1
|
Pietersen PI, Laursen CB, Petersen RH, Konge L. Structured and evidence-based training of technical skills in respiratory medicine and thoracic surgery. J Thorac Dis 2021; 13:2058-2067. [PMID: 33841995 PMCID: PMC8024809 DOI: 10.21037/jtd.2019.02.39] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Within the last decade, the number of technical procedures in respiratory medicine and thoracic surgery has grown and created a higher demand for effective and evidence-based education. Today, trainees are often allowed to perform procedures unsupervised on patients after obtaining a course certificate from a theoretic course and having performed a fixed number of supervised procedures. However, these methods do not ensure adequate competence. Well-structured and effective educational programmes including validated tests are needed to reduce economic expenses, optimize time spend, and ensure patient safety. The aim of this article is to summarize current state of educational strategies for technical procedures within respiratory medicine and thoracic surgery. Thus, to discuss future recommendations for curriculum development and assessment of competences based on Kern’s framework. The approach by Kern consists of six topics, which needs to be considered and evaluated and in order to educate physicians and surgeons most effective and evidence-based. We present a practical guide contributing to future educators’ considerations on (I) problem identification and general needs assessment, (II) targeted needs assessment, (III) goals and objectives, (IV) educational strategies, (V) implementation, and finally (VI) evaluation and feedback.
Collapse
Affiliation(s)
- Pia Iben Pietersen
- Regional Center for Technical Simulation, Region of Southern Denmark, Odense, Denmark.,Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Insitute for Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Insitute for Clinical Research, University of Southern Denmark, Odense, Denmark
| | - René Horsleben Petersen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Capital Region, Copenhagen, Denmark
| |
Collapse
|
2
|
Forslund Jacobsen M, Konge L, la Cour M, Holm L, Kjærbo H, Moldow B, Saleh GM, Thomsen ASS. Simulation of advanced cataract surgery - validation of a newly developed test. Acta Ophthalmol 2020; 98:687-692. [PMID: 32304357 PMCID: PMC7687069 DOI: 10.1111/aos.14439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/22/2020] [Indexed: 01/14/2023]
Abstract
PURPOSE To develop and investigate an Eyesi simulator-based test for the more experienced cataract surgeon for evidence of validity. METHODS The study was a prospective interventional cohort study and carried out at the Copenhagen Academy for Medical Education and Simulation. The Eyesi Simulator was used for the test which was developed by three expert cataract surgeons. Ten cataract surgeons (>250 surgeries performed) and ten ophthalmic residents performed two repetitions of the test. The test consisted of four modules: Iris Expansion Ring insertion - level 1, Iris Expansion Ring extraction - level 2, Capsulorhexis - level 3 and Anterior Vitrectomy - level 6. RESULTS Internal consistency reliability showed Cronbach's alpha of 0.63. Test-retest reliabilities were significant for Iris Expansion Ring extraction - level 2 (p = 0.012) and Capsulorhexis - level 3 (p = 0.018). Differences between the two groups were only significant in both repetitions for the Iris Expansion Ring extraction - level 2 (p < 0.001 and p = 0.041, respectively). Furthermore, we found a statistically significant difference between the mean module scores for novices and the more experienced surgeons for Iris Expansion Ring insertion - level 1 (p = 0.021) and Capsulorhexis - level 3 (p = 0.019) in the first repetition. CONCLUSION The investigated modules show evidence of validity within several aspects of Messick's framework. However, the evidence is not strong enough to apply the test for certification purposes of cataract surgeons, but the modules may still be relevant in the training of advanced cataract surgical procedures.
Collapse
Affiliation(s)
- Mads Forslund Jacobsen
- Department of OphthalmologyRigshospitalet – GlostrupCopenhagenDenmark
- Copenhagen Academy for Medical Education and SimulationCentre for HRCapital Region of DenmarkCopenhagenDenmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and SimulationCentre for HRCapital Region of DenmarkCopenhagenDenmark
| | - Morten la Cour
- Department of OphthalmologyRigshospitalet – GlostrupCopenhagenDenmark
| | - Lars Holm
- Department of OphthalmologyRigshospitalet – GlostrupCopenhagenDenmark
| | - Hadi Kjærbo
- Department of OphthalmologyRigshospitalet – GlostrupCopenhagenDenmark
| | - Birgitte Moldow
- Department of OphthalmologyRigshospitalet – GlostrupCopenhagenDenmark
| | - George M. Saleh
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of OphthalmologyLondonUK
| | - Ann Sofia Skou Thomsen
- Department of OphthalmologyRigshospitalet – GlostrupCopenhagenDenmark
- Copenhagen Academy for Medical Education and SimulationCentre for HRCapital Region of DenmarkCopenhagenDenmark
| |
Collapse
|
3
|
Ternov NK, Vestergaard T, Hölmich LR, Karmisholt K, Wagenblast AL, Klyver H, Hald M, Schøllhammer L, Konge L, Chakera AH. Reliable test of clinicians' mastery in skin cancer diagnostics. Arch Dermatol Res 2020; 313:235-243. [PMID: 32596742 DOI: 10.1007/s00403-020-02097-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/17/2020] [Indexed: 11/25/2022]
Abstract
Differentiating between benign and malignant skin lesions can be very difficult and should only be done by sufficiently trained and skilled clinicians. To our knowledge there are no validated tests for reliable assessments of clinicians' ability to perform skin cancer diagnostics. To develop and gather validity evidence for a test in skin cancer diagnostics, a multiple-choice questionnaire (MCQ) was developed based on informal interviews with seven content experts from five skin cancer centers in Denmark. Validity evidence for the test was gathered from May until July 2019 using Messick's validity framework (content, response process, internal structure, relationship to other variables and consequences). Item content was revised through a Delphi-like review process and then piloted on 36 medical students and 136 doctors using a standardized response process. Results enabled an analysis of the internal structure and relationship to other variables of the test. Finally, the contrasting groups method was used to investigate the test's consequences (pass-fail standard). The initial 90-item MCQ was reduced to 40 items during the Delphi-like review process. Item analysis revealed that 25 of the 40 selected items were level I-III quality items with a high internal consistency (Cronbach's α = 0.83) and highly significant (P ≤ 0.0001) differences in test scores between participants with different occupations or levels of experience. A pass-fail standard of 12 (48%) correct answers was established using the contrasting groups' method. The skin cancer diagnostics MCQ developed in this study can be used for reliable assessments of clinicians' competencies.
Collapse
Affiliation(s)
- Niels Kvorning Ternov
- Department of Plastic Surgery, Herlev and Gentofte University Hospital, Herlev Ringvej 75, Herlev, 2730, Copenhagen, Denmark. .,Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark. .,Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark.
| | - T Vestergaard
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark.,Faculty of Health Sciences, University of Southern Denmark, Copenhagen, Denmark
| | - L Rosenkrantz Hölmich
- Department of Plastic Surgery, Herlev and Gentofte University Hospital, Herlev Ringvej 75, Herlev, 2730, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - K Karmisholt
- Department of Dermatology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - A L Wagenblast
- Department of Plastic Surgery, Breast Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - H Klyver
- Department of Plastic Surgery, Breast Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - M Hald
- Department of Dermatology, Herlev and Gentofte University Hospital, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - L Schøllhammer
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - L Konge
- Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - A H Chakera
- Department of Plastic Surgery, Herlev and Gentofte University Hospital, Herlev Ringvej 75, Herlev, 2730, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| |
Collapse
|
4
|
Jørgensen M, Savran MM, Christakopoulos C, Bek T, Grauslund J, Toft PB, Ziemssen F, Konge L, Sørensen TL, Subhi Y. Development and validation of a multiple-choice questionnaire-based theoretical test in direct ophthalmoscopy. Acta Ophthalmol 2019; 97:700-706. [PMID: 30816642 DOI: 10.1111/aos.14065] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 02/02/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE Direct ophthalmoscopy can reveal systemic, neurologic and ophthalmic conditions, but is poorly mastered among young physicians. A theoretical test is needed to measure effect of educational interventions. We developed and gathered validity evidence for a multiple-choice questionnaire (MCQ)-based theoretical test in direct ophthalmoscopy. METHODS The MCQ was developed by interviewing experts. Then, validity evidence was evaluated using Messick's validity framework. Content was ensured by inviting the experts to contribute in a Delphi-like process. Response process was ensured by piloting and by streamlining all instructions. Then, the test was taken by ophthalmologists and by medical students without experience in direct ophthalmoscopy. Results were used to evaluate internal structure (item quality analysis and internal consistency), relations to other variables (correlation of test scores to experience level) and consequences (establishment of pass-fail score and the consequences of its use). RESULTS The first phase of the study yielded 100 MCQs. In second phase, we identified that 60 items fulfilled predefined relevance and item quality requirements. These items demonstrated very high internal consistency (Cronbach's alpha = 0.95), significantly discriminated medical students from specialists (p < 0.001, independent samples t-test) and the established pass-fail score of 50 (83%) correct answers resulted in no false positives (students passing) and no false negatives (specialists failing). A Decision study identified that sampling 15 items suffice for certification. CONCLUSION We developed and validated an MCQ-based theoretical test in direct ophthalmoscopy that enables an evidence-based approach to measuring, evaluating and certifying the theoretical knowledge necessary for direct ophthalmoscopy.
Collapse
Affiliation(s)
- Morten Jørgensen
- Department of Ophthalmology Zealand University Hospital Roskilde Denmark
- CAMES – Copenhagen Academy for Medical Education and Simulation Capital Region of Denmark Copenhagen Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Mona Meral Savran
- CAMES – Copenhagen Academy for Medical Education and Simulation Capital Region of Denmark Copenhagen Denmark
- Department of Obstetrics and Gynaecology Copenhagen University Hospital Amager and Hvidovre Hvidovre Denmark
| | | | - Toke Bek
- Department of Ophthalmology Aarhus University Hospital Aarhus Denmark
| | - Jakob Grauslund
- Department of Ophthalmology Odense University Hospital Odense Denmark
- Department of Clinical Research Faculty of Healthy Science University of Southern Denmark Odense Denmark
| | - Peter Bjerre Toft
- Department of Ophthalmology, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Focke Ziemssen
- Center for Ophthalmology Eberhard‐Karl University Tübingen Tübingen Germany
| | - Lars Konge
- CAMES – Copenhagen Academy for Medical Education and Simulation Capital Region of Denmark Copenhagen Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Torben Lykke Sørensen
- Department of Ophthalmology Zealand University Hospital Roskilde Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Yousif Subhi
- Department of Ophthalmology Zealand University Hospital Roskilde Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| |
Collapse
|
5
|
Abstract
OBJECTIVE To identify current trends in the use of validity frameworks in surgical simulation, to provide an overview of the evidence behind the assessment of technical skills in all surgical specialties, and to present recommendations and guidelines for future validity studies. SUMMARY OF BACKGROUND DATA Validity evidence for assessment tools used in the evaluation of surgical performance is of paramount importance to ensure valid and reliable assessment of skills. METHODS We systematically reviewed the literature by searching 5 databases (PubMed, EMBASE, Web of Science, PsycINFO, and the Cochrane Library) for studies published from January 1, 2008, to July 10, 2017. We included original studies evaluating simulation-based assessments of health professionals in surgical specialties and extracted data on surgical specialty, simulator modality, participant characteristics, and the validity framework used. Data were synthesized qualitatively. RESULTS We identified 498 studies with a total of 18,312 participants. Publications involving validity assessments in surgical simulation more than doubled from 2008 to 2010 (∼30 studies/year) to 2014 to 2016 (∼70 to 90 studies/year). Only 6.6% of the studies used the recommended contemporary validity framework (Messick). The majority of studies used outdated frameworks such as face validity. Significant differences were identified across surgical specialties. The evaluated assessment tools were mostly inanimate or virtual reality simulation models. CONCLUSION An increasing number of studies have gathered validity evidence for simulation-based assessments in surgical specialties, but the use of outdated frameworks remains common. To address the current practice, this paper presents guidelines on how to use the contemporary validity framework when designing validity studies.
Collapse
|
6
|
Pietersen PI, Konge L, Madsen KR, Bendixen M, Maskell NA, Rahman N, Graumann O, Laursen CB. Development of and Gathering Validity Evidence for a Theoretical Test in Thoracic Ultrasound. Respiration 2019; 98:221-229. [PMID: 31137031 DOI: 10.1159/000500146] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/03/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Thoracic ultrasound (TUS) has a high diagnostic accuracy for many common pulmonary diseases, but theoretic knowledge in sonographic physics, thoracic anatomy and physiology, and sonopathologic patterns is required to develop competence. OBJECTIVES The aims of the study were to develop and gather validity evidence for a theoretical test in TUS and to establish a pass/fail standard. METHODS Content was provided based on expert interviews, leading to the creation of 113 initial multiple-choice question (MCQ) items. Consensus was reached on 92 proceeding items through a Delphi process, and items were presented to physicians with different knowledge and experience in TUS. Answers were used for item statistics in order to select the items with the most optimal item discrimination and difficulty (i.e., level I items) to be included in the final test. Mean scores of the novice, intermediate and experienced groups were compared, and a pass/fail score was established using the contrasting groups' standard setting method. RESULTS Item statistics revealed 38 level I items, of which 30 were selected to be included in the final test. The internal consistency was high (Cronbach's alpha = 0.88). Differences in mean scores were 8.6 points (p < 0.001), 6.3 points (p = 0.01), and 14.9 points (p < 0.001) between novices and intermediates, intermediates and experienced, and novices and experienced, respectively. A pass/fail standard of 20 points was established. CONCLUSION The established MCQ test can distinguish between physicians with different levels of competence in TUS and enables an objective, evidence-based approach for assessing the theoretical knowledge of trainees undergoing an educational programme in TUS.
Collapse
Affiliation(s)
- Pia Iben Pietersen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark,
- Regional Center for Technical Simulation, Odense University Hospital, Odense, Denmark,
- Institute for Clinical Research, University of Southern Denmark, Odense, Denmark,
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Capital Region of Denmark, Copenhagen, Denmark
| | - Kristian Rørbæk Madsen
- Department of Anaesthesiology and Intensive Care Medicine, Odense University Hospital, Odense, Denmark
| | - Morten Bendixen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Najib Rahman
- Oxford Pleural Unit and NIHR Biomedical Research Unit, Oxford University Hospital, Oxford, United Kingdom
| | - Ole Graumann
- Institute for Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Institute for Clinical Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
7
|
Bjerrum F, Thomsen ASS, Nayahangan LJ, Konge L. Surgical simulation: Current practices and future perspectives for technical skills training. MEDICAL TEACHER 2018; 40:668-675. [PMID: 29911477 DOI: 10.1080/0142159x.2018.1472754] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Simulation-based training (SBT) has become a standard component of modern surgical education, yet successful implementation of evidence-based training programs remains challenging. In this narrative review, we use Kern's framework for curriculum development to describe where we are now and what lies ahead for SBT within surgery with a focus on technical skills in operative procedures. Despite principles for optimal SBT (proficiency-based, distributed, and deliberate practice) having been identified, massed training with fixed time intervals or a fixed number of repetitions is still being extensively used, and simulators are generally underutilized. SBT should be part of surgical training curricula, including theoretical, technical, and non-technical skills, and be based on relevant needs assessments. Furthermore, training should follow evidence-based theoretical principles for optimal training, and the effect of training needs to be evaluated using relevant outcomes. There is a larger, still unrealized potential of surgical SBT, which may be realized in the near future as simulator technologies evolve, more evidence-based training programs are implemented, and cost-effectiveness and impact on patient safety is clearly demonstrated.
Collapse
Affiliation(s)
- Flemming Bjerrum
- a Department of Surgery , Herlev Gentofte Hospital , Herlev , Denmark
- b Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and the Capital Region of Denmark , Copenhagen , Denmark
| | - Ann Sofia Skou Thomsen
- b Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and the Capital Region of Denmark , Copenhagen , Denmark
- c Department of Ophthalmology , Rigshospitalet-Glostrup , Copenhagen , Denmark
| | - Leizl Joy Nayahangan
- b Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and the Capital Region of Denmark , Copenhagen , Denmark
| | - Lars Konge
- b Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and the Capital Region of Denmark , Copenhagen , Denmark
- d Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark
| |
Collapse
|
8
|
Konge L, Petersen RH, Ringsted C. Developing competency in video-assisted thoracic surgery (VATS) lobectomy. J Thorac Dis 2018; 10:S2025-S2028. [PMID: 30023109 DOI: 10.21037/jtd.2018.05.91] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Lars Konge
- Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - René Horsleben Petersen
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Charlotte Ringsted
- Centre for Health Science Education, Faculty of Health, Aarhus University, Aarhus, Denmark
| |
Collapse
|
9
|
A novel assessment tool for evaluating competence in video-assisted thoracoscopic surgery lobectomy. Surg Endosc 2018; 32:4173-4182. [PMID: 29603007 DOI: 10.1007/s00464-018-6162-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 03/21/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Specific assessment tools can accelerate trainees' learning through structured feedback and ensure that trainees attain the knowledge and skills required to practice as competent, independent surgeons (competency-based surgical education). The objective was to develop an assessment tool for video-assisted thoracoscopic surgery (VATS) lobectomy by achieving consensus within an international group of VATS experts. METHOD The Delphi method was used as a structured process for collecting and distilling knowledge from a group of internationally recognized VATS experts. Opinions were obtained in an iterative process involving answering repeated rounds of questionnaires. Responses to one round were summarized and integrated into the next round of questionnaires until consensus was reached. RESULTS Thirty-one VATS experts were included and four Delphi rounds were conducted. The response rate for each round were 68.9% (31/45), 100% (31/31), 96.8% (30/31), and 93.3% (28/30) for the final round where consensus was reached. The first Delphi round contained 44 items and the final VATS lobectomy Assessment Tool (VATSAT) comprised eight items with rating anchors: (1) localization of tumor and other pathological tissue, (2) dissection of the hilum and veins, (3) dissection of the arteries, (4) dissection of the bronchus, (5) dissection of lymph nodes, (6) retrieval of lobe in bag, (7) respect for tissue and structures, and (8) technical skills in general. CONCLUSION A novel and dedicated assessment tool for VATS lobectomy was developed based on VATS experts' consensus. The VATSAT can support the learning of VATS lobectomy by providing structured feedback and help supervisors make the important decision of when trainees have acquired VATS lobectomy competencies for independent performance.
Collapse
|
10
|
Jensen K, Bjerrum F, Hansen HJ, Petersen RH, Pedersen JH, Konge L. Using virtual reality simulation to assess competence in video-assisted thoracoscopic surgery (VATS) lobectomy. Surg Endosc 2016; 31:2520-2528. [PMID: 27655381 DOI: 10.1007/s00464-016-5254-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 09/14/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The societies of thoracic surgery are working to incorporate simulation and competency-based assessment into specialty training. One challenge is the development of a simulation-based test, which can be used as an assessment tool. The study objective was to establish validity evidence for a virtual reality simulator test of a video-assisted thoracoscopic surgery (VATS) lobectomy of a right upper lobe. METHODS Participants with varying experience in VATS lobectomy were included. They were familiarized with a virtual reality simulator (LapSim®) and introduced to the steps of the procedure for a VATS right upper lobe lobectomy. The participants performed two VATS lobectomies on the simulator with a 5-min break between attempts. Nineteen pre-defined simulator metrics were recorded. RESULTS Fifty-three participants from nine different countries were included. High internal consistency was found for the metrics with Cronbach's alpha coefficient for standardized items of 0.91. Significant test-retest reliability was found for 15 of the metrics (p-values <0.05). Significant correlations between the metrics and the participants VATS lobectomy experience were identified for seven metrics (p-values <0.001), and 10 metrics showed significant differences between novices (0 VATS lobectomies performed) and experienced surgeons (>50 VATS lobectomies performed). A pass/fail level defined as approximately one standard deviation from the mean metric scores for experienced surgeons passed none of the novices (0 % false positives) and failed four of the experienced surgeons (29 % false negatives). CONCLUSION This study is the first to establish validity evidence for a VATS right upper lobe lobectomy virtual reality simulator test. Several simulator metrics demonstrated significant differences between novices and experienced surgeons and pass/fail criteria for the test were set with acceptable consequences. This test can be used as a first step in assessing thoracic surgery trainees' VATS lobectomy competency.
Collapse
Affiliation(s)
- Katrine Jensen
- Department of Cardiothoracic Surgery, Sect. 2152, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark. .,Copenhagen Academy for Medical Education and Simulation (CAMES), Section 5404, University of Copenhagen and Capital Region, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Copenhagen, Denmark.
| | - Flemming Bjerrum
- JMC Simulation Unit, The Juliane Marie Centre, Section 4704, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Henrik Jessen Hansen
- Department of Cardiothoracic Surgery, Sect. 2152, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - René Horsleben Petersen
- Department of Cardiothoracic Surgery, Sect. 2152, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Jesper Holst Pedersen
- Department of Cardiothoracic Surgery, Sect. 2152, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Section 5404, University of Copenhagen and Capital Region, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Copenhagen, Denmark
| |
Collapse
|
11
|
Jensen JT, Savran MM, Møller AM, Vilmann P, Hornslet P, Konge L. Development and validation of a theoretical test in non-anaesthesiologist-administered propofol sedation for gastrointestinal endoscopy. Scand J Gastroenterol 2016; 51:872-9. [PMID: 26872690 DOI: 10.3109/00365521.2016.1141433] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Safety with non-anaesthesiologist-administered propofol sedation (NAAP) during gastrointestinal (GI) endoscopy is related to theoretical knowledge. A summative testing of knowledge before attempting supervised nurse-administered propofol sedation (NAPS) in the clinic is advised. The aims of this study were to develop a theoretical test about propofol sedation, to gather validity evidence for the test and to measure the effect of a NAPS-specific training course. MATERIAL AND METHODS A three-phased psychometric study on multiple choice questionnaire (MCQ) test development, gathering of validity evidence and evaluation of the effect of a specific NAAP course on the test result. A MCQ containing 86 questions was developed and administered 113 times to 91 participants representing novices, intermediates and experienced. RESULTS Question difficulty analyses revealed 50 level I and II questions. The 50 MCQs showed mean (SD) intergroup differences (p = 0.001) between novices = 28.6 (4.82), intermediates = 36.8 (5.43) and experienced = 41.8 (4.65) and provided a pass score of 35.2. The course with pre-course test had significant effect on the knowledge of nurses (18% increase) and physicians (19% increase; p = 0.001 and 0.001, respectively). CONCLUSIONS Data supported the validity of the developed MCQ test. The NAPS-specific course with pre-course testing adds theoretical knowledge to already well-prepared participants.
Collapse
Affiliation(s)
- Jeppe Thue Jensen
- a Department of Surgical Gastroenterology , Herlev University Hospital , Herlev , Capital Region of Denmark
| | - Mona Meral Savran
- b Centre for HR , Copenhagen Academy for Medical Education and Simulation , Copenhagen , Capital Region of Denmark
| | - Ann Merete Møller
- c Department of Anaesthesiology , Herlev University Hospital , Herlev , Capital Region of Denmark
| | - Peter Vilmann
- a Department of Surgical Gastroenterology , Herlev University Hospital , Herlev , Capital Region of Denmark
| | - Pernille Hornslet
- a Department of Surgical Gastroenterology , Herlev University Hospital , Herlev , Capital Region of Denmark
| | - Lars Konge
- b Centre for HR , Copenhagen Academy for Medical Education and Simulation , Copenhagen , Capital Region of Denmark
| |
Collapse
|
12
|
Konge L, Ringsted C, Bjerrum F, Tolsgaard MG, Bitsch M, Sørensen JL, Schroeder TV. The Simulation Centre at Rigshospitalet, Copenhagen, Denmark. JOURNAL OF SURGICAL EDUCATION 2015; 72:362-5. [PMID: 25725952 DOI: 10.1016/j.jsurg.2014.11.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 11/27/2014] [Indexed: 05/07/2023]
Affiliation(s)
- Lars Konge
- Centre for Clinical Education, The Capital Region of Denmark, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Charlotte Ringsted
- Centre for Clinical Education, The Capital Region of Denmark, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Anesthesia, University of Toronto and University Health Network, Toronto, Ontario, Canada; The Wilson Centre, University of Toronto and University Health Network, Toronto, Ontario, Canada
| | - Flemming Bjerrum
- JMC Simulation Unit, The Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Martin G Tolsgaard
- Centre for Clinical Education, The Capital Region of Denmark, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; JMC Simulation Unit, The Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mikael Bitsch
- Centre for Clinical Education, The Capital Region of Denmark, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jette L Sørensen
- JMC Simulation Unit, The Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Torben V Schroeder
- Centre for Clinical Education, The Capital Region of Denmark, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|