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Development and evaluation of a virtual knowledge assessment tool for transanal total mesorectal excision

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Abstract

Background

Transanal total mesorectal excision (TATME) is difficult to learn and can result in serious complications. Current paradigms for assessing performance and competency may be insufficient. This study aims to develop and provide preliminary validity evidence for a TATME virtual assessment tool (TATME-VAT) to assess the cognitive skills necessary to safely complete TATME dissection.

Methods

Participants from North America, Europe, Japan and China completed the test via an interactive online platform between 11/2019 and 05/2020. They were grouped into expert, experienced and novice surgeons depending on the number of independently performed TATMEs. TATME-VAT is a 24-item web-based assessment evaluating advanced cognitive skills, designed according to a blueprint from consensus guidelines. Eight items were multiple choice questions. Sixteen items required making annotations on still frames of TATME videos (VCT) and were scored using a validated algorithm derived from experts’ responses. Annotation (range 0–100), multiple choice (range 0–100), and overall scores (sum of annotation and multiple-choice scores, normalized to μ = 50 and σ = 10) were reported.

Results

There were significant differences between the expert, experienced, and novice groups for the annotation (p < 0.001), multiple-choice (p < 0.001), and overall scores (p < 0.001). The annotation (p = 0.439) and overall (p = 0.152) scores were similar between the experienced and novice groups. Annotation scores were higher in participants with 51 or more vs. 30–50 vs. less than 30 cases. Scores were also lower in users with a self-reported recent complication vs. those without.

Conclusions

This study describes the development of an interactive video-based virtual assessment tool for TATME dissection and provides initial validity evidence for its use.

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Availability of data and material

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

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Funding

LL is supported by a Career Development Award from the American Society of Colon and Rectal Surgeons (CDA-019).

Author information

Authors and Affiliations

  1. The Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Center, Montreal, QC, Canada

    Hamzeh Naghawi, Johnny Chau, Pepa Kaneva, Carmen Mueller & Lawrence Lee

  2. The University Health Network – Toronto General Hospital, Toronto, ON, Canada

    Amin Madani

  3. AdventHealth Medical Group, Orlando, FL, USA

    John Monson

  4. Colon and Rectal Surgery, Department of Surgery, McGill University Health Centre, 1001 Decarie Boulevard, DS1-3310, Montreal, QC, H4A 3J1, Canada

    Lawrence Lee

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  1. Hamzeh Naghawi
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Contributions

Conceptualization: HN, JC, AM, JM, CM, LL. Data acquisition and analysis: HN, JC, PK CM, LL. Interpretation of the data: HN, JC, AM, PK, JM, CM, LL. Drafting of the manuscript: HN, PK, CM, LL. Critical revision: JC, PK, AM, JM, CM, LL. Approval of the final version to be submitted: HN, JC, AM, JK, JM, CM, LL.

Corresponding author

Correspondence to Lawrence Lee.

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Conflict of interest

Dr. Hamzeh Naghawi: No conflicts of interest. Dr. Johnny Chau: No conflicts of interest. Dr. Amin Madani: No conflicts of interest. Ms. Pepa Kaneva: No conflicts of interest. Dr. John Monson: JM reports speaker fees from Applied Medical. Dr. Carmen Mueller: CM reports educational grant from TheatOR. Dr. Lawrence Lee: LL is supported by a Career Development Award from the American Society of Colon and Rectal Surgeons (CDA-019). LL also reports speaker fees from Stryker.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Ethics approval for this study has been granted by the McGill University Faculty of Medicine institutional review board under IRB study number A09-E66-18B.

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Informed consent was obtained from all individual participants included in the study.

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Naghawi, H., Chau, J., Madani, A. et al. Development and evaluation of a virtual knowledge assessment tool for transanal total mesorectal excision. Tech Coloproctol 26, 551–560 (2022). https://doi.org/10.1007/s10151-022-02621-0

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  • DOI: https://doi.org/10.1007/s10151-022-02621-0

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