Bayona Sofia, Akhtar Kash, Gupte Chinmay, Emery Roger J H, Dodds Alexander L, Bello Fernando
Department of Computer Architecture and Technology, Computing Sciences, and Artificial Intelligence, Universidad Rey Juan Carlos, Calle Tulipán s/n, 28933 Móstoles, Madrid, Spain. E-mail address:
Department of Surgery and Cancer, Imperial College London, Fulham Palace Road, London, W68RF United Kingdom. E-mail address for C. Gupte:
J Bone Joint Surg Am. 2014 Jul 2;96(13):e112. doi: 10.2106/JBJS.M.00304.
Surgical training is undergoing major changes with reduced resident work hours and an increasing focus on patient safety and surgical aptitude. The aim of this study was to create a valid, reliable method for an assessment of arthroscopic skills that is independent of time and place and is designed for both real and simulated settings. The validity of the scale was tested using a virtual reality shoulder arthroscopy simulator.
The study consisted of two parts. In the first part, an Imperial Global Arthroscopy Rating Scale for assessing technical performance was developed using a Delphi method. Application of this scale required installing a dual-camera system to synchronously record the simulator screen and body movements of trainees to allow an assessment that is independent of time and place. The scale includes aspects such as efficient portal positioning, angles of instrument insertion, proficiency in handling the arthroscope and adequately manipulating the camera, and triangulation skills. In the second part of the study, a validation study was conducted. Two experienced arthroscopic surgeons, blinded to the identities and experience of the participants, each assessed forty-nine subjects performing three different tests using the Imperial Global Arthroscopy Rating Scale. Results were analyzed using two-way analysis of variance with measures of absolute agreement. The intraclass correlation coefficient was calculated for each test to assess inter-rater reliability.
The scale demonstrated high internal consistency (Cronbach alpha, 0.918). The intraclass correlation coefficient demonstrated high agreement between the assessors: 0.91 (p < 0.001). Construct validity was evaluated using Kruskal-Wallis one-way analysis of variance (chi-square test, 29.826; p < 0.001), demonstrating that the Imperial Global Arthroscopy Rating Scale distinguishes significantly between subjects with different levels of experience utilizing a virtual reality simulator.
The Imperial Global Arthroscopy Rating Scale has a high internal consistency and excellent inter-rater reliability and offers an approach for assessing technical performance in basic arthroscopy on a virtual reality simulator.
The Imperial Global Arthroscopy Rating Scale provides detailed information on surgical skills. Although it requires further validation in the operating room, this scale, which is independent of time and place, offers a robust and reliable method for assessing arthroscopic technical skills.
随着住院医师工作时长的减少以及对患者安全和手术能力的日益关注，外科培训正在经历重大变革。本研究的目的是创建一种有效、可靠的评估关节镜技术的方法，该方法不受时间和地点限制，适用于真实和模拟场景。使用虚拟现实肩关节镜模拟器对该量表的有效性进行了测试。
本研究包括两个部分。在第一部分中，采用德尔菲法制定了用于评估技术操作的帝国全球关节镜评分量表。应用该量表需要安装双摄像头系统，以同步记录模拟器屏幕和学员的身体动作，从而实现不受时间和地点限制的评估。该量表包括有效入路定位、器械插入角度、关节镜操作熟练度、摄像头充分操控能力以及三角测量技能等方面。在研究的第二部分，进行了一项验证研究。两名经验丰富的关节镜外科医生在不知道参与者身份和经验的情况下，各自使用帝国全球关节镜评分量表对49名进行三种不同测试的受试者进行评估。使用双向方差分析和绝对一致性测量方法对结果进行分析。计算每个测试的组内相关系数以评估评分者间的可靠性。
该量表显示出较高的内部一致性（克朗巴哈α系数为0.918）。组内相关系数显示评估者之间具有高度一致性：0.91（p < 0.001）。使用Kruskal-Wallis单向方差分析（卡方检验，29.826；p < 0.001）评估结构效度，结果表明帝国全球关节镜评分量表能够显著区分使用虚拟现实模拟器的不同经验水平的受试者。
帝国全球关节镜评分量表具有较高的内部一致性和出色的评分者间可靠性，并为在虚拟现实模拟器上评估基本关节镜检查的技术操作提供了一种方法。
帝国全球关节镜评分量表提供了有关手术技能的详细信息。尽管它需要在手术室中进一步验证，但这种不受时间和地点限制的量表为评估关节镜技术技能提供了一种强大而可靠的方法。
