Validating a Methodology for Establishing a Criteria and Proficiency Levels in Surgical Skills Simulators

Abstract : OBJECTIVE: The new paradigm in surgical education for basic skills training is using computer-based (manikin, augmented or virtual reality) simulators with embedded criteria to be achieved by students before performing surgery on patients. To establish training criteria, we have assessed the performance of 18 experienced laparoscopic surgeons basic technical surgical skills of recorded electronically in 26 basic skills modules selected in five commercially available, computer-based simulators. METHODS/PROCEDURES: Quantitative data produced by the surgeons practicing repetitively during three one-half day sessions on each of five different simulators were collected in a Stanford IRB-approved study. Laparoscopic surgeons ( S generalists, six gynecologists, and four urologists) were recruited; eleven were academic surgeons, and fifteen perform > ten laparoscopic surgeries per month. Surgeons were randomly assigned to simulator stations (a total of 15 were provided by vendors) during each session. Each surgeon received a demonstration of the functioning of each module by a trained assistant who also logged the surgeon into and out of modules, using assigned participant numbers to assure anonymity. Demographic and opinion data were obtained to facilitate analysis. We developed proficiency score formulas for each module of the form b(sub 0) + b(sub 1)X(sub 1) + b(sub 2)X(sub 2) +... + b(sub k)X(sub k), where b(sub 0), b(sub 1),b(sub 2)......, b(sub k) are constants (called coefficients) and X(sub 1), X(sub 2), . . ., X(sub k) are the measures (variables) recorded in the module. Assumptions in the analysis are that the proficiency levels of subjects are > 50%, best performances do not exceed 100%, and proficiency increases with practice.