Construct validity testing of the Arthroscopic Knot Trainer (ArK)

  • Ivan H. Wong
  • Matthew Denkers
  • Nathan Urquhart
  • Forough Farrokhyar
Sports Medicine
First Online:
Received:
Accepted:

Abstract

Purpose

This study introduced a novel simulator called the Arthroscopic Knot Trainer (ArK) and reports preliminary evidence to support its construct validity. To our knowledge, the ArK is the first non-anatomical tissue reduction simulator designed to meet learning objectives specific for developing knot-tying skills.

Materials and methods

A step-by-step instructional video was used to teach orthopaedic residents how to tie an arthroscopic SMC knot. Residents were video recorded to assess time of completion, number of knots tied in 10 min and re-assessed 6 months later. Subjects were surveyed for content evidence after using the ArK. Data were analysed by paired t test and independent sample t test in order to compare the mean time to tie knots from test at baseline to retest at 6 months and the between group mean time, respectively.

Results

Content evidence supports the ArK trainer as appropriate for teaching and assessing arthroscopic knot-tying skills. Relation to other variables evidence supports the ArK trainer model whether stratified by year of training or by self-reported experience; time required for knot tying was inversely correlated with experience in tying arthroscopic knots. Internal structure evidence was supported with similar findings at retesting.

Conclusions

There are three sources of evidence supporting the construct validity of the ArK as a simulator for arthroscopic knot tying: content, relationship to other variable and internal structure evidence. The ArK is easy to use and has the capacity to distinguish between groups with different skill levels.

Level of evidence

II.

Keywords

Arthroscopy Knot tying Education Simulation 
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References

  1. 1.
    Anastakis DJ, Wanzel KR, Brown MH, McIlroy JH, Hamstra SJ, Ali J, Hutchison CR, Murnaghan J, Reznick RK, Regehr G (2003) Evaluating the effectiveness of a 2-year curriculum in a surgical skills center. Am J Surg 185:378–385CrossRefPubMedGoogle Scholar
  2. 2.
    Baumgarten KM, Wright RW (2010) Incorporating evidence-based medicine in arthroscopic knot preferences: a survey of American Orthopaedic Society for sports medicine members. Am J Ortho 39(12):577Google Scholar
  3. 3.
    Beckman TJ, Cook DA, Mandrekar JN (2005) What is the validity evidence for assessments of clinical teaching? J Gen Intern Med 20:1159–1164CrossRefPubMedCentralPubMedGoogle Scholar
  4. 4.
    Choy I, Okrainec A (2010) Simulation in surgery: perfecting the practice. Surg Clin North Am 90:457–473CrossRefPubMedGoogle Scholar
  5. 5.
    Cook DA, Beckman TJ (2006) Current concepts in validity and reliability for psychometric instruments: theory and application. Am J Med 119:166.e7–166.e16CrossRefGoogle Scholar
  6. 6.
    Cristancho SM, Moussa F, Dubrowski A (2011) A framework-based approach to designing simulation-augmented surgical education and training programs. Am J Surg 202:344–351CrossRefPubMedGoogle Scholar
  7. 7.
    Downing SM (2003) Validity: on meaningful interpretation of assessment data. Med Educ 37:830–837CrossRefPubMedGoogle Scholar
  8. 8.
    Grober ED, Hamstra SJ, Wanzel KR, Reznick RK, Matsumoto ED, Sidhu RS, Jarvi KA (2004) The educational impact of bench model fidelity on the acquisition of technical skill: the use of clinically relevant outcome measures. Ann Surg 240:374CrossRefPubMedCentralPubMedGoogle Scholar
  9. 9.
    Insel A, Carofino B, Leger R, Arciero R, Mazzocca AD (2009) The development of an objective model to assess arthroscopic performance. J Bone Jt Surg Am 91:2287–2295CrossRefGoogle Scholar
  10. 10.
    Kim SH, Ha KI (2000) The SMC knot—a new slip knot with locking mechanism. Arthroscopy 16:563–565CrossRefPubMedGoogle Scholar
  11. 11.
    Kneebone R (2003) Simulation in surgical training: educational issues and practical implications. Med Educ 37:267–277CrossRefPubMedGoogle Scholar
  12. 12.
    Lipsett PA, Kern DE (2009) Step 6: evaluation and feedback. In: Kern DE, Thomas PA, Hughes MT (eds) Curriculum development for medical education: a six-step approach, 2nd edn. The Johns Hopkins University Press, Baltimore, pp 101–141Google Scholar
  13. 13.
    Lo IKY, Ochoa E, Burkhart SS (2010) A comparison of knot security and loop security in arthroscopic knots tied with newer high-strength suture materials. Arthroscopy 26:S120–S126CrossRefPubMedGoogle Scholar
  14. 14.
    Mabrey JD, Gillogly SD, Kasser JR, Sweeney HJ, Zarins B, Mevis H, Garrett WE Jr, Poss R, Cannon WD (2002) Virtual reality simulation of arthroscopy of the knee. Arthroscopy 18:E28CrossRefPubMedGoogle Scholar
  15. 15.
    Matsumoto ED, Hamstra SJ, Radomski SB, Cusimano MD (2002) The effect of bench model fidelity on endourological skills: a randomized controlled study. J Urol 167:1243–1247CrossRefPubMedGoogle Scholar
  16. 16.
    McDougall EM (2007) Validation of surgical simulators. J Endourol 21:244–247CrossRefPubMedGoogle Scholar
  17. 17.
    Moulton C-AE, Dubrowski A, MacRae H, Graham B, Grober E, Reznick R (2006) Teaching surgical skills: what kind of practice makes perfect? A randomized, controlled trial. Ann Surg 244:400–409PubMedCentralPubMedGoogle Scholar
  18. 18.
    Palter VN, Grantcharov TP (2010) Simulation in surgical education. CMAJ 182:1191–1196. doi: 10.1503/cmaj.091743 CrossRefPubMedCentralPubMedGoogle Scholar
  19. 19.
    Punjabi VM, Bokor DJ, Pelletier MH, Walsh WR (2011) The effect on loop elongation and stress relaxation during longitudinal loading of FiberWire in shoulder arthroscopic knots. Arthroscopy 27:750–754CrossRefPubMedGoogle Scholar
  20. 20.
    Reznick RK, MacRae H (2006) Teaching surgical skills—changes in the wind. N Engl J Med 355:2664CrossRefPubMedGoogle Scholar
  21. 21.
    Safir O, Dubrowski A, Williams C, Hui Y, Backstein D, Carnahan H (2012) The benefits of fundamentals of laparoscopic surgery (FLS) training on simulated arthroscopy performance. Stud Health Technol Inf 173:412–417Google Scholar
  22. 22.
    Scott DJ, Cendan JC, Pugh CM, Minter RM, Dunnington GL, Kozar RA (2008) The changing face of surgical education: simulation as the new paradigm. J Surg Res 147:189–193CrossRefPubMedCentralPubMedGoogle Scholar
  23. 23.
    Srivastava S, Youngblood PL, Rawn C, Hariri S, Heinrichs WL, Ladd AL (2004) Initial evaluation of a shoulder arthroscopy simulator: establishing construct validity. J Should Elbow Surg 13:196–205CrossRefGoogle Scholar
  24. 24.
    Tavakol M, Mohagheghi MA, Dennick R (2008) Assessing the skills of surgical residents using simulation. J Surg Educ 65:77–83CrossRefPubMedGoogle Scholar
  25. 25.
    Tuijthof GJM, van Sterkenburg MN, Sierevelt IN, van Oldenrijk J, van Dijk CN, Kerkhoffs GMMJ (2010) First validation of the PASSPORT training environment for arthroscopic skills. Knee Surg Sports Traumatol Arthrosc 18:218–224CrossRefPubMedGoogle Scholar
  26. 26.
    Wanzel KR, Ward M, Reznick RK (2002) Teaching the surgical craft: from selection to certification. Curr Probl Surg 39:573–659CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Ivan H. Wong
    • 1
  • Matthew Denkers
    • 2
  • Nathan Urquhart
    • 1
  • Forough Farrokhyar
    • 3
  1. 1.HalifaxCanada
  2. 2.Hamilton General HospitalHamiltonCanada
  3. 3.HamiltonCanada

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