title: Reliable and valid assessment of Lichtenstein hernia repair skills.
abstract: OBJECTIVE
  Lichtenstein hernia repair is a common surgical procedure and one of the first procedures performed by a surgical trainee. However, formal assessment tools developed for this procedure are few and sparsely validated. The aim of this study was to determine the reliability and validity of an assessment tool designed to measure surgical skills in Lichtenstein hernia repair.
  
  
  METHODS
  Key issues were identified through a focus group interview. On this basis, an assessment tool with eight items was designed. Ten surgeons and surgical trainees were video recorded while performing Lichtenstein hernia repair, (four experts, three intermediates, and three novices). The videos were blindly and individually assessed by three raters (surgical consultants) using the assessment tool. Based on these assessments, validity and reliability were explored.
  
  
  RESULTS
  The internal consistency of the items was high (Cronbach's alpha = 0.97). The inter-rater reliability was very good with an intra-class correlation coefficient (ICC) = 0.93. Generalizability analysis showed a coefficient above 0.8 even with one rater. The coefficient improved to 0.92 if three raters were used. One-way analysis of variance found a significant difference between the three groups which indicates construct validity, p < 0.001.
  
  
  CONCLUSIONS
  Lichtenstein hernia repair skills can be assessed blindly by a single rater in a reliable and valid fashion with the new procedure-specific assessment tool. We recommend this tool for future assessment of trainees performing Lichtenstein hernia repair to ensure that the objectives of competency-based surgical training are met.
authors.affiliation: Centre of Medical Education, Aarhus University, Incuba Science Park, Brendstrupgaardsvej 102, 8200, Aarhus N, Denmark, cgc@medu.au.dk.
authors.forename: C G
authors.initials: CG
authors.lastname: Carlsen
authors.forename: K
authors.initials: K
authors.lastname: Lindorff-Larsen
authors.forename: P
authors.initials: P
authors.lastname: Funch-Jensen
authors.forename: L
authors.initials: L
authors.lastname: Lund
authors.forename: P
authors.initials: P
authors.lastname: Charles
authors.forename: L
authors.initials: L
authors.lastname: Konge
mesh_terms: D002983:Clinical Competence; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000592:standards*; D006801:Humans; D015203:Reproducibility of Results