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Establishing Validity for a Vaginal Hysterectomy Simulation Model for Surgical Skills Assessment
Chi Chung Grace Chen1, Ernest G Lockrow, Christopher C DeStephano
1Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; the Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, Maryland; the Department of Gynecology, Mayo Clinic, Jacksonville, Florida; the Department of Obstetrics and Gynecology, University of California Riverside, Riverside, California; the Department of Obstetrics and Gynecology, Oklahoma University College of Medicine, Oklahoma City, Oklahoma; Augmented Reality Systems Inc., Windham, New Hampshire; and the Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, North Carolina. At the time of study, all participating institutions were members of the American College of Obstetricians and Gynecologists Simulations Working Group.
This study validates a simulation model for assessing vaginal hysterectomy skills. The modified Vaginal Surgical Skills Index accurately differentiates surgeon competency based on experience.
Area of Science:
- Surgical Education
- Medical Simulation
- Gynecologic Surgery
Background:
- Assessing surgical skills is crucial for patient safety.
- Simulation-based training offers a controlled environment for skill acquisition.
- Objective assessment tools are needed to evaluate proficiency in complex procedures like vaginal hysterectomy.
Purpose of the Study:
- To apply the Messick validity framework to a simulation-based assessment of vaginal hysterectomy skills.
- To evaluate the validity of a high-fidelity vaginal surgery model for skill assessment.
- To determine the reliability and accuracy of the modified Vaginal Surgical Skills Index.
Main Methods:
- Physicians at various training levels performed vaginal hysterectomy on a high-fidelity model.
- Objective assessment used a modified 10-item Vaginal Surgical Skills Index and a global performance scale.
- Expert surgeons, blinded to participant identity, evaluated video recordings.
Main Results:
- Surgeon experience strongly correlated with higher scores on both assessment tools (r=0.81, P<.001).
- The modified Vaginal Surgical Skills Index demonstrated excellent internal consistency (Cronbach's alpha=0.97) and good interrater reliability.
- A cutoff score of 27 on the index accurately differentiated competent from noncompetent surgeons (AUC=0.951).
Conclusions:
- Validity evidence supports using a high-fidelity vaginal surgery model for assessing vaginal hysterectomy skills.
- The modified Vaginal Surgical Skills Index and global scale score are reliable tools for this assessment.
- Simulation-based assessment effectively differentiates surgeon competency.
