Development and Validation of Performance Assessment Scales for Core Cardiac Surgical Procedures: A National Simulation-Based Study
Abstract
Abstract Background Valid and reliable objective tools are needed to assess technical performance in cardiac surgical training. We developed and validated procedure-specific Performance Assessment of Surgical Skills (PASS) scales for core cardiac surgical procedures: median sternotomy (STERNO-PASS), cardiopulmonary bypass (CPB-PASS), surgical aortic valve replacement (SAVR-PASS), and internal mammary artery harvesting (IMA-PASS). Methods Scales were developed through literature review, expert consensus using a Delphi process, and response process testing during simulation sessions. Validation included 43 trainees performing simulated SAVR via median sternotomy under cardiopulmonary bypass and 36 trainees performing internal mammary artery harvesting. Performances were assessed by independent observers. Internal structure was evaluated using Cronbach’s alpha, McDonald’s omega (ω), intraclass correlation coefficient (ICC), linear regression (R²), and Bland–Altman analysis. Inter-observer comparisons used non-parametric tests. Results Final instruments included 10 items for STERNO-PASS, 33 items for CPB-PASS, 17 items for SAVR-PASS, and 13 items for IMA-PASS. Internal consistency showed Cronbach’s alpha values of 0.64, 0.86, 0.88, and 0.83 and McDonald's omega values of 0.79, 0.89, 0.88, and 0.86, respectively, with an overall alpha of 0.92 and omega of 0.95 for the complete SAVR procedure. Inter-observer reliability showed ICC values from 0.92 to 0.96 with no significant…
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