A valid method of laparoscopic simulation training and competence assessment
A valid method of laparoscopic simulation training and competence assessment
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DOI：
10.1016/s0022-4804(03)00315-9
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发表时间：
2003-10-01
影响因子：
2.2
通讯作者：
Gandsas, A
中科院分区：
文献类型：
--
作者：
Adrales, GL;Park, AE;Gandsas, A
本研究的目的是评估腹腔镜技术性能指标的结构效度和三个腹腔镜模拟的表面效度。材料和方法。不同手术经验水平的受试者（N = 27）进行了三次腹腔镜模拟，分别代表阑尾切除术（LA）、胆囊切除术（LC）和腹股沟半缝合术（LH）。五名腹腔镜外科医生，不知道受试者的身份，对受试者的程序能力进行二进制评分，并在四个技能类别的5分制：临床判断，灵巧，串行/同时的复杂性，空间定位。非临床工作人员使用特定任务检查表评估技术错误。手术经验水平与评分、技术错误和每次手术的时间相关。受试者对无生命模型的效用的调查的反应进行了评估。经验年数与技能等级（P < 0.001）和三种程序的能力等级（P < 0.01）直接相关。经验与每个程序的时间（P < 0.01）和三种模型的技术错误总数（P < 0.05）呈负相关。几乎所有的受试者都被模拟所代表（LA 96%，LC 96%，LH 100%）。腹腔镜模拟证明了面效度和结构效度。无论手术经验水平如何，受试者都发现模型是实际腹腔镜手术的合适代表。随着手术经验的增加，任务速度提高。更重要的是，随着经验的增加，性能的质量也在提高，正如专家腹腔镜外科医生的技能评估所示。(C)2003年爱思唯尔公司All rights reserved.
Background The purpose of our study was to evaluate the construct validity of laparoscopic technical performance measures and the face validity of three laparoscopic simulations.Materials and methods. Subjects (N = 27) of varying levels of surgical experience performed three laparoscopic simulations, representing appendectomy (LA), cholecystectomy (LC), and inguinal hemiorrhaphy (LH). Five laparoscopic surgeons, blinded to the identity of the subjects, rated the subjects on procedural competence on a binary scale and in four skills categories on a 5-point scale: clinical judgment, dexterity, serial/simultaneous complexity, and spatial orientation. Using a task-specific checklist, non-clinical staff assessed the technical errors. The level of surgical experience was correlated with the ratings, the technical errors, and the time for each procedure. Subject responses to a survey regarding the utility of the inanimate models were evaluated.Results. Years of experience directly correlated with the skills ratings (all P < 0.001) and with the competence ratings across the three procedures (P < 0.01). Experience inversely correlated with the time for each procedure (P < 0.01) and the technical error total across the three models (P < 0.05). Nearly all subjects represented by the simulations (LA 96%, LC 96%, LH 100%).Conclusion. The laparoscopic simulations demonstrated both face and construct validity. Regardless of the level of surgical experience, the subjects found the models to be suitable representations of actual laparoscopic procedures. Task speed improved with surgical experience. More importantly, the quality of performance increased with experience, as shown by the improvement in the skills assessments by expert laparoscopic surgeons. (C) 2003 Elsevier Inc. All rights reserved.