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Validation of an anorectal malformation trainer - Can a high-fidelity model simulate real life?
Claire A. Ostertag-Hill,
1 Prathima Nandivada,
1 Aaron P. Garrison,
2 Richard J. Wood,
3 Michael G. Silver,
4 Gregory Loan,
4 Stephen F. Wilson,
4 Belinda H. Dickie
1
1Department of Surgery, Boston Children’s Hospital, Boston, MA, USA, 2Department of Surgery, Cincinnati Children’s Hospital, Cincinnati, OH, USA, 3Department of Surgery, Nationwide Children’s Hospital, Columbus, OH, 4Boston Children’s Hospital, Boston, MA USA
Background: The average number of anorectal malformation (ARM) repairs performed by U.S. pediatric surgery trainees is 15 with recertifying pediatric surgeons performing an average of only 2 ARM repairs annually. The aim of this study was to investigate the validity of this simulator.
Methods: A high-fidelity ARM simulator was designed using digital modeling software packages and fabricated using 3D-printing, hand-sculpting, and multi-stage silicone injection molding techniques. A cross-sectional observational study was performed at an international surgical meeting, recruiting 27 surgeons (n=11 experts, n=16 novice). Each participant performed a posterior sagittal anorectoplasty (PSARP) on the model and completed a questionnaire on the model’s realism and didactic value. Each session of the simulation was recorded and independently assessed by 3 experienced pediatric colorectal surgeons (raters) using a standardized general skills (OSATS) and PSARP step-specific assessment tools.
Results: All items, including anatomical structures, haptics, and procedural steps, were evaluated as significantly better than neutral (p-values 0.003 to <0.0001). Significant differences between the groups were observed for multiple items in the OSATS checklist, including respect for tissue (p=0.017), instrument handling (p=0.012), flow of operation (p=0.004), and knowledge of specific procedure (p=0.014). Additionally, pediatric colorectal raters indicated that the model could distinguish between experts and novices on all PSARP steps (p-values 0.005 to 0.046).
Conclusion: Evaluation of a newly developed high-fidelity, 3D-printed anorectal malformation surgical simulator demonstrated face, content, and discriminant construct validity. Given the low number of PSARPs performed annually by surgical fellows and attendings, this simulator can offer a high-fidelity training tool.
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