Evaluation of Three Sources of Validity Evidence for a Synthetic Thoracoscopic Esophageal Atresia/Tracheoesophageal Fistula Repair Simulator
Evaluation of Three Sources of Validity Evidence for a Synthetic Thoracoscopic Esophageal Atresia/Tracheoesophageal Fistula Repair Simulator
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DOI：
10.1089/lap.2014.0370
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发表时间：
2015-07-01
影响因子：
1.3
通讯作者：
O'Brien, Ellie
中科院分区：
文献类型：
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作者：
Barsness, Katherine A.;Rooney, Deborah M.;O'Brien, Ellie
目的：胸腔镜下食道闭锁(EA)/气管食管瘘(TEF)修补术在技术上具有挑战性。我们之前已经报告了我们在胸腔镜EA/TEF中使用高保真混合模型进行基于模拟的教育教学的经验，包括这些模型的高成本组织。本研究的目的是(1)建立低成本的合成组织EA/TEF修复模拟模型；(2)评价合成组织模拟器的内容效度。材料和方法：回顾文献和计算机断层扫描图像，为人工合成的、大小合适的EA/TEF组织植入物创建计算机辅助绘图(CAD)。然后，将CAD图像的反面打印在六个不同的部分，以创建一个可以填充铂固化硅胶的模具。然后将硅胶EA/TEF植入物放置在前面描述的新生儿胸腔内，并用人造皮肤覆盖。在机构审查委员会的豁免决定之后，47名参与者在两个独立的国际会议(国际儿科内外科小组[Ipeg]和世界儿科外科协会联合会[WOFAPS])上进行了部分或全部模拟胸腔镜EA/TEF。参与者被确定为专家，接受过6-50次胸腔镜下EA/TEF修复，以及新手，接受过0-5次胸腔镜下EA/TEF修复。参与者完成了一份由6个领域、24个项目组成的自我报告工具，包括23个5分评价表和1个4分全球评价表。使用多层面Rasch模型评估与测试内容和反应过程相关的效度证据，并使用Cronbach‘sα评估内部结构(项目间一致性)的证据。结果：对参与者评级的审查表明，不同网站(ipeg与WOFAPS，P=.84)或经验(专家与新手，P=.17)之间没有总体差异。观察到的最高平均值为4.4(模拟器作为训练工具的值)、4.3(物理属性胸围、胸深和肋间间隙)和4.3(经验瘘管位置的真实性)。观察到的最低平均分为3.5(瘘管闭合能力)、3.7(获取靶点的能力)、3.8(物理属性标志性可视化)、3.8(上眼袋吻合和分离能力)和3.9(材料真实性)。全球评分为2.9分，与该模拟器的反应一致，可考虑用于新生儿TEF修复训练，但可略有改进。合成EA/TEF插件的材料成本不到每个插件2美元。结论：我们成功地制造了一种低成本的合成EA/TEF组织植入物，用于新生儿胸腔镜EA/TEF修复模拟器。对合成的EA/TEF模拟模型参与者评分的分析表明，该模型具有价值，可用于培训儿科外科医生，特别是那些处于学习曲线早期的医生，以开始执行胸腔镜EA/TEF修复。确定了模型改进的领域，这些领域将是未来对合成EA/TEF修复模拟器进行修改的重点。
Purpose: Thoracoscopic esophageal atresia (EA)/tracheoesophageal fistula (TEF) repair is technically challenging. We have previously reported our experiences with a high-fidelity hybrid model for simulation-based educational instruction in thoracoscopic EA/TEF, including the high cost of the tissue for these models. The purposes of this study were (1) to create a low-cost synthetic tissue EA/TEF repair simulation model and (2) to evaluate the content validity of the synthetic tissue simulator. Materials and Methods: Review of the literature and computed tomography images were used to create computer-aided drawings (CAD) for a synthetic, size-appropriate EA/TEF tissue insert. The inverse of the CAD image was then printed in six different sections to create a mold that could be filled with platinum-cured silicone. The silicone EA/TEF insert was then placed in a previously described neonatal thorax and covered with synthetic skin. Following institutional review board-exempt determination, 47 participants performed some or all of a simulated thoracoscopic EA/TEF during two separate international meetings (International Pediatric Endosurgery Group [IPEG] and World Federation of Associations of Pediatric Surgeons [WOFAPS]). Participants were identified as experts, having 6-50 self-reported thoracoscopic EA/TEF repairs, and novice, having 0-5 self-reported thoracoscopic EA/TEF repairs. Participants completed a self-report, six-domain, 24-item instrument consisting of 23 5-point rating scales and one 4-point Global Rating Scale. Validity evidence relevant to test content and response processes was evaluated using the many-facet Rasch model, and evidence of internal structure (interitem consistency) was estimated using Cronbach's alpha. Results: A review of the participants' ratings indicates there were no overall differences across sites (IPEG versus WOFAPS, P=.84) or experience (expert versus novice, P=.17). The highest observed averages were 4.4 (Value of Simulator as a Training Tool), 4.3 (Physical Attributeschest circumference, chest depth, and intercostal space), and 4.3 (Realism of Experiencefistula location). The lowest observed averages were 3.5 (Ability to Performclosure of fistula), 3.7 (Ability to Performacquisition target trocar sites), 3.8 (Physical Attributeslandmark visualization), 3.8 (Ability to Performanastomosis and dissection of upper pouch), and 3.9 (Realism of Materialsskin). The Global Rating Scale was 2.9, coinciding with a response of this simulator can be considered for use in neonatal TEF repair training, but could be improved slightly. Material costs for the synthetic EA/TEF inserts were less than $2 U.S. per insert. Conclusions: We have successfully created a low-cost synthetic EA/TEF tissue insert for use in a neonatal thoracoscopic EA/TEF repair simulator. Analysis of the participants' ratings of the synthetic EA/TEF simulation model indicates that it has value and can be used to train pediatric surgeons, especially those early in their learning curve, to begin to perform a thoracoscopic EA/TEF repair. Areas for model improvement were identified, and these areas will be the focus for future modifications to the synthetic EA/TEF repair simulator.