E. Matthew Ritter, MD1, Aimee K Gardner, PhD2, Brian J Dunkin, MD, Linda Schultz4, Liane Feldman, MD5. 1Uniformed Services University/Walter Reed National Military Medical Center, 2Baylor College of Medicine, 3Houston Methodist, Weill Cornell Medical College, 4Society of American Gastrointestinal and Endoscopic Surgeons, 5Department of Surgery, McGill University
Introduction: While better technical performance correlates with improved outcomes, there is a lack of procedure-specific tools to perform video based assessment (VBA). SAGES is developing a series of VBA tools with enough validity evidence to allow reliable measurement of surgeon competence. A task force was established to develop a VBA tool for laparoscopic fundoplication using an evidence-based process that can be replicated for additional procedures.
Methods: Forty-two subject matter experts (SME) in laparoscopic fundoplication were interviewed to obtain consensus on procedural steps, identify potential variations in technique, and to generate an inventory of required skills and common errors. The results of these interviews were used to inform creation of a task inventory questionnaire (TIQ) that was delivered to a larger SME group (n=188) to quantify the criticality and difficulty of the procedural steps, the impact of potential errors associated with each step, the technical skills required to complete the procedure, and the likelihood that future techniques or technologies may change the presence or importance of any of these factors. Results of the TIQ were used to generate a list of steps, skills, and errors with strong validity evidence.
Results: Initial SMEs interviewed included Fellowship Program Directors (45%), recent Fellows (24%), international surgeons (19%), and highly experienced super SMEs with quality outcomes data (12%). Qualitative analysis of interview data identified 6 main procedural steps (visualization, hiatal dissection, fundus mobilization, esophageal mobilization, hiatal repair, & wrap creation) each with 2-5 substeps. Additionally, the TIQ identified 5-10 potential errors for each step and 11 key technical skills required to perform the procedure. Based on the TIQ, the mean criticality and difficulty scores for the 21 substeps included in the final scoring rubric is 4.28/5 (5=absolutely essential for patient outcomes) and 3.28/5 (5=difficulty level requires significant experience and use of alternative strategies to accomplish consistently), respectively. The mean criticality and frequency scores for the 11 technical skills included is 4.20/5 and 4.21/5 (5= constantly used ≥80% of the time), respectively. The mean impact score of the 47 errors incorporated into the final rubric is 3.78/5 (5=significant error that is unrecoverable, or even if recovered, likely to have a negative impact on patient outcome).
Conclusions: A rigorous, multi-method process has documented the content validity evidence for the SAGES video-based assessment tool for laparoscopic fundoplication. Work is ongoing to pilot the assessment tool on recorded fundoplication procedures to establish reliability and further validity evidence.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95998
Program Number: S089
Presentation Session: Plenary I
Presentation Type: Podium