RESUMEN
BACKGROUND: Simulation is increasingly being explored as an assessment modality. This study sought to develop and collate validity evidence for a novel simulation-based assessment of operative competence. We describe the approach to assessment design, development, pilot testing, and validity investigation. METHODS: Eight procedural stations were generated using both virtual reality and bio-hybrid models. Content was identified from a previously conducted Delphi consensus study of trainers. Trainee performance was scored using an equally weighted Objective Structured Assessment of Technical Skills (OSATS) tool and a modified Procedure-Based Assessment (PBA) tool. Validity evidence was analyzed in accordance with Messick's validity framework. Both 'junior' (ST2-ST4) and 'senior' trainees (ST 5-ST8) were included to allow for comparative analysis. RESULTS: Thirteen trainees were assessed by ten assessors across eight stations. Inter-station reliability was high (α = 0.81), and inter-rater reliability was acceptable (inter-class correlation coefficient 0.77). A significant difference in mean station score was observed between junior and senior trainees (44.82 vs 58.18, p = .004), while overall mean scores were moderately correlated with increasing training year (rs = .74, p = .004, Kendall's tau-b .57, p = 0.009). A pass-fail score generated using borderline regression methodology resulted in all 'senior' trainees passing and 4/6 of junior trainees failing the assessment. CONCLUSION: This study reports validity evidence for a novel simulation-based assessment, designed to assess the operative competence of higher specialist trainees in general surgery.
Asunto(s)
Competencia Clínica , Evaluación Educacional , Cirugía General , Entrenamiento Simulado , Humanos , Cirugía General/educación , Entrenamiento Simulado/métodos , Reproducibilidad de los Resultados , Evaluación Educacional/métodos , Educación de Postgrado en Medicina/métodos , Realidad Virtual , Proyectos Piloto , Técnica Delphi , Simulación por ComputadorRESUMEN
Robot-assisted partial nephrectomy (RAPN) has rapidly evolved as the standard of care for appropriately selected renal tumours, offering key patient benefits over radical nephrectomy or open surgical approaches. Accordingly, RAPN is a key competency that urology trainees wishing to treat kidney cancer must master. Training in robotic surgery is subject to numerous challenges, and simulation has been established as valuable step in the robotic learning curve. However, simulation models are often both expensive and suboptimal in fidelity. This means that the number of practice repetitions for a trainee may limited by cost restraints, and that trainees may struggle to reconcile the skills obtained in the simulation laboratory with real-world practice in the operating room. We have developed a high-fidelity, low-cost, customizable model for RAPN simulation based on porcine tissue. The model has been utilised in teaching courses at our institution, confirming both feasibility of use and high user acceptability. We share the design of our model in this proof-of-concept report.
Asunto(s)
Carcinoma de Células Renales , Neoplasias Renales , Procedimientos Quirúrgicos Robotizados , Robótica , Humanos , Animales , Porcinos , Procedimientos Quirúrgicos Robotizados/métodos , Nefrectomía/educación , Neoplasias Renales/cirugía , Neoplasias Renales/patología , Carcinoma de Células Renales/cirugía , Resultado del TratamientoRESUMEN
OBJECTIVE: Thoracotomy is an acute, time-sensitive procedure. Simulation-based education provides a safe-learning platform to learn these techniques under close supervision. METHODS: We used the spiral model and concepts of functional fidelity to guide the evolutionary design and fabrication of a hybrid thoracotomy simulator. RESULTS: This model simulates a clamshell thoracotomy that physically integrates with bespoke manikins and adds a high-fidelity technical skills element to immersive team-based simulation training. CONCLUSIONS: We describe the creation of a thoracotomy simulation model that allows trainees to practice these techniques in a safe-learning environment.