Assessment of EVAR Competence: Validity of a Novel Rating Scale (EVARATE) in a Simulated Setting

Research output: Contribution to journalArticle


Objectives: The aims of this study were to investigate the validity evidence for a novel procedure specific assessment tool of competence in endovascular aortic repair (EVAR) and to establish a pass/fail level for the assessment. Methods: Computed tomography angiography data of a 55 mm in diameter infrarenal aortic aneurysm was implemented into an endovascular simulator. Twenty-three physicians with varying EVAR experiences were video-recorded when performing a standard EVAR procedure on the simulator. Two experienced EVAR operators assessed the participants using the novel rating scale, “EndoVascular Aortic Repair Assessment of Technical Expertise” (EVARATE). Validity was studied according to the framework endorsed by the American Educational Research Association. Results: The EVARATE scale had a high internal consistency (Cronbach's alpha =.90). The inter-rater reliability was acceptable (Intraclass Correlation Coefficient =.68, p =.005). Specific EVAR experience correlated significantly with the EVARATE score (Spearman's rho =.62, p =.002), but general endovascular experience did not. Consequence analysis showed that the EVARATE assessment could distinguish novices from intermediates (p <.01) and from experts (p <.001). A pass/fail score was determined using the contrasting groups’ method. Conclusion: This paper presents the initial validity evidence for a novel procedure specific assessment tool, EVARATE, for operator competence in endovascular aortic repair investigated in a simulated setting. The assessment tool can be used to provide structured formative feedback to trainees.


  • Michael Strøm
  • Lars Lönn
  • Lars Konge
  • Torben V. Schroeder
  • Hans Lindgren
  • Thomas Nyheim
  • Maarit Venermo
  • Bo Bech
External organisations
  • Copenhagen University Hospital
  • University of Copenhagen
  • Helsingborg Hospital
  • Oslo university hospital
  • University of Oslo
  • Helsinki University Central Hospital
  • University of Helsinki
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cardiac and Cardiovascular Systems
  • Surgery


  • Abdominal aortic aneurysm, Educational assessment, Endovascular, EVAR, Simulation, Training
Original languageEnglish
Pages (from-to)137-144
JournalEuropean Journal of Vascular and Endovascular Surgery
Issue number1
Early online date2018 Apr 5
Publication statusPublished - 2018
Publication categoryResearch