Eur J Pediatr Surg
DOI: 10.1055/s-0041-1736387
Original Article

Validation of a Newly Developed Competency Assessment Tool for the Posterior Sagittal Anorectoplasty

1  Department of Pediatric Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
Guus M.J. Bökkerink
2  Department of Pediatric Surgery, Princess Maxima Center for Pediatric Oncology, Utrecht, Utrecht, The Netherlands
Jonathan Sutcliffe
3  Department of Paediatric Surgery, Leeds Children's Hospital, F Floor, Martin Wing Leeds General Infirmary GT George Street, Leeds, W Yorkshire, United Kingdom
Marc A. Levitt
4  Department of Surgery, Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, District of Columbia, Washington, United States
Karen Diefenbach
5  Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, United States
Carlos A. Reck
6  Department of Pediatric Surgery, Medical University of Vienna, Wien, Wien, Austria
6  Department of Pediatric Surgery, Medical University of Vienna, Wien, Wien, Austria
7  Department of Pediatric Surgery, Radboud Medical Centre, Nijmegen, The Netherlands
Sanne M.B.I. Botden
8  Department of Pediatric Surgery, Radboudumc-Amalia Children's Hospital, Nijmegen, The Netherlands
› Author Affiliations
Funding The authors have no financial ties to disclosure. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.


Introduction The correction of an anorectal malformation (ARM) is complex and relatively infrequent. Simulation training and subsequent assessment may result in better clinical outcomes. Assessment can be done using a competency assessment tool (CAT). This study aims to develop and validate a CAT for the posterior sagittal anorectoplasty (PSARP) on a simulation model.

Materials and Methods The CAT-PSARP was developed after consultation with experts in the field. The PSARP was divided into five steps, while tissue and instrument handling were scored separately. Participants of pediatric colorectal hands-on courses in 2019 and 2020 were asked to participate. They performed one PSARP procedure on an ARM simulation model, while being assessed by two objective observers using the CAT-PSARP.

Results A total of 82 participants were enrolled. A fair interobserver agreement was found for general skills (intraclass correlation coefficient [ICC] = 0.524, p < 0.001), a good agreement for specific skills (ICC = 0.646, p < 0.001), and overall performance (ICC = 0.669, p < 0.001). The experienced group scored higher on all steps (p < 0.001), except for “anoplasty (p = 0.540),” compared with an inexperienced group.

Conclusion The CAT-PSARP is a suitable objective assessment tool for the overall performance of the included steps of the PSARP for repair of an ARM on a simulation model.

Ethics Approval and Consent to Participate

Written informed consent was obtained from all participants. According to national law and legislation, ethical board approval of the ethics committee of Arnhem and Nijmegen was deemed unnecessary. Approval of the ethics committee of the institution Radboudumc was waived according to national regulations.[26] The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Availability of Data and Materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Authors' Contributions

Study concept and design: M.J., I.B., and S.M.B.I.B.

Data acquisition: M.J., G.M.J.B., J.S., M.A.L., K.D., C.A.R., W.K., I.B., and S.M.B.I.B.

Analysis and data interpretation: M.J.

Drafting manuscript: M.J.

Critical revision: G.M.J.B., J.S., M.A.L., K.D., C.A.R., W.K., I.B., and S.M.B.I.B.

All authors read and approved the final manuscript.

Publication History

Received: 21 May 2021

Accepted: 20 August 2021

Publication Date:
25 November 2021 (online)

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