Kramp, K.H. (Kelvin) (2014) Beoordeling van laparoscopische vaardigheden d.m.v. de OSATS, GOALS en een procedure-specifieke beoordelingsmethode. thesis, Medicine.
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Abstract
Background: Today, there is no widely used standardized method to evaluate procedure specific laparoscopic skills in the Netherlands. The assessment with the OSATS (Objective Surgical Assessment of Technical Skills), the current golden standard, seems to lack reliability and according to some authors therefore cannot be used for certification in a specific procedure. The first aim of this study is to develop a valid and reliable procedure specific assessment method that can be standardized for procedural learning and certification. The second aim is to compare the reliability and support of the procedure specific assessment method with the reliability of global assessment methods: OSATS and GOALS (Global Operative Assessment of Laparoscopic Skills). Method: A procedure specific assessment form (PSAF) containing 6 mainsteps and 18 substeps was created on the basis of the recently published consensus reached with the Delphi method on the procedural key steps of the laparoscopic cholecystectomy. Each step was linked to a scale of independency ranging from 0 to 4. The validity of the procedure specific assessment was estimated by using the assessment of live observation. The Spearman rho correlation coefficient between experience and score was calculated and a regression analysis was performed to calculate if the scores significantly fitted to the function of a learning curve. The reliability of the OSATS, GOALS and PSAF was estimated through video assessment. Three videos were selected of trainees with different experience in performing laparoscopic cholecystectomies: 1) novice 2) advanced beginner and 3) almost competent. The three videos were blinded by subtitling the communication between trainee and surgeon and muting the sound. The assessment was done by 6 OR nurses, 2 trainees and 2 researchers. The video assessments were preceded by an introduction video that contained instructions for assessment. The reliability was estimated with the absolute agreement and consistency agreement intra-class correlation coefficient (resp. AA-ICC and CA-ICC). A survey was conducted to estimate the amount of support for implementation of the procedure specific assessment. The significance level was set at 0.05 in all analyses. Results: Twenty-one laparoscopic cholecystectomies performed by 3 trainees were assessed with the PSAF. Nine assessments were excluded from validity analysis. The Spearman rho correlation coefficient was 0.970 (p<0.001) and the assessment score on the PSAF could significantly be fitted to the exponential function of a learning curve with a learning constant of -0.110 (p<0.001). The AA-ICCs of the OSATS, GOALS and PSAF were resp. 0.857 (p<0.001), 0.806 (p<0.001) and 0.848 (p<0.001). The CA-ICCs were resp. 0.908 (p<0.001), 0.865 (p<0.001) and 0.867 (p<0.001). Although the PSAF contains 18 items, the participants did not consider it to be an administrative burden. Furthermore, there was support for implementation of the PSAF for other laparoscopic procedures. Discussion/Conclusion: Using the Delphi method to develop a list of procedural key steps and combining the individual key steps with a scale of independency is a practical method for the development of a valid and reliable procedure specific assessments. Furthermore, it seems that a high interrater reliability can be achieved with OSATS and GOALS when the assessment is preceded by a short introduction video with instructions for assessment. Further research consisting of assessments by surgeons is necessary to confirm these findings.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Pierie, Prof. dr. J.P.E.N. and Medisch Centrum Leeuwarden en UMCG |
| Supervisor name: | Det, Dr. M.J. van and Ziekenhuis Groep Twente and afdeling chirurgie, Almelo |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:42 |
| Last Modified: | 25 Jun 2020 10:42 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/382 |
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