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

This video discusses the critical challenge of maintaining surgical skills for rare procedures like posterior sagittal anorectoplasties (PSARP) due to low case volumes in pediatric surgery. It introduces a novel high-fidelity, 3D-printed PSARP simulator developed by researchers from leading children's hospitals. The simulator, which accurately replicates complex anatomy and haptics, has been validated as an effective teaching tool that reliably differentiates expert from novice surgeons.

Claire A Ostertag-Hill, Prathima Nandivada, Aaron P Garrison, Richard J Wood, Michael G Silver, Gregory Loan, Stephen F Wilson, Belinda Hsi Dickie

Background: 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.

Study design: 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.

Results: 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).

Conclusion: 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.

Type: video · 1 min · posted 2026-06-24
Canonical: https://library.globalcastmd.com/watch/validation-of-an-anorectal-malformation-trainer-can-a-high-fidelity-model-simulate-real-life-12687

## Chapters
- [0:00](https://library.globalcastmd.com/watch/validation-of-an-anorectal-malformation-trainer-can-a-high-fidelity-model-simulate-real-life-12687?t=0) The Low-Volume Problem in PSARP Training
- [0:30](https://library.globalcastmd.com/watch/validation-of-an-anorectal-malformation-trainer-can-a-high-fidelity-model-simulate-real-life-12687?t=30) Simulator Design and Validation Study
- [1:03](https://library.globalcastmd.com/watch/validation-of-an-anorectal-malformation-trainer-can-a-high-fidelity-model-simulate-real-life-12687?t=63) Validation Results and Implementation

## Statements
- "The average American pediatric surgery fellow performs just 15 posterior sagittal anorectoplasties during their entire training" — Paul McClure (epidemiological) [0:09](https://library.globalcastmd.com/watch/validation-of-an-anorectal-malformation-trainer-can-a-high-fidelity-model-simulate-real-life-12687?t=9)
- "Recertifying surgeons are averaging only 2 PSARPs per year" — Paul McClure (epidemiological) [0:16](https://library.globalcastmd.com/watch/validation-of-an-anorectal-malformation-trainer-can-a-high-fidelity-model-simulate-real-life-12687?t=16)
- "Nearly 30% of recertifying surgeons are doing no PSARPs at all" — Paul McClure (epidemiological) [0:16](https://library.globalcastmd.com/watch/validation-of-an-anorectal-malformation-trainer-can-a-high-fidelity-model-simulate-real-life-12687?t=16)
- "Technical precision in PSARP directly impacts continence outcomes" — Paul McClure (clinical) [0:23](https://library.globalcastmd.com/watch/validation-of-an-anorectal-malformation-trainer-can-a-high-fidelity-model-simulate-real-life-12687?t=23)
- "The PSARP simulator was developed by a team of researchers at Boston Children's, Cincinnati Children's, and Nationwide Children's Hospitals" — Paul McClure (clinical) [0:30](https://library.globalcastmd.com/watch/validation-of-an-anorectal-malformation-trainer-can-a-high-fidelity-model-simulate-real-life-12687?t=30)
- "The simulator validation study was published in the Journal of Pediatric Surgery" — Paul McClure (clinical) [0:30](https://library.globalcastmd.com/watch/validation-of-an-anorectal-malformation-trainer-can-a-high-fidelity-model-simulate-real-life-12687?t=30)
- "The simulator replicates the full anatomy of a recto vestibular and ectal malformation, including a fistula, the sphincter complex, vagina, and rectum, with realistic haptics" — Paul McClure (clinical) [0:42](https://library.globalcastmd.com/watch/validation-of-an-anorectal-malformation-trainer-can-a-high-fidelity-model-simulate-real-life-12687?t=42)
- "27 surgeons (11 experts and 16 novices) performed a complete PSARP on the model at an international surgery meeting" — Paul McClure (clinical) [0:51](https://library.globalcastmd.com/watch/validation-of-an-anorectal-malformation-trainer-can-a-high-fidelity-model-simulate-real-life-12687?t=51)
- "Sessions were independently scored by 3 blinded colorectal surgeons" — Paul McClure (clinical) [0:51](https://library.globalcastmd.com/watch/validation-of-an-anorectal-malformation-trainer-can-a-high-fidelity-model-simulate-real-life-12687?t=51)
- "The model demonstrated face, content and discriminate construct validity" — Paul McClure (clinical) [1:03](https://library.globalcastmd.com/watch/validation-of-an-anorectal-malformation-trainer-can-a-high-fidelity-model-simulate-real-life-12687?t=63)
- "Participants rated the anatomy and haptics as highly realistic" — Paul McClure (clinical) [1:07](https://library.globalcastmd.com/watch/validation-of-an-anorectal-malformation-trainer-can-a-high-fidelity-model-simulate-real-life-12687?t=67)
- "Experienced colorectal surgeons confirmed the simulator's value as a teaching tool" — Paul McClure (opinion) [1:11](https://library.globalcastmd.com/watch/validation-of-an-anorectal-malformation-trainer-can-a-high-fidelity-model-simulate-real-life-12687?t=71)
- "The simulator reliably differentiated experts from novices on every single step of the procedure" — Paul McClure (clinical) [1:11](https://library.globalcastmd.com/watch/validation-of-an-anorectal-malformation-trainer-can-a-high-fidelity-model-simulate-real-life-12687?t=71)
- "Boston Children's Hospital has integrated the simulator into their fellowship curriculum" — Paul McClure (clinical) [1:27](https://library.globalcastmd.com/watch/validation-of-an-anorectal-malformation-trainer-can-a-high-fidelity-model-simulate-real-life-12687?t=87)
- "A male rectal urethral fistula version of the simulator is in development" — Paul McClure (clinical) [1:31](https://library.globalcastmd.com/watch/validation-of-an-anorectal-malformation-trainer-can-a-high-fidelity-model-simulate-real-life-12687?t=91)

## Transcript
How do you maintain your skills in a procedure you might only do a handful of times a year? Hi, I'm Paul McClure from Stay Current, and this is a paper we think you should know. The average American pediatric surgery fellow performs just 15 posterior sagittal anorectoplasties during their entire training. Once in practice, recertifying surgeons are averaging only 2 per year, and nearly 30% are doing none at all. For a procedure where technical precision directly impacts continence outcomes, that presents a real problem for both trainees and practicing surgeons alike. This paper from a team of researchers at Boston Children's, Cincinnati Children's, and Nationwide Children's Hospitals published in the Journal of Pediatric Surgery validates a high fidelity 3D printed PSARP simulator. It replicates the full anatomy of a recto vestibular and ectal malformation, including a fistula, the sphincter complex, vagina, and rectum, with realistic haptics throughout. 27 surgeons, 11 experts, and 16 novices performed a complete PSARP on the model at an international surgery meeting with sessions independently scored by 3 blinded colorectal surgeons. The model demonstrated face, content and discriminate construct validity. Meaning participants rated the anatomy and haptics as highly realistic. Experienced colorectal surgeons confirmed its value as a teaching tool, and perhaps most importantly, it reliably differentiated experts from novices on every single step of the procedure. The bottom line, this is a validated high fidelity training tool for a procedure most trainees and practicing surgeons just don't do enough of. Boston Children's Hospital has already integrated it into their fellowship curriculum. And a male rectal urethral fistula version is in development. How is stimulation being used at your institution?

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Not medical advice · citation policy: https://library.globalcastmd.com/ai