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Validation of a six-task simulation model in minimally invasive surgery

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Abstract

Background

The content validity of currently available inanimate simulation models is questionable, because some tasks seem too far from clinical reality. The aim of this study was to validate a simulation model with six tasks commonly used in clinical practice (6-TSM) for the acquisition of psychomotor skills in minimally invasive surgery (MIS).

Methods

This was a prospective randomized trial comparing the 6-TSM to a previously described three-task training method (3-TTM). All first, second, and third postgraduate year surgical residents were eligible. The 6-TSM included clipping and dividing of a vessel, excision of lesion, appendectomy, mesh repair, suturing perforation, and hand-sewn anastomosis. The outcome measures of 6-TSM included accuracy error, tissue damage, sliding knot, leak, operating time, and dangerous movements. After completion of training, 6-TSM and 3-TTN residents were tested by the Minimally Invasive Surgical Trainer—Virtual Reality (MIST-VR). Criterion-related and construct validity, responsiveness, test–retest, and interrater reliability were assessed.

Results

During six months, 17 residents underwent training with the 6-TSM or the 3-TTM as allocated. The mean duration of training with 6-TSM and 3-TTM was similar (7.8 vs 8.1 h). The criterion-related validity of the 6-TSM was shown by significantly increased skill improvement in the 6-TSM residents, as compared with the 3-TTM residents at MIST-VR. Construct validity the of 6-TSM was shown by the finding that the experts’ baseline was superior to the residents’ baseline. The responsiveness of the 6-TSM was shown by the significantly increased skill improvement of the 6-TSM residents in sliding knot, leak, and operating time. The test–retest reliability of the 6-TSM was good (> 0.80), except for accuracy error and dangerous movements (Cronbach’s intraclass correlation coefficient α: 0.57, p < 0.0001; 0.62, p < 0.0001, respectively). The interrater reliability of the 6-TSM was good (>0.80) except for leak (Kendall’s concordance coefficient tau_b:0.76, p = 0.06 for hand-sewn anastomosis) and dangerous movements (tau_b:0.72, p = 0.08 for suturing perforation and tau_b:0.68, p = 0.10 for hand-sewn anastomosis). The perresident cost for 6-TSM was $769.

Conclusions

The 6-TSM is a valid and reliable learning tool for surgical residents’ acquisition of laparoscopic motor skills.

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Authors and Affiliations

  1. Minimally Invasive Surgery Center, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA, 15212, USA

    M. Uchal, Y. Raftopoulos & R. Bergamaschi

  2. Department for Research and Development, Forde Health System, Forde, Norway

    J. Tjugum

Authors
  1. M. Uchal
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  2. Y. Raftopoulos
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  3. J. Tjugum
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  4. R. Bergamaschi
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Corresponding author

Correspondence to R. Bergamaschi.

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Uchal, M., Raftopoulos, Y., Tjugum, J. et al. Validation of a six-task simulation model in minimally invasive surgery. Surg Endosc 19, 109–116 (2005). https://doi.org/10.1007/s00464-004-8145-1

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