title: Discriminative validity of the Minimally Invasive Surgical Trainer in Virtual Reality (MIST-VR) using criteria levels based on expert performance.
abstract: BACKGROUND
  Increasing constraints on the time and resources needed to train surgeons have led to a new emphasis on finding innovative ways to teach surgical skills outside the operating room. Virtual reality training has been proposed as a method to both instruct surgical students and evaluate the psychomotor components of minimally invasive surgery ex vivo.
  
  
  METHODS
  The performance of 100 laparoscopic novices was compared to that of 12 experienced (>50 minimally invasive procedures) and 12 inexperienced (<10 minimally invasive procedures) laparoscopic surgeons. The values of the experienced surgeons' performance were used as benchmark comparators (or criterion measures). Each subject completed six tasks on the Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR) three times. The outcome measures were time to complete the task, number of errors, economy of instrument movement, and economy of diathermy.
  
  
  RESULTS
  After three trials, the mean performance of the medical students approached that of the experienced surgeons. However, 7-27% of the scores of the students fell more than two SD below the mean scores of the experienced surgeons (the criterion level).
  
  
  CONCLUSIONS
  The MIST-VR system is capable of evaluating the psychomotor skills necessary in laparoscopic surgery and discriminating between experts and novices. Furthermore, although some novices improved their skills quickly, a subset had difficulty acquiring the psychomotor skills. The MIST-VR may be useful in identifying that subset of novices.
authors.affiliation: Emory Endosurgery Unit, Emory University School of Medicine, 1364 Clifton Road, NE, Atlanta, GA 30322, USA. AGGallagher@emoryendosurgery.org
authors.forename: A G
authors.initials: AG
authors.lastname: Gallagher
authors.forename: A B
authors.initials: AB
authors.lastname: Lederman
authors.forename: K
authors.initials: K
authors.lastname: McGlade
authors.forename: R M
authors.initials: RM
authors.lastname: Satava
authors.forename: C D
authors.initials: CD
authors.lastname: Smith
mesh_terms: D000328:Adult; D019985:Benchmarking; D002983:Clinical Competence; D003198:Computer Simulation; D003972:Diathermy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000193:education* / Q000295:instrumentation; D008953:Models, Anatomic; D010820:Physicians / Q000523:psychology; D011597:Psychomotor Performance; D013334:Students / Q000523:psychology; D013337:Students, Medical / Q000523:psychology; D013647:Task Performance and Analysis; D014584:User-Computer Interface