Development of a performance rubric for transanal endoscopic rectal purse-string sutures
Development of a performance rubric for transanal endoscopic rectal purse-string sutures
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DOI：
10.1007/s10151-021-02545-1
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发表时间：
2021-11-10
影响因子：
3.3
通讯作者：
Ito, M.
中科院分区：
文献类型：
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作者：
Teramura, K.;Imai, S.;Ito, M.
背景：经肛门内窥镜直肠荷包缝合术(TaEPS)是经肛门全直肠系膜切除术(TaTME)的重要组成部分。然而，没有提供系统的培训来提高taEPS的特定程序技能。这项研究的目的是建立一个绩效量表，以提高taEPS技能，并为其有效性提供初步证据。方法通过咨询taTME手术和性能评估专家，建立基于taEPS的技术考虑因素的性能标准。2018年1月至2019年3月，10名独立的盲评分员在日本千叶市东区国立癌症中心医院(NCCHE)使用标准和全球腹腔镜技能手术评估(GOGAL)评估了连续10例taTME病例的10次录像taEPS手术。计算了内部一致性和评分者间的信度。录像的TEPS手术按标准进行计时和评估。分析Rbric评分与缝合次数的相关性。结果量表由4个项目组成：装针(LN)、无创穿刺法(AP)、计划缝合路径(PS)和总体性能(OA)。录像带的表演根据3分的利克特评分标准进行评分；分数以分数的总和计算。克朗巴赫的内部一致性系数为0.713。评分员间信度分别为LN：0.73，AP：0.76，PS：0.71，OA：0.70。题目和得分之间有很强的相关性(r=0.964，p<；0.001)。在连续的112次TEA评分中，评分与缝合时间密切相关(r=-0.69，p<；0.001)。外科医生使用taTME的经验与评分和缝合时间有关。结论本研究为taEPS技能操作量表提供了初步验证。通过为受训者提供关键的临床考虑，该委员会的结构化培训可能会促进技能的获得。
Background Placing a transanal endoscopic rectal purse-string suture (taEPS) is the crucial first component of transanal total mesorectal excision (taTME). However, no structured training is available to improve the procedure-specific skills for taEPS. The aim of this study was to create a performance rubric to improve taEPS skills and provide preliminary evidence for its validity. Methods A performance rubric was created based on technical considerations for taEPS, identified by consulting with taTME surgical and performance assessment experts. Ten independent, blinded raters assessed 10 videotaped taEPS procedures of consecutive taTME cases, at National Cancer Center Hospital East (NCCHE), Chiba, Japan, in January 2018-March 2019 using the rubric and the Global Operative Assessment of Laparoscopic Skills (GOALS). Internal consistency and inter-rater reliabilities were calculated. Videotaped taEPS procedures were timed and assessed by the rubric. Correlation between rubric scores and suturing times were analyzed. Results The rubric consists of four items: loading the needle (LN), atraumatic needle passage (AP), planned suture path (PS), and overall performance (OA). Videotaped performances were graded on a 3-point Likert scale; scores were calculated as sums of the points. Cronbach's alpha for internal consistency was 0.713. Inter-rater reliabilities were LN: 0.73, AP: 0.76, PS: 0.71, and OA: 0.70. Rubric and GOALS scores were strongly correlated (r = 0.964, p < 0.001). In 112 consecutive taEPS performances, rubric scores were strongly correlated with suturing time (r = - 0.69, p < 0.001). Surgeons' experience with taTME was associated with rubric scores and suturing time. Conclusions This study provides preliminary validation for the taEPS skill performance rubric. The rubric's structured training may facilitate skill acquisition by providing trainees with critical clinical considerations.