title: Crowd-Sourced Assessment of Technical Skills for Validation of Basic Laparoscopic Urologic Skills Tasks.
abstract: The BLUS (Basic Laparoscopic Urologic Skills) consortium sought to address the construct validity of BLUS tasks and the wider problem of accurate, scalable and affordable skill evaluation by investigating the concordance of 2 novel candidate methods with faculty panel scores, those of automated motion metrics and crowdsourcing.
  
  
  
  A faculty panel of surgeons (5) and anonymous crowdworkers blindly reviewed a randomized sequence of a representative sample of 24 videos (12 pegboard and 12 suturing) extracted from the BLUS validation study (454) using the GOALS (Global Objective Assessment of Laparoscopic Skills) survey tool with appended pass-fail anchors via the same web based user interface. Pre-recorded motion metrics (tool path length, jerk cost etc) were available for each video. Cronbach's alpha, Pearson's R and ROC with AUC statistics were used to evaluate concordance between continuous scores, and as pass-fail criteria among the 3 groups of faculty, crowds and motion metrics.
  
  
  
  Crowdworkers provided 1,840 ratings in approximately 48 hours, 60 times faster than the faculty panel. The inter-rater reliability of mean expert and crowd ratings was good (α=0.826). Crowd score derived pass-fail resulted in 96.9% AUC (95% CI 90.3-100; positive predictive value 100%, negative predictive value 89%). Motion metrics and crowd scores provided similar or nearly identical concordance with faculty panel ratings and pass-fail decisions.
  
  
  
  The concordance of crowdsourcing with faculty panels and speed of reviews is sufficiently high to merit its further investigation alongside automated motion metrics. The overall agreement among faculty, motion metrics and crowdworkers provides evidence in support of the construct validity for 2 of the 4 BLUS tasks.
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 Biostatistics, University of Washington, Seattle, Washington.
authors.forename: Bryan
authors.initials: B
authors.lastname: Comstock
authors.affiliation: Department of Urology, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Robert
authors.initials: R
authors.lastname: Sweet
authors.affiliation: Department of Mechanical Engineering, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Cory
authors.initials: C
authors.lastname: Schaffhausen
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, Columbus, 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: Cleveland Clinic, Cleveland, Ohio.
authors.forename: Jihad
authors.initials: J
authors.lastname: Kaouk
authors.affiliation: Department of Urology, Ohio State University, Columbus, Ohio.
authors.forename: Bodo
authors.initials: B
authors.lastname: Knudsen
authors.affiliation: Department of Urology, UC 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, Springfield, 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
authors.affiliation: Department of Urology, University of Washington and Seattle Children's Hospital, Seattle, Washington. Electronic address: thomas.lendvay@seattlechildrens.org.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Lendvay
mesh_terms: D019540:Area Under Curve; D002983:Clinical Competence / Q000706:statistics & numerical data*; D063045:Crowdsourcing / Q000706:statistics & numerical data*; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D013520:Urologic Surgical Procedures / Q000193:education*; D014741:Video Recording
keywords: clinical competence; crowdsourcing; laparoscopy; urologic surgical procedures; validation studies