Assessment of construct validity of the endoscopic sinus surgery simulator

Objective: To study the relationship between performance on an endoscopic sinus surgery simulator (ES3) and fundamental perceptual, visuospatial, and psychomotor abilities. Design: Validation study. Setting: Tertiary care medical center. Participants: Thirty-four medical students and 4 otolaryngology residents voluntarily enrolled. Interventions: Subjects performed tasks on the ES3, minimally invasive surgical trainer virtual reality (MIST-VR), pictorial surface orientation (PicSOr), and 3 visuospatial tests (cube comparison, card rotation, and map planning). Main Outcome Measures: The MIST-VR was scored for time, task error, economy of hand movement, economy of diathermy, and total score. Scores were generated for the PicSOr task and visuospatial tests. Scores were correlated with time, accuracy, and total subscore on navigation, injection, and dissection tasks, as well as hazard score and total trial score on the ES3. Results: The PicSOr score was statistically significantly correlated with the hazard score on the ES3 (r=0.50, P<.001). Cube comparison (r=0.43, P<01) and card rotation (r=0.45, P<.01) scores correlated significantly with the ES3 trial score, as did the MIST-VR total score and the ES3 trial score (r=0.57, P<.001). In a multiple regression model, the PicSOr, cube comparison, and MIST-VR total scores were statistically significant predictors of ES3 performance (r=0.63, P<.01). Conclusions: Scores on the ES3 correlate strongly with scores on previously validated measures of perceptual, visuospatial, and psychomotor performance. The ES3 provides a reliable assessment of factors that are important to the acquisition of minimally invasive surgical skills, demonstrating construct validity.