Validation of an anorectal malformation trainer - Can a high-fidelity model simulate real life?

• A high-fidelity, 3D-printed anorectal malformation surgical simulator has been developed • Face, content, and discriminant construct validity of the simulator has been established • The simulator offers a tool for training and maintenance of skills A high-fidelity, 3D-printed anorectal malformation surgical simulator has been developed Face, content, and discriminant construct validity of the simulator has been established The simulator offers a tool for training and maintenance of skills The reconstruction of anorectal malformations (ARMs) is a technical but reproducible operation. The average number of ARM repairs performed by U.S. pediatric surgery trainees is 15 with recertifying pediatric surgeons performing an average of only 2 ARM repairs annually. The aim of this study was to investigate the validity of a surgical simulator that replicates the steps of repair. A high-fidelity ARM simulator was designed using digital modeling software packages and fabricated using 3D-printing, hand-sculpting, and multi-stage silicone injection molding techniques. A cross-sectional observational study was performed at an international surgical meeting, recruiting 27 surgeons (n=11 experts, n=16 novice). Each participant performed a posterior sagittal anorectoplasty (PSARP) on the model and completed a questionnaire on the model’s realism and didactic value. Each session of the simulation was recorded and independently assessed by 3 experienced pediatric colorectal surgeons (raters) using a standardized general skills (OSATS) and PSARP step-specific assessment tools. All items, including anatomical structures, haptics, and procedural steps, were evaluated as significantly better than neutral (p-values 0.003 to <0.0001). Significant differences between the groups were observed for multiple items in the OSATS checklist, including respect for tissue (p=0.017), instrument handling (p=0.012), flow of operation (p=0.004), and knowledge of specific procedure (p=0.014). Additionally, there were significant differences in performance by experts and novices on all PSARP steps as evaluated by experienced pediatric colorectal raters (p-values 0.005 to 0.046). Evaluation of a newly developed high-fidelity, 3D-printed anorectal malformation surgical simulator demonstrated face, content, and discriminant construct validity. Given the low number of PSARPs performed annually by surgical fellows and attendings, this simulator can offer a high-fidelity training tool.