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A novel assessment tool for evaluating competence in video-assisted thoracoscopic surgery lobectomy

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Abstract

Background

Specific assessment tools can accelerate trainees’ learning through structured feedback and ensure that trainees attain the knowledge and skills required to practice as competent, independent surgeons (competency-based surgical education). The objective was to develop an assessment tool for video-assisted thoracoscopic surgery (VATS) lobectomy by achieving consensus within an international group of VATS experts.

Method

The Delphi method was used as a structured process for collecting and distilling knowledge from a group of internationally recognized VATS experts. Opinions were obtained in an iterative process involving answering repeated rounds of questionnaires. Responses to one round were summarized and integrated into the next round of questionnaires until consensus was reached.

Results

Thirty-one VATS experts were included and four Delphi rounds were conducted. The response rate for each round were 68.9% (31/45), 100% (31/31), 96.8% (30/31), and 93.3% (28/30) for the final round where consensus was reached. The first Delphi round contained 44 items and the final VATS lobectomy Assessment Tool (VATSAT) comprised eight items with rating anchors: (1) localization of tumor and other pathological tissue, (2) dissection of the hilum and veins, (3) dissection of the arteries, (4) dissection of the bronchus, (5) dissection of lymph nodes, (6) retrieval of lobe in bag, (7) respect for tissue and structures, and (8) technical skills in general.

Conclusion

A novel and dedicated assessment tool for VATS lobectomy was developed based on VATS experts’ consensus. The VATSAT can support the learning of VATS lobectomy by providing structured feedback and help supervisors make the important decision of when trainees have acquired VATS lobectomy competencies for independent performance.

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References

  1. Falcoz PE, Puyraveau M, Thomas PA, Decaluwe H, Hurtgen M, Petersen RH, Hansen H, Brunelli A (2016) Video-assisted thoracoscopic surgery versus open lobectomy for primary non-small-cell lung cancer: a propensity-matched analysis of outcome from the European Society of Thoracic Surgeon database. Eur J Cardiothorac Surg 49:602–609. https://doi.org/10.1093/ejcts/ezv154

    Article  PubMed  Google Scholar 

  2. Laursen L, Petersen RH, Hansen HJ, Jensen TK, Ravn J, Konge L (2016) Video-assisted thoracoscopic surgery lobectomy for lung cancer is associated with a lower 30-day morbidity compared with lobectomy by thoracotomy. Eur J Cardiothorac Surg 49:870–875. https://doi.org/10.1093/ejcts/ezv205

    Article  PubMed  Google Scholar 

  3. Whitson BA, Groth SS, Duval SJ, Swanson SJ, Maddaus MA (2008) Surgery for early-stage non-small cell lung cancer: a systematic review of the video-assisted thoracoscopic surgery versus thoracotomy approaches to lobectomy. Ann Thorac Surg 86:2008–2018. https://doi.org/10.1016/j.athoracsur.2008.07.009

    Article  PubMed  Google Scholar 

  4. Yan TD, Cao C, D’Amico TA, Demmy TL, He J, Hansen H, Swanson SJ, Walker WS (2014) Video-assisted thoracoscopic surgery lobectomy at 20 years: a consensus statement. Eur J Cardiothorac Surg 45:633–639. https://doi.org/10.1093/ejcts/ezt463

    Article  PubMed  Google Scholar 

  5. Cao C, Tian DH, Wolak K, Oparka J, He J, Dunning J, Walker WS, Yan TD (2014) Cross-sectional survey on lobectomy approach (X-SOLA). Chest 146:292–298. https://doi.org/10.1378/chest.13-1075

    Article  PubMed  Google Scholar 

  6. Petersen RH, Hansen HJ (2010) Learning thoracoscopic lobectomy. Eur J Cardiothorac Surg 37:516–520. https://doi.org/10.1016/j.ejcts.2009.09.012

    Article  PubMed  Google Scholar 

  7. Ferguson J, Walker W (2006) Developing a VATS lobectomy programme—can VATS lobectomy be taught? Eur J Cardiothorac Surg 29:806–809. https://doi.org/10.1016/j.ejcts.2006.02.012

    Article  PubMed  Google Scholar 

  8. Carrott PW, Jones DR (2013) Teaching video-assisted thoracic surgery (VATS) lobectomy. J Thorac Dis. https://doi.org/10.3978/j.issn.2072-1439.2013.07.31

    Article  PubMed  PubMed Central  Google Scholar 

  9. Moorthy K, Munz Y, Sarker SK, Darzi A (2003) Clinical review objective assessment of technical skills in surgery. BMJ 327:1032–1037

    Article  Google Scholar 

  10. Moon MR (2014) Technical skills assessment in thoracic surgery education: we won’t get fooled again. J Thorac Cardiovasc Surg 148:2497–2498. https://doi.org/10.1016/j.jtcvs.2014.09.057

    Article  PubMed  Google Scholar 

  11. Grantcharov TP, Reznick RK (2008) Teaching procedural skills. BMJ 336:1129–1131. https://doi.org/10.1136/bmj.39517.686956.47

    Article  PubMed  PubMed Central  Google Scholar 

  12. Lodge D, Grantcharov T (2011) Training and assessment of technical skills and competency in cardiac surgery. Eur J Cardiothorac Surg 39:287–293. https://doi.org/10.1016/j.ejcts.2010.06.035

    Article  PubMed  Google Scholar 

  13. Gardner AK, Scott DJ, Choti M, Mansour JC (2015) Developing a comprehensive resident education evaluation system in the era of milestone assessment. J Surg Educ. https://doi.org/10.1016/j.jsurg.2014.12.007

    Article  PubMed  Google Scholar 

  14. Meyerson SL, Tong BC, Balderson SS, D’Amico TA, Phillips JD, Decamp MM, Darosa DA (2012) Needs assessment for an errors-based curriculum on thoracoscopic lobectomy. Ann Thorac Surg 94:368–373. https://doi.org/10.1016/j.athoracsur.2012.04.023

    Article  PubMed  PubMed Central  Google Scholar 

  15. Öhrn A, Olai A, Rutberg H, Nilsen P, Tropp H (2011) Adverse events in spine surgery in Sweden. Acta Orthop 82:727–731. https://doi.org/10.3109/17453674.2011.636673

    Article  PubMed  PubMed Central  Google Scholar 

  16. Konge L, Lehnert P, Hansen HJ, Petersen RH, Ringsted C (2012) Reliable and valid assessment of performance in thoracoscopy. Surg Endosc 26:1624–1628. https://doi.org/10.1007/s00464-011-2081-7

    Article  PubMed  Google Scholar 

  17. Aggarwal R, Grantcharov T, Moorthy K, Milland T, Darzi A (2008) Toward feasible, valid, and reliable video-based assessments of technical surgical skills in the operating room. Ann Surg 247:372–379. https://doi.org/10.1097/SLA.0b013e318160b371

    Article  PubMed  Google Scholar 

  18. ten Cate O, Scheele F (2007) Competency-based postgraduate training: can we bridge the gap between theory and clinical practice? Acad Med 82:542–547. https://doi.org/10.1097/ACM.0b013e31805559c7

    Article  PubMed  Google Scholar 

  19. Hopmans CJ, den Hoed PT, van der Laan L, van der Harst E, van der Elst M, Mannaerts GHH, Dawson I, Timman R, Wijnhoven BPL, IJzermans JNM (2014) Assessment of surgery residents’ operative skills in the operating theater using a modified objective structured assessment of technical skills (OSATS): a prospective multicenter study. Surgery 156:1078–1088. https://doi.org/10.1016/j.surg.2014.04.052

    Article  PubMed  Google Scholar 

  20. Vassiliou MC, Feldman LS (2011) Objective assessment, selection, and certification in surgery. Surg Oncol 20:140–145. https://doi.org/10.1016/j.suronc.2010.09.004

    Article  PubMed  Google Scholar 

  21. Szasz P, Louridas M, Harris KA, Aggarwal R, Grantcharov TP (2015) Assessing technical competence in surgical trainees: a systematic review. Ann Surg 26:1046–1055. https://doi.org/10.1097/SLA.0000000000000866

    Article  Google Scholar 

  22. Rocco G, Internullo E, Cassivi SD, Van Raemdonck D, Ferguson MK (2008) The variability of practice in minimally invasive thoracic surgery for pulmonary resections. Thorac Surg Clin 18:235–247. https://doi.org/10.1016/j.thorsurg.2008.06.002

    Article  PubMed  Google Scholar 

  23. Day J, Bobeva M (2005) A generic toolkit for the successful management of delphi studies. Electron J Bus Res Methods 3:103–116

    Google Scholar 

  24. Jensen K, Bjerrum F, Hansen HJ, Petersen RH, Pedersen JH, Konge L (2015) A new possibility in thoracoscopic virtual reality simulation training: development and testing of a novel virtual reality simulator for video-assisted thoracoscopic surgery lobectomy. Interact Cardiovasc Thorac Surg 21:420–426. https://doi.org/10.1093/icvts/ivv183

    Article  PubMed  Google Scholar 

  25. Jensen K, Ringsted C, Hansen HJ, Petersen RH, Konge L (2014) Simulation-based training for thoracoscopic lobectomy: a randomized controlled trial: virtual-reality versus black-box simulation. Surg Endosc 28:1821–1829. https://doi.org/10.1007/s00464-013-3392-7

    Article  PubMed  Google Scholar 

  26. Savran MM, Hansen HJ, Petersen RH, Walker W, Schmid T, Bojsen SR, Konge L (2015) Development and validation of a theoretical test of proficiency for video-assisted thoracoscopic surgery (VATS) lobectomy. Surg Endosc 29:2598–2604. https://doi.org/10.1007/s00464-014-3975-y

    Article  PubMed  Google Scholar 

  27. Meyerson SL, LoCascio F, Balderson SS, D’Amico TA (2010) An inexpensive, reproducible tissue simulator for teaching thoracoscopic lobectomy. Ann Thorac Surg 89:594–597. https://doi.org/10.1016/j.athoracsur.2009.07.067

    Article  PubMed  Google Scholar 

  28. Tong BC, Gustafson MR, Balderson SS, D’Amico TA, Meyerson SL (2012) Validation of a thoracoscopic lobectomy simulator. Eur J Cardiothorac Surg 42:364–369. https://doi.org/10.1093/ejcts/ezs012

    Article  PubMed  Google Scholar 

  29. Miskovic D, Ni M, Wyles SM, Kennedy RH, Francis NK, Parvaiz A, Cunningham C, Rockall TA, Gudgeon AM, Coleman MG, Hanna GB (2013) Is competency assessment at the specialist level achievable? A study for the national training programme in laparoscopic colorectal surgery in England. Ann Surg 257:476–482. https://doi.org/10.1097/SLA.0b013e318275b72a

    Article  PubMed  Google Scholar 

  30. Ilgen JS, Ma IWY, Hatala R, Cook DA (2015) A systematic review of validity evidence for checklists versus global rating scales in simulation-based assessment. Med Educ 49:161–173. https://doi.org/10.1111/medu.12621

    Article  PubMed  Google Scholar 

  31. Sharma B, Mishra A, Aggarwal R, Grantcharov TP (2011) Non-technical skills assessment in surgery. Surg Oncol 20:169–177. https://doi.org/10.1016/j.suronc.2010.10.001

    Article  PubMed  Google Scholar 

  32. Barsuk JH, Cohen ER, Wayne DB, Siddall VJ, McGaghie WC (2016) Developing a simulation-based mastery learning curriculum. Simul Healthc J Soc Simul Healthc 11:52–59. https://doi.org/10.1097/SIH.0000000000000120

    Article  Google Scholar 

  33. Mcgaghie WC (2015) Mastery learning: it is time for medical education to join the 21st century. Acad Med 90:1–4. https://doi.org/10.1097/ACM.0000000000000911

    Article  Google Scholar 

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Acknowledgements

VATS lobectomy experts were kindly asked to participate as part of the expert panel, and could decline at any phase in the study. At any time, participants could withdraw their consent for participation and their data would be deleted. All data were kept strictly confidential. The questionnaires from each expert were not discussed with colleagues or other individuals. The experts were told that the answers they gave in the questionnaires were anonymous for all except the main author who was handling the data via email and Survey Monkey, but that they would be acknowledged by name in the published paper if they wished to.

VATS lobectomy assessment tool expert panel: Baste JM, Bodner J, Cao C, Casali G, D’amico T, De Ryck F, Decaluwe HMA, Decker G, Dunning J, Gossot D, Kohno T, Leschber G, Liptay MJ, Loscertales J, McKenna RJ, Mitchell JD, Oosterhuis JW, Piwkowski CT, Schmid T, Schneiter D, Shackcloth M, Siebenga J, Sihoe A, Sokolow Y, Solaini L, Wright GM, Yan TD.

Funding

The salary of Katrine Jensen was partly funded by a grant from The Danish Cancer Society (Kræftens Bekæmpelse, Denmark).

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Correspondence to Katrine Jensen.

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Disclosures

Henrik Jessen Hansen and René Horsleben Petersen are at the speaker’s bureau for Covidien. Jesper Holst Pedersen, William Walker, and Lars Konge have no conflicts of interest or financial ties to disclose.

Ethical approval

No samples from humans were used in the study and no drugs were administered; hence, this study needed no approval from The Danish National Committee on Biomedical Research Ethics.

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Jensen, K., Petersen, R.H., Hansen, H.J. et al. A novel assessment tool for evaluating competence in video-assisted thoracoscopic surgery lobectomy. Surg Endosc 32, 4173–4182 (2018). https://doi.org/10.1007/s00464-018-6162-8

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