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Published on: March 23, 2019
External validity of task-specific metrics for performance assessment in laparoscopic crural repair
Sofia Garces-Palacios1, Alexis Desir1, Apoorva Pise1
1Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
Background:
Laparoscopic hiatal hernia repair is a common foregut procedure, yet high-fidelity simulation tools for training and assessment remain limited. Previously, task-specific metrics (TSMs) were developed and validated at a single institution to evaluate performance during simulated laparoscopic crural repair. This study assessed the external validity and reliability of these TSMs using a broader, international cohort.
Methods:
Participants at the 2024 SAGES Education and Innovation Center performed a simulated laparoscopic crural repair using an inanimate silicone model housed in a standard laparoscopic trainer box. Demographic data and surgical experience were collected via pre-survey. Performances were video-recorded and independently assessed by three blinded raters using both the Objective Structured Assessment of Technical Skills (OSATS) and TSMs. Participants were stratified into novice (PGY1-2) or experienced (PGY3-5, fellows, attendings). Inter-rater reliability was evaluated using intraclass correlation coefficient (ICC). Performance comparisons were analyzed using the Wilcoxon-Mann-Whitney test. Linear regression modeled training level as an ordered predictor, adjusting for simulation exposure. Correlation between OSATS and TSM scores was measured using Spearman's rank correlation.
Results:
Thirty-three participants were enrolled; 30 completed the task (attendings: 9; fellows: 3; PGY1-5: 18). 22 were U.S.-trained and 8 internationally trained. Inter-rater reliability was high for both scoring methods (ICC = 0.85; p < 0.001). Experienced participants scored significantly higher than novices on both OSATS (20 vs. 14; p = 0.039) and TSMs (39 vs. 18.5; p = 0.02). In adjusted models, robotic simulation training was independently associated with higher OSATS (β = 4.67, p = 0.021) and TSM scores (β = 15.01, p = 0.024). TSM and OSATS scores were strongly correlated (R = 0.88; p < 0.001).
Conclusions:
TSMs demonstrated strong external validity and reliability, effectively discriminating between experience levels and supporting their use as standardized assessment tool in surgical education and global training programs.