Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.
Montreal General Hospital Medical Library, McGill University Health Centre, 1650, Cedar Avenue, L9. 309, Montréal, QC, H3G 1A4, Canada.
Surg Endosc. 2019 Nov;33(11):3798-3805. doi: 10.1007/s00464-019-06662-9. Epub 2019 Jan 22.
Operative skills correlate with patient outcomes, yet at the completion of training or after learning a new procedure, these skills are rarely formally evaluated. There is interest in the use of summative video assessment of laparoscopic benign foregut and hiatal surgery (LFS). If this is to be used to determine competency, it must meet the robust criteria established for high-stakes assessments. The purpose of this review is to identify tools that have been used to assess performance of LFS and evaluate the available validity evidence for each instrument.
A systematic search was conducted up to July 2017. Eligible studies reported data on tools used to assess performance in the operating room during LFS. Two independent reviewers considered 1084 citations for eligibility. The characteristics and testing conditions of each assessment tool were recorded. Validity evidence was evaluated using five sources of validity (content, response process, internal structure, relationship to other variables, and consequences).
There were six separate tools identified. Two tools were generic to laparoscopy, and four were specific to LFS [two specific to Nissen fundoplication (NF), one heller myotomy (HM), and one paraesophageal hernia repair (PEH)]. Overall, only one assessment was supported by moderate evidence while the others had limited or unknown evidence. Validity evidence was based mainly on internal structure (all tools reporting reliability and item analysis) and content (two studies referencing previous papers for tool development in the context of clinical assessment, and four listing items without specifying the development procedures). There was little or no evidence supporting test response process (one study reporting rater training), relationship to other variables (two comparing scores in subjects with different clinical experience), and consequences (no studies). Two tools were identified to have evidence for video assessment, specific to NF.
There is limited evidence supporting the validity of assessment tools for laparoscopic foregut surgery. This precludes their use for summative video-based assessment to verify competency. Further research is needed to develop an assessment tool designed for this purpose.
手术技能与患者预后相关，但在培训结束或学习新手术程序后，这些技能很少得到正式评估。人们对腹腔镜良性前肠和食管裂孔手术（LFS）的总结性视频评估感兴趣。如果要将其用于确定能力，则必须符合高风险评估所建立的严格标准。本综述的目的是确定用于评估 LFS 性能的工具，并评估每种仪器的可用有效性证据。
系统检索截至 2017 年 7 月的文献。合格的研究报告了在 LFS 手术室中使用工具评估性能的数据。两名独立的审查员对 1084 条引用进行了资格审查。记录了每个评估工具的特征和测试条件。使用五种有效性来源（内容、反应过程、内部结构、与其他变量的关系和后果）评估有效性证据。
确定了六种不同的工具。两种工具适用于腹腔镜检查，四种工具专门用于 LFS[两种专门用于 Nissen 胃底折叠术（NF），一种 Heller 肌切开术（HM），一种食管裂孔疝修补术（PEH）]。总体而言，只有一种评估得到了中等证据的支持，而其他评估则证据有限或未知。有效性证据主要基于内部结构（所有工具均报告可靠性和项目分析）和内容（两项研究参考了以前的论文，以在临床评估的背景下制定工具，四项列出了项目而没有指定开发程序）。几乎没有或没有证据支持测试反应过程（一项研究报告了评分者培训），与其他变量的关系（两项研究比较了具有不同临床经验的受试者的分数）和后果（没有研究）。有两种工具被确定为具有 NF 特定的腹腔镜前肠手术视频评估的证据。
腹腔镜前肠手术评估工具的有效性证据有限。这排除了它们在总结性基于视频的评估中用于验证能力的用途。需要进一步研究来开发专门为此目的设计的评估工具。
