Assessment of Technical Skills in Axillary Lymph Node Dissection

Abstract

Response to Editor and ReviewersReferee 1 Comments to the Author: This report comes from the Imperial College where the surgeons have led in models used for simulation. They have developed a model for axillary lymph node dissection and then studied it amongst "experts, senior residents and junior residents" and claim their findings provide construct validity. Referee 2Comments to the Author: Timely article and fascinating results. Authors' response: We thank the reviewer and agree the results are extremely timely given the attenuation in the number of axillary lymph node procedures and recently documented worldwide attenuation in training opportunities in axillary procedures. The results are indeed fascinating with relevance for both residents in training and board-certified cancer surgeons.Referee 1, comment 1. How were the raters trained? Did they assess videos until their scores were congruent? Authors' response: The attendings received no additional training in axillary lymphadenectomy assessment. However, both raters were involved in the development of this simulation and in designing the assessment methods therein. Moreover, they regularly teach and assess axillary lymph node dissection in both clinical practice and across the region on behalf of the London Deanery Skills Training Programme using breast simulation. The authors performed post-hoc analyses to evaluate both the consistency and reliability between raters (see R1 supplementary digital content -SDC5); these results demonstrated good internal consistency (Cronbach's =0.89-0.97) and modest inter-rater reliability (Cohen's Kappa=0.1-0.2).

Langer’s arch: A rare but important consideration for axillary surgery with implications for training

“…The creation of a virtual anatomy museum could address the lack of exposure to anatomical variations 16 . Alternatively, physical 17,18 or virtual 19 simulation models could include anatomical variants. Viable solutions should be sought to address the gap in training and experience.…”