title: Zone calculation as a tool for assessing performance outcome in laparoscopic suturing.
abstract: BACKGROUND
  Simulator performance is measured by metrics, which are valued as an objective way of assessing trainees. Certain procedures such as laparoscopic suturing, however, may not be suitable for assessment under traditionally formulated metrics. Our aim was to assess if our new metric is a valid method of assessing laparoscopic suturing.
  
  
  METHODS
  A software program was developed to order to create a new metric, which would calculate the percentage of time spent operating within pre-defined areas called "zones." Twenty-five candidates (medical students N = 10, surgical residents N = 10, and laparoscopic experts N = 5) performed the laparoscopic suturing task on the ProMIS III(®) simulator. New metrics of "in-zone" and "out-zone" scores as well as traditional metrics of time, path length, and smoothness were generated. Performance was also assessed by two blinded observers using the OSATS and FLS rating scales. This novel metric was evaluated by comparing it to both traditional metrics and subjective scores.
  
  
  RESULTS
  There was a significant difference in the average in-zone and out-zone scores between all three experience groups (p < 0.05). The new zone metrics scores correlated significantly with the subjective-blinded observer scores of OSATS and FLS (p = 0.0001). The new zone metric scores also correlated significantly with the traditional metrics of path length, time, and smoothness (p < 0.05).
  
  
  CONCLUSIONS
  The new metric is a valid tool for assessing laparoscopic suturing objectively. This could be incorporated into a competency-based curriculum to monitor resident progression in the simulated setting.
authors.affiliation: National Surgical Training Centre, Royal College of Surgeons in Ireland, 121 St Stephens Green, Dublin 2, Ireland, bucklece@tcd.ie.
authors.forename: Christina E
authors.initials: CE
authors.lastname: Buckley
authors.forename: Dara O
authors.initials: DO
authors.lastname: Kavanagh
authors.forename: Emmeline
authors.initials: E
authors.lastname: Nugent
authors.forename: Donncha
authors.initials: D
authors.lastname: Ryan
authors.forename: Oscar J
authors.initials: OJ
authors.lastname: Traynor
authors.forename: Paul C
authors.initials: PC
authors.lastname: Neary
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003162:Competency-Based Education; D003198:Computer Simulation; D004521:Educational Measurement / Q000379:methods*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D012984:Software; D013536:Suture Techniques; D055815:Young Adult