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--- jnl:ghanem2016 [2019/05/02 07:45]
admin
+++ jnl:ghanem2016 [2020/05/15 05:43] (current)
admin [Commentary]
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 {{:jnl:ghanem2017-fig5.png?400|The average errors per anastomosis of each group on day 3 were compared with those in day 5, except in the expert control whereby the average errors for the first three anastomoses were compared with the second three anastomoses. Asterisks indicate significance within groups, between the two time points. All apart from the expert controls show statistical significance between the time points (p < 0.0001).}}
+{{:jnl:ghanem2017-fig6.png?400|The anastomosis lapse index (ALI) assessment tool}}
 ====Commentary====
 ===Key===
   * Good: low-fi, can differentiate expert/novice
   * Bad: manual ? inter-rater?; how does it correlate with real micro skills?
+    * need an expert to do it
 ===Assessment Model===
   * Outcome only
+  * Assessor score. Bias, rating, score - [[ac:stats:scores|statistical considerations]]
+  * Weighting - each error given equal weight -- is that really the case? see [[bk:altman1991|Altman]] page 14 on Scores.
+    * Experts: also made errors (between 2-2.5 errors); do they make different errors?
   * Size of rat aorta?
   * Can differentiate expert, but how does it correlate with patency?
+===Methodology===
+  * 29 participants with 2 anastomosis each on day 3 and day 5; 2 experts with 3 anastomosis on D1 and 3 on D3
+    * "expert" group very concentrated
+  * SD for expert group higher (2.5) vs (1.0-1.3) for other groups --> there is some variability anastomosis to anastomosis
+===Discussion===
+The authors quote [[jnl:kaufman1987:Kaufman]] (whom I assume takes from [[pp:Fitts-Posner]]), the cognitive, associative and autonomous stages in the development of technical skill (or expertise). I am not so convinced this model is entirely useful for surgical training. It is useful for some surgical task training, but not for surgery in general. See page on [[co:expertise]].
 ===So What?===
   * Authors suggest: ALI > 6 == novice, ALI 3-6 == intermediate, ALI < 3 == expert; BUT can you really improve so quickly as from novice to intermediate?
-  *
+====Others====
+  * See also
+    * [[ac:global_rating_scales]]
+    * [[ac:motion_analysis]]
 ====Source====
 Ghanem, A. M., Omran, Y. Al, Shatta, B., Kim, E., & Myers, S. (2016). Anastomosis Lapse Index (ALI): A Validated End Product Assessment Tool for Simulation Microsurgery Training. J Reconstr Microsurg, 32, 233–241. https://doi.org/10.1055/s-0035-1568157

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