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Surg Endosc (2006) 20: 744747DOI: 10.1007/s00464-005-3008-y Springer Science+Business Media, Inc. 2006The MISTELS program to measure technical skill in laparoscopic
surgeryEvidence for reliabilityM. C. Vassiliou,1 G. A. Ghitulescu,1 L. S. Feldman,1 D. Stanbridge,1 K. Leondre,2 H. H. Sigman,1 G. M. Fried11 SteinbergBernstein Centre for Minimally Invasive Surgery, Department of Surgery, McGill University Health Centre, 1650 Cedar Avenue,
#L9.309, Montreal, Quebec, Canada H3G 1A42 Department of Social and Preventive Medicine, University of Montreal, Pavillon 1420 boul. Mont-Royal, Montreal, Quebec, Canada H2V 4P3Received: 17 June 2005/Accepted: 17 July 2005/Online publication: 27 February 2006AbstractBackground: The McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS)
is a series of ve tasks with an objective scoring system.
The purpose of this study was to estimate the interrater
and testretest reliability of the MISTELS metrics and
to assess their internal consistency.Methods: To determine interrater reliability, two trained
observers scored 10 subjects, either live or on tape. Test
retest reliability was assessed by having 12 subjects
perform two tests, the second immediately following the
rst. Interrater and testretest reliability were assessed
using intraclass correlation coecients. Internal consistency between tasks was estimated using Cronbachs
alpha.Results: The interrater and testretest reliabilities for the
total scores were both excellent at 0.998 [95% condence
interval (CI), 0.9851.00] and 0.892 (95% CI, 0.6650.968), respectively. Cronbachs alpha for the rst
assessment of the testretest was 0.86.Conclusions: The MISTELS metrics have excellent reliability, which exceeds the threshold level of 0.8 required
for high-stakes evaluations. These ndings support the
use of MISTELS for evaluation in many dierent settings, including residency training programs.Key words: Laparoscopic training Simulation
Education Evaluation Reliability
The current method of evaluating technical skill in surgical trainees is a subjective assessment performed by
practicing surgeons. This is relied on during the licensing
process and in the selection of medical students for entry
into surgical residency programs. Acquisition of skill has
traditionally taken place almost exclusively in the operating room, where resources are limited. Recently, the
widespread acceptance of minimally invasive techniques
has required the development of new and complex
technical skills. Important skills required in the practice
of laparoscopic surgery, such as handeye coordination
and three-dimensional visual spatial perception while
viewing through a monocular viewing system, are easily
reproduced in an inanimate system. In addition, inanimate...