Evaluation of surgical performance during laparoscopic incisional hernia repair: a multicenter study

Ghaderi, Iman; Vaillancourt, Monica; Sroka, Gideon; Kaneva, Pepa; Vassiliou, Melina C.; Choy, Ian; Okrainec, Allan; Seagull, F. Jacob; Sutton, Erica; George, Ivan; Park, Adrian; Brintzenhoff, Rita; Stefanidis, Dimitrios; Fried, Gerald M.; Feldman, Liane S.

doi:10.1007/s00464-011-1586-4

Cited by 20 publications

(7 citation statements)

References 17 publications

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“…Equally important to a feasible training model is the evaluation method. The GOALS assessment tool has been validated and widely utilized in laparoscopic training [10,18–20], and it has been adopted by our institution for the assessment of robotic trainees using ex vivo tissue models including the one presented in this study [21]. We adopted GOALS for this robotic training model and further developed two novel metrics we believe are relevant in robotic surgery: ‘awareness of instrument and camera’ and ‘precision’.…”

Section: Discussionmentioning

confidence: 99%

Validation of a novel robotic‐assisted partial nephrectomy surgical training model

Hung

Patil

et al. 2012

BJU International

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Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? One area of particular growth for robotic surgery has been partial nephrectomy. Despite a perceived notion that robotic‐assisted partial nephrectomy is more easily adaptable compared to laparoscopic partial nephrectomy, there is nonetheless an associated learning curve. Validated training models with a corresponding assessment method for robotic‐assisted partial nephrectomy were previously unavailable. We have designed and validated a RAPN surgical model appropriate for resident and fellow training. OBJECTIVE To evaluate the face, content and construct validities of a novel ex vivo surgical training model for robotic‐assisted partial nephrectomy (RAPN). METHODS We prospectively identified participants as novice (not completed any robotic console cases), intermediate (at least one robotic console case but <100 cases), and expert (≥100 robotic console cases). Each participant performed a partial nephrectomy using the da Vinci Si Surgical System on an ex vivo porcine kidney with an embedded Styrofoam ball that mimics a renal tumour. Subjects completed a post‐study questionnaire assessing training model realism and utility. Participants were anonymously judged by three expert reviewers using a validated laparoscopic assessment tool. Performance between groups was compared using the tukey–kramer test. RESULTS The 46 participants recruited for this study included 24 novices, nine intermediates, and 13 experts. Overall, expert surgeons rated the training model as ‘very realistic’ (median visual analogue score 7/10) (face validity). Experts also rated the model as an ‘extremely useful’ training tool for residents (median 9/10) and fellows (9/10) (content validity), although less so for experienced robotic surgeons (5/10). Experts outscored novices on overall performance (P= 0.0002) as well as individual metrics, including ‘depth perception,’‘bimanual dexterity,’‘efficiency,’‘tissue handling,’‘autonomy,’‘precision,’ and ‘instrument and camera awareness’ (P < 0.05) (construct validity). Experts similarly outperformed intermediates in most metrics (P < 0.05). CONCLUSION Our novel ex vivo RAPN surgical model has demonstrated face, content and construct validity. Future development of this model should include simulation of haemostasis management and renal reconstruction.

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Section: Discussionmentioning

confidence: 99%

Validation of a novel robotic‐assisted partial nephrectomy surgical training model

Hung

Patil

et al. 2012

BJU International

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“…The interrater reliability for this GOALS-IH item in the operating room between 2 observers was also reported to be the lowest (ICC = .52). 16 This item represents a critical step in the operation and novice participants may not yet have the knowledge required to properly assess their own performance. Further analysis was done in the small subset of participants that were evaluated by 2 observers to clarify this issue.…”

Section: Discussionmentioning

confidence: 99%

“…GOALS-IH is a 7-domain global rating scale that has been previously described. 16 Each domain is scored on a 5-point Likert-type scale with anchors at 1, 3, and 5. The total score ranges from 7 to 35 with items assessing both procedural knowledge and technical skills.…”

Section: Goals-ihmentioning

confidence: 99%

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GOALS-Incisional Hernia: A Valid Assessment of Simulated Laparoscopic Incisional Hernia Repair

et al. 2011

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The Global Operative Assessment of Laparoscopic Skills (GOALS) is a valid and reliable measure of basic, non-procedure-specific laparoscopic skills. GOALS-incisional hernia (GOALS-IH) was developed to evaluate performance of laparoscopic incisional hernia repair (LIHR). The purpose of this study was to assess the validity and reliability of GOALS-IH during LIHR simulation. GOALS-IH assesses 7 domains with a maximum score of 35. A total of 12 experienced surgeons and 10 novices performed LIHR on the Surgical Abdominal Wall simulator. Performance was assessed by a trained observer and by self-assessment using GOALS-IH, basic GOALS and a visual analog scale (VAS) for overall competence. Both interrater reliability and internal consistency were high (.76 and .95 respectively). Experienced surgeons had higher mean GOALS-IH scores than novices (32.3 ± 2 versus 22.7 ± 5). There was excellent correlation between GOALS-IH and other measures of performance (GOALS r = .93 and VAS r = .93). GOALS-IH is easy to use, valid and reliable for assessment of simulated LIHR.

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“…The use of a scale, in the context of the assessment of a technical gesture, seems essential. As with other tools, any scale must be validated beforehand [47,[70][71][72].…”

Section: Simulators (High and Low-technologymentioning

confidence: 99%

Simulation-based summative assessment in healthcare: an overview of key principles for practice

et al. 2022

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Background Healthcare curricula need summative assessments relevant to and representative of clinical situations to best select and train learners. Simulation provides multiple benefits with a growing literature base proving its utility for training in a formative context. Advancing to the next step, “the use of simulation for summative assessment” requires rigorous and evidence-based development because any summative assessment is high stakes for participants, trainers, and programs. The first step of this process is to identify the baseline from which we can start. Methods First, using a modified nominal group technique, a task force of 34 panelists defined topics to clarify the why, how, what, when, and who for using simulation-based summative assessment (SBSA). Second, each topic was explored by a group of panelists based on state-of-the-art literature reviews technique with a snowball method to identify further references. Our goal was to identify current knowledge and potential recommendations for future directions. Results were cross-checked among groups and reviewed by an independent expert committee. Results Seven topics were selected by the task force: “What can be assessed in simulation?”, “Assessment tools for SBSA”, “Consequences of undergoing the SBSA process”, “Scenarios for SBSA”, “Debriefing, video, and research for SBSA”, “Trainers for SBSA”, and “Implementation of SBSA in healthcare”. Together, these seven explorations provide an overview of what is known and can be done with relative certainty, and what is unknown and probably needs further investigation. Based on this work, we highlighted the trustworthiness of different summative assessment-related conclusions, the remaining important problems and questions, and their consequences for participants and institutions of how SBSA is conducted. Conclusion Our results identified among the seven topics one area with robust evidence in the literature (“What can be assessed in simulation?”), three areas with evidence that require guidance by expert opinion (“Assessment tools for SBSA”, “Scenarios for SBSA”, “Implementation of SBSA in healthcare”), and three areas with weak or emerging evidence (“Consequences of undergoing the SBSA process”, “Debriefing for SBSA”, “Trainers for SBSA”). Using SBSA holds much promise, with increasing demand for this application. Due to the important stakes involved, it must be rigorously conducted and supervised. Guidelines for good practice should be formalized to help with conduct and implementation. We believe this baseline can direct future investigation and the development of guidelines.

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Evaluation of surgical performance during laparoscopic incisional hernia repair: a multicenter study

Abstract: Surgical performance during clinical LIHR can be assessed reliably using GOALS-IH. Results can be used to provide formative feedback to the surgeon and to identify steps of the operation that would benefit from specific educational interventions.

Cited by 20 publications

References 17 publications

Validation of a novel robotic‐assisted partial nephrectomy surgical training model

Validation of a novel robotic‐assisted partial nephrectomy surgical training model

GOALS-Incisional Hernia: A Valid Assessment of Simulated Laparoscopic Incisional Hernia Repair

Simulation-based summative assessment in healthcare: an overview of key principles for practice

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