Validation and reliability testing of a rating scale for objective assessment of performance in laparoscopic appendicectomy surgery

Backgrounds: To achieve a competency-based training paradigm, the ability to obtain reliable and valid quantitative assessments of intraoperative performance is required. Through this, weaknesses can be identified and practiced, and competency assessed. This study aimed to determine the validity and reliability an objective evaluation tool for assessment of performance in laparoscopic appendicectomy (LA). Methods: A prospective single-blinded observational study design was used. Videos of inexperienced (performed <10 LAs) and experienced (performed >100 LAs) surgeons performing LA surgery were collected. Surgical performance during each recording was rated by two independent, blinded expert surgeons using the LA Rating Scale (LARS) and the modified Objective Structured Assessment of Technical Skill (OSATS) scale. Results: The intraclass correlation coefficient (ICC) for LARS was 0.95 (95%CI 0.83–0.98). The ICC for each step ranged from 0.48 to 0.90, and the test–retest ICC for LARS was 0.91 (95%CI 0.69–0.98). Significant differences (P < 0.001) between median performance scores as rated by LARS were observed between the inexperienced and experienced surgeons. A Spearman's correlation coefficient of 0.87 (P < 0.001) was observed between LARS performance scores and modified OSATS scores. Conclusion: LARS demonstrated excellent inter-rater and test–retest reliability, and construct and concurrent validity and can be used to quantitatively evaluate performance during LA. This can potentially allow specific weaknesses to be identified and improved upon through deliberate practice. Progress can be tracked through re-evaluation and scores of expert surgeons can be used as performance goals for credentialing in LA.