Face, content, and construct validity of the EndoViS training system for objective assessment of psychomotor skills of laparoscopic surgeons

Abstract

Background The aim of this study is to present face, content, and constructs validity of the endoscopic orthogonal video system (EndoViS) training system and determines its efficiency as a training and objective assessment tool of the surgeons' psychomotor skills. Methods Thirty-five surgeons and medical students participated in this study: 11 medical students, 19 residents, and 5 experts. All participants performed four basic skill tasks using conventional laparoscopic instruments and EndoViS training system. Subsequently, participants filled out a questionnaire regarding the design, realism, overall functionality, and its capabilities to train hand-eye coordination and depth perception, rated on a 5-point Likert scale. Motion data of the instruments were obtained by means of two webcams built into a laparoscopic physical trainer. To identify the surgical instruments in the images, colored markers were placed in each instrument. Thirteen motion-related metrics were used to assess laparoscopic performance of the participants. Statistical analysis of Flores • performance was made between novice, intermediate, and expert groups. Internal consistency of all metrics was analyzed with Cronbach's a test.Results Overall scores about features of the EndoViS system were positives. Participants agreed with the usefulness of tasks and the training capacities of EndoViS system (score >4). Results presented significant differences in the execution of three skill tasks performed by participants. Seven metrics showed construct validity for assessment of performance with high consistency levels. Conclusions EndoViS training system has been successfully validated. Results showed that EndoViS was able to differentiate between participants of varying laparoscopic experience. This simulator is a useful and effective tool to objectively assess laparoscopic psychomotor skills of the surgeons. Keywords Laparoscopic surgery • Surgical training • Objective assessment • Motion metrics • Validation • Endoscopic orthogonal video system (EndoViS)Laparoscopic surgery has become an important technique within several surgical specialties, such as general surgery, gynecology, and urology. This minimally invasive technique offers many benefits for the patients as less postoperative pain, better cosmetics results, and shorter periods of hospitalization [1][2][3]. Laparoscopic surgery, however, demands additional psychomotor abilities and skills different from those in conventional open surgery [4,5].Traditionally, surgical residents acquire minimally invasive skills based on the classic apprenticeship model with hands-on training in the operation room [6,7]. This training method is not efficient, prolongs the learning curve of surgeons, and represents a potential risk to patient safety. Due to concerns for medical safety, it is essential the development of training methods for safe practice of laparoscopic surgery outside of the operating theater with the additional assessment of the surgical skills of surgeons.Currently, laparoscopic sur...

Motion analysis for better understanding of psychomotor skills in laparoscopy: objective assessment-based simulation training using animal organs

“…There is a growing body of literature on motion analyses of psychomotor skills in laparoscopic surgery, using different types of measurement methods such as an electromagnetic tracking system (e.g., The Imperial College Surgical Assessment Device, ICSAD [2,3]), optical scale sensors and micro-encoders (e.g., Hiroshima University Endoscopic Surgical Assessment Device, HUESAD [4]), optical sensors (e.g., TrEndo [5,6]), a computer-software tracking system based on endoscopic video analysis (e.g., Endoscopic Video Analysis, EVA [7]), and infrared camera motion tracking (e.g., iSurgeon [8]). Intracorporeal suturing/knot tying were extensively analyzed in a dry box training environment using non-biological materials, and a shorter task time, shorter path length, faster velocity, and better motion smoothness were previously reported [5,6,[8][9][10][11][12][13][14][15]. However, to our knowledge, other core surgical skills, such as tissue dissection or applying a vascular clip on a pedicle, have not been fully analyzed.…”

Development and Validation of a Homemade, Low-Cost Laparoscopic Simulator for Resident Surgeons (LABOT)

“…• simulating the surgical reality; As employed previously in the literature [16][17][18][19][20][21], for the validation of the LABOT, we used the following validity models: "face validity," "content validity," and "construct validity" [22,23].…”

Construct validity of eoSim – a low-cost and portable laparoscopic simulator

“…Bad habits are hard to break, but with early objective assessment, candidates will get a chance to change these habits. Objective assessment is also crucial with regard to patient safety; a surgeon who lacks basic technical skills can put a patient undergoing surgery at risk of adverse outcomes [13].…”

“…Prices vary, but are comparable to the cost of VR simulators [13][14][15]. Box-trainers, on the other hand, can be portable, relatively inexpensive and they provide realistic tactile feedback.…”