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Background <p>Laparoscopic hiatal hernia repair is a common foregut procedure, yet high-fidelity simulation tools for training and assessment remain limited. Previously, task-specific metrics (TSMs) were developed and validated at a single institution to evaluate performance during simulated laparoscopic crural repair. This study assessed the external validity and reliability of these TSMs using a broader, international cohort.</p> Methods <p>Participants at the 2024 SAGES Education and Innovation Center performed a simulated laparoscopic crural repair using an inanimate silicone model housed in a standard laparoscopic trainer box. Demographic data and surgical experience were collected via pre-survey. Performances were video-recorded and independently assessed by three blinded raters using both the Objective Structured Assessment of Technical Skills (OSATS) and TSMs. Participants were stratified into novice (PGY1–2) or experienced (PGY3–5, fellows, attendings). Inter-rater reliability was evaluated using intraclass correlation coefficient (ICC). Performance comparisons were analyzed using the Wilcoxon–Mann–Whitney test. Linear regression modeled training level as an ordered predictor, adjusting for simulation exposure. Correlation between OSATS and TSM scores was measured using Spearman’s rank correlation.</p> Results <p>Thirty-three participants were enrolled; 30 completed the task (attendings: 9; fellows: 3; PGY1–5: 18). 22 were U.S.-trained and 8 internationally trained. Inter-rater reliability was high for both scoring methods (ICC = 0.85; <i>p</i> &lt; 0.001). Experienced participants scored significantly higher than novices on both OSATS (20 vs. 14; <i>p</i> = 0.039) and TSMs (39 vs. 18.5; <i>p</i> = 0.02). In adjusted models, robotic simulation training was independently associated with higher OSATS (<i>β</i> = 4.67, <i>p</i> = 0.021) and TSM scores (<i>β</i> = 15.01, <i>p</i> = 0.024). TSM and OSATS scores were strongly correlated (<i>R</i> = 0.88; <i>p</i> &lt; 0.001).</p> Conclusions <p>TSMs demonstrated strong external validity and reliability, effectively discriminating between experience levels and supporting their use as standardized assessment tool in surgical education and global training programs.</p>

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External validity of task-specific metrics for performance assessment in laparoscopic crural repair

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月1日

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  • Sofia Garces-Palacios,
  • Alexis Desir,
  • Apoorva Pise,
  • Carla Holcomb,
  • Daniel J. Scott,
  • Ganesh Sankaranarayanan

摘要

Background

Laparoscopic hiatal hernia repair is a common foregut procedure, yet high-fidelity simulation tools for training and assessment remain limited. Previously, task-specific metrics (TSMs) were developed and validated at a single institution to evaluate performance during simulated laparoscopic crural repair. This study assessed the external validity and reliability of these TSMs using a broader, international cohort.

Methods

Participants at the 2024 SAGES Education and Innovation Center performed a simulated laparoscopic crural repair using an inanimate silicone model housed in a standard laparoscopic trainer box. Demographic data and surgical experience were collected via pre-survey. Performances were video-recorded and independently assessed by three blinded raters using both the Objective Structured Assessment of Technical Skills (OSATS) and TSMs. Participants were stratified into novice (PGY1–2) or experienced (PGY3–5, fellows, attendings). Inter-rater reliability was evaluated using intraclass correlation coefficient (ICC). Performance comparisons were analyzed using the Wilcoxon–Mann–Whitney test. Linear regression modeled training level as an ordered predictor, adjusting for simulation exposure. Correlation between OSATS and TSM scores was measured using Spearman’s rank correlation.

Results

Thirty-three participants were enrolled; 30 completed the task (attendings: 9; fellows: 3; PGY1–5: 18). 22 were U.S.-trained and 8 internationally trained. Inter-rater reliability was high for both scoring methods (ICC = 0.85; p < 0.001). Experienced participants scored significantly higher than novices on both OSATS (20 vs. 14; p = 0.039) and TSMs (39 vs. 18.5; p = 0.02). In adjusted models, robotic simulation training was independently associated with higher OSATS (β = 4.67, p = 0.021) and TSM scores (β = 15.01, p = 0.024). TSM and OSATS scores were strongly correlated (R = 0.88; p < 0.001).

Conclusions

TSMs demonstrated strong external validity and reliability, effectively discriminating between experience levels and supporting their use as standardized assessment tool in surgical education and global training programs.