Construct Validity Testing of a Laparoscopic Surgical Simulator Elspeth M McDougall, MD, FRCSC, Federico A Corica, MD, John R Boker, PhD, Leandro G Sala, MD, Gabriela Stoliar, MD, James F Borin, MD, Frank T Chu, BSc, Ralph V Clayman, MD, FACS BACKGROUND: We present initial data on the construct, content, and face validity of the LAPMentor (Simbionix), virtual reality laparoscopic surgical simulator. STUDY DESIGN: Medical students (MS), residents and fellows (R/F), and experienced laparoscopic surgeons (ES), with  30 laparoscopic cases per year (ES  30) and those with  30 laparoscopic cases per year (ES  30), were tested on 9 basic skill tasks (SK) including manipulation of 0-degree and 30-degree cameras (SK1, SK2), eye-hand coordination (SK3), clipping (SK4), grasping and clipping (SK5), two-handed maneuvers (SK6), cutting (SK7), fulguration (SK8), and object- translocation (SK9). RESULTS: Mean MS (n = 23), R/F (n = 24), ES  30 (n = 26), and ES  30 (n = 30) ages were 26 years (range 21 to 32 years), 31 years (range 27 to 39 years), 49 years (range 31 to 70 years) and 47 years (range 34 to 69 years), respectively. In the lower level skill tasks (SK3, SK4, SK5, and SK6) the ES  30, ES  30, and R/F had similar scores, but were all substantially better than the MS scores. In the higher level skill tasks (SK7, SK8, and SK9), the ES  30 scores tended to be better than the R/F and ES  30, which were similar, and these, in turn, were markedly better than the MS. The ES  30 had notably higher SK8 scores than the R/F and ES  30, who had similar scores, and these had notably better scores than the MS. CONCLUSIONS: The noncamera skills (SK3 to 9) of the LAPMentor surgical simulator can distinguish between laparoscopically naive and ES. SK8 showed the highest level of construct validity, by accurately differentiating among the MS, R/F, ES  30 and ES  30. (J Am Coll Surg 2006;202: 779–787. © 2006 by the American College of Surgeons) Laparoscopy is an integral component of today’s uro- logic practice. The rapid evolution of this field at major medical centers, however, has been slow to disseminate into general urologic practice because most urologic ap- plications involve a steep learning curve. The reduced depth perception and two-dimensional image, with more attenuation in tactile sensation and end force of the instruments that are manipulated in a totally counter-intuitive environment, make this a challenging learning process. But because of these same limitations, the laparoscopic environment, unlike the open surgical environment, can be replicated in a computer-generated virtual reality format. The need for repetitive practice of these challenging laparoscopic skills has made basic lapa- roscopy amenable to simulator-based training. 1 So sur- gical simulators may help neophyte surgeons master skills such as manipulation of laparoscopic instruments, compensation for the camera angle and the fulcrum ef- fect of the instruments, and performance of ambidex- trous tasks. 2 Before a surgical simulator can be used to assess compe- tency, it must be vigorously and objectively evaluated to determine both its scientific reliability and its validity. 3 Among the five recognized validities (content, face, con- struct, concurrent, and predictive), we sought to study the three most basic ones: content, face, and construct Elspeth M McDougall, MD, FRCSC, is Director, Astellas Center for Urolog- ical Education. Astellas Pharma US, Inc, has received an unrestricted research grant from Endocare, Inc, and grants from Karl Storz America Endoscopy; Intuitive Surgical; Simbionix; and Ethicon Endo-surgery for equipment sup- port in the laboratory. Ralph V Clayman, MD, FACS, is a shareholder in Applied Medical and a consultant and speaker for Endocare, Inc and Intuitive Surgical. He has unrestricted educational grants from Baxter Corp, Endocare, Inc, and Boston Scientific. He receives royalties from Boston Scientific, Greenwald Surgical, Orthopedic Systems Inc, and Cook Urological. Received November 18, 2005; Revised January 11, 2006; Accepted January 12, 2006. From the Departments of Urology and Family Medicine, University of Califor- nia, Irvine, Orange, CA. Correspondence address: Elspeth M McDougall, MD, FRCSC, UCI Medical Center, Building 55, Room 304, Rt 81, 101 The City Drive, Orange, CA 92868. 779 © 2006 by the American College of Surgeons ISSN 1072-7515/06/$32.00 Published by Elsevier Inc. doi:10.1016/j.jamcollsurg.2006.01.004