Reliable and valid assessment of performance in thoracoscopy

Centre for Clinical Education, University of Copenhagen and the Capital Region of Denmark, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Surgical Endoscopy (Impact Factor: 3.26). 12/2011; 26(6):1624-8. DOI: 10.1007/s00464-011-2081-7
Source: PubMed


As we move toward competency-based education in medicine, we have lagged in developing competency-based evaluation methods. In the era of minimally invasive surgery, there is a need for a reliable and valid tool dedicated to measure competence in video-assisted thoracoscopic surgery. The purpose of this study is to create such an assessment tool, and to explore its reliability and validity.
An expert group of physicians created an assessment tool consisting of 10 items rated on a five-point rating scale. The following factors were included: economy and confidence of movement, respect for tissue, precision of operative technique, creation and placement of ports, localization of pathologic tissue, use of staplers, retrieval of tissue in bag and placement of chest tube. Fifty consecutive thoracoscopic wedge resections were recorded and assessed blindly and independently by two experts using the tool.
Four residents, four fellows and five consultants performed 1-10 (median 4) operations each. The fellows performed significantly better than the residents (P = 0.03; effect size, ES = 0.72). The consultants scored 11% higher than the fellows, but this difference was not significant (P = 0.10, ES = 0.64). The inter-rater reliability was acceptable (Cronbach's alpha 0.71).
This tool for assessing performance in thoracoscopy is reliable and valid. It can provide unbiased feedback to trainees, and can be used to evaluate new teaching curricula, i.e. simulation-based training. Furthermore, it has potential to aid in certification of new thoracic surgeons.

1 Follower
4 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Pleuroscopy provides a window to the pleural space while enabling biopsy of the parietal pleura under direct visual guidance for effusions of unknown etiology, guided chest tube placement, and pleurodesis for recurrent pleural effusions or pneumothoraces in selected patients. The procedure enjoyed resurgence when thoracic surgeons introduced the technique for video-assisted thoracic surgery (VATS). VATS is performed under general anesthesia with single-lung ventilation; pleuroscopy is performed in an endoscopy suite using nondisposable rigid or flex-rigid instruments, local anesthesia, and conscious sedation. Pleuroscopy is less invasive; in this review, we discuss the indications, complications, techniques, and recent advances in the procedure.
    Clinics in chest medicine 03/2013; 34(1):81-91. DOI:10.1016/j.ccm.2012.11.003 · 2.07 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: An increasing proportion of thoracic procedures are performed using video-assisted thoracic surgery. This minimally invasive technique places special demands on the surgeons. Using simulation-based training on artificial models or animals has been proposed to overcome the initial part of the learning curve. This study aimed to investigate the effect of simulation-based training and to compare self-guided and educator-guided training. Methods: The study included a surgeon group (n = 10) and 30 randomized novices in 3 groups. A control group (n = 10) and the group of surgeons (n = 10) were tested with no previous simulator training. A self-guided training group (n = 10) and an educator-guided training group (n = 10) trained for 3 hours on 3 scenarios of increasing fidelity and difficulty before taking a standardized test consisting of performing a wedge resection on a porcine lung, which was recorded and assessed blindly and independently by 2 thoracoscopic experts using a modified version of a validated assessment tool. Results: Interrater reliability was acceptable (Spearman ρ = 0.73, P < 0.001). The control group and the self-guided training group performed significantly worse than the experienced surgeons (P = 0.012 and P = 0.010, respectively). There was no significant difference between the educator-guided training group and the experienced surgeons (P = 0.271). Conclusions: This randomized study concerning simulation-based training for thoracoscopy showed that 3 hours of intensive simulator training with a dedicated educator enables novices to perform an acceptable wedge resection in a simple, simulated model. Although not significant, it seemed that having an educator present during training had a beneficiary effect. Transfer studies are required for further conclusions.
    Simulation in healthcare: journal of the Society for Simulation in Healthcare 04/2013; 8(5). DOI:10.1097/SIH.0b013e31828df760 · 1.48 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Pleuroscopy is considered a safe procedure with a high diagnostic accuracy but this record is based on studies published by pulmonologists experienced in performing the procedure. Review of 40 consecutive patients who underwent semirigid pleuroscopy by a pulmonary fellow under the supervision of a pulmonologist. Pleuroscopy was performed for diagnosis of pleural effusion (n=33), or treatment of pleural effusion (n=4) or pneumothorax (n=3). The mean age±SD of the patients was 58.23±12.98 years and 23 patients were male. Pleuroscopy was performed with a flex-rigid pleuroscope under local anesthesia and conscious sedation. An ultrasound was used to choose the entry site. The dose of midazolam and fentanyl used was 6.45±2.87 mg and 173.39±77.17 mcg, respectively. The duration of the procedure was 69.3±25.3 minutes. The amount of pleural fluid removed was 1.5±0.94 L. The overall diagnostic accuracy of pleuroscopy was 87.8%, and the sensitivity, specificity, negative and positive predictive value for malignancy was 93.9%, 100%, 92.3% and 100%, respectively. There were a few complications: desaturation (n=2), hypotension (n=5), extensive subcutaneous emphysema (n=3), and persistent air leak (n=1). There was no case of significant bleeding or death from the procedure. Six of the 7 cardiopulmonary complications occurred during the first 4 procedures performed by the fellows. The diagnostic accuracy of pleuroscopy remains high in the hands of pulmonary fellows. However, the procedure can be associated with a slightly higher rate of complications when performed by fellows in training, especially in the early part of their learning curve. Most of the few complications observed were not caused by the procedure per se and resulted from over-zealous use of medications for conscious sedation.
    Journal of Bronchology and Interventional Pulmonology 07/2013; 20(3):213-23. DOI:10.1097/LBR.0b013e31829aeac7
Show more