Validation of an endoscopic flavectomy training model

Abstract

Objective: to validate a lumbar spine endoscopic flavectomy simulator using the construct method and to assess the acceptability of the simulator in medical education. Methods: thirty medical students and ten video-assisted surgery experienced orthopedists performed an endoscopic flavectomy procedure in the simulator. Time, look-downs, lost instruments, respect for the stipulated edge of the ligamentum flavum, regularity of the incision, GOALS checklist (Global Operative Assessment of Laparoscopic Skills), and responses to the Likert Scale adapted for this study were analyzed. Results: all variables differed between groups. Procedure time was shorter in the physician group (p < 0.001). Look-downs and instrument losses were seven times greater among students than physicians. Half of the students respected the designated incision limits, compared to 80% of the physicians. In the student group, about 30% of the incisions were regular, compared to 100% in the physician group (p < 0.001). The physicians performed better in all GOALS checklist domains. All the physicians and more than 96% of the students considered the activity enjoyable, and approximately 90% believed that the model was realistic and could contribute to medical education. Conclusions: the simulator could differentiate the groups’ experience level, indicating construct validity, and both groups reported high acceptability.

Validação de constructo e experiência de uso de um simulador de artroscopia de ombro de baixo custo

“…The aforementioned endoscopic flavectomy study, comparing surgeons and students with the GOALS score, showed differences between groups, corroborating the findings of this study. 28 In a knee model, similar to ours and using the ASSET score, students and surgeons were compared and showed statistical difference, again confirming the hypothesis that the construct allows the differentiation between individuals with different levels of experience. 13 For the shoulder, we found a single study that used the GOALS score that evaluated first-year medical students and their evolution with the use of the device, and the authors showed significant improvement, as in our study.…”

“…No estudo de flavectomia endoscópica já citado, comparando cirurgiões e estudantes com o escore de GOALS, demonstrou diferenças entre os grupos, corroborando os achados deste estudo. 28 Em um modelo de joelho, semelhante ao nosso e utilizando o escore ASSET, estudantes e cirurgiões foram comparados e mostraram diferença estatística, confirmando novamente a hipótese de que o construto permite a diferenciação entre indivíduos com diferentes níveis de experiência. 13 Para o ombro encontramos um único estudo que utilizou o escore GOALS que avaliou estudantes de medicina do primeiro ano e sua evolução com o uso do dispositivo e os autores apresentaram melhora significativa como em nosso estudo.…”

“…22 For a more objective evaluation of the results, it was decided to use the GOALS score, which, despite having been created to evaluate laparoscopic surgeries, 18 had already been used in the evaluation of a shoulder arthroscopy simulator and a training model in flavectomy endoscopic. 15,28 To be as objective as possible, we created a scale of time or number of attempts to perform specific tasks and correlated it with each item of the GOALS score and in the intergroup comparison we observed differences between all groups in the first test. The same results were observed in the second test comparing surgeons and residents, but not when comparing residents and students.…”

Education for Being A Spine Endoscopic Surgeon: What Matters?

“…This conveyed an vital message to organizations and manufactures who are dedicated to promote the technique and help the less-experienced surgeons. Even though cadavers are not always available especially for some regions, it is joyful to see some innovative alternative training program has been come up by peers [23][24]. This trend is in line with the survey and it should be continually pushed forward to make our efforts comes in.…”

Training to be a spinal endoscopic surgeon: What matters?

“…This conveyed a vital message to organizations and manufacturers who are dedicated to promoting the technique and helping less-experienced surgeons. Even though cadavers are not always available, especially in some regions, it is satisfying to see peers develop innovative alternative training programs ( 23 , 24 ). This trend is in line with the survey, and it should be maintained for our efforts to be worthwhile.…”