title: Using virtual reality simulation to assess competence in video-assisted thoracoscopic surgery (VATS) lobectomy.
abstract: The societies of thoracic surgery are working to incorporate simulation and competency-based assessment into specialty training. One challenge is the development of a simulation-based test, which can be used as an assessment tool. The study objective was to establish validity evidence for a virtual reality simulator test of a video-assisted thoracoscopic surgery (VATS) lobectomy of a right upper lobe.
  
  
  
  Participants with varying experience in VATS lobectomy were included. They were familiarized with a virtual reality simulator (LapSim®) and introduced to the steps of the procedure for a VATS right upper lobe lobectomy. The participants performed two VATS lobectomies on the simulator with a 5-min break between attempts. Nineteen pre-defined simulator metrics were recorded.
  
  
  
  Fifty-three participants from nine different countries were included. High internal consistency was found for the metrics with Cronbach's alpha coefficient for standardized items of 0.91. Significant test-retest reliability was found for 15 of the metrics (p-values <0.05). Significant correlations between the metrics and the participants VATS lobectomy experience were identified for seven metrics (p-values <0.001), and 10 metrics showed significant differences between novices (0 VATS lobectomies performed) and experienced surgeons (>50 VATS lobectomies performed). A pass/fail level defined as approximately one standard deviation from the mean metric scores for experienced surgeons passed none of the novices (0 % false positives) and failed four of the experienced surgeons (29 % false negatives).
  
  
  
  This study is the first to establish validity evidence for a VATS right upper lobe lobectomy virtual reality simulator test. Several simulator metrics demonstrated significant differences between novices and experienced surgeons and pass/fail criteria for the test were set with acceptable consequences. This test can be used as a first step in assessing thoracic surgery trainees' VATS lobectomy competency.
authors.affiliation: Department of Cardiothoracic Surgery, Sect. 2152, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark. katrine.jensen@rh.regionh.dk.|Copenhagen Academy for Medical Education and Simulation (CAMES), Section 5404, University of Copenhagen and Capital Region, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Copenhagen, Denmark. katrine.jensen@rh.regionh.dk.
authors.forename: Katrine
authors.identifier: 0000-0002-7008-8111
authors.initials: K
authors.lastname: Jensen
authors.affiliation: JMC Simulation Unit, The Juliane Marie Centre, Section 4704, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Flemming
authors.initials: F
authors.lastname: Bjerrum
authors.affiliation: Department of Cardiothoracic Surgery, Sect. 2152, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Henrik Jessen
authors.initials: HJ
authors.lastname: Hansen
authors.affiliation: Department of Cardiothoracic Surgery, Sect. 2152, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark.
authors.forename: René Horsleben
authors.initials: RH
authors.lastname: Petersen
authors.affiliation: Department of Cardiothoracic Surgery, Sect. 2152, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Jesper Holst
authors.initials: JH
authors.lastname: Pedersen
authors.affiliation: Copenhagen Academy for Medical Education and Simulation (CAMES), Section 5404, University of Copenhagen and Capital Region, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Copenhagen, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Konge
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000592:standards*; D003162:Competency-Based Education / Q000379:methods*; D003198:Computer Simulation; D004521:Educational Measurement; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D011013:Pneumonectomy / Q000193:education / Q000379:methods; D015203:Reproducibility of Results; D000066908:Simulation Training / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000193:education*; D020775:Thoracic Surgery, Video-Assisted / Q000193:education / Q000379:methods; D000076142:Virtual Reality
keywords: Lobectomy; VATS; Validity; Video-assisted thoracoscopic surgery; Virtual reality simulation