Barsness Katherine A, Rooney Deborah M, Davis Lauren M, O'Brien Ellie
1 Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois.
J Laparoendosc Adv Surg Tech A. 2015 May;25(5):429-34. doi: 10.1089/lap.2014.0364. Epub 2014 Dec 23.
Thoracoscopic lobectomy in infants requires advanced minimally invasive skills. Simulation-based education has the potential to improve complex procedural skills without exposing the patient to undue risks. The study purposes were (1) to create a size-appropriate infant lobectomy simulator and (2) to evaluate validity evidence to support or refute its use in surgical education.
In this Institutional Review Board-exempt study, a size-appropriate rib cage for a 3-month-old infant was created. Fetal bovine tissue completed the simulator. Thirty-three participants performed the simulated thoracoscopic lobectomy. Participants completed a self-report, 26-item instrument consisting of 25 4-point rating scales (from 1=not realistic to 4=highly realistic) and a one 4-point Global Rating Scale. Validity evidence relevant to test content and response processes was evaluated using the many-facet Rasch model, and evidence of internal structure (inter-item consistency) was estimated using Cronbach's alpha.
Experienced surgeons (observed average=3.6) had slightly higher overall rating than novice surgeons (observed average=3.4, P=.001). The highest combined observed averages were for the domain Physical Attributes (3.7), whereas the lowest ratings were for the domains Realism of Experience and Ability to Perform Tasks (3.4). The global rating was 2.9, consistent with "this simulator can be considered for use in infant lobectomy training, but could be improved slightly." Inter-item consistency for items used to evaluate the simulator's quality was high (α=0.90).
With ratings consistent with high physical attributes and realism, we successfully created an infant lobectomy simulator, and preliminary evidence relevant to test content, response processes, and internal structure was supported. Participants rated the model as realistic, relevant to clinical practice, and valuable as a learning tool. Minor improvements were suggested prior to its full implementation as an educational and testing tool.
婴儿胸腔镜肺叶切除术需要先进的微创技术。基于模拟的教育有潜力提高复杂的手术技能，同时避免让患者承受不必要的风险。本研究的目的是：（1）创建一个尺寸合适的婴儿肺叶切除术模拟器；（2）评估支持或反驳其在外科教育中应用的有效性证据。
在这项经机构审查委员会豁免的研究中，制作了一个适合3个月大婴儿尺寸的胸腔模型。用胎牛组织完善模拟器。33名参与者进行了模拟胸腔镜肺叶切除术。参与者完成一份自我报告，这是一份包含25个4分制评分量表（从1分=不真实到4分=非常真实）和一个4分制整体评分量表的26项工具。使用多面Rasch模型评估与测试内容和反应过程相关的有效性证据，并用Cronbach's α估计内部结构（项目间一致性）的证据。
经验丰富的外科医生（观察平均值=3.6）的总体评分略高于新手外科医生（观察平均值=3.4，P = 0.001）。观察到的综合平均值最高的是“物理属性”领域（3.7），而评分最低的是“经验真实性”和“执行任务能力”领域（3.4）。整体评分为2.9，与“该模拟器可考虑用于婴儿肺叶切除术培训，但可稍作改进”一致。用于评估模拟器质量的项目间一致性较高（α = 0.90）。
该模拟器在物理属性和真实性方面的评分较高，我们成功创建了一个婴儿肺叶切除术模拟器，并获得了与测试内容、反应过程和内部结构相关的初步证据支持。参与者将该模型评为真实、与临床实践相关且作为学习工具很有价值。在将其全面用作教育和测试工具之前，建议进行一些小的改进。
