title: Development and construct validity of a low-fidelity training platform for driving large and small suture needles.
abstract: BACKGROUND
  The objective of this study was to describe and validate a novel training platform for driving large and small suture needles, which can ultimately be used for elemental vascular surgical training.
  
  
  METHODS
  We developed a novel trainer and proficiency-based training curriculum that provides a platform for practice with handling fine vascular tools and needles as well as precision in suture targeting. The trainer comprises 2 concentric circles printed on cotton fiber material with 8 evenly spaced targets on each circle. The first exercise was designed for practice with Castroviejo needle drivers and a fine needle such that the needle is passed through all targets in sequential order. A second, larger figure serves the same function but is designed for conventional needle drivers and a larger needle. A total of 5 attending surgeons from vascular and trauma surgery were recruited to serve as "expert" participants. These surgeons completed 3 repetitions of each task, which were used to develop proficiency timing and quality standards for practice. The curriculum was validated by recruiting 10 senior surgical residents and 12 surgical interns. Senior residents completed 3 repetitions of each task. Each first-year resident completed a proctored pretest, trained to proficiency by self-paced practice on the trainer according to standards set by the attending surgeons, and completed a proctored posttest.
  
  
  RESULTS
  First-year residents performed significantly worse on the pretest compared with senior residents and faculty surgeons on both exercises (small figure = 58.9 vs 174.2 vs 201.3, p < 0.001; large figure = 112.1 vs 202.9 vs 198.1, p < 0.001). After proficiency-based practice, first-year residents improved significantly from pretest to posttest (small figure = 216.0 vs 58.9, p < 0.001; large figure = 211.7 vs 112.1, p = 0.001).
  
  
  CONCLUSIONS
  The vascular trainer platform demonstrated construct validity for self-paced elemental vascular surgical practice.
authors.affiliation: Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: John R
authors.initials: JR
authors.lastname: Admire
authors.affiliation: Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: Lori L
authors.initials: LL
authors.lastname: Pounds
authors.affiliation: Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Adams
authors.affiliation: Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: Pedro Pablo
authors.initials: PP
authors.lastname: Gomez
authors.affiliation: Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Electronic address: willisr@uthscsa.edu.
authors.forename: Ross E
authors.initials: RE
authors.lastname: Willis
mesh_terms: D002983:Clinical Competence; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000379:methods*; D004521:Educational Measurement; D006801:Humans; D007396:Internship and Residency; D009048:Motor Skills; D009339:Needles; D000066908:Simulation Training; D013525:Surgical Instruments; D013536:Suture Techniques / Q000193:education*; D014656:Vascular Surgical Procedures / Q000193:education*
keywords: Medical Knowledge; Practice-Based Learning and Improvement; Systems-Based Practice; elemental training; surgical education; surgical skills; vascular anastomosis