Construct validity of an objective assessment method for laparoscopic intracorporeal suturing and knot tying
The ideal objective assessment method for laparoscopic technical skills is difficult to achieve in the operating room. Recent “VR2OR” studies have used a blinded, 2-reviewer error-based video tape analysis for intraoperative performance assessment. This study examines the validity of this methodolog...
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| Published in | The American journal of surgery Vol. 196; no. 1; pp. 74 - 80 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
New York, NY
Elsevier Inc
01.07.2008
Elsevier Elsevier Limited |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0002-9610 1879-1883 1879-1883 |
| DOI | 10.1016/j.amjsurg.2007.08.058 |
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| Abstract | The ideal objective assessment method for laparoscopic technical skills is difficult to achieve in the operating room. Recent “VR2OR” studies have used a blinded, 2-reviewer error-based video tape analysis for intraoperative performance assessment. This study examines the validity of this methodology applied to laparoscopic intracorporeal suturing and knot tying.
Four groups of subjects—experts (EX), surgery residents trained to expert criterion levels using simulation (TR), surgery residents receiving no supplemental training (NR), and medical students receiving simulation-based training (MS)—performed the fundal suturing portion of a laparoscopic Nissen fundoplication and were video-recorded for analysis. Two separate groups of surgeon reviewers (K.V.S. + M.B.; I.-P.H. + A.G.) were trained to evaluate laparoscopic suturing and knot tying performance using specific metrics. Subjects' operative performance was assessed by reviewers blinded to their training status and scored using an error-based, step specific scoring system to an inter-rater agreement of 80% or greater. Three primary performance measures were assessed: time, errors, and needle manipulations and comparisons between groups were made using a 1-way analysis of variance (ANOVA) with post-test.
A total of 40 fundal sutures (10 in each group) were scored by 2 separate rater groups with inter-rater agreement consistently greater than 80%. Inter-rater agreement was highest with the EX group (91%, range 76%–100%) and lowest with the NR group (85%, range 81%–98%). On average, the EX group significantly outperformed the other groups with regards to time (
P <.0001), errors (
P <.002), and needle manipulations (
P <.01). Performance of the TR group was comparable to the EX group with regards to errors and manipulations (
P = not significant [NS]), and outperformed the NR and MS groups with regards to time (
P <.05 and
P <.001). Performance between the NR and MS groups were similar for all 3 measures.
This assessment method demonstrates discriminative validity. Time appears to be the most sensitive indicator of skill level, as significant differences between EX, TR, and NR/MS groups were seen. The methodology is transferable across different reviewers and is acceptable for high-stakes assessment. |
|---|---|
| AbstractList | The ideal objective assessment method for laparoscopic technical skills is difficult to achieve in the operating room. Recent “VR2OR” studies have used a blinded, 2-reviewer error-based video tape analysis for intraoperative performance assessment. This study examines the validity of this methodology applied to laparoscopic intracorporeal suturing and knot tying.
Four groups of subjects—experts (EX), surgery residents trained to expert criterion levels using simulation (TR), surgery residents receiving no supplemental training (NR), and medical students receiving simulation-based training (MS)—performed the fundal suturing portion of a laparoscopic Nissen fundoplication and were video-recorded for analysis. Two separate groups of surgeon reviewers (K.V.S. + M.B.; I.-P.H. + A.G.) were trained to evaluate laparoscopic suturing and knot tying performance using specific metrics. Subjects' operative performance was assessed by reviewers blinded to their training status and scored using an error-based, step specific scoring system to an inter-rater agreement of 80% or greater. Three primary performance measures were assessed: time, errors, and needle manipulations and comparisons between groups were made using a 1-way analysis of variance (ANOVA) with post-test.
A total of 40 fundal sutures (10 in each group) were scored by 2 separate rater groups with inter-rater agreement consistently greater than 80%. Inter-rater agreement was highest with the EX group (91%, range 76%–100%) and lowest with the NR group (85%, range 81%–98%). On average, the EX group significantly outperformed the other groups with regards to time (
P <.0001), errors (
P <.002), and needle manipulations (
P <.01). Performance of the TR group was comparable to the EX group with regards to errors and manipulations (
P = not significant [NS]), and outperformed the NR and MS groups with regards to time (
P <.05 and
P <.001). Performance between the NR and MS groups were similar for all 3 measures.
This assessment method demonstrates discriminative validity. Time appears to be the most sensitive indicator of skill level, as significant differences between EX, TR, and NR/MS groups were seen. The methodology is transferable across different reviewers and is acceptable for high-stakes assessment. The ideal objective assessment method for laparoscopic technical skills is difficult to achieve in the operating room. Recent "VR2OR" studies have used a blinded, 2-reviewer error-based video tape analysis for intraoperative performance assessment. This study examines the validity of this methodology applied to laparoscopic intracorporeal suturing and knot tying. Four groups of subjects--experts (EX), surgery residents trained to expert criterion levels using simulation (TR), surgery residents receiving no supplemental training (NR), and medical students receiving simulation-based training (MS)--performed the fundal suturing portion of a laparoscopic Nissen fundoplication and were video-recorded for analysis. Two separate groups of surgeon reviewers (K.V.S. + M.B.; I.-P.H. + A.G.) were trained to evaluate laparoscopic suturing and knot tying performance using specific metrics. Subjects' operative performance was assessed by reviewers blinded to their training status and scored using an error-based, step specific scoring system to an inter-rater agreement of 80% or greater. Three primary performance measures were assessed: time, errors, and needle manipulations and comparisons between groups were made using a 1-way analysis of variance (ANOVA) with post-test. A total of 40 fundal sutures (10 in each group) were scored by 2 separate rater groups with inter-rater agreement consistently greater than 80%. Inter-rater agreement was highest with the EX group (91%, range 76%-100%) and lowest with the NR group (85%, range 81%-98%). On average, the EX group significantly outperformed the other groups with regards to time (P <.0001), errors (P <.002), and needle manipulations (P <.01). Performance of the TR group was comparable to the EX group with regards to errors and manipulations (P = not significant [NS]), and outperformed the NR and MS groups with regards to time (P <.05 and P <.001). Performance between the NR and MS groups were similar for all 3 measures. This assessment method demonstrates discriminative validity. Time appears to be the most sensitive indicator of skill level, as significant differences between EX, TR, and NR/MS groups were seen. The methodology is transferable across different reviewers and is acceptable for high-stakes assessment. The ideal objective assessment method for laparoscopic technical skills is difficult to achieve in the operating room. Recent "VR2OR" studies have used a blinded, 2-reviewer error-based video tape analysis for intraoperative performance assessment. This study examines the validity of this methodology applied to laparoscopic intracorporeal suturing and knot tying.BACKGROUNDThe ideal objective assessment method for laparoscopic technical skills is difficult to achieve in the operating room. Recent "VR2OR" studies have used a blinded, 2-reviewer error-based video tape analysis for intraoperative performance assessment. This study examines the validity of this methodology applied to laparoscopic intracorporeal suturing and knot tying.Four groups of subjects--experts (EX), surgery residents trained to expert criterion levels using simulation (TR), surgery residents receiving no supplemental training (NR), and medical students receiving simulation-based training (MS)--performed the fundal suturing portion of a laparoscopic Nissen fundoplication and were video-recorded for analysis. Two separate groups of surgeon reviewers (K.V.S. + M.B.; I.-P.H. + A.G.) were trained to evaluate laparoscopic suturing and knot tying performance using specific metrics. Subjects' operative performance was assessed by reviewers blinded to their training status and scored using an error-based, step specific scoring system to an inter-rater agreement of 80% or greater. Three primary performance measures were assessed: time, errors, and needle manipulations and comparisons between groups were made using a 1-way analysis of variance (ANOVA) with post-test.METHODSFour groups of subjects--experts (EX), surgery residents trained to expert criterion levels using simulation (TR), surgery residents receiving no supplemental training (NR), and medical students receiving simulation-based training (MS)--performed the fundal suturing portion of a laparoscopic Nissen fundoplication and were video-recorded for analysis. Two separate groups of surgeon reviewers (K.V.S. + M.B.; I.-P.H. + A.G.) were trained to evaluate laparoscopic suturing and knot tying performance using specific metrics. Subjects' operative performance was assessed by reviewers blinded to their training status and scored using an error-based, step specific scoring system to an inter-rater agreement of 80% or greater. Three primary performance measures were assessed: time, errors, and needle manipulations and comparisons between groups were made using a 1-way analysis of variance (ANOVA) with post-test.A total of 40 fundal sutures (10 in each group) were scored by 2 separate rater groups with inter-rater agreement consistently greater than 80%. Inter-rater agreement was highest with the EX group (91%, range 76%-100%) and lowest with the NR group (85%, range 81%-98%). On average, the EX group significantly outperformed the other groups with regards to time (P <.0001), errors (P <.002), and needle manipulations (P <.01). Performance of the TR group was comparable to the EX group with regards to errors and manipulations (P = not significant [NS]), and outperformed the NR and MS groups with regards to time (P <.05 and P <.001). Performance between the NR and MS groups were similar for all 3 measures.RESULTSA total of 40 fundal sutures (10 in each group) were scored by 2 separate rater groups with inter-rater agreement consistently greater than 80%. Inter-rater agreement was highest with the EX group (91%, range 76%-100%) and lowest with the NR group (85%, range 81%-98%). On average, the EX group significantly outperformed the other groups with regards to time (P <.0001), errors (P <.002), and needle manipulations (P <.01). Performance of the TR group was comparable to the EX group with regards to errors and manipulations (P = not significant [NS]), and outperformed the NR and MS groups with regards to time (P <.05 and P <.001). Performance between the NR and MS groups were similar for all 3 measures.This assessment method demonstrates discriminative validity. Time appears to be the most sensitive indicator of skill level, as significant differences between EX, TR, and NR/MS groups were seen. The methodology is transferable across different reviewers and is acceptable for high-stakes assessment.CONCLUSIONSThis assessment method demonstrates discriminative validity. Time appears to be the most sensitive indicator of skill level, as significant differences between EX, TR, and NR/MS groups were seen. The methodology is transferable across different reviewers and is acceptable for high-stakes assessment. Abstract Background The ideal objective assessment method for laparoscopic technical skills is difficult to achieve in the operating room. Recent “VR2OR” studies have used a blinded, 2-reviewer error-based video tape analysis for intraoperative performance assessment. This study examines the validity of this methodology applied to laparoscopic intracorporeal suturing and knot tying. Methods Four groups of subjects—experts (EX), surgery residents trained to expert criterion levels using simulation (TR), surgery residents receiving no supplemental training (NR), and medical students receiving simulation-based training (MS)—performed the fundal suturing portion of a laparoscopic Nissen fundoplication and were video-recorded for analysis. Two separate groups of surgeon reviewers (K.V.S. + M.B.; I.-P.H. + A.G.) were trained to evaluate laparoscopic suturing and knot tying performance using specific metrics. Subjects' operative performance was assessed by reviewers blinded to their training status and scored using an error-based, step specific scoring system to an inter-rater agreement of 80% or greater. Three primary performance measures were assessed: time, errors, and needle manipulations and comparisons between groups were made using a 1-way analysis of variance (ANOVA) with post-test. Results A total of 40 fundal sutures (10 in each group) were scored by 2 separate rater groups with inter-rater agreement consistently greater than 80%. Inter-rater agreement was highest with the EX group (91%, range 76%–100%) and lowest with the NR group (85%, range 81%–98%). On average, the EX group significantly outperformed the other groups with regards to time ( P <.0001), errors ( P <.002), and needle manipulations ( P <.01). Performance of the TR group was comparable to the EX group with regards to errors and manipulations ( P = not significant [NS]), and outperformed the NR and MS groups with regards to time ( P <.05 and P <.001). Performance between the NR and MS groups were similar for all 3 measures. Conclusions This assessment method demonstrates discriminative validity. Time appears to be the most sensitive indicator of skill level, as significant differences between EX, TR, and NR/MS groups were seen. The methodology is transferable across different reviewers and is acceptable for high-stakes assessment. Background The ideal objective assessment method for laparoscopic technical skills is difficult to achieve in the operating room. Recent "VR2OR" studies have used a blinded, 2-reviewer error-based video tape analysis for intraoperative performance assessment. This study examines the validity of this methodology applied to laparoscopic intracorporeal suturing and knot tying. Methods Four groups of subjects--experts (EX), surgery residents trained to expert criterion levels using simulation (TR), surgery residents receiving no supplemental training (NR), and medical students receiving simulation-based training (MS)--performed the fundal suturing portion of a laparoscopic Nissen fundoplication and were video-recorded for analysis. Two separate groups of surgeon reviewers (K.V.S. + M.B.; I.-P.H. + A.G.) were trained to evaluate laparoscopic suturing and knot tying performance using specific metrics. Subjects' operative performance was assessed by reviewers blinded to their training status and scored using an error-based, step specific scoring system to an inter-rater agreement of 80% or greater. Three primary performance measures were assessed: time, errors, and needle manipulations and comparisons between groups were made using a 1-way analysis of variance (ANOVA) with post-test. Results A total of 40 fundal sutures (10 in each group) were scored by 2 separate rater groups with inter-rater agreement consistently greater than 80%. Inter-rater agreement was highest with the EX group (91%, range 76%-100%) and lowest with the NR group (85%, range 81%-98%). On average, the EX group significantly outperformed the other groups with regards to time (P<.0001), errors (P<.002), and needle manipulations (P<.01). Performance of the TR group was comparable to the EX group with regards to errors and manipulations (P= not significant [NS]), and outperformed the NR and MS groups with regards to time (P<.05 andP<.001). Performance between the NR and MS groups were similar for all 3 measures. Conclusions This assessment method demonstrates discriminative validity. Time appears to be the most sensitive indicator of skill level, as significant differences between EX, TR, and NR/MS groups were seen. The methodology is transferable across different reviewers and is acceptable for high-stakes assessment. |
| Author | Goldenberg, Adam Ritter, E. Matt Huang, Ih-Ping Van Sickle, Kent R. Baghai, Mercedeh Smith, C. Daniel |
| Author_xml | – sequence: 1 givenname: Kent R. surname: Van Sickle fullname: Van Sickle, Kent R. email: sickle@uthscsa.edu organization: Department of Surgery, Division of General and Laparoendoscopic Surgery, University of Texas Health Science Center San Antonio, San Antonio, TX, USA – sequence: 2 givenname: Mercedeh surname: Baghai fullname: Baghai, Mercedeh organization: Emory Simulation Training and Robotics, Emory University School of Medicine, Atlanta, GA, USA – sequence: 3 givenname: Ih-Ping surname: Huang fullname: Huang, Ih-Ping organization: Emory Simulation Training and Robotics, Emory University School of Medicine, Atlanta, GA, USA – sequence: 4 givenname: Adam surname: Goldenberg fullname: Goldenberg, Adam organization: Emory Simulation Training and Robotics, Emory University School of Medicine, Atlanta, GA, USA – sequence: 5 givenname: C. Daniel surname: Smith fullname: Smith, C. Daniel organization: Emory Simulation Training and Robotics, Emory University School of Medicine, Atlanta, GA, USA – sequence: 6 givenname: E. Matt surname: Ritter fullname: Ritter, E. Matt organization: National Capital Area Medical Simulation Center, Uniformed Services University of the Health Sciences, Bethesda, MD, USA |
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| Keywords | Validation Objective assessment Intracorporeal knot tying Laparoscopic suturing Methodology Laparoscopy Method Medicine Test validation Construct validity Treatment Surgery Endoscopy |
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| Snippet | The ideal objective assessment method for laparoscopic technical skills is difficult to achieve in the operating room. Recent “VR2OR” studies have used a... Abstract Background The ideal objective assessment method for laparoscopic technical skills is difficult to achieve in the operating room. Recent “VR2OR”... The ideal objective assessment method for laparoscopic technical skills is difficult to achieve in the operating room. Recent "VR2OR" studies have used a... Background The ideal objective assessment method for laparoscopic technical skills is difficult to achieve in the operating room. Recent "VR2OR" studies have... |
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| Title | Construct validity of an objective assessment method for laparoscopic intracorporeal suturing and knot tying |
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