Objective: In this paper, we evaluate face, content and construct validity of the da Vinci Surgical Skills Simulator (dVSSS) across 3 surgical disciplines. Methods: In total, 48 participants from urology, gynecology and general surgery participated in the study as novices (0 robotic cases performed), intermediates (1-74) or experts (≥75). Each participant completed 9 tasks (Peg board level 2, match board level 2, needle targeting, ring and rail level 2, dots and needles level 1, suture sponge level 2, energy dissection level 1, ring walk level 3 and tubes). The Mimic Technologies software scored each task from 0 (worst) to 100 (best) using several predetermined metrics. Face and content validity were evaluated by a questionnaire administered after task completion. Wilcoxon test was used to perform pair wise comparisons. Results: The expert group comprised of 6 attending surgeons. The intermediate group included 4 attending surgeons, 3 fellows and 5 residents. The novices included 1 attending surgeon, 1 fellow, 13 residents, 13 medical students and 2 research assistants. The median number of robotic cases performed by experts and intermediates were 250 and 9, respectively. The median overall realistic score (face validity) was 8/10. Experts rated the usefulness of the simulator as a training tool for residents (content validity) as 8.5/10. For construct validity, experts outperformed novices in all 9 tasks (p < 0.05). Intermediates outperformed novices in 7 of 9 tasks (p < 0.05); there were no significant differences in the energy dissection and ring walk tasks. Finally, experts scored significantly better than intermediates in only 3 of 9 tasks (matchboard, dots and needles and energy dissection) (p < 0.05). Conclusions: This study confirms the face, content and construct validities of the dVSSS across urology, gynecology and general surgery. Larger sample size and more complex tasks are needed to further differentiate intermediates from experts. IntroductionThe American College of Surgeons has recommended simulation-based training for surgical trainees to increase proficiency and patient safety in light of recent restrictions to trainee work hours and increased concerns over patient safety.1 The first validated low-fidelity objective training and assessment tool for basic laparoscopic skills is the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS), which has been adapted by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) for the Fundamentals of Laparoscopic Surgery (FLS) program.2 Currently, FLS certification is required for candidates applying for certification from the American Board of Surgery. Furthermore, construct validity of MISTELS has been established for urology trainees and attending urologists.3 Recently, the American Urological Association's Committee on Laparoscopy, Robotic and New Technology modified the original MISTELS/FLS program into a more urocentric curriculum, the Basic Laparoscopic Urologic Surgery (BLUS) skills curriculu...

Background Sperm DNA damage is associated with male infertility but whether normozoospermic infertile men also have DNA damage is unknown. Objective To evaluate sperm DNA and chromatin integrity in men with mild male factor infertility. Design, setting and participants Prospective study of 102 consecutive men (78 normozoospermic, 15 asthenozoospermic, 9 oligozoospermic) enrolled for intrauterine insemination (IUI) and 15 fertile controls. Outcome measurements and statistical analysis Standard semen parameters and sperm chromatin and DNA integrity were assessed and compared between groups. Sperm chromatin quality was assessed by (1) aniline blue staining (AB is specific to histone lysines), (2) iodoacetamide fluorescein fluorescence (IAF targets free protamine sulfhydryl groups) and (3) sperm chromatin structure assay (SCSA) with the results expressed as % DNA fragmentation index (%DFI). Results and limitationsThe mean (±SD) percentage of spermatozoa with positive IAF fluorescence was significantly higher in the IUI population compared to fertile controls (17 %±10 % vs. 8 %±6 %, P =0.0011) and also in the normozoospermic subset (n = 78) compared to controls (16 %±9 % vs. 8 %±6 %, P <0.0001, ANOVA). We also observed a trend toward lower %progressive motility, and higher %AB staining and %DFI in the IUI group compared to controls. We observed significant relationships between sperm %DFI and progressive motility (r =−0.40, P <0.0001) and between positive AB staining and IAF fluorescence (r =0.58, P <0.0001). Conclusions The data indicate that sperm chromatin integrity may be abnormal in men enrolled in IUI treatment cycles, despite the fact that most of these men are normozoospermic.

ObjectivesThe educational environment plays a crucial role in the learning process. We aimed to evaluate the educational-environment perceptions of Saudi urology residents using the postgraduate hospital educational environment measure (PHEEM) inventory, and to investigate associations of their perception with stages of residency program, regions of Saudi Arabia, and main sectors of the health care system.MethodsWe used PHEEM to measure the educational environment of Saudi urology residents. Respondents’ perception was compared regarding different levels of residency training, regions of Saudi Arabia, and sectors of the health care system. Internal reliability of the inventory was assessed using Cronbach’s alpha coefficient.ResultsOut of 72 registered residents, 38 (53%) completed the questionnaire. The residents did not perceive their environment positively (77.7±16.5). No significant differences in perception were found among residents of different program stages or Saudi regions. Residents from different health care sectors differed significantly regarding the total PHEEM score (P=0.024) and the teaching subscale (P=0.017). The inventory showed a high internal consistency with Cronbach’s alpha of 0.892.ConclusionSaudi urology residents perceived the educational environment as less than satisfactory. Perception of the educational environment did not change significantly among different stages of the program or different regions of Saudi Arabia. However, some sectors of the health care system are doing better than others.

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BackgroundScript Concordance Test (SCT) is a new assessment tool that reliably assesses clinical reasoning skills. Previous descriptions of developing SCT-question banks were merely subjective. This study addresses two gaps in the literature: 1) conducting the first phase of a multistep validation process of SCT in Plastic Surgery, and 2) providing an objective methodology to construct a question bank based on SCT.MethodsAfter developing a test blueprint, 52 test items were written. Five validation questions were developed and a validation survey was established online. Seven reviewers were asked to answer this survey. They were recruited from two countries, Saudi Arabia and Canada, to improve the test’s external validity. Their ratings were transformed into percentages. Analysis was performed to compare reviewers’ ratings by looking at correlations, ranges, means, medians, and overall scores.ResultsScores of reviewers’ ratings were between 76% and 95% (mean 86% ± 5). We found poor correlations between reviewers (Pearson’s: +0.38 to −0.22). Ratings of individual validation questions ranged between 0 and 4 (on a scale 1–5). Means and medians of these ranges were computed for each test item (mean: 0.8 to 2.4; median: 1 to 3). A subset of test items comprising 27 items was generated based on a set of inclusion and exclusion criteria.ConclusionThis study proposes an objective methodology for validation of SCT-question bank. Analysis of validation survey is done from all angles, i.e., reviewers, validation questions, and test items. Finally, a subset of test items is generated based on a set of criteria.