title: Validation of the AUA BLUS Tasks.
abstract: OBJECTIVE
  Standardized assessment of laparoscopic skill in urology is lacking. We investigated whether the AUA (American Urological Association) BLUS (Basic Laparoscopic Urologic Skills) skill tasks are valid to address this need.
  
  
  METHODS
  This institutional review board approved study included 27 medical students, 42 urology residents, 18 fellows and 37 faculty urologists across 8 sites. Using the EDGE (Electronic Data Generation and Evaluation) device (Simulab, Seattle, Washington) 454 recordings were collected on peg transfer, pattern cutting, suturing and clip applying tasks, which together comprise the expert determined BLUS tasks. We collected synchronized video and tool motion data for each trial. For each task errors, time, path length, economy of motion, peak grasp force and EDGE score were collected. An expert panel of 5 faculty members performed GOALS (Global Objective Assessment of Laparoscopic Skills) evaluations on a representative subset of peg transfer and suturing skill tasks performed by 24 participants (IRR = 0.95).
  
  
  RESULTS
  Demographically derived skill levels proved unsuitable to evaluate construct validity. Separation of mean scores by grouped skill levels was strongest for the suturing task. Objective motion metrics and errors supported construct validity vis-à-vis correlation with blinded expert video ratings (motion metrics R(2) = 0.95, p <0.01). Expert scores appeared to reward errors in suturing but not in block transfer.
  
  
  CONCLUSIONS
  BLUS skill task performance scoring can discriminate among basic laparoscopic technical skill levels. Self-reported demographics are an unreliable source of determining laparoscopic technical skill.
authors.affiliation: Department of Mechanical Engineering, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Kowalewski
authors.affiliation: Department of Urology, University of Minnesota, Minneapolis, Minnesota. Electronic address: rsweet@umn.edu.
authors.forename: Robert
authors.initials: R
authors.lastname: Sweet
authors.affiliation: Department of Urology, University of Washington and Seattle Children's Hospital, Seattle, Washington.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Lendvay
authors.affiliation: Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Ashleigh
authors.initials: A
authors.lastname: Menhadji
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Timothy
authors.initials: T
authors.lastname: Averch
authors.affiliation: Department of Urology, Ohio State University, Cleveland, Ohio.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Box
authors.affiliation: Madigan Army Medical Center, Uniformed Services University of the Health Sciences, Tacoma, Washington.
authors.forename: Timothy
authors.initials: T
authors.lastname: Brand
authors.affiliation: Department of Urology, Duke University, Durham, North Carolina.
authors.forename: Michael
authors.initials: M
authors.lastname: Ferrandino
authors.affiliation: Columbus and Cleveland Clinic, Cleveland, Ohio.
authors.forename: Jihad
authors.initials: J
authors.lastname: Kaouk
authors.affiliation: Department of Urology, Ohio State University, Cleveland, Ohio.
authors.forename: Bodo
authors.initials: B
authors.lastname: Knudsen
authors.affiliation: Department of Urology, University of California-Irvine, Orange, California.
authors.forename: Jaime
authors.initials: J
authors.lastname: Landman
authors.affiliation: Department of Urology and Oncology, Tulane University, New Orleans, Louisiana.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Lee
authors.affiliation: Division of Urology, Southern Illinois University, Carbondale, Illinois.
authors.forename: Bradley F
authors.initials: BF
authors.lastname: Schwartz
authors.affiliation: Department of Urologic Sciences, University of British Colombia, Vancouver, British Columbia, Canada.
authors.forename: Elspeth
authors.initials: E
authors.lastname: McDougall
mesh_terms: D002983:Clinical Competence; D006801:Humans; D010535:Laparoscopy / Q000592:standards*; D012955:Societies, Medical; D014481:United States; D014572:Urology / Q000592:standards*
keywords: clinical competence; education; laparoscopy/standards; medical; urologic surgical procedures/education; validation studies