Validation of a Novel Inverted Peg Transfer Task: Advancing Beyond the Regular Peg Transfer Task for Surgical Simulation-Based Assessment

Publication date: Available online 14 October 2017
Source:Journal of Surgical Education
Author(s): Amro M. Abdelrahman, Denny Yu, Bethany R. Lowndes, EeeLN H. Buckarma, Becca L. Gas, David R. Farley, Juliane Bingener, M. Susan Hallbeck
ObjectiveTo evaluate the validity of a novel inverted peg transfer (iPT) task for assessing laparoscopic skills of novices and experts and compare iPT to the regular PT (rPT) task to ensure surgical trainee acquisition of an adequate advanced laparoscopic skills level for safe laparoscopic practice in the operating room.DesignProspective crossover study.SettingMultidisciplinary simulation center and motion analysis laboratory, Mayo Clinic.ParticipantsNovices were medical students and surgical interns without laparoscopic experience. Experts were surgeons with at least 3 years of experience in laparoscopic surgery.MethodsThis was the first exposure to iPT for both groups. Completion time and performance metrics were recorded. A scoring rubric was used to calculate a normalized performance score between 0 and 100. Wilcoxon rank sum and Mann-Whitney tests were performed with α = 0.05. Receiver-operating characteristic curves were graphed for the 2 task scores to assess the tasks' sensitivity and specificity in differentiating laparoscopic experience level.Main Outcome MeasuresPerformance measures of completion time, transferred triangles, dropped triangles (errors), and the overall performance score on both tasks between- and within-subjects (i.e., novices and experts).ResultsThirty-six novices and eight experts participated. Both experts and novices had longer completion time and lower scores during iPT than rPT (p < 0.05). Within iPT, novice completion times were 144 seconds longer (p = 0.04), and performance score was 35 points lower than experts (p < 0.01). No differences between novices and experts were observed for completion time or performance scores (p > 0.05) for rPT. The iPT scores had a higher sensitivity and specificity than the rPT (area under the receiver-operating characteristic curve: iPT = 0.91; rPT = 0.69).ConclusionsiPT is a valid assessment of advanced laparoscopic skills for surgical trainees with higher specificity and sensitivity than rPT. As advanced minimally invasive surgery becomes more common, it is important that tasks such as iPT be included in surgical simulation curricula and training assessment.



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