Development of a web-based laparoscopic technical skills assessment and testing instrument: a pilot study

Area of Science:

• Surgical Education Technology
• Medical Simulation
• Quantitative Skill Assessment

Background:

• Current surgical training relies on subjective assessments for operative proficiency.
• Standardized testing is crucial for evaluating scholastic ability but less so for technical skills.
• A novel laparoscopic simulator aims to bridge this gap with objective, real-time feedback.

Purpose of the Study:

• To develop and validate a compact laparoscopic simulator for objective skill evaluation.
• To assess if simulator-generated skill metrics follow normal or log-normal distributions for percentile scoring.
• To determine the simulator's construct validity in differentiating skill levels.

Main Methods:

• 29 surgical trainees performed a peg-transfer task 5 times using a laparoscopic simulator.
• A proprietary device collected data on 8 metrics, including instrument use, movement economy, and bimanual coordination.
• Statistical analyses (goodness-of-fit, ANOVA) were used to test metric distributions and skill level differentiation.

Main Results:

• Five metrics (angular path, depth perception, rotation, smoothness, bimanual coordination) fit normal or log-normal distributions.
• Metrics for time, volume, and economy of movement did not fit these desired distributions.
• Analysis of variance confirmed significant differences in skill levels across 5 metrics (p ≤ 0.023).

Conclusions:

• The simulator provides quantitative laparoscopic skill assessment capable of differentiating trainee skill levels.
• Five of eight tested metrics are suitable for percentile-based ranking.
• The system exhibits construct validity, suggesting utility for longitudinal assessment in surgical training.