Katherine M McKendy1,2, Yusuke Watanabe3,4, Elif Bilgic3, Ghada Enani3, Amani Munshi3, Lawrence Lee3, Liane S Feldman3, Gerald M Fried3, Melina C Vassiliou3. 1. Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada. katherine.mckendy@mail.mcgill.ca. 2. Henry K.M. de Kuyper Education Center, Department of Surgery, McGill University Health Centre, 1650 Cedar Ave, D6-257, Montreal, QC, H3G 1A4, Canada. katherine.mckendy@mail.mcgill.ca. 3. Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada. 4. Department of Gastroenterological Surgery II, Hokkaido University, Sapporo, Hokkaido, Japan.
Abstract
BACKGROUND: Time and accuracy are commonly used metrics to assess laparoscopic skills in a simulated environment. However, they do not provide trainees with meaningful information about how to improve their skills. The objective of this study was to provide preliminary validity evidence for the creation a formative feedback tool (FFT) for advanced laparoscopic suturing skills. METHODS: Videotapes of senior surgical residents (PGY3-5; SRs) and minimally invasive surgeons (MIS) performing 3 advanced laparoscopic suturing tasks were analyzed: needle handling (NH), suturing under tension (UT), and continuous suturing (CS). A FFT was created based on a grounded theory analysis of interviews with MIS surgeons about the key technical aspects of each task. The FFT was used to assess the videotaped performances of SRs and MIS surgeons by two blinded independent raters. RESULTS: The FFT is composed of three parts: NH contains 10 items, UT 18, and CS 20. Each item was classified according to seven key surgical principles: depth perception, safety, bimanual dexterity, exposure, tissue handling, instrument manipulation, and forward planning. The videotaped performance of SR and MIS surgeons was graded on a 3-point Likert scale ("does well," "needs some improvement," and "does poorly") and scores were calculated as a sum of the points. ICCs for all three tasks were high (NH 0.90, UT 0.87, and CS 0.90). FFT score correlated strongly with combined time and accuracy measurements for UT (0.82, p < 0.01) and CS (0.81, p < 0.01), and moderately for NH (0.65, p < 0.01). MIS surgeons performed significantly better than SRs on UT (p = 0.02) and CS (p = 0.05), while scores on NH were similar (p = 0.57). CONCLUSIONS: A comprehensive tool for providing feedback about advanced laparoscopic suturing skills was developed. The FFT demonstrates evidence for validity as a measure of suturing skills and experience, and provides meaningful information to trainees about how to improve their skills and engage in more deliberate and efficient practice.
BACKGROUND: Time and accuracy are commonly used metrics to assess laparoscopic skills in a simulated environment. However, they do not provide trainees with meaningful information about how to improve their skills. The objective of this study was to provide preliminary validity evidence for the creation a formative feedback tool (FFT) for advanced laparoscopic suturing skills. METHODS: Videotapes of senior surgical residents (PGY3-5; SRs) and minimally invasive surgeons (MIS) performing 3 advanced laparoscopic suturing tasks were analyzed: needle handling (NH), suturing under tension (UT), and continuous suturing (CS). A FFT was created based on a grounded theory analysis of interviews with MIS surgeons about the key technical aspects of each task. The FFT was used to assess the videotaped performances of SRs and MIS surgeons by two blinded independent raters. RESULTS: The FFT is composed of three parts: NH contains 10 items, UT 18, and CS 20. Each item was classified according to seven key surgical principles: depth perception, safety, bimanual dexterity, exposure, tissue handling, instrument manipulation, and forward planning. The videotaped performance of SR and MIS surgeons was graded on a 3-point Likert scale ("does well," "needs some improvement," and "does poorly") and scores were calculated as a sum of the points. ICCs for all three tasks were high (NH 0.90, UT 0.87, and CS 0.90). FFT score correlated strongly with combined time and accuracy measurements for UT (0.82, p < 0.01) and CS (0.81, p < 0.01), and moderately for NH (0.65, p < 0.01). MIS surgeons performed significantly better than SRs on UT (p = 0.02) and CS (p = 0.05), while scores on NH were similar (p = 0.57). CONCLUSIONS: A comprehensive tool for providing feedback about advanced laparoscopic suturing skills was developed. The FFT demonstrates evidence for validity as a measure of suturing skills and experience, and provides meaningful information to trainees about how to improve their skills and engage in more deliberate and efficient practice.
Authors: Marilou Vaillancourt; Iman Ghaderi; Pepa Kaneva; Melina Vassiliou; Nicoleta Kolozsvari; Ivan George; F Erica Sutton; F Jacob Seagull; Adrian E Park; Gerald M Fried; Liane S Feldman Journal: Surg Innov Date: 2011-01-07 Impact factor: 2.058
Authors: Cara R King; Nicole Donnellan; Richard Guido; Amanda Ecker; Andrew D Althouse; Suketu Mansuria Journal: Obstet Gynecol Date: 2015-10 Impact factor: 7.661
Authors: M C Vassiliou; G A Ghitulescu; L S Feldman; D Stanbridge; K Leffondré; H H Sigman; G M Fried Journal: Surg Endosc Date: 2006-02-27 Impact factor: 4.584
Authors: Samer G Mattar; Adnan A Alseidi; Daniel B Jones; D Rohan Jeyarajah; Lee L Swanstrom; Ralph W Aye; Steven D Wexner; José M Martinez; Sharona B Ross; Michael M Awad; Morris E Franklin; Maurice E Arregui; Bruce D Schirmer; Rebecca M Minter Journal: Ann Surg Date: 2013-09 Impact factor: 12.969