Jensen Katrine, Bjerrum Flemming, Hansen Henrik Jessen, Petersen René Horsleben, Pedersen Jesper Holst, Konge Lars
Department of Cardiothoracic Surgery, Sect. 2152, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark.
Copenhagen Academy for Medical Education and Simulation (CAMES), Section 5404, University of Copenhagen and Capital Region, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Copenhagen, Denmark.
Surg Endosc. 2017 Jun;31(6):2520-2528. doi: 10.1007/s00464-016-5254-6. Epub 2016 Sep 21.
The societies of thoracic surgery are working to incorporate simulation and competency-based assessment into specialty training. One challenge is the development of a simulation-based test, which can be used as an assessment tool. The study objective was to establish validity evidence for a virtual reality simulator test of a video-assisted thoracoscopic surgery (VATS) lobectomy of a right upper lobe.
Participants with varying experience in VATS lobectomy were included. They were familiarized with a virtual reality simulator (LapSim) and introduced to the steps of the procedure for a VATS right upper lobe lobectomy. The participants performed two VATS lobectomies on the simulator with a 5-min break between attempts. Nineteen pre-defined simulator metrics were recorded.
Fifty-three participants from nine different countries were included. High internal consistency was found for the metrics with Cronbach's alpha coefficient for standardized items of 0.91. Significant test-retest reliability was found for 15 of the metrics (p-values <0.05). Significant correlations between the metrics and the participants VATS lobectomy experience were identified for seven metrics (p-values <0.001), and 10 metrics showed significant differences between novices (0 VATS lobectomies performed) and experienced surgeons (>50 VATS lobectomies performed). A pass/fail level defined as approximately one standard deviation from the mean metric scores for experienced surgeons passed none of the novices (0 % false positives) and failed four of the experienced surgeons (29 % false negatives).
This study is the first to establish validity evidence for a VATS right upper lobe lobectomy virtual reality simulator test. Several simulator metrics demonstrated significant differences between novices and experienced surgeons and pass/fail criteria for the test were set with acceptable consequences. This test can be used as a first step in assessing thoracic surgery trainees' VATS lobectomy competency.
胸外科协会正致力于将模拟和基于能力的评估纳入专科培训。其中一个挑战是开发一种基于模拟的测试，可将其用作评估工具。本研究的目的是为右上叶电视辅助胸腔镜手术（VATS）肺叶切除术的虚拟现实模拟器测试建立效度证据。
纳入了在VATS肺叶切除术中经验各异的参与者。他们熟悉了虚拟现实模拟器（LapSim），并了解了VATS右上叶肺叶切除术的步骤。参与者在模拟器上进行了两次VATS肺叶切除术，两次尝试之间休息5分钟。记录了19个预先定义的模拟器指标。
纳入了来自9个不同国家的53名参与者。这些指标具有较高的内部一致性，标准化项目的Cronbach's alpha系数为0.91。15个指标具有显著的重测信度（p值<0.05）。7个指标在指标与参与者的VATS肺叶切除术经验之间发现了显著相关性（p值<0.001），10个指标在新手（未进行VATS肺叶切除术）和经验丰富的外科医生（进行>50例VATS肺叶切除术）之间显示出显著差异。将通过/失败水平定义为与经验丰富的外科医生的平均指标得分相差约一个标准差，没有新手通过（假阳性率为0%），4名经验丰富的外科医生未通过（假阴性率为29%）。
本研究首次为VATS右上叶肺叶切除术虚拟现实模拟器测试建立了效度证据。几个模拟器指标在新手和经验丰富的外科医生之间显示出显著差异，并且设定的测试通过/失败标准具有可接受的结果。该测试可作为评估胸外科住院医师VATS肺叶切除术能力的第一步。
