Validity and reliability evidence support task-specific metrics for laparoscopic crural repair
摘要
Simulation is an important aspect in surgical training as it pertains to gaining proficiency in technical maneuvers. Our previous work in laparoscopic hiatal hernia repair has established task-specific metrics by expert consensus, specifically related to the diaphragmatic crural closure. The aim of this study was to establish the validity and reliability of these task-specific metrics using an inanimate model for eventual incorporation in a virtual reality simulator.
MethodsStudy participants were video recorded performing a crural closure using an inanimate model compatible with the Advanced Training in Laparoscopic Suturing (ATLAS) training box. Two blinded raters evaluated performances using the Objective Structured Assessment of Technical Skills (global rating scale) and task-specific metrics. We assessed Interrater Reliability (IRR) using the Intraclass Correlation Coefficient (ICC). Between-group differences were evaluated using Wilcoxon Rank Sum tests. Additionally, Spearman’s rank correlation coefficient was computed to evaluate the correlation between global and task-specific scores.
ResultsThe study included 33 participants categorized by years of postgraduate training: (novices were PGY1–2, intermediate were PGY3–6 and experts were faculty). When compared to novices, intermediates demonstrated superior technical performance on both global (13.5 vs 23.0, p = 0.015) and task-specific metrics (30.5 vs 52.7, p = 0.006) and completed the task faster (17.39 vs 43.68, p = 0.004). IRR was high for global (ICC = 0.86, p < 0.001) and moderately high for task-specific metrics (ICC = 0.78, p < 0.001). There was a strong positive correlation between the global and task-specific scores (R = 0.95, p < 0.001).
ConclusionSignificant discriminant validity was observed for both global and task-specific ratings in our novel crural closure model. These validated metrics of assessment can be incorporated into a future virtual reality simulator.