Schijven Marlies P, Jakimowicz Jack J, Carter Fiona J
Department of Surgery, Erasmus Medical Center, Dr. Molewaterplein 40, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
J Surg Res. 2004 Sep;121(1):112-9. doi: 10.1016/j.jss.2004.02.005.
Although a controversial topic in medical education, the selection of aspirant surgical trainees is a subject that needs to be addressed. In the view of preventing surgical trainee drop-outs and of appropriate allocation of limited resources, it is an issue critical to the profession. Traditional methods of selection are often subjective, and do not seem to correlate with skill needed for surgery. Standardized neuropsychometric test batteries may be useful in helping to select aspirant laparoscopic surgeons. Our study attempts to link surgical novices' psychometric ability test battery data with actual performance outcome on an objective, validated, and reproducible surgical laparoscopic task using virtual-reality simulation.
Thirty-three novices with no laparoscopic surgical experience participated. Each participant performed the Xitact LS500 Virtual Reality cholecystectomy clip-and-cut module 30 times. Individual learning curves were computed and patterns were assessed. Participants were examined using the aptitude test battery including the Abstract Reasoning test, the Space Relations test, the Gibson Spiral Maze test, and the Crawford Small Parts Dexterity tester.
Over 900 virtual-reality simulation tasks were generated and assessed. Of the participants, 93.3% were able to complete the virtual-reality simulation 30 times and all elements of our aptitude test battery. The abstract reasoning test is the only test correlating significantly to Xitact test outcome. This test is highly correlated to the space relations test. Both tests have discriminative power, comparing groups of performers.
The present study addresses the concurrent validity in aptitude testing, comparing scores of surgical novices on the Xitact LS500 laparoscopic cholecystectomy virtual-reality simulation with performance scores on a battery of standardized psychometric aptitude tests. The abstract reasoning and the space-relation test have predictive and selective value, identifying individuals who have good laparoscopic surgical virtual-reality performance. Aspiring laparoscopic surgeons who score below 25 on either test, that is, an expected 36%, would have to be further assessed using Xitact surgical task performance. The group of participants scoring above 35 on the Abstract Reasoning test and above 45 on the Space Relations test, that is, an expected 18% of the population, is unlikely to mal-perform on Xitact. The other 46% could very well benefit from Xitact simulation and assessment when the opportunity is present.
尽管在医学教育中是一个有争议的话题，但有志于成为外科实习生的选拔是一个需要解决的问题。从防止外科实习生辍学和合理分配有限资源的角度来看，这是该行业的一个关键问题。传统的选拔方法往往主观，而且似乎与手术所需技能无关。标准化的神经心理测试组合可能有助于选拔有志于成为腹腔镜外科医生的人。我们的研究试图将外科新手的心理测试组合数据与使用虚拟现实模拟在客观、有效且可重复的外科腹腔镜任务中的实际表现结果联系起来。
33名没有腹腔镜手术经验的新手参与了研究。每位参与者进行了30次Xitact LS500虚拟现实胆囊切除术夹切模块操作。计算了个体学习曲线并评估了模式。使用包括抽象推理测试、空间关系测试、吉布森螺旋迷宫测试和克劳福德小零件灵巧度测试仪在内的能力测试组合对参与者进行了检查。
生成并评估了900多个虚拟现实模拟任务。在参与者中，93.3%能够完成30次虚拟现实模拟以及我们能力测试组合的所有项目。抽象推理测试是唯一与Xitact测试结果显著相关的测试。该测试与空间关系测试高度相关。在比较不同表现水平的组时，这两项测试都具有区分能力。
本研究探讨了能力测试中的同时效度，将外科新手在Xitact LS500腹腔镜胆囊切除术虚拟现实模拟中的得分与一系列标准化心理能力测试的表现得分进行了比较。抽象推理和空间关系测试具有预测和选择价值，能够识别出在腹腔镜手术虚拟现实表现良好的个体。在这两项测试中任何一项得分低于25分的有志于成为腹腔镜外科医生的人，即预计占36%，将必须使用Xitact手术任务表现进行进一步评估。在抽象推理测试中得分高于35分且在空间关系测试中得分高于45分的参与者组，即预计占总体的18%，在Xitact测试中不太可能表现不佳。当有机会时，其他46%的人很可能会从Xitact模拟和评估中受益。
