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Introduction <p>Laparoscopy is underutilized&#xa0;in lower- and middle-income countries (LMICs) due to limited access to&#xa0;training opportunities. Laparoscopic cholecystectomy is the gold standard for treating gallbladder disease in high-income countries (HICs), yet the open approach predominates in LMICs. A low-cost, simulation-based educational module for teaching laparoscopic cholecystectomy was developed by an international collaboration. A novel tool for verifying proficiency (CHOLE-VOP), incorporating a procedural checklist, a global rating scale (GRS), and a final competency rating, was designed and piloted to evaluate psychomotor skill acquisition in laparoscopic cholecystectomy.</p> Methods <p>Fifty-two users completed the learning module, submitted a video recording of their performance on the tool, and performed self- and peer-assessment of videos using the CHOLE-VOP. A Kruskal–Wallis test was used to assess the CHOLE-VOP’s ability to differentiate psychomotor performance across three experience levels [novice (no laparoscopic experience), intermediate (1–30 cases), and expert (&gt; 30 cases)] and between settings (LMICs vs. HICs). Inter-rater agreement was measured between self-assessment and peer-assessment, across reviewer reviewer experience levels.</p> Results <p>Among users [novices (14), intermediates (18), experts (17), unknown (3)], checklist scores significantly increased from novice (<i>M</i> = 28.16) to intermediate (<i>M</i> = 31.33) and expert (<i>M</i> = 32.66), <i>P</i> &lt; 0.001. Both GRS and final ratings effectively discriminated between experience levels, <i>P</i> &lt; 0.001. LMIC users had higher checklist scores (32.41 vs. 29.35, <i>P</i> = 0.008) and GRS scores (17.54 vs. 15.14, <i>P</i> = 0.002). Inter-rater agreement between self- and peer-assessments was moderate (ICC = 0.52), with poor agreement for novices (ICC = 0.24), who tended to overestimate their performance, and good agreement for intermediate users (ICC = 0.79).</p> Conclusion <p>The CHOLE-VOP successfully discriminated between experience levels in a simulated laparoscopic cholecystectomy training module. LMIC users outperformed HIC users in select skill parameters. Self-assessments, particularly among novices, showed limited concordance with peer-assessments.</p> Graphical abstract <p></p>

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A novel tool for assessing psychomotor proficiency in laparoscopic cholecystectomy using simulation-based training

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年4月18日

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  • Erin Kim,
  • Marius J. Tchinde,
  • Deborah M. Rooney,
  • Blessing N. Ngam,
  • R. Luke Rettig,
  • Christopher L. Gross,
  • Mark J. Snell,
  • Melanie L. Barnard,
  • Kevin El-Hayek,
  • David R. Jeffcoach,
  • Grace J. Kim

摘要

Introduction

Laparoscopy is underutilized in lower- and middle-income countries (LMICs) due to limited access to training opportunities. Laparoscopic cholecystectomy is the gold standard for treating gallbladder disease in high-income countries (HICs), yet the open approach predominates in LMICs. A low-cost, simulation-based educational module for teaching laparoscopic cholecystectomy was developed by an international collaboration. A novel tool for verifying proficiency (CHOLE-VOP), incorporating a procedural checklist, a global rating scale (GRS), and a final competency rating, was designed and piloted to evaluate psychomotor skill acquisition in laparoscopic cholecystectomy.

Methods

Fifty-two users completed the learning module, submitted a video recording of their performance on the tool, and performed self- and peer-assessment of videos using the CHOLE-VOP. A Kruskal–Wallis test was used to assess the CHOLE-VOP’s ability to differentiate psychomotor performance across three experience levels [novice (no laparoscopic experience), intermediate (1–30 cases), and expert (> 30 cases)] and between settings (LMICs vs. HICs). Inter-rater agreement was measured between self-assessment and peer-assessment, across reviewer reviewer experience levels.

Results

Among users [novices (14), intermediates (18), experts (17), unknown (3)], checklist scores significantly increased from novice (M = 28.16) to intermediate (M = 31.33) and expert (M = 32.66), P < 0.001. Both GRS and final ratings effectively discriminated between experience levels, P < 0.001. LMIC users had higher checklist scores (32.41 vs. 29.35, P = 0.008) and GRS scores (17.54 vs. 15.14, P = 0.002). Inter-rater agreement between self- and peer-assessments was moderate (ICC = 0.52), with poor agreement for novices (ICC = 0.24), who tended to overestimate their performance, and good agreement for intermediate users (ICC = 0.79).

Conclusion

The CHOLE-VOP successfully discriminated between experience levels in a simulated laparoscopic cholecystectomy training module. LMIC users outperformed HIC users in select skill parameters. Self-assessments, particularly among novices, showed limited concordance with peer-assessments.

Graphical abstract