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      Feasibility and construct validity of a novel laparoscopic skills testing and training model

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          Proving the value of simulation in laparoscopic surgery.

          To assess the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) physical laparoscopic simulator for construct and predictive validity and for its educational utility. MISTELS is the physical simulator incorporated by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) in their Fundamentals of Laparoscopic Surgery (FLS) program. MISTELS' metrics have been shown to have high interrater and test-retest reliability and to correlate with skill in animal surgery. Over 200 surgeons and trainees from 5 countries were assessed using MISTELS in a series of experiments to assess the validity of the system and to evaluate whether practicing MISTELS basic skills (transferring) would result in skill acquisition transferable to complex laparoscopic tasks (suturing). Face validity was confirmed through questioning 44 experienced laparoscopic surgeons using global rating scales. MISTELS scores increased progressively with increasing laparoscopic experience (n = 215, P < 0.0001), and residents followed over time improved their scores (n = 24, P < 0.0001), evidence of construct validity. Results in the host institution did not differ from 5 beta sites (n = 215, external validity). MISTELS scores correlated with a highly reliable validated intraoperative rating of technical skill during laparoscopic cholecystectomy (n = 19, r = 0.81, P < 0.0004; concurrent validity). Novice laparoscopists were randomized to practice/no practice of the transfer drill for 4 weeks. Improvement in intracorporeal suturing skill was significantly related to practice but not to baseline ability, career goals, or gender (P < 0.001). MISTELS is a practical and inexpensive inanimate system developed to teach and measure technical skills in laparoscopy. This system is reliable, valid, and a useful educational tool.
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            Validation of surgical simulators.

            Although apprenticeship served surgeons in training well a hundred years ago, the complexity of surgical technology in the 21st Century has exponentially increased the demands on surgical education. Pelvic trainers can provide the necessary basic training for endoscopic and laparoscopic surgeons, but it usually is necessary to incorporate live-animal or cadaver practice or both to train fully in today's complex procedures. Advances in computer and materials technology have allowed the development of realistic simulators, but validation studies are required. Reliability is the reproducibility and precision of the test or testing device. Validity measures whether the simulator actually is teaching or evaluating what it is intended to teach or measure. Face validity relates to the realism of the simulator; content validity is a judgment of the appropriateness of the simulator as a teaching modality. Criterion validity compares the evaluation results from the new simulator with those of the old technique. The two types of criterion validity are concurrent - the extent to which the simulator correlates with the "gold standard" - and predictive - the extent to which the simulator predicts future performance. Construct validity indicates whether the simulator is able to distinguish the experienced from the inexperienced surgeon. For competency assessment, performance on a simulator should predict, or at least correlate with, an individual's performance in the operating room. A variety of endourologic models and simulators have been described, but only a few have been subjected to validity testing. An even greater number of simulators has been developed for laparoscopic skills training, but none is dedicated to training for laparoscopic urology. Surgical simulation must be used within an effective learning environment, underpinned by knowledge and professional attitudes.
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              Simulator training for laparoscopic suturing using performance goals translates to the operating room.

              The purpose of this study was to develop a performance-based laparoscopic suturing curriculum using simulators and to test the effectiveness (transferability) of the curriculum. Surgical residents (PGY1 to PGY5, n = 17) proficient in basic skills, but with minimal laparoscopic suturing experience, were enrolled in an IRB-approved, randomized controlled protocol. Subjects viewed an instructional video and were pretested on a live porcine laparoscopic Nissen fundoplication model by placing three gastrogastric sutures tied in an intracorporeal fashion. A blinded rater objectively scored each knot based on a previously published formula (600 minus completion time [sec] minus penalties for accuracy and knot integrity errors). Subjects were stratified according to pretest scores and randomized. The trained group practiced on a videotrainer suturing model until an expert-derived proficiency score (512) was achieved on 12 attempts. The control group received no training. Both the trained and control groups were posttested on the porcine Nissen model. For the training group, mean time to demonstrate simulator proficiency was 151 minutes (range 107 to 224 minutes) and mean number of attempts was 37 (range 24 to 51 attempts). Both the trained and control groups demonstrated significant improvement in overall score from baseline. But the trained group performed significantly better than the control group at posttesting (389 +/- 70 versus 217 +/- 140, p < 0.001), confirming curriculum effectiveness. These data suggest that training to a predetermined expert level on a videotrainer suture model provides trainees with skills that translate into improved operative performance. Such curricula should be further developed and implemented as a means of ensuring proficiency.
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                Author and article information

                Journal
                Gynecological Surgery
                Gynecol Surg
                Springer Nature
                1613-2076
                1613-2084
                November 2008
                May 2008
                : 5
                : 4
                : 281-290
                Article
                10.1007/s10397-008-0391-0
                c0721097-9822-48b7-a50a-1455fcd98074
                © 2008
                History

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