Developing and Testing Competency Levels for Laparoscopic Skills Training

Abstract

Hypothesis: Expert levels can be developed for use as training end points for a basic video-trainer skills curriculum, and the levels developed will be suitable for training. Design: Fifty subjects with minimal prior simulator exposure were enrolled using an institutional review boardapproved protocol. As a measure of baseline performance, medical students (n=11) and surgery residents (n=39) completed 3 trials on each of 5 validated videotrainer tasks. Four board-certified surgeons established as laparoscopic experts (with more than 250 basic and more than 50 advanced cases) performed 11 trials on each of the 5 tasks. The mean score was determined and outliers (Ͼ2 SDs) were trimmed; the trimmed mean was used as the competency level. Baseline performance of each subject was compared with the competency level for each task.

Global Rating Scales and Motion Analysis Are Valid Proficiency Metrics in Virtual and Benchtop Knee Arthroscopy Simulators

“…By the subjective GRS, the proficient group performed better on virtual (14 ± 6 [95% confidence interval {CI}, [10][11][12][13][14][15][16][17][18] (Fig. 1).…”

“…Future work should compare different modalities in the efficiency of skill acquisition, retention, and transferability to the operating room. Ultimately, as previously attempted in general surgery [4,7,17,26,30], patient safety may be improved by determining predefined levels of competence on simulated modalities. Such a measure would allow safe and measurable transition of residents from practicing in the laboratory to performing on patients in the operating room.…”

“…Global rating scales (GRS), procedure times, and motion analysis metrics were used to evaluate performance. Results The proficient group scored higher on virtual (14 ± 6 [95% confidence interval {CI}, [10][11][12][13][14][15][16][17][18] Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request.…”

The Changing Face of Surgical Education: Simulation as the New Paradigm

“…Despite this limited construct validity, we did find that practice on the LapMentor ™ simulator resulted in improved performance of basic skills in a porcine model [16]. These results were utilized to develop a proficiency-based laparoscopic basic skills curriculum, in conjunction with the work of Korndorffer and Scott who have established construct validity for a series of box trainer exercises (the "Southwestern stations") [18] (Table 1). This curriculum was then evaluated in a randomized, controlled study designed to evaluate the impact of this proficiency-based curriculum on intra-operative performance.…”

Training in laparoscopic surgery: From the lab to the or

“…Trainer boxes are relatively cheap and accessible [13], whereas virtual reality models provide an objective evaluation of the learning process [14], with both being equally effective for acquiring laparoscopic skills [15]. In spite of the promising data available about the evaluation and training of laparoscopic skills [16][17][18][19][20], validated and well-structured programs including pre-clinical training are not universally implemented. The ideal model must be feasible, reproducible, reliable and validated for its realism (face validity), its appropriateness as a teaching tool (content validity), its capacity to distinguish between different levels of experience (construct validity), its capacity to correlate with the gold-standard of the moment (concurrent validity), and also its capacity to predict future performance (predictive validity).…”