Bastard F, Veiler K, Nachaoui H, Godret R, Letourneur J, Enoh M, Martin L, Schmitt F
Pôle Femme-Mère-Enfant, département de chirurgie de l'enfant, CHU d'Angers, Angers, France.
Département de chirurgie plastique et reconstructrice, CHU d'Angers, Angers, France.
Ann Chir Plast Esthet. 2024 Sep;69(5):391-399. doi: 10.1016/j.anplas.2024.06.005. Epub 2024 Jul 14.
Health simulation is a recognized educational method for teaching and validating surgical procedural skills. The latter requires the development of adapted assessment tools, reaching different validity criteria. The aim of this study was to validate a multimodal assessment tool for a complex skin suturing exercise, combining a manual knot, an intradermal linear suturing and a needle holder tied knot.
The suturing exercise was realized on a synthetic skin model by voluntary participants after having obtained their written consent, including 9 postgraduate medical students, 40 surgical residents of different levels of experience, and a group of 9 senior surgeons. The multimodal assessment tool (MAT) combined a checklist, a speed score and a global rating scale. Each exercise was scored by two evaluators. Medical students' performances were filmed anonymously so that they could be scored iteratively. Content validity was tested through a satisfaction questionnaire randomly completed by participants.
The MAT was considered relevant or very relevant by 98% of the participants, with a better appreciation for the checklist than for the global rating scale. Internal consistency was strong with a Cronbach α coefficient at 0.78, and a good correlation between the results of the checklist and the global rating scale (r=0.79, P<0.0001). The MAT showed continuous improvement in mean scores from 34.4±3.6 for novices to 47.4±2.5/50 points for experts, passing through three intermediate levels groups, and allowed for significant discrimination between groups. The MAT was reliable, with a coefficient of correlation set at 0.88 for intra-observer reliability, and 0.72 for inter-observer reliability. On sub score analysis, the global rating scale and the speed score better discriminated between groups than the checklist, the latter moreover showing slightly lower reliability than the global rating scale.
Despite its banality in any surgeon's practice and the fact that it is taught from the 2nd cycle of medical studies, suturing and its technical components have rarely been the subject of publications dedicated to the validation of specific assessment tools. Hence, this work on the MAT and its sub scores made it possible to validate them on many validity and reliability criteria. They can therefore be proposed to surgical teachers for evaluating a complex suturing exercise, with a checklist that is easier to use even for novices and a global rating scale showing better discrimination capacity.
健康模拟是一种公认的用于教授和验证外科手术技能的教育方法。后者需要开发适用的评估工具，以达到不同的效度标准。本研究的目的是验证一种用于复杂皮肤缝合练习的多模态评估工具，该练习结合了手工打结、皮内直线缝合和持针器打结。
在获得自愿参与者的书面同意后，他们在合成皮肤模型上进行缝合练习，参与者包括9名医学研究生、40名不同经验水平的外科住院医师以及一组9名资深外科医生。多模态评估工具（MAT）结合了一份检查表、一个速度评分和一个整体评分量表。每项练习由两名评估者评分。医学生的表现进行匿名拍摄，以便可以反复评分。通过参与者随机填写的满意度问卷测试内容效度。
98%的参与者认为MAT相关或非常相关，对检查表的评价比对整体评分量表的评价更好。内部一致性很强，Cronbach α系数为0.78，检查表结果与整体评分量表之间具有良好的相关性（r=0.79，P<0.0001）。MAT显示平均分数从新手的34.4±3.6持续提高到专家的47.4±2.5/50分，经过三个中级水平组，并且能够在不同组之间进行显著区分。MAT是可靠的，观察者内信度的相关系数设定为0.88，观察者间信度的相关系数为0.72。在子分数分析中，整体评分量表和速度评分在区分不同组方面比检查表更好，检查表的信度也略低于整体评分量表。
尽管缝合及其技术组成部分在任何外科医生的实践中都很常见，并且从医学学习的第二阶段就开始教授，但很少有专门致力于验证特定评估工具的出版物涉及缝合。因此，这项关于MAT及其子分数的工作使得能够在许多效度和信度标准上对它们进行验证。因此，可以将它们推荐给外科教师，用于评估复杂的缝合练习，其中检查表即使对于新手也更容易使用，而整体评分量表显示出更好的区分能力。
