Assessing the Surgeonʼs Technical Skills: Analysis of the Available Tools

Abstract

The concept of assessing competency in surgical practice is not new and has taken on an added urgency in view of the recent high-profile inquiries into "botched cases" involving surgeons of various levels in different parts of the world. Until very recently, surgeons in the United Kingdom and other parts of the world, although required to undergo formal and compulsory examinations to test their factual knowledge and decision making, were not required to demonstrate technical ability. Therefore, there existed (and still exist) no objective assessment criteria to test trainees' surgical skill, especially during the exit examination, which, if passed, provides unrestricted license to surgeons to practice their specialties. However, with the introduction of a new curriculum by various surgical societies and a demand from the lay community for better standards, new assessment tools are emerging that focus on technical competency and that could objectively and reliably measure surgical skills. Furthermore, training authorities and hospitals are keen to embrace these changes for satisfactory accreditation and reaccreditation processes and to assure the public of the safety of the public and private health care systems. In the United Kingdom, two new surgical tools (Surgical Direct Observation of Procedural Skill, and Procedure Based Assessments) have been simultaneously introduced to assess surgical trainees. The authors describe these two assessment methods, provide an overview of other assessment tools currently or previously used to assess surgical skills, critically analyze the two new assessment tools, and reflect on the merit of simultaneously introducing them.

Computer-Aided Feedback of Surgical Knot Tying Using Optical Tracking

“…With the adoption of proficiencybased training curricula, there is a growing need for tools for objective feedback and assessment of technical competence. 1 Barriers to the implementation and optimal use of skills laboratories include both equipment costs and the cost of faculty teaching effort. 2,3 Although many basic skills can be accomplished without direct guidance, supervising mentorship is important to provide performance feedback and assessment.…”

An Operative Performance Rating System for Urology Residents

“…10,11 OSATS has been applied to gynecologic procedures and the European Board of Vascular Surgery incorporated OSATS into the fellowship examination. 12,13 Since the development of OSATS in general surgery and application to other surgical fields, various assessment instruments have been developed for anatomical models, cadavers, computer simulators and video recordings of operations. Although simulators, computer animated devices and video recordings can provide a value adjunct to assess resident surgical skill, they are not uniformly applied across programs, can be expensive and do not evaluate operating room performance.…”

Use of a Machine Learning Algorithm to Classify Expertise

“…[3][4][5][6] These limitations have prevented widespread adoption of such tracking devices. The only motion economy metric in widespread use is total task time, which needs to be used alongside a measure of quality/error such as in the summative assessment of minimally invasive skills using the fundamentals of laparoscopic surgery tool (which requires human proctoring).…”