The San Antonio kidney transplant model: validity evidence and proficiency benchmarks

Abstract

Simulation has become an increasingly important tool in training complex and high-stake surgical techniques, including kidney transplantation. While several kidney transplant models have been described, there remains a need for a low-cost model with established proficiency targets. We developed a low-cost kidney transplant model to simulate a renal vein to iliac vein end-to-side anastomosis, and a proficiency-based curriculum to prepare and evaluate trainees. This low-fidelity model utilizes a constrained space and adjustable depth to simulate the iliac fossa, with replaceable Penrose drains as vascular conduits. 18 novices (PGY1), 19 junior intermediates (PGY 2–3), 7 senior intermediates (PGY 4–5) and 6 experts (faculty transplant surgeons) each performed anastomoses on the model. Three metrics were used to rate each performance—completion time, a scoring rubric, and a composite technical score (CTS) formula. Messick’s validity framework was used to evaluate the model and scoring rubric to provide evidence for content alignment, response process validity, internal structure validity, and construct validity. Resident participants reported the model was easy to set up (8.6/10) and added value to their surgical education (9.8/10). Transplant surgery faculty reported the model realistically simulated an end-to-side renal vein anastomosis (8.3/10), supporting content alignment. One-way ANOVAs for each of the three metrics was statistically significant across all skill levels (p < 0.001), supporting construct validity. Response process validity was achieved using blinded raters to review the video performances. Finally, inter-rater reliability was obtained with an intraclass correlation coefficient of 0.896 (< 0.001), supporting internal structure validity. We utilized Messick’s validity framework to provide validity evidence for a low-cost, low-fidelity kidney transplant model and a scoring rubric. Furthermore, we provided proficiency benchmarks for trainees to train towards. This model is well suited for preparing surgical trainees to perform in vivo kidney transplants.