A novel tool for assessing psychomotor proficiency in laparoscopic cholecystectomy using simulation-based training

Area of Science:

• Surgical Education
• Medical Simulation
• Minimally Invasive Surgery

Background:

• Laparoscopic cholecystectomy is underutilized in lower- and middle-income countries (LMICs) due to limited training opportunities, with open surgery predominating.
• A low-cost, simulation-based educational module was developed to teach laparoscopic cholecystectomy.
• A novel proficiency verification tool, CHOLE-VOP, was created to assess psychomotor skill acquisition.

Purpose of the Study:

• To evaluate the effectiveness of a novel simulation-based training module for laparoscopic cholecystectomy.
• To assess the proficiency verification tool (CHOLE-VOP) in differentiating skill levels.
• To compare surgical skill acquisition between users in LMICs and high-income countries (HICs).

Main Methods:

• Fifty-two users completed the laparoscopic cholecystectomy simulation module.
• Performance was assessed using the CHOLE-VOP, including a procedural checklist, global rating scale (GRS), and final competency rating.
• Kruskal-Wallis tests and inter-rater agreement (ICC) were used to analyze skill differentiation and assessment concordance across experience levels and settings.

Main Results:

• CHOLE-VOP successfully discriminated between novice, intermediate, and expert laparoscopic surgery skill levels (P < 0.001).
• Users from LMICs demonstrated higher checklist and GRS scores compared to HIC users (P = 0.008 and P = 0.002, respectively).
• Moderate inter-rater agreement was found between self- and peer-assessments (ICC = 0.52), with lower agreement for novices.

Conclusions:

• The CHOLE-VOP is a valid tool for assessing laparoscopic cholecystectomy proficiency in a simulated environment.
• LMIC users showed superior performance in specific skill parameters within the simulation.
• Self-assessment concordance with peer-assessment was limited, especially for novice surgeons.