A Valid Model for Testing and Training Laparoscopic Psychomotor Skills

Abstract

A number of training devices and methods for laparoscopic skills acquisition have been developed. Very few have focused on the specific essential laparoscopic psychomotor skills (LPS) required for a future laparoscopist to be able to enter in a one-to-one teaching process in the operating room. The Laparoscopic Skills Testing and Training (LASTT) model is a new in vitro model developed by the European Academy of Gynaecological Surgery to measure LPS. It has been well demonstrated that this model can distinguish between experienced and inexperienced surgeons, and some investigators have suggested that it may be cost effective for continuous training and evaluation of LPS in all surgical disciplines performing laparoscopic procedures. The study investigated the face and construct validity of the LASTT model for measuring LPS. The study subjects were residents and gynecologists with different levels of experience in laparoscopic surgery (n = 199), who attended workshops organized by the European Academy of Gynaecological Surgery in 2008 and 2009. To correlate between the level of clinical experience and proficiency in the essential LPS, the participants were classified in 3 groups (G1: no/little, G2: intermediate, G3: important). The ability of the study subjects to perform 3 standardized exercises (E1: camera navigation, E 2 : hands-eyes coordination, and E 3 : bimanual coordination) was investigated for specific measurable objectives within a defined time frame. An 11-item questionnaire using a 10-cm visual analogue scale evaluated the face validity of the LASTT model. Its capacity for testing and training LPS was assessed in Question 1 to Question 8, and its relevance for actual laparoscopic surgery was addressed in Question 9 to Question 11. To include the scores of participants unable to complete the task in the assigned time, the final score was obtained by dividing the actual time used by the number of objectives successfully accomplished. A comparison was made between the prior levels of exposure to laparoscopy and E1 to E 3 scores to determine the construct validity of the model. Participants with previous exposure to a larger amount of laparoscopic procedures had higher E1 to E 3 scores in comparison to those with exposure to fewer procedures. All participants had a favorable opinion of the model for both testing and training purposes without inter-group differences. These findings clearly show that the LASTT model has face and construct validity, and may be a useful tool for training and evaluation of LPS among surgeons performing laparoscopic procedures.