Abstract
Background
Laparoscopic training remains inaccessible for surgeons in low- and middle-income countries, limiting its widespread adoption. We developed a novel tool for assessment of laparoscopic appendectomy skills through ALL-SAFE, a low-cost laparoscopy training system.
Methods
This pilot study in Ethiopia, Cameroon, and the USA assessed appendectomy skills using the ALL-SAFE training system. Performance measures were captured using the ALL-SAFE verification of proficiency tool (APPY-VOP), consisting of a checklist, modified Objective Structured Assessment of Technical Skills (m-OSATS), and final rating. Twenty participants, including novice (n = 11), intermediate (n = 8), and expert (n = 1), completed an online module covering appendicitis management and psychomotor skills in laparoscopic appendectomy. After viewing an expert skills demonstration video, participants recorded their performance within ALL-SAFE. Using the APPY-VOP, participants rated their own and three peer videos. We used the Kruskal–Wallis test and a Many-Facet Rasch Model to evaluate (i) capacity of APPY-VOP to differentiate performance levels, (ii) correlation among three APPY-VOP components, and (iii) rating differences across groups.
Results
Checklist scores increased from novice (M = 21.02) to intermediate (M = 23.64) and expert (M = 28.25), with differentiation between experts and novices, P = 0.005. All five m-OSATS domains and global summed, total summed, and final rating discriminated across all performance levels (P < 0.001). APPY-VOP final ratings adequately discriminated Competent (M = 2.0), Borderline (N = 1.8), and Not Competent (M = 1.4) performances, Χ2 (2,85) = 32.3, P = 0.001. There was a positive correlation between ALL-SAFE checklist and m-OSATS summed scores, r(83) = 0.63, P < 0.001. Comparison of ratings suggested no differences across expertise levels (P = 0.69) or location (P = 0.66).
Conclusion
APPY-VOP effectively discriminated between novice and expert performance in laparoscopic appendectomy skills in a simulated setting. Scoring alignment across raters suggests consistent evaluation, independent of expertise. These results support the use of APPY-VOP among all skill levels inside a peer rating system. Future studies will focus on correlating proficiency to clinical practice and scaling ALL-SAFE to other settings.
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Acknowledgements
The authors would like to thank surgery residents at Soddo Christian Hospital, Ethiopia and Mbingo Baptist Hospital, Cameroon, as well as medical students involved in the Surgery Olympics program at University of Michigan Medical School.
Funding
Christopher W. Reynolds was supported by a grant from the National Institutes of Health during this study (T-35 Short-Term Biomedical Research Training Program). This work was supported by a grant from the Intuitive Foundation in partnership with the Massachusetts Institute of Technology Solve Initiative as part of the Global Surgery Training Challenge.
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Mr. Christopher W. Reynolds was supported by a grant from the National Institutes of Health during this study (T-35 Short-Term Biomedical Research Training Program). Dr. Grace J. Kim was supported by a grant from the Intuitive Foundation in partnership with the Massachusetts Institute of Technology Solve Initiative as part of the Global Surgery Training Challenge (no grant number). Drs. Deborah M. Rooney, David R. Jeffcoach, Melanie Barnard, Mark J. Snell, Kevin El-Hayek, Blessing Ngoin Ngam, and John Tanyi and Ms. Serena S. Bidwell, Ms. Chioma Anidi, and Ms. C. Yoonhee Ryder have no conflicts of interest or financial ties to disclose.
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Reynolds, C.W., Rooney, D.M., Jeffcoach, D.R. et al. Evidence supporting performance measures of laparoscopic appendectomy through a novel surgical proficiency assessment tool and low-cost laparoscopic training system. Surg Endosc 37, 7170–7177 (2023). https://doi.org/10.1007/s00464-023-10182-y
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DOI: https://doi.org/10.1007/s00464-023-10182-y