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The San Antonio kidney transplant model: validity evidence and proficiency benchmarks

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Global Surgical Education - Journal of the Association for Surgical Education Aims and scope Submit manuscript

Abstract

Purpose

Simulation has become an increasingly important tool in training complex and high-stake surgical techniques, including kidney transplantation. While several kidney transplant models have been described, there remains a need for a low-cost model with established proficiency targets.

Methods

We developed a low-cost kidney transplant model to simulate a renal vein to iliac vein end-to-side anastomosis, and a proficiency-based curriculum to prepare and evaluate trainees. This low-fidelity model utilizes a constrained space and adjustable depth to simulate the iliac fossa, with replaceable Penrose drains as vascular conduits. 18 novices (PGY1), 19 junior intermediates (PGY 2–3), 7 senior intermediates (PGY 4–5) and 6 experts (faculty transplant surgeons) each performed anastomoses on the model. Three metrics were used to rate each performance—completion time, a scoring rubric, and a composite technical score (CTS) formula. Messick’s validity framework was used to evaluate the model and scoring rubric to provide evidence for content alignment, response process validity, internal structure validity, and construct validity.

Results

Resident participants reported the model was easy to set up (8.6/10) and added value to their surgical education (9.8/10). Transplant surgery faculty reported the model realistically simulated an end-to-side renal vein anastomosis (8.3/10), supporting content alignment. One-way ANOVAs for each of the three metrics was statistically significant across all skill levels (p < 0.001), supporting construct validity. Response process validity was achieved using blinded raters to review the video performances. Finally, inter-rater reliability was obtained with an intraclass correlation coefficient of 0.896 (< 0.001), supporting internal structure validity.

Conclusion

We utilized Messick’s validity framework to provide validity evidence for a low-cost, low-fidelity kidney transplant model and a scoring rubric. Furthermore, we provided proficiency benchmarks for trainees to train towards. This model is well suited for preparing surgical trainees to perform in vivo kidney transplants.

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Data availability

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

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Acknowledgements

We would like to thank the Surgical Education Research Fellowship (SERF) for supporting this project and Dr. Daniel Scott for being my SERF mentor. We would like to thank the Ruth L Kirschstein NRSA Institutional Research Training Grant (T32CA148724 awarded to Dr. Mustafa Khan). We would like to acknowledge the transplant surgery faculty at UT Health San Antonio for their support in making this project a reality. Finally, we would like to thank Sushmitha Ramesh, MD, for her arterial anastomosis illustrations for the next iteration.

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Correspondence to Ronit Patnaik.

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Supplementary file1 Appendix: A) Video of performance (DOCX 15 KB)

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Patnaik, R., Khan, M.T.A., Willis, R.E. et al. The San Antonio kidney transplant model: validity evidence and proficiency benchmarks. Global Surg Educ 1, 39 (2022). https://doi.org/10.1007/s44186-022-00041-0

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