The SParTA Score: A New Assessment System for Microsurgical Training.

Abstract

We describe the Suture Parameters for Training Assessment (SParTA) tool, which is reliable and easily administered, to assess and guide both training and practice in microsurgery. It comprises six parameters that are easily measured from an image. [See Figure, Supplemental Digital Content 1, which demonstrates the six parameters of the SParTA scoring system: suture length (mm), yellow line; suture angle (degree), between the yellow line and blue line (the strip border); suture alignment (mm), distance between the green dot (midpoint of the suture) and blue dot (intersection point between the wound axis and that suture); suture interval (mm), distance between two adjacent green dots; area (mm2), formed by four red points (end points of the cut suture); and the missing suture, defined as having less than nine required sutures, https://links.lww.com/PRS/F92.] Twenty-six completed microsurgical suture strips (Digital Surgicals, Singapore) from our database were picked to represent the spectrum of performance. Participants were instructed to cut the strip perpendicularly and place nine interrupted sutures using 11-0 nylon. Images of the suture strips were captured and imported into ImageJ software version 2 (National Institutes of Health, Bethesda, Md.) for measurement. Five experts were provided with the same photographs of the suture strips. The experts independently ranked the suture strips using a four-point Likert scale, with 1 = very poor, 2 = poor, 3 = good, and 4 = very good. The average expert score was utilized as a standard for validation of the scoring systems. Subsequently, the samples were assessed using three scoring systems: our system, the DS Micro Trainer system (Digital Surgical Pte., Ltd., Singapore),1 and the End Product Intimal Assessment tool.2 The scores were compared against expert evaluations as a standard for validation. SParTA was used to score the strips, first by two different assessors and a second time by one of the two assessors after 7 days, for interrater and intrarater validity, respectively. All analyses were performed using SPSS version 23.0 software (SPSS, Inc., Chicago, Ill.). Statistical significance was defined as p less than 0.05. Intrarater and interrater reliability were determined using the intraclass correlation coefficient (95 percent confidence interval, two-way mixed effects model, absolute agreement, single rater, κ = 2). The mean differences of the intrarater and interrater scores were further evaluated using the two-tailed t test. SParTA scores ranged from 13 to 105, with a lower score indicating better performance (0 is the best possible score). The mean differences in intrarater and interrater scores were 1.27 (±7.36) and 1.31 (±9.02), respectively (p > 0.05). Both the intrarater and interrater scores were further validated using the intraclass correlation coefficient, which showed good to excellent reliability, with an intrarater intraclass correlation coefficient of 0.95 (95 percent CI, 0.89 to 0.98) and an interrater intraclass correlation coefficient of 0.93 (95 percent CI, 0.86 to 0.97). When the three scoring systems were compared to the expert assessment, there was strongest positive correlation between the expert score and SParTA (r = 0.89, p = 0.00) (Fig. 1), followed by the expert score and the DS Micro Trainer (r = 0.78, p = 0.00). A weaker positive correlation was observed for the End Product Intimal Assessment tool (r = 0.56, p = 0.03).Fig. 1.: Scatterplots and linear relationships between the SParTA scoring algorithm and expert assessment.SParTA’s parameters were chosen to reflect suturing characteristics that directly reflect the quality of work done. For example, SParTA assesses suture spacing rather than suture knot spacing, as done in the DS Micro Trainer.1,3 Beyond a score (and parameter subscores), SParTA provides useful detailed information that guides training and practice. Standardized microsurgery simulation tasks allow educators and trainees to benchmark their performance and learning.4 This is contingent on valid and reliable assessment of the training task. SParTA is a product scoring system that fulfils this requirement for microsurgical training. DISCLOSURE The authors have no financial disclosures to report. No funding was received for this article.