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

Laparoscopy is underutilized in lower- and middle-income countries (LMICs) due to limited access to training opportunities. Laparoscopic cholecystectomy is the gold standard for treating gallbladder disease in high-income countries (HICs), yet the open approach predominates in LMICs. A low-cost, simulation-based educational module for teaching laparoscopic cholecystectomy was developed by an international collaboration. A novel tool for verifying proficiency (CHOLE-VOP), incorporating a procedural checklist, a global rating scale (GRS), and a final competency rating, was designed and piloted to evaluate psychomotor skill acquisition in laparoscopic cholecystectomy.

Fifty-two users completed the learning module, submitted a video recording of their performance on the tool, and performed self- and peer-assessment of videos using the CHOLE-VOP. A Kruskal-Wallis test was used to assess the CHOLE-VOP's ability to differentiate psychomotor performance across three experience levels [novice (no laparoscopic experience), intermediate (1-30 cases), and expert (> 30 cases)] and between settings (LMICs vs. HICs). Inter-rater agreement was measured between self-assessment and peer-assessment, across reviewer reviewer experience levels.

Among users [novices (14), intermediates (18), experts (17), unknown (3)], checklist scores significantly increased from novice (M = 28.16) to intermediate (M = 31.33) and expert (M = 32.66), P < 0.001. Both GRS and final ratings effectively discriminated between experience levels, P < 0.001. LMIC users had higher checklist scores (32.41 vs. 29.35, P = 0.008) and GRS scores (17.54 vs. 15.14, P = 0.002). Inter-rater agreement between self- and peer-assessments was moderate (ICC = 0.52), with poor agreement for novices (ICC = 0.24), who tended to overestimate their performance, and good agreement for intermediate users (ICC = 0.79).

The CHOLE-VOP successfully discriminated between experience levels in a simulated laparoscopic cholecystectomy training module. LMIC users outperformed HIC users in select skill parameters. Self-assessments, particularly among novices, showed limited concordance with peer-assessments.