Beyond task time: automated measurement augments fundamentals of laparoscopic skills methodology
Beyond task time: automated measurement augments fundamentals of laparoscopic skills methodology
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DOI：
10.1016/j.jss.2014.05.077
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发表时间：
2014-12-01
影响因子：
2.2
通讯作者：
Sinanan, Mika N.
中科院分区：
文献类型：
--
作者：
Kowalewski, Timothy M.;White, Lee W.;Sinanan, Mika N.
背景：腹腔镜心理技能的学习和客观评价具有挑战性。腹腔镜技能基础（FLS）计划提供了一个流行的，廉价的，广泛研究和报告的方法来评估基本的腹腔镜技能。强调培训安全性之前的效率，我们提出的数据，探讨在FLS courseals.Materials和方法的指标：一个多机构（n = 3）的横断面研究招募受试者（n = 98）的所有腹腔镜技能水平，执行FLS任务的仪器箱教练。记录的任务视频由教师评审员（n = 2）使用修改后的技术技能客观结构化评估（OSATS）方案对受试者身份进行盲态后评价。计算每个完成任务的FLS分数，并与人口统计学上建立的技能水平进行比较（训练水平和手术次数）、视频回顾评分和客观性能指标（包括路径长度、运动经济性和峰值抓取力）。三个标准用于确定专家技能，培训和经验水平，通过OSATS对教师的表现进行盲态审查，以及FLS评分，不同意建立并发效度确定“真正的专家”在FLS任务。FLS评分与所有三项任务的任务时间均表现出接近完美的相关性（Pearson r = 0.99，1.00，1.00，P <0.0000001）。FLS错误惩罚对FLS分数的影响可以忽略不计。峰值抓力与任务时间或FLS scores.Conclusions：FLS技术技能分数提出了可以忽略不计的好处超出测量任务时间。FLS评分更侧重于速度而非精度，可能无法显著解决组织处理技能差的问题，尤其是关于过度夹持力的问题。经验或培训水平的类别可能不构成建立熟练程度阈值或技术技能结构有效性研究的适当基础。(C)2014 Elsevier Inc. All rights reserved.
Background: Laparoscopic psychomotor skills are challenging to learn and objectively evaluate. The Fundamentals of Laparoscopic Skills (FLS) program provides apopular, inexpensive, widely-studied, and reported method for evaluating basic laparoscopic skills. With an emphasis on training safety before efficiency, we present data that explore the metrics in the FLS curriculum.Materials and methods: A multi-institutional (n = 3) cross-sectional study enrolled subjects (n = 98) of all laparoscopic skill levels to perform FLS tasks in an instrumented box trainer. Recorded task videos were postevaluated by faculty reviewers (n = 2) blinded to subject identity using a modified Objective Structured Assessment of Technical Skills (OSATS) protocol. FLS scores were computed for each completed task and compared with demographically established skill levels (training level and number of procedures), video review scoring, and objective performance metrics including path length, economy of motion, and peak grasping force.Results: Three criteria used to determine expert skill, training and experience level, blinded review of performance by faculty via OSATS, and FLS scores, disagree in establishing concurrent validity for determining "true experts" in FLS tasks. FLS-scoring exhibited near-perfect correlation with task time for all three tasks (Pearson r = 0.99, 1.00, 1.00 with P < 0.00000001). FLS error penalties had negligible effect on FLS scores. Peak grasping force did not correlate with task time or FLS scores.Conclusions: FLS technical skills scores presented negligible benefit beyond the measurement of task time. FLS scoring is weighted more toward speed than precision and may not significantly address poor tissue handling skills, especially regarding excessive grasping force. Categories of experience or training level may not form a suitable basis for establishing proficiency thresholds or for construct validity studies for technical skills. (C) 2014 Elsevier Inc. All rights reserved.