Orsi Academy, Proefhoevestraat 12, 9090, Ghent, Belgium.
Department of Urology, Hospital da Luz, Lisbon, Portugal.
J Robot Surg. 2024 Apr 2;18(1):153. doi: 10.1007/s11701-024-01911-z.
Robot-assisted partial nephrectomy (RAPN) is a complex and index procedure that urologists need to learn how to perform safely. No validated performance metrics specifically developed for a RAPN training model (TM) exist. A Core Metrics Group specifically adapted human RAPN metrics to be used in a newly developed RAPN TM, explicitly defining phases, steps, errors, and critical errors. A modified Delphi meeting concurred on the face and content validation of the new metrics. One hundred percent consensus was achieved by the Delphi panel on 8 Phases, 32 Steps, 136 Errors and 64 Critical Errors. Two trained assessors evaluated recorded video performances of novice and expert RAPN surgeons executing an emulated RAPN in the newly developed TM. There were no differences in procedure Steps completed by the two groups. Experienced RAPN surgeons made 34% fewer Total Errors than the Novice group. Performance score for both groups was divided at the median score using Total Error scores, into HiError and LoError subgroups. The LowErrs Expert RAPN surgeons group made 118% fewer Total Errors than the Novice HiErrs group. Furthermore, the LowErrs Expert RAPN surgeons made 77% fewer Total Errors than the HiErrs Expert RAPN surgeons. These results established construct and discriminative validity of the metrics. The authors described a novel RAPN TM and its associated performance metrics with evidence supporting their face, content, construct, and discriminative validation. This report and evidence support the implementation of a simulation-based proficiency-based progression (PBP) training program for RAPN.
机器人辅助部分肾切除术(RAPN)是一项复杂的指标性手术,泌尿科医生需要学习如何安全地进行。目前还没有专门为 RAPN 培训模型(TM)开发的经过验证的绩效指标。一个核心指标小组专门将人类 RAPN 指标进行了改编,以便在新开发的 RAPN TM 中使用,明确定义了阶段、步骤、错误和关键错误。经过修改的德尔菲会议一致认为新指标具有表面和内容有效性。德尔菲小组在 8 个阶段、32 个步骤、136 个错误和 64 个关键错误上达成了 100%的共识。两名受过培训的评估员评估了新手和专家 RAPN 外科医生在新开发的 TM 中执行模拟 RAPN 的视频表现。两组在完成的手术步骤上没有差异。经验丰富的 RAPN 外科医生比新手组总共少犯 34%的错误。两组的绩效评分都根据总错误评分在中位数处进行划分,分为高错误(HiError)和低错误(LoError)亚组。低错误(LowErrs)专家 RAPN 外科医生组的总错误比新手高错误(HiErrs)组少 118%。此外,低错误(LowErrs)专家 RAPN 外科医生组比高错误(HiErrs)专家 RAPN 外科医生组的总错误少 77%。这些结果确立了这些指标的构建和判别有效性。作者描述了一种新的 RAPN TM 及其相关的绩效指标,并有证据支持其表面、内容、构建和判别有效性。本报告和证据支持为 RAPN 实施基于模拟的熟练度进展(PBP)培训计划。
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