How to select aspirant laparoscopic surgical trainees: establishing concurrent validity comparing Xitact LS500 index...

Although a controversial topic in medical education, the selection of aspirant surgical trainees is a subject that needs to be addressed. In the view of preventing surgical trainee drop-outs and of appropriate allocation of limited resources, it is an issue critical to the profession. Traditional methods of selection are often subjective, and do not seem to correlate with skill needed for surgery. Standardized neuropsychometric test batteries may be useful in helping to select aspirant laparoscopic surgeons. Our study attempts to link surgical novices' psychometric ability test battery data with actual performance outcome on an objective, validated, and reproducible surgical laparoscopic task using virtual-reality simulation.

Thirty-three novices with no laparoscopic surgical experience participated. Each participant performed the Xitact LS500 Virtual Reality cholecystectomy clip-and-cut module 30 times. Individual learning curves were computed and patterns were assessed. Participants were examined using the aptitude test battery including the Abstract Reasoning test, the Space Relations test, the Gibson Spiral Maze test, and the Crawford Small Parts Dexterity tester.

Over 900 virtual-reality simulation tasks were generated and assessed. Of the participants, 93.3% were able to complete the virtual-reality simulation 30 times and all elements of our aptitude test battery. The abstract reasoning test is the only test correlating significantly to Xitact test outcome. This test is highly correlated to the space relations test. Both tests have discriminative power, comparing groups of performers.

The present study addresses the concurrent validity in aptitude testing, comparing scores of surgical novices on the Xitact LS500 laparoscopic cholecystectomy virtual-reality simulation with performance scores on a battery of standardized psychometric aptitude tests. The abstract reasoning and the space-relation test have predictive and selective value, identifying individuals who have good laparoscopic surgical virtual-reality performance. Aspiring laparoscopic surgeons who score below 25 on either test, that is, an expected 36%, would have to be further assessed using Xitact surgical task performance. The group of participants scoring above 35 on the Abstract Reasoning test and above 45 on the Space Relations test, that is, an expected 18% of the population, is unlikely to mal-perform on Xitact. The other 46% could very well benefit from Xitact simulation and assessment when the opportunity is present.