LAUSR

Purpose To investigate validity evidence for a simulator-based test in robot-assisted radical prosta-tectomy (RARP). Materials and methods The test consisted of three modules on the RobotiX Mentor VR-simulator : Bladder Neck Dissection, Neurovascular Bundle Dissection, and Ureterovesical Anastomosis. Validity evidence was investigated using Messick's framework by including doctors with different RARP experience: novices (who had assisted for RARP), intermediates (robotic surgeons, but not RARP surgeons) or experienced (RARP surgeons). The simulator metrics were ana-lysed and Cronbach's alpha and generalizability theory were used to explore reliability. In-tergroup comparisons were done with mixed-model, repeated measurement analysis of vari-ance and the correlation between the number of robotic procedures and the mean test score was examined. A pass/fail score was established using the contrasting groups' method. Results Ten novices, eleven intermediates, and six experienced RARP surgeons were included. Six metrics could discriminate between groups and showed acceptable internal consistency reli-ability, Cronbach's α = 0.49, p<0.001. Test-retest reliability was 0.75, 0.85, and 0.90 for one, two, and three repetitions of test, respectively. Six metrics were combined into a simulator score that could discriminate between all three groups, p=0.002, p<0.001, and p=0.029 for novices vs. intermediates, novices vs. experienced, and intermediates vs. experienced, re-spectively. Total number of robotic operations and the mean score of the three repetitions were significantly correlated, Pearson's r=0.74, p<0.001. Conclusion This study provides validity evidence for a simulator-based test in RARP. We determined a pass/fail level that can be used to ensure competency before proceeding to supervised clini-cal training.  .