Expanding Global Laparoscopic Training: Validity Testing of a Ugandan-Manufactured Box Trainer

Laparoscopic training is needed in Africa. KeyTrainer (KT) is a low-cost laparoscopic box trainer, manufactured in Uganda, with laparoscopic tasks adapted for the African context. We report on the construct validity of KT by testing with Ugandan laparoscopic surgical faculty and trainees.

Validity testing was conducted among medical students, residents, and laparoscopic faculty in both Uganda and the United States (US). Participants completed 5 laparoscopic tasks adapted from the fundamentals of laparoscopic surgery (FLS) curriculum. The US participants additionally completed the 3 tasks with an FLS correlate on the FLS towers. Construct validity was assessed by comparing task completion times and errors across training levels. Content validity was assessed through postexperience surveys.

A total of 41 participants (26 Ugandan and 18 US) completed 274 timed trials. Across all 5 tasks, task performance times significantly differentiated between students, residents, and faculty (p < 0.05), supporting construct validity. The US participants performed tasks faster on the FLS trainer than on KT, but both systems similarly detected skill level differences. Survey results supported content validity, with > 90% of participants agreeing the tasks improved hand-eye coordination, depth perception, and instrument handling. Overall, 89% of participants endorsed future use of the trainer.

Construct and content validity of the KT was demonstrated with significant differences in task performance times between surgical trainees and faculty, suggesting the ability to detect different skill levels. KT may provide a locally available solution for laparoscopic training in sub-Saharan Africa.