title: The Joint Council on Thoracic Surgery Education coronary artery assessment tool has high interrater reliability.
abstract: BACKGROUND
  Barriers to incorporation of simulation in cardiothoracic surgery training include lack of standardized, validated objective assessment tools. Our aim was to measure interrater reliability and internal consistency reliability of a coronary anastomosis assessment tool created by the Joint Council on Thoracic Surgery Education.
  
  
  METHODS
  Ten attending surgeons from different cardiothoracic residency programs evaluated nine video recordings of 5 individuals (1 medical student, 1 resident, 1 fellow, 2 attendings) performing coronary anastomoses on two simulation models, including synthetic graft task station (low fidelity) and porcine explant (high fidelity), as well as in the operative setting. All raters, blinded to operator identity, scored 13 assessment items on a 1 to 5 (low to high) scale. Each performance also received an overall pass/fail determination. Interrater reliability and internal consistency were assessed as intraclass correlation coefficients and Cronbach's α, respectively.
  
  
  RESULTS
  Both interrater reliability and internal consistency were high for all three models (intraclass correlation coefficients = 0.98, 0.99, and 0.94, and Cronbach's α = 0.99, 0.98, and 0.97 for low fidelity, high fidelity, and operative setting, respectively). Interrater reliability for overall pass/fail determination using κ were 0.54, 0.86, 0.15 for low fidelity, high fidelity, and operative setting, respectively.
  
  
  CONCLUSIONS
  Even without instruction on the assessment tool, experienced surgeons achieved high interrater reliability. Future resident training and evaluation may benefit from utilization of this tool for formative feedback in the simulated and operative environments. However, summative assessment in the operative setting will require further standardization and anchoring.
authors.affiliation: Saint Louis University, St. Louis, Missouri, USA. rlee@slu.edu
authors.forename: Richard
authors.initials: R
authors.lastname: Lee
authors.forename: Daniel
authors.initials: D
authors.lastname: Enter
authors.forename: Xiaoying
authors.initials: X
authors.lastname: Lou
authors.forename: Richard H
authors.initials: RH
authors.lastname: Feins
authors.forename: George L
authors.initials: GL
authors.lastname: Hicks
authors.forename: Mario
authors.initials: M
authors.lastname: Gasparri
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
authors.forename: J Nilas
authors.initials: JN
authors.lastname: Young
authors.forename: John H
authors.initials: JH
authors.lastname: Calhoon
authors.forename: Fred A
authors.initials: FA
authors.lastname: Crawford
authors.forename: Nahush A
authors.initials: NA
authors.lastname: Mokadam
authors.forename: James I
authors.initials: JI
authors.lastname: Fann
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000193:education; D002983:Clinical Competence / Q000592:standards*; D003198:Computer Simulation; D003331:Coronary Vessels / Q000601:surgery*; D004503:Education, Medical, Graduate / Q000592:standards* / Q000639:trends; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000592:standards / Q000639:trends; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D015588:Observer Variation; D015203:Reproducibility of Results; D012955:Societies, Medical / Q000592:standards; D011795:Surveys and Questionnaires; D019616:Thoracic Surgical Procedures / Q000193:education* / Q000592:standards; D014481:United States; D014741:Video Recording