Validation of an in vivo porcine simulation model of pedicled latissimus dorsi myocutaneous flap elevation

Maha Wagdy Hamada,Youn Hwan Kim,Giorgios Pafitanis,Simon Myers,Ali Ghanem,Alex Nistor

doi:10.1007/s00238-020-01734-9

Abstract

BackgroundIn vivo and ex vivo simulation training workshops can contribute to surgical skill acquisition but require validation before becoming incorporated within curricula. Ideally, that validation should include the following: face, content, construct, concurrent, and predictive validity.MethodsDuring two in vivo porcine surgical training workshops, 27 participants completed questionnaires relating to face and content validity of porcine in vivo flap elevation. Six participants’ performances raising a pedicled myocutaneous latissimus dorsi (LD) flap in the pig (2 experts and 4 trainees) were sequentially and objectively assessed for construct validity with hand motion analysis (HMA), a performance checklist, a blinded randomized procedure-specific rating scale of standardized video recordings, and flap viability by fluorescence imaging.ResultsFace and content validity were demonstrated straightforwardly. Construct validity was demonstrated for average procedure time by HMA between trainees and experts (p = 0.036). Skill acquisition was demonstrated by trainees’ HMA average number of hand movements (p = 0.046) and fluorescence flap viability (p = 0.034).ConclusionFace and content validity for in vivo porcine flap elevation simulation training were established. Construct validity was established for an in vivo porcine latissimus dorsi flap elevation simulation specifically. Predictive validity will prove more challenging to establish.Level of evidence: Not ratable .

Highlights

Trainee surgeons are increasingly expected to complete a variety of competency-based surgical courses during specialty training
Microsurgical simulation training courses generally extend over a number of consecutive days aiming to provide a bundle of skills within a patient safe and non-threatening training environment for trainees [3, 4]
Of the total 27 participants canvassed for both courses, 100% agreed strongly or moderately that the live pig is a useful model for flap elevation training

Summary

Introduction

Trainee surgeons are increasingly expected to complete a variety of competency-based surgical courses during specialty training. Surgical courses on high fidelity simulation models provide students and junior trainees with key practical skills placing them at the center of the educational experience as opposed to the clinical setting [1]. Microsurgical simulation training courses generally extend over a number of consecutive days aiming to provide a bundle of skills within a patient safe and non-threatening training environment for trainees [3, 4]. These educational and training interventions have been shown to lead to significant technical and non-technical skill acquisition both over the course period, as well as over a long term [5,6,7]. That validation should include the following: face, content, construct, concurrent, and predictive validity

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Conclusion