In the paper by Derossis and associates entitled “Evaluation of laparoscopic skills: a 2-year follow-up during residency training” (Can J Surg 1999;42[4]:293–6), we disagree with the assertion that “this simulator is a valuable teaching tool for training and evaluation of basic laparoscopic tasks in laparoscopic surgery.” This conclusion does not appear to be substantiated by the authors’ methods.
Finding a linear correlation between performance scores and level of training only serves to confirm that residents coincidentally become more dexterous at artificial exercises as they advance in their surgical training. It does not demonstrate construct validity of the measure but rather serves only to show convergence between simulator scores and year of residency. Furthermore, the authors do not indicate how much simulator practice time was accumulated by residents in the 2-year interval, a factor that could be singly responsible for the improved scores. Since all residents presumably complete a full 5-year program of training, to be of true value in assessing surgical skills this measure should be able to discriminate among residents, in the same year of training, deemed strongly and poorly competent by other means.
We further contend that to establish this simulator as a valuable training instrument requires evidence of improved clinical surgical skill that correlates with practice time on the training device.