSecond Test\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eThird\u003c/p\u003e \u003cp\u003eTest\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eH\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExperimental Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal Score (points)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.0 (22, 25.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13.0 (12, 14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.0 (9, 12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e21.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInstrument Handling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.0 (11, 13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.0 (6, 7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.0 (5, 6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e20.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTissue Handling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.0 (11, 12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.0 (6, 7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.0 (4, 6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e21.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eError Count (times)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.0 (4, 5.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.0 (1, 3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.0 (1, 1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e19.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal Score (points)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.0 (22, 25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.0 (16, 19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.0 (10, 15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e16.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInstrument Handling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.0 (12, 13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.0 (8, 10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.0 (5, 7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e16.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTissue Handling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.0 (10, 12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.0 (8, 10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (5, 8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e14.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eError Count (times)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.0 (4, 5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.0 (3, 4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.0 (2, 3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e11.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of LS-CAT Scores Between Experimental and Control Groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTest\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ez\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLS-CAT Total Score (points)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecond Test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLS-CAT Instrument Handling Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecond Test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.596\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLS-CAT Tissue Handling Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecond Test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.824\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperation Error Count (times)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecond Test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLS-CAT Total Score (points)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThird Test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.345\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLS-CAT Instrument Handling Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThird Test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.671\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.536\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLS-CAT Tissue Handling Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThird Test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperation Error Count (times)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThird Test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.824\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Confidence and Imagery Scores Before and After Training\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBefore Training\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAfter Training\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ez\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExperimental Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurgical Confidence Score (points)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.0 (20.5, 34.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.0 (30.5, 40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAction Imagery (points)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.0 (19.5, 25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.0 (22.5, 30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImagery Training Participation (points)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.0 (18, 23.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.0 (22, 25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurgical Confidence Score (points)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (23, 29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29 (26, 31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.209\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eLaparoscopic surgical skills training has long been a global medical education and surgical research focus. Studies have shown that standardized laparoscopic surgical simulation training can reduce surgical complications and the risk of conversion to open surgery [9,10]. Among these skills, intracorporeal suturing and knot-tying under laparoscopy are recognized as one of the most challenging aspects of laparoscopic surgical simulation training. Traditional teaching methods involve instructing and practicing continuous, complete actions. However, resident physicians often experience learning stagnation at critical points due to high learning difficulty, leading to low training efficiency and prolonged learning curves. Additionally, the current equipment and funding for laparoscopic training are limited [11].\u003c/p\u003e \u003cp\u003eIn light of increasing hospital operating costs, finding ways to help trainees focus on training steps suitable for their skill levels, thereby smoothly overcoming learning bottlenecks, improving the learning outcomes and efficiency of laparoscopic suturing skills, and saving training costs, has become an urgent issue. This study compared the differences in learning outcomes and efficiency of laparoscopic suturing skills between this new teaching method, which combines the progressive and imagery training with traditional teaching methods.\u003c/p\u003e \u003cp\u003eAfter 150 minutes of training, the trainees in the experimental group had significantly higher LS-CAT score than those in the control group (Experimental group: 13.0 (12, 14) vs. Control group: 18.0 (16, 19); p\u0026thinsp;=\u0026thinsp;0.005). Additionally, the operation error counts in the experimental group were significantly lower than those in the control group (Experimental group: 1.0 (1, 3) vs. Control group: 4.0 (3, 4); p\u0026thinsp;=\u0026thinsp;0.001). In the experimental group, 88.9% of the trainees achieved proficiency, compared to only 28.6% in the control group. However, the two groups had no significant difference regarding total suturing time. The result indicates that the new teaching method can more effectively help trainees acquire intracorporeal suturing and knot-tying skills under laparoscopy.\u003c/p\u003e \u003cp\u003eAlthough there was no significant difference in total suturing time between the two groups, the experimental group\u0026rsquo;s LS-CAT scores and operation error counts were significantly lower than those in the control group. The above result demonstrates that the new teaching method significantly improves the learning efficiency and suturing quality of laparoscopic suturing skills. In surgery, the quality of suturing is crucial. If the suturing quality is inadequate or inconsistent, having the ability to suture quickly becomes meaningless.\u003c/p\u003e \u003cp\u003eThe progressive training method breaks down the complex laparoscopic suturing operations into simple, manageable segments, allowing trainees to advance progressively from simple to complex tasks and to repeatedly practice specific challenging points. This approach helps trainees adapt to high-difficulty operations, gradually building complete skills, and significantly improves learning efficiency. The progressive training method has been widely applied in related surgical fields such as laparoscopy and colonoscopy [12\u0026ndash;14]. In Japan, Tomoko Mizota and colleagues found that a step-by-step training method with remote guidance for laparoscopic suturing skills training could more effectively utilize the time of both trainees and trainers [15]. Further studies by Chen HA and Huang SW confirmed that medical students and surgical trainees who used the progressive training method improved their laparoscopic suturing skills [16] significantly. These findings are consistent with the results of this study.\u003c/p\u003e \u003cp\u003eAdditionally, this study introduced the imagery training method. This method uses psychological training to repeatedly simulate the skill operation process in the learner's mind, thereby deepening the memory and understanding of the skills. The imagery training method emphasizes the close connection between mental and physical states. Psychological simulation can improve motor skills and strategies. The training process includes image formation, multi-sensory integration, repeated simulation, increasing complexity, and combining with actual operations. Moreover, this method encourages learners to reflect on their operations promptly, continually improving and enhancing their skill levels. Reflective learning is a crucial skill in clinical practice, aiding healthcare practitioners in developing professional skills and lifelong learning abilities [17].\u003c/p\u003e \u003cp\u003eThe findings of this study revealed that the combination of the progressive training method and the imagery training method in the training of the challenging skill of intracorporeal suturing and knot-tying under laparoscopy can significantly enhance the efficiency of resident doctors in learning laparoscopic suturing skills in a short period of time while also improving the quality of suturing operations.\u003c/p\u003e \u003cp\u003eAfter 300 minutes of training, all trainees have met the proficiency standard. Although there was no significant difference in the total LS-CAT scores, the experimental group had significantly fewer operation error counts than those in the control group (Experimental group: 1.0 (1, 3) vs. Control group: 4.0 (3, 4); p\u0026thinsp;=\u0026thinsp;0.003). Additionally, the experimental group's LS-CAT scores for tissue handling were significantly better than those of the control group (Experimental group: 5.0 (4, 6) vs. Control group: 6.0 (5, 8); p\u0026thinsp;=\u0026thinsp;0.042). The above result indicates that while both teaching methods can enable trainees to achieve proficiency in intracorporeal suturing skills under laparoscopy given sufficient training time, the combination of the progressive training method and imagery training methods significantly improves intracorporeal suturing quality.\u003c/p\u003e \u003cp\u003eIn Japan, a study by Tomoko Mizota and colleagues showed that all trainees finally achieved proficiency using either a step-by-step training method with remote guidance or a method that involved practicing complete laparoscopic suturing and knot-tying tasks. Their self-practice times showed no significant difference (Step-by-step training group: 202.5 (113.8, 267.5) minutes vs. Comprehensive group: 252.5 (117.5, 357.5) minutes). However, the total instructor time was significantly lower in the step-by-step training group, demonstrating the advantage of the progressive training method.\u003c/p\u003e \u003cp\u003eIn this study, researchers increased the total practice time to 300 minutes. After 300 minutes of training, all trainees reached the proficiency standard, and the operation error counts in the experimental group were significantly lower than those in the control group. Compared to the Japanese study, this research further proves that extending the total practice time ensures trainees achieve proficiency while significantly reducing operation errors and improving suturing quality using progressive and imagery training methods. However, more evidence is needed to support these conclusions due to differences in study subjects and evaluation metrics between the two studies.\u003c/p\u003e \u003cp\u003eAdditionally, the surgical confidence scores and imagery training participation scores of the trainees in the experimental group were significantly higher after training compared to before training. This indicates that the new training method not only improves the trainee\u0026rsquo;s surgical skills but also enhances their confidence. Moreover, the imagery training method received positive recognition and participation from the trainees in practical application.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn summary, this project significantly improved the laparoscopic suturing skills of resident physicians through the innovative combination of progressive and imagery training methods. It greatly enhanced the efficiency and quality of learning intracorporeal suturing and knot-tying skills for surgical and obstetrics-gynecology residents. This method shortened the time required for resident doctors to reach proficiency and high-quality standards in laparoscopic suturing, and reduced the consumption of training resources. Proficiency in laparoscopic suturing skills helps to reduce surgery time and the incidence of complications, thereby significantly improving the safety and success rates of surgeries, directly benefiting patients. Moreover, this study provides new ideas and methods for training laparoscopic skills in resident physicians, contributing to the reform and innovation of medical education.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval was given, by whom and the relevant Judgement\u003c/strong\u003e\u003cstrong\u003e\u0026rsquo;\u003c/strong\u003e\u003cstrong\u003es reference number\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was reviewed and approved by\u0026nbsp;Wenzhou Central Hospital\u0026rsquo;s Medical Ethics Committee（no.202402270046000397799）\u0026nbsp;And the study was in accordance with Helsinki Declaration of 1964 and later versions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSources of funding for the research\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis article is supported by Basic Public Welfare Research Project of Wenzhou Science and Technology Bureau（no.Y20240713）\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number: \u003c/strong\u003enot applicable\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eWenxue Lin: Data curation, Writing original draft, ConceptualizationJian Yu : Software, ValidationRizeng Li : Writing Review\u0026amp;Editing, Conceptualization，MethodologyXiaoping Peng: Data curation，visualizationJianfu Xia: Quality Control, Formal AnalysisBingchen Huang: Resource，project management\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData is provided within the manuscript or supplementary information files\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cspan\u003eMcCluney AL, Vassiliou MC, Kaneva PA, et al. FLS simulator performance predicts intraoperative laparoscopic skill. Surgical Endoscopy. 2007;21:1991\u0026ndash;1995.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eDeziel DJ, Millikan KW, Economou SG, et al. Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,604 cases. The American Journal of Surgery. 1993;165(1):9\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eLouridas M, Szasz P, de Montbrun S, Harris KA, Grantcharov TP. Can we predict technical aptitude? a systematic review. Annals of Surgery. 2016;263(4):673\u0026ndash;691.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eYang J, Luo P, Wang Z, Shen J. Simulation training of laparoscopic pancreaticojejunostomy and stepwise training program on a 3D-printed model. International Journal of Surgery. 2022;107:106958.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eMizota T, Kurashima Y, Poudel S, et al. Step-by-step training in basic laparoscopic skills using two-way web conferencing software for remote coaching: a multicenter randomized controlled study. The American Journal of Surgery. 2018;216(1):88\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eKim T, Frank C, Schack T. A systematic investigation of the effect of action observation training and motor imagery training on the development of mental representation structure and skill performance. Frontiers in Human Neuroscience. 2017;11:499.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eVassiliou MC, Dunkin BJ, Marks JM, Fried GM. FLS and FES: comprehensive models of training and assessment. Surgical Clinics. 2010;90(3):535\u0026ndash;558.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eIJgosse WM, Leijte E, Ganni S, et al. Competency assessment tool for laparoscopic suturing: development and reliability evaluation. Surgical Endoscopy. 2020;34:2947\u0026ndash;2953.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eJunjun Ma, Minhua Zheng. Cultivation and Development of Laparoscopic Surgical Techniques for Colorectal Surgeons. Colorectal and Anal Surgery. 2021;27(1):1\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eCoffin SJ, Wrenn SM, Callas PW, Abu-Jaish W. Three decades later: investigating the rate of and risks for conversion from laparoscopic to open cholecystectomy. Surgical Endoscopy. 2018;32:923\u0026ndash;929.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eArmbrust L, Lenz M, Elrod J, et al. Factors influencing performance in laparoscopic suturing and knot tying: a cohort study. European Journal of Pediatric Surgery. 2023;33(02):144\u0026ndash;151.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eIacopini F, Bella A, Costamagna G, et al. Stepwise training in rectal and colonic endoscopic submucosal dissection with differentiated learning curves. Gastrointestinal Endoscopy. 2012;76(6):1188\u0026ndash;1196.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eYamada S, Shimada M, Imura S, et al. Effective stepwise training and procedure standardization for young surgeons to perform laparoscopic left hepatectomy. Surgical Endoscopy. 2017;31:2623\u0026ndash;2629.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eImai K, Hotta K, Yamaguchi Y, et al. Preoperative indicators of failure of en bloc resection or perforation in colorectal endoscopic submucosal dissection: implications for lesion stratification by technical difficulties during stepwise training. Gastrointestinal Endoscopy. 2016;83(5):954\u0026ndash;962.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eMizota T, Kurashima Y, Poudel S, et al. Step-by-step training in basic laparoscopic skills using two-way web conferencing software for remote coaching: a multicenter randomized controlled study. The American Journal of Surgery. 2018;216(1):88\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eChen HA, Huang SW, Shen SC, et al. Stepwise training program: A novel practice schedule for laparoscopic suturing. Heliyon. 2023;9(12).\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eLane AS, Roberts C. Contextualised reflective competence: a new learning model promoting reflective practice for clinical training. BMC Medical Education. 2022;22(1):71.\u003c/span\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Laparoscopic suturing skills, Intracorporeal suturing and knot-tying, Progressive training method, Imagery training method, Resident physicians, Laparoscopic simulation training","lastPublishedDoi":"10.21203/rs.3.rs-5272100/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5272100/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study aims to explore an efficient teaching method to improve laparoscopic suturing skills in resident physicians by combining the progressive training method with the imagery training method.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study used a randomized controlled trial methodology. The experimental group received training utilizing a combination of the progressive training method and the imagery training method In contrast, the control group followed the traditional teaching method of practicing continuous complete actions. Both groups were trained in intracorporeal suturing and knot-tying under laparoscopy. The training effects of the two groups were compared and analyzed before and after the training, including LS-CAT scores and suturing time.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn the second test, the experimental group had much higher LS-CAT scores than the control group, as well as a considerably lower number of operation errors. In the experimental group, 88.9% of the trainees were proficient, compared to only 28.6% in the control group. There was no significant difference in suturing time between the two groups. In the third test, all trainees met proficiency standards, and the total LS-CAT scores were not significantly different between the two groups. However, the experimental group outperformed the control group in terms of LS-CAT scores in tissue handling and operation mistakes.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe combination of the progressive training method and the imagery training method significantly improved resident physicians\u0026rsquo; laparoscopic suturing skills. This method greatly enhanced the efficiency and quality of learning laparoscopic suturing and knot-tying skills among surgical and gynecological resident doctors.\u003c/p\u003e","manuscriptTitle":"Study on the Application of Progressive Training Method Combined with Imagery Training Method in Laparoscopic Suturing Skills Training for Resident Physicians","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-24 04:10:36","doi":"10.21203/rs.3.rs-5272100/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-10-23T09:09:04+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-10-22T12:48:14+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-10-22T12:41:16+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2024-10-16T02:37:57+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6c58b8c2-6da0-4b27-afb4-cd2f41c5caed","owner":[],"postedDate":"October 24th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-03-17T15:59:10+00:00","versionOfRecord":{"articleIdentity":"rs-5272100","link":"https://doi.org/10.1186/s12909-025-06928-y","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2025-03-12 15:56:55","publishedOnDateReadable":"March 12th, 2025"},"versionCreatedAt":"2024-10-24 04:10:36","video":"","vorDoi":"10.1186/s12909-025-06928-y","vorDoiUrl":"https://doi.org/10.1186/s12909-025-06928-y","workflowStages":[]},"version":"v1","identity":"rs-5272100","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5272100","identity":"rs-5272100","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}