Barsness Katherine A, Rooney Deborah M, Davis Lauren M
Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
J Laparoendosc Adv Surg Tech A. 2013 Aug;23(8):714-8. doi: 10.1089/lap.2013.0196. Epub 2013 Jun 22.
Thoracoscopic diaphragmatic hernia (DH) repair has a high recurrence rate. Effective simulation modeling may improve technical performance for thoracoscopic DH repair. The study purpose was to evaluate measures of validity evidence for a low-cost thoracoscopic DH simulator.
Synthetic diaphragm/intestine was connected to a to-scale left-sided neonatal rib cage and then covered with synthetic skin. Forty participants evaluated the DH repair simulator, using survey ratings that were analyzed for test content and internal structure validity evidence.
Observed averages (on a scale of 0-5) for the domains were 4.6 for Relevance, 4.5 for Value, 4.3 for Physical attributes, 4.0 for Realism of experience, 3.8 for Realism of materials, and 4.2 for Ability to perform. The highest observed averages were "relevance to practice" and "value, testing tool," whereas the lowest ratings were realism, intestines and realism, diaphragm. The observed average of global opinion ratings was 2.84/4.0, indicating the simulator can be considered for teaching thoracoscopic DH repair but could be improved. Experienced surgeons (more than eight DH repairs, at least four thoracoscopic repairs) had higher overall ratings than inexperienced surgeons (4.4 versus 4.1, P=.001).
We successfully created a thoracic space relevant to a thoracoscopic DH repair and completed the model using inexpensive, readily accessible materials. After participants performed a simulated thoracoscopic DH repair, their ratings indicated the simulator was relevant to clinical practice and valuable as a learning tool but still requires improvements. Improvements and additional evaluation of validity evidence (content, internal structure, response processes, and relationship to other variables) are necessary prior to full implementation of this model as an educational tool.
胸腔镜下膈疝（DH）修补术的复发率较高。有效的模拟模型可能会提高胸腔镜下DH修补术的技术水平。本研究的目的是评估一种低成本胸腔镜DH模拟器的效度证据指标。
将合成的膈肌/肠管连接到按比例缩小的左侧新生儿胸廓上，然后用合成皮肤覆盖。40名参与者对DH修补模拟器进行了评估，使用调查问卷评分，对测试内容和内部结构效度证据进行分析。
各领域的观察平均值（0-5分制）分别为：相关性4.6分、价值4.5分、物理属性4.3分、体验真实感4.0分、材料真实感3.8分、操作能力4.2分。观察到的最高平均值是“与实践的相关性”和“价值，测试工具”，而最低评分是肠管真实感和膈肌真实感。总体意见评分的观察平均值为2.84/4.0，表明该模拟器可考虑用于胸腔镜下DH修补术的教学，但仍有改进空间。经验丰富的外科医生（进行过超过8次DH修补术，至少4次胸腔镜修补术）的总体评分高于经验不足的外科医生（4.4分对4.1分，P=0.001）。
我们成功创建了一个与胸腔镜下DH修补术相关的胸腔空间，并使用廉价、易于获取的材料完成了模型制作。参与者进行模拟胸腔镜下DH修补术后的评分表明，该模拟器与临床实践相关，作为学习工具具有价值，但仍需改进。在将该模型作为教育工具全面实施之前，有必要对效度证据（内容、内部结构、反应过程以及与其他变量的关系）进行改进和进一步评估。
