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Reliable and valid assessment of performance in thoracoscopy

机译：对胸腔镜检查性能进行可靠，有效的评估

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Background As we move toward competency-based education in medicine, we have lagged in developing competency-based evaluation methods. In the era of minimally invasive surgery, there is a need for a reliable and valid tool dedicated to measure competence in videoassisted thoracoscopic surgery. The purpose of this study is to create such an assessment tool, and to explore its reliability and validity. Methods An expert group of physicians created an assessment tool consisting of 10 items rated on a five-point rating scale. The following factors were included: economy and confidence of movement, respect for tissue, precision of operative technique, creation and placement of ports, localization of pathologic tissue, use of staplers, retrieval of tissue in bag and placement of chest tube. Fifty consecutive thoracoscopic wedge resections were recorded and assessed blindly and independently by two experts using the tool. Results Four residents, four fellows and five consultants performed 1-10 (median 4) operations each. The fellows performed significantly better than the residents (P = 0.03; effect size, ES = 0.72). The consultants scored 11% higher than the fellows, but this difference was not significant (P = 0.10, ES = 0.64). The inter-rater reliability was acceptable (Cronbach's alpha 0.71). Conclusions This tool for assessing performance in thoracoscopy is reliable and valid. It can provide unbiased feedback to trainees, and can be used to evaluate new teaching curricula, i.e. simulation-based training. Furthermore, it has potential to aid in certification of new thoracic surgeons.
机译：背景技术随着我们朝着基于胜任力的医学教育方向发展，我们已经落后于开发基于胜任力的评估方法。在微创手术时代，需要一种可靠且有效的工具来专门测量电视胸腔镜手术的能力。这项研究的目的是创建这样一种评估工具，并探讨其可靠性和有效性。方法一个专家医师小组创建了一个评估工具，该工具包含五项评分量表中的10个项目。包括以下因素：运动的经济性和信心，对组织的尊重，手术技术的准确性，端口的创建和放置，病理组织的定位，订书机的使用，袋中组织的取回以及胸管的放置。记录了连续50例胸腔镜楔形切除术，并由两名专家使用该工具盲目且独立地进行了评估。结果4名居民，4名研究员和5名顾问分别进行了1-10次（中位数4次）手术。研究员的表现明显好于居民（P = 0.03;效应量，ES = 0.72）。顾问的得分比同伴高11％，但是这种差异并不显着（P = 0.10，ES = 0.64）。评价者间的可靠性是可以接受的（Cronbach的alpha为0.71）。结论该评估胸腔镜检查性能的工具是可靠且有效的。它可以向受训者提供公正的反馈，并可用于评估新的教学课程，即基于模拟的培训。此外，它具有帮助新胸部外科医师进行认证的潜力。

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