Design and validation of a novel low-cost open paediatric inguinal herniotomy simulator

Simulation-based education is a valuable tool in paediatric surgery. Inguinal hernias are a common paediatric surgical presentation with an incidence of 1-5% in full-term infants. While previous simulators have been created for adult inguinal hernias and laparoscopic paediatric inguinal hernias, there are limited models for the open paediatric procedure. We aimed to create and validate a simulator for a paediatric open inguinal hernia repair.

Essential procedural steps of an open inguinal herniotomy were determined, and a low-cost paediatric simulator was developed. Novices (medical students) and experts (paediatric surgeons) were recruited. A questionnaire on an 11-point Likert-type scale assessed face validity, content validity, and functional task alignment. Median scores > 7.0/10.0 were deemed valid. The total number and type of procedural errors were assessed to determine construct validity. Statistical analysis included Fisher's exact test, a p-value < 0.05 was considered significant.

A total of 34 participants were recruited (expert:10, novice:24). The simulator received favourable median scores in the following content validity domains: useful for surgical trainees (7.0/10.0), useful to train open surgical skills (7.5/10.0), and logical flow of procedural steps (9.0/10.0). It was not deemed a valuable training tool for experts (2.0/10.0). The simulator had median scores below 7.0/10.0 for face validity domains, including its tissue and visual realism. Construct validity was demonstrated by novices making more errors on the simulator, p = 0.02.

This low-cost open inguinal herniotomy simulator demonstrated content validity, construct validity, and a high degree of functional task alignment.