title: Validation of the Imperial College Surgical Assessment Device (ICSAD) for labour epidural placement.
abstract: OBJECTIVE
  Technical proficiency in anesthesia has historically been determined subjectively. The purpose of this study was to establish the construct validity for the Imperial College Surgical Assessment Device (ICSAD), a measure of hand motion efficiency, as an objective assessment tool for technical skill performance, by examining its ability to distinguish between operators of different levels of experience performing a labour epidural. Concurrent validity for the ICSAD was investigated by comparison to a validated task specific checklist (CL) and global rating scale (GRS).
  
  
  METHODS
  A single blinded, prospective, controlled study design compared three groups of subjects: novice residents (<30 epidurals), experienced residents (>100 epidurals), and staff anesthesiologists (>500 epidurals). Performance was measured using the ICSAD (number of movements, path length, time) and scores from a CL and GRS graded by examiners blinded to the level of training. Data were analyzed by multivariate analysis of variance (MANOVA).
  
  
  RESULTS
  Twenty-nine subjects were recruited. Novice residents had longer path lengths compared to experienced residents (P = 0.031) and staff anesthesiologists (P = 0.0004), made more movements (P = 0.012) and took more time than staff (P = 0.009). Novice residents scored significantly worse on the GRS compared to experienced residents (P = 0.029) and staff (P = 0.01) and had significantly lower CL scores compared to staff (P = 0.003).
  
  
  CONCLUSIONS
  Construct and concurrent validity for the ICSAD was established for a regional anesthesia technique by demonstrating that it can distinguish between operators of different levels of experience and by comparing it to the current standards of technical skill assessment.
authors.affiliation: Department of Anesthesiology, St. Michael's Hospital, University of Toronto, 30 Bond St., Toronto, ON, M5B 1W8, Canada. megan.hayter@utoronto.ca
authors.forename: Megan A
authors.initials: MA
authors.lastname: Hayter
authors.forename: Zeev
authors.initials: Z
authors.lastname: Friedman
authors.forename: M Dylan
authors.initials: MD
authors.lastname: Bould
authors.forename: John G
authors.initials: JG
authors.lastname: Hanlon
authors.forename: Rita
authors.initials: R
authors.lastname: Katznelson
authors.forename: Bruno
authors.initials: B
authors.lastname: Borges
authors.forename: Viren N
authors.initials: VN
authors.lastname: Naik