R. Rao1, R. Caskey1, N. Williams1, D. Dempsey1, J. Morris1, K. Dumon1, A. D. Brooks1 1University Of Pennsylvania,Division Of Surgical Education,Philadelphia, PA, USA
Introduction:
Laparoscopic cholecystectomy, the gold standard in the management of gallbladder disease, has received much attention in the field of general surgical education and simulation. However, the optimal way to evaluate surgery residents in performing laparoscopic cholecystectomy within the simulation environment has yet to be determined. We have recently developed a technical rating scale (LCTRS) which is both specific for laparoscopic cholecystectomy and based on previously published expert consensus. This is in contrast to the currently used generic scales like OSATS (Objective Structured Rating of Technical Skills).
Methods:
At our institution, simulation training for laparoscopic cholecystectomy consists of faculty mentored sessions in a simulated OR setting followed by faculty supervised practice on an inanimate model and then concludes with the resident performance of a laparoscopic cholecystectomy on an ex-vivo porcine liver. In order to better evaluate resident performance of this final task we developed a technical rating scale specific for laparoscopic cholecystectomy (LCTRS). To do this, the following critical steps were identified as essential to the performance of a safe laparoscopic cholecystectomy: Starting dissection high on the gallbladder at Calot's triangle, Appropriate retraction and exposure, Understanding of relevant anatomy, Establishing critical view of safety, Appropriate decision to proceed, Securing cystic duct, Safe use of energy devices, and Appropriate tissue handling. The weight of each of these steps was calculated from published expert ratings of the importance of each step and are 1.15, 1.18, 1.11, 1.05, 1.03, 1.03, 1.01 and 1.00 respectively. To evaluate a resident, the performance of each critical step is rated on a Likert scale of 1-4 (1 being below standard, 2 being standard of care, 3 and 4 being above standard) and then weighted appropriately. To test the validity of LCTRS, video recordings were made of six PGY-1 residents performing ex-vivo laparoscopic cholecystectomy. The videos were then evaluated using both LCTRS and OSATS by two independent surgeons. Inter-rater reliability was calculated using intra-class correlation coefficient. The two scales were then correlated using Pearson’s correlation coefficient. All scores are reported as the mean± standard error of the mean.
Results:
The mean resident score using LCTRS was 22.7 ± 1.2. There was excellent correlation between LCTRS and OSATS (r=0.85, p=0.03). The inter-rater reliability for the LCTRS and the OSATS scale were 0.79 and 0.49 respectively.
Conclusion:
The LCTRS for laparoscopic cholecystectomy is both procedure specific and based on expert consensus and is therefore superior to generic rating scales like OSATS. Future uses of the LCTRS will include the determination of benchmarks necessary for resident progression as well as the tracking of individual resident progress.