Assessing competency in surgery: Where to begin?

Sidhu, Ravindar S.; Grober, Ethan; Musselman, Laura J.; Reznick, Richard K.

doi:10.1016/s0039-6060(03)00154-5

Cited by 120 publications

(99 citation statements)

References 57 publications

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“…VR simulators and HMT systems are able to provide real-time scores in the form of evidence-based reports (path length, errors, overall score, time, etc.) [9]. However, this information is devoid of meaning without proper interpretation which, if provided by a tutor figure, may lose its character of immediate and objective.…”

Section: Automatic Analysis For Skills Assessmentmentioning

confidence: 99%

“…Assessment based on In-Training Evaluation Reports (ITERs) [9] is subjective, expensive, and prone to undesirable side effects, such as a halo effect [10]. The halo effect is a result of influenced perception of the performance in one área (e.g., laparoscopic task) by the performance in another área (e.g., relationship between trainee and mentor) [11].…”

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confidence: 99%

“…The Objective Structured Clinical Examination (OSCE) [13] has been used to assess clinical performance of trainees on various clinical stations (comprising different tasks). Since OSCE mainly focuses on the assessment of procedural knowledge and attitude of the trainee towards the patient, technical evaluation of psychomotor skills is not given leading relevance [9].…”

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confidence: 99%

“…Implementation of the OSATS in the OR, however, may present ambiguities in the scoring systems [16]. Another drawback is the high amount of resources required, from the number of experts deployed at each station to evalúate the trainees, to the marginal costs of each exam per candidate [9]. Laparoscopic video offline-evaluation has been proposed to reduce some of these costs with good reliability results [17].…”

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confidence: 99%

“…As the need for objective and structured assessment of technical performance grows, new tools and methods have emerged over the last few years [9,15,18]. Training methods are being gradually changed, leaving the traditional ways behind on behalf of criterion-based curricula [19].…”

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confidence: 99%

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Methods and Tools for Objective Assessment of Psychomotor Skills in Laparoscopic Surgery

García

Sánchez-González

Lamata

et al. 2011

Journal of Surgical Research

133

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Training and assessment paradigms for laparoscopic surgical skills are evolving from traditional mentortrainee tutorship towards structured, more objective and safer programs. Accreditation of surgeons requires reaching a consensus on metrics and tasks used to assess surgeons' psychomotor skills. Ongoing development of tracking systems and software Solutions has allowed for the expansión of novel training and assessment means in laparoscopy. The current challenge is to adapt and include these systems within training programs, and to exploit their possibilities for evaluation purposes. This paper describes the state of the art in research on measuring and assessing psychomotor laparoscopic skills. It gives an overview on tracking systems as well as on metrics and advanced statistical and machine learning techniques employed for evaluation purposes. The later ones have a potential to be used as an aid in deciding on the surgical competence level, which is an important aspect when accreditation of the surgeons in particular, and patient safety in general, are considered. The prospective of these methods and tools make them complementary means for surgical assessment of motor skills, especially in the early stages of training. Successful examples such as the Fundamentáis of Laparoscopic Surgery should help drive a paradigm change to structured curricula based on objective parameters. These may improve the accreditation of new surgeons, as 1 To whom correspondence and reprint requests should be addressed at Bioengineering and Telemedicine Centre (GBT), ETSI Telecomunicación, Universidad Politécnica de Madrid (UPM). Avda Complutense, 30, 28040, Madrid, Spain. E-mail: ioropesa@gbt.tfo. upm.es. well as optimize their already overloaded training schedules.

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Section: Automatic Analysis For Skills Assessmentmentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Methods and Tools for Objective Assessment of Psychomotor Skills in Laparoscopic Surgery

García

Sánchez-González

Lamata

et al. 2011

Journal of Surgical Research

133

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Are Young Surgeons Competent to Perform Alimentary Tract Surgery?

Prystowsky¹,

Curet²,

Rothenberger³

et al. 2005

Arch Surg

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Background: Assessment of competency during residency training has received increased attention recently. There has been less attention given to the competency of residents after training. Hypothesis: Patient outcomes for alimentary tract surgery (ATS) should be similar for surgeons who recently completed their residency training compared with more experienced surgeons, indicating that the younger surgeons had achieved clinical competency on completion of their residency training.

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Analysis of Surgical Volume in Military Medical Treatment Facilities and Clinical Combat Readiness of US Military Surgeons

et al. 2022

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IMPORTANCE Low surgical volume in the US Military Health System (MHS) has been identified as a challenge to military surgeon readiness. The Uniformed Services University of Health Sciences, in partnership with the American College of Surgeons, developed the Knowledge, Skills, and Abilities (KSA) Clinical Readiness Program that includes a tool for quantifying the clinical readiness value of surgeon workload, known as the KSA metric.OBJECTIVE To describe changes in US military general surgeon procedural volume and readiness using the KSA metric.DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed general surgery workload performed across the MHS, including military and civilian facilities, between fiscal year 2015 and 2019 and the calculated KSA metric value. The surgeon-level readiness among military general surgeons was calculated based on the KSA metric readiness threshold. Data were obtained from TRICARE, the US Department of Defense health insurance product. MAIN OUTCOMES AND MEASURESThe main outcomes were general surgery procedural volumes and the KSA metric point value of those procedures across the MHS as well as the number of military general surgeons meeting the KSA metric readiness threshold. Aggregate facility and regional market-level claims data were used to calculate the procedural volumes and KSA metric readiness value of those procedures. Annual adjusted KSA metric points earned were used to determine the number of individual US military general surgeons meeting the readiness threshold. RESULTSThe number of general surgery procedures generating KSAs in military hospitals decreased 25.6%, from 128 377 in 2015 to 95 461 in 2019, with a 19.1% decrease in the number of general surgeon KSA points (from 7 155 563 to 5 790 001). From 2015 to 2019, there was a 3.2% increase in both the number of procedures (from 419 980 to 433 495) and KSA points (from 21 071 033 to 21 748 984) in civilian care settings. The proportion of military general surgeons meeting the KSA metric readiness threshold decreased from 16.7% (n = 97) in 2015 to 10.1% (n = 68) in 2019. CONCLUSIONS AND RELEVANCEThis study noted that the number of KSA metric points and procedural volume in military hospitals has been decreasing since 2015, whereas both measures have increased in civilian facilities. The findings suggest that loss of surgical workload has resulted in further decreases in military surgeon readiness and may require substantial changes in patient care flow in the MHS to reverse the change.

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Assessing competency in surgery: Where to begin?

Cited by 120 publications

References 57 publications

Methods and Tools for Objective Assessment of Psychomotor Skills in Laparoscopic Surgery

Methods and Tools for Objective Assessment of Psychomotor Skills in Laparoscopic Surgery

Are Young Surgeons Competent to Perform Alimentary Tract Surgery?

Analysis of Surgical Volume in Military Medical Treatment Facilities and Clinical Combat Readiness of US Military Surgeons

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