The left upper lobe challenge in video-assisted thoracoscopic surgery—use of a composite score to improve the assessment of simulated lobectomy

The left upper lobe challenge in video-assisted thoracoscopic surgery—use of a composite score to improve the assessment of simulated lobectomy

AIMThe aim of this study is to develop a reliable composite score based on simulator metrics to assess competency in virtual reality video-assisted thoracoscopic surgery lobectomy and explore the benefits of combining it with expert rater assessments. METHODSStandardized objective assessments (time,...

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Veröffentlicht in:European journal of cardio-thoracic surgery 2022-11, Vol.62 (6)
Hauptverfasser: Haidari, Tamim Ahmad, Bjerrum, Flemming, Grimstrup, Søren, Christensen, Thomas Decker, Vad, Henrik, Møller, Lars Borgbjerg, Hansen, Henrik Jessen, Konge, Lars, Petersen, René Horsleben
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container_issue 6
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container_title European journal of cardio-thoracic surgery
container_volume 62
creator Haidari, Tamim Ahmad
Bjerrum, Flemming
Grimstrup, Søren
Christensen, Thomas Decker
Vad, Henrik
Møller, Lars Borgbjerg
Hansen, Henrik Jessen
Konge, Lars
Petersen, René Horsleben
description AIMThe aim of this study is to develop a reliable composite score based on simulator metrics to assess competency in virtual reality video-assisted thoracoscopic surgery lobectomy and explore the benefits of combining it with expert rater assessments. METHODSStandardized objective assessments (time, bleeding, economy of movement) and subjective expert rater assessments from 2 previous studies were combined. A linear mixed model including experience level, lobe and the number of previous simulated procedures was applied for the repeated measurements. Reliability for each of the 4 assessments was calculated using Cronbach's alpha. The Nelder-Mead numerical optimization algorithm was used for optimal weighting of scores. A pass-fail standard for the composite score was determined using the contrasting groups' method. RESULTSIn total, 123 virtual reality video-assisted thoracoscopic surgery lobectomies were included. Across the 4 different assessments, there were significant effects (P 
doi_str_mv 10.1093/ejcts/ezac465
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METHODSStandardized objective assessments (time, bleeding, economy of movement) and subjective expert rater assessments from 2 previous studies were combined. A linear mixed model including experience level, lobe and the number of previous simulated procedures was applied for the repeated measurements. Reliability for each of the 4 assessments was calculated using Cronbach's alpha. The Nelder-Mead numerical optimization algorithm was used for optimal weighting of scores. A pass-fail standard for the composite score was determined using the contrasting groups' method. RESULTSIn total, 123 virtual reality video-assisted thoracoscopic surgery lobectomies were included. Across the 4 different assessments, there were significant effects (P &lt; 0.01) of experience, lobe, and simulator experience, but not for simulator attempts on bleeding (P = 0.98). The left upper lobe was significantly more difficult compared to other lobes (P = 0.02). A maximum reliability of 0.92 could be achieved by combining the standardized simulator metrics with standardized expert rater scores. The pass/fail level for the composite score when including 1 expert rater was 0.33. CONCLUSIONSCombining simulator metrics with 1 or 2 raters increases reliability and can serve as a more objective method for assessing surgical trainees. The composite score may be used to implement a standardized and feasible simulation-based mastery training program in video-assisted thoracoscopic surgery lobectomy.</description><identifier>ISSN: 1873-734X</identifier><identifier>EISSN: 1873-734X</identifier><identifier>DOI: 10.1093/ejcts/ezac465</identifier><language>eng</language><ispartof>European journal of cardio-thoracic surgery, 2022-11, Vol.62 (6)</ispartof><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c309t-cc0928b15892001a260c78ab2e0dae8711349ac2bf60cd641bfb09f2aaa209ac3</citedby><cites>FETCH-LOGICAL-c309t-cc0928b15892001a260c78ab2e0dae8711349ac2bf60cd641bfb09f2aaa209ac3</cites><orcidid>0000-0002-3586-1869 ; 0000-0001-6509-8510</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids></links><search><creatorcontrib>Haidari, Tamim Ahmad</creatorcontrib><creatorcontrib>Bjerrum, Flemming</creatorcontrib><creatorcontrib>Grimstrup, Søren</creatorcontrib><creatorcontrib>Christensen, Thomas Decker</creatorcontrib><creatorcontrib>Vad, Henrik</creatorcontrib><creatorcontrib>Møller, Lars Borgbjerg</creatorcontrib><creatorcontrib>Hansen, Henrik Jessen</creatorcontrib><creatorcontrib>Konge, Lars</creatorcontrib><creatorcontrib>Petersen, René Horsleben</creatorcontrib><title>The left upper lobe challenge in video-assisted thoracoscopic surgery—use of a composite score to improve the assessment of simulated lobectomy</title><title>European journal of cardio-thoracic surgery</title><description>AIMThe aim of this study is to develop a reliable composite score based on simulator metrics to assess competency in virtual reality video-assisted thoracoscopic surgery lobectomy and explore the benefits of combining it with expert rater assessments. METHODSStandardized objective assessments (time, bleeding, economy of movement) and subjective expert rater assessments from 2 previous studies were combined. A linear mixed model including experience level, lobe and the number of previous simulated procedures was applied for the repeated measurements. Reliability for each of the 4 assessments was calculated using Cronbach's alpha. The Nelder-Mead numerical optimization algorithm was used for optimal weighting of scores. A pass-fail standard for the composite score was determined using the contrasting groups' method. RESULTSIn total, 123 virtual reality video-assisted thoracoscopic surgery lobectomies were included. Across the 4 different assessments, there were significant effects (P &lt; 0.01) of experience, lobe, and simulator experience, but not for simulator attempts on bleeding (P = 0.98). The left upper lobe was significantly more difficult compared to other lobes (P = 0.02). A maximum reliability of 0.92 could be achieved by combining the standardized simulator metrics with standardized expert rater scores. The pass/fail level for the composite score when including 1 expert rater was 0.33. CONCLUSIONSCombining simulator metrics with 1 or 2 raters increases reliability and can serve as a more objective method for assessing surgical trainees. 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METHODSStandardized objective assessments (time, bleeding, economy of movement) and subjective expert rater assessments from 2 previous studies were combined. A linear mixed model including experience level, lobe and the number of previous simulated procedures was applied for the repeated measurements. Reliability for each of the 4 assessments was calculated using Cronbach's alpha. The Nelder-Mead numerical optimization algorithm was used for optimal weighting of scores. A pass-fail standard for the composite score was determined using the contrasting groups' method. RESULTSIn total, 123 virtual reality video-assisted thoracoscopic surgery lobectomies were included. Across the 4 different assessments, there were significant effects (P &lt; 0.01) of experience, lobe, and simulator experience, but not for simulator attempts on bleeding (P = 0.98). The left upper lobe was significantly more difficult compared to other lobes (P = 0.02). A maximum reliability of 0.92 could be achieved by combining the standardized simulator metrics with standardized expert rater scores. The pass/fail level for the composite score when including 1 expert rater was 0.33. CONCLUSIONSCombining simulator metrics with 1 or 2 raters increases reliability and can serve as a more objective method for assessing surgical trainees. The composite score may be used to implement a standardized and feasible simulation-based mastery training program in video-assisted thoracoscopic surgery lobectomy.</abstract><doi>10.1093/ejcts/ezac465</doi><orcidid>https://orcid.org/0000-0002-3586-1869</orcidid><orcidid>https://orcid.org/0000-0001-6509-8510</orcidid><oa>free_for_read</oa></addata></record>
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title The left upper lobe challenge in video-assisted thoracoscopic surgery—use of a composite score to improve the assessment of simulated lobectomy
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