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Practice till you can't get it wrong! - Making a Fundoplication Simulator for Today's Surgical Trainees
Sadia Tasnim, Ravi Dhamija, Monisha Sudarshan, Daniel Raymond, Siva Raja, Sudish Murthy, James Yun, Dean Schraufnagel
Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, United States
Objective:
Surgical trainees need effective simulation tools, that are easily replicated and implemented for academic medical centers to implement them. Our objective was to create and validate a cost-effective Dor fundoplication simulator for surgical trainees and develop a simulation curriculum.
Methods:
A scale-appropriate replica of the distal esophagus, proximal stomach, and diaphragmatic hiatus was created using felt ($2). Ten experienced foregut surgeons from multiple institutions evaluated the model for physical attributes, realism of materials and experience, ability to perform tasks, values as teaching and testing tools, and relevance to clinical practice. They rated it from 1 (Not realistic) to 5 (Highly realistic). From 5/1/2023 to 11/30/2023, 56 trainees (cardiothoracic fellows, integrated cardiothoracic surgery residents, general surgery residents, and medical students) performed Dor fundoplication before and after watching a focused teaching video and completed pre- and post-confidence surveys. Post-graduate level 3 and under were considered Junior trainees. Post-graduate level 4 and up were considered Senior trainees. The two attempts were video recorded, and trainees were scored for the specimen and video based on Objective Structured Assessment of Technical Skills criteria.
Three validation criteria should be fulfilled for a validated teaching tool namely: 1) Face Validity (the degree to which the simulated environment represents reality), 2) Content Validity (a measure of the usefulness of a training tool from the perspective of an expert user) and 3) Construct Validity (the ability of a learning tool to differentiate different levels of trainees). A median score of >4 (out of 5) was considered the face and content validity benchmark. Construct validity was evaluated using the Wilcoxon Rank Sum test, which compares the Juniors' video and specimen scores to those of the Seniors for both attempts. The overall experience was rated from 1 (Not valuable) to 5 (Very valuable).
Results:
The observed median [IQR] of the domains were 5 [4,5] (Relevance), 5 [4,5] (Ability to perform the task), 4.5 [4,5] (Value), 4 [4,5] (Physical attributes), 4 [4,5] (Realism of experience), and 4 [4,4.25] (Realism of materials) satisfying face and content validity. Seniors (n=28) scored significantly higher on both objective and subjective measures for both video and specimen scores for both attempts (p<.001) satisfying construct validity (Figure). Trainees reported higher confidence in performing the assigned task (p<.001) on the second attempt with seniors reporting higher confidence levels than juniors (n=28). The overall simulation was rated as a median of 5 [4,5] by trainees.
Conclusions:
This model satisfies all three benchmark criteria required to be considered validated. The global findings and comments indicate that the simulator is valuable as a Dor fundoplication teaching tool. We are currently building a teaching curriculum with this model to train our surgical trainees to practice before coming to the operating room.
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