A simulator was created to allow for safe practice and assessment of Axillary Lymph Node Dissection (ALND), and face, content, and construct validity were studied. The decline in the frequency of ALNDs done has resulted in a drop in resident awareness and confidence. Between July 2017 and August 2018, a cross-sectional multicenter observational study was conducted. Following the creation of the model, 30 surgeons with varied levels of experience (n = “experts,” n=11 “senior residents,” and n=10 “junior residents”) were asked to execute a simulated ALND. Immediately after ALND, face and content validity surveys were given out. All ALND procedures were retrospectively appraised by 2 attending breast surgeons using a video-based assessment tool and an end product assessment instrument, blinded to operator identification. The axillary clearance assessment instrument showed statistically significant variations between groups across all operational subphases (P<0.001). Overall procedure quality (P<0.05) and the total number of lymph nodes removed (P<0.001) were found to be significantly different across groups. However, operator grade could not discriminate other end product characteristics such as axillary vein damage (P=0.864) and long thoracic nerve injury (P=0.094). The simulator offers pleasing anatomical (median score >7) and procedural realism (median score >7), according to participants. The construct validity of the ALND evaluation was demonstrated by video analysis. This simulation was a good supplement for technical skills training, and formative Deanery or Faculty delivered assessments due to the reduced ALND exposure.
