Development and validation of a simulator-based test in transurethral resection of bladder tumours (TURBEST)
Development and validation of a simulator-based test in transurethral resection of bladder tumours (TURBEST)
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DOI：
10.1080/21681805.2019.1663921
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发表时间：
2019-09-18
影响因子：
1.5
通讯作者：
Azawi, Nessn
中科院分区：
文献类型：
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作者：
Bube, Sarah Hjartbro;Hansen, Rikke Boelling;Azawi, Nessn
目标：一项前瞻性观察试验，旨在使用 Messick 的 TURB 模拟器测试框架开发和收集有效性证据。方法：从泌尿科（赫尔莱夫/根托夫特大学医院、哥本哈根大学医院和西兰大学医院罗斯基勒）招募了 49 名医生，并于 2018 年 4 月至 9 月入组。TURB MentorTM 虚拟现实 (VR) 模拟器在选择临床相关病例的专家会议上进行了评估和指标。测试是在丹麦两所大学医院的相同模拟器上进行的。所有参与者在 VR 模拟器上执行了 3 次 TURB 手术。通过方差分析 (ANOVA) 来分析模拟器指标，并将能够区分各组的指标合并到模拟器总分中。最后，使用对比组的方法确定通过/失败分数。结果：发现 11 个模拟器指标合格，其中 4 个在能力水平之间具有显着区分能力：切除的病理学 (%) (p = 0.008)；膀胱壁切割 (n) (p = 0.004)；时间（秒）（p = 0.034）；以及膀胱壁检查 (%) (p = 0.002)。模拟器总评分[（切除的病理*检查膀胱壁）/时间]内部结构的组内相关系数较高，Cronbach's alpha = 0.85。新手组的平均模拟器总分显着低于中级组，分别为 15.9 和 25.6（平均差异 = 9.7，p = 0.011）和经验丰富的组，30.6（平均差异 = 14.7，p < 0.001）。确定的通过/失败分数为 22。结论：我们找到了新开发的基于 VR 模拟器的测试的有效性证据，并建立了识别 TURB 手术技能的通过/失败分数。 TURBEST 测试可用于基于熟练程度的 TURB 模拟器培训计划，以便在对患者进行监督手术之前进行认证。
Objectives: A prospective observational trial to develop and gather validity evidence using Messick's framework for a simulator-based test in TURB.Methods: Forty-nine doctors were recruited from urology departments (Herlev/Gentofte University Hospital, Rigshospitalet Copenhagen University Hospital and Zealand University Hospital Roskilde) and enrolled from April to September 2018. The TURB MentorTM virtual reality (VR) simulator was assessed at an expert meeting selecting clinically relevant cases and metrics. Test sessions were done on identical simulators at two university hospitals in Denmark. All participants performed three TURB procedures on the VR simulator. Simulator metrics were analysed with analysis of variance (ANOVA) and metrics with the ability to discriminate between groups were combined in a total simulator score. Finally, a pass/fail score was identified using the contrasting groups' method.Results: Eleven simulator metrics were found eligible and four had significant discrimination ability between competency levels: resected pathology (%) (p = 0.008); cutting in bladder wall (n) (p = 0.004); time (s) (p = 0.034); and inspection of the bladder wall (%) (p = 0.002). The internal structure of the total simulator score [(resected pathology* inspection of the bladder wall)/time] was high with the intraclass correlation coefficient, Cronbach's alpha = 0.85. The mean total simulator score was significantly lower in the novice group than in the intermediate, 15.9 and 25.6, respectively (mean difference = 9.7, p = 0.011) and experienced group, 30.6 (mean difference = 14.7, p< 0.001). A pass/fail score of 22 was identified.Conclusion: We found validity evidence for a newly developed VR simulator-based test and establised a pass/fail score identifying surgical skills in TURB. The TURBEST test can be used in a proficiency-based TURB simulator training programme for accreditation prior to supervised procedures on patients.