Anaya-Prado R, Ortega-León LH, Ramirez-Solis ME, Vázquez-García JA, Medina-Portillo JB, Ayala-López EA

Language: Spanish
References: 28
Page: 261-269
PDF size: 699.03 Kb.

ABSTRACT

Background: Assessment of technical dexterity is currently the weakest issue in surgical evaluation. It is imperative to develop an objective exam that allows us to correct training deficiencies and abilities and to objectively feedback education programs and hospitals. The purpose of this study was to perform a correlation between theoretical knowledge and surgical skills.
Methods: We performed a national pilot study in in surgeons certifying by the Mexican Board of Surgery in 2010. This was a two-stage study: written exam (stage I) and oral exam (viva voce) to all surgeons approving the written exam (stage II). In stage II we utilized an objective structured assessment of technical skills (OSATS) whose results were correlated with those of the written and oral exams. The assessment involved seven skill stations and a global rating scale to indicate correctly performed or not and a fail/pass exam, respectively.
Results: Sixty-two surgeons approved the written exam in two places. We found no statistical difference among skills in open surgery (bowel anastomosis, liver and vascular suture), laparoscopic surgery (grape pilling, cutting a circle and intracorporeal knot tying) and instrument identification. There was a statistically significant difference (p ‹0.001) when median values were compared between laparoscopic surgery vs. open surgery and the identification of surgical instruments. There was a correlation between theoretical knowledge and surgical skills.
Conclusion: When applying an OSATS, we found a positive correlation between theoretical knowledge and surgical skills. This assessment proves to to be valid and reliable for the evaluation of surgical dexterity.

REFERENCES

1. Darzi A, Smith S, Taffinder N. Assessing operative skills. Needs to become more objective. BMJ 1999;318(7188):887-888.

2. Darzi A, Mackary S. Skills assessment of surgeons. Surgery 2002;131:121-124.

3. Hiemstra E, Kolkman W, Wolterbeek R, Trimbos B, Jansen FW. Value of an objective assessment tool in the operating room. Can J Surg 2011;54:116-122.

4. Moorthy K, Munz Y, Sarker SK, Darzi A. Objective assessment of technical skills in surgery. BMJ 2003;327(7422):1032-1037.

5. Cuschieri A, Francis N, Crosby J, Hanna GB. What do master surgeons think of surgical competence and revalidation? Am J Surg 2001;182:110-116.

6. Memon MA, Brigden D, Subramanya MS. Assessing the surgeon’s technical skills: analysis of the available tools. Acad Med 2010;85:869-880.

7. Khan MS, Bann SD, Darzi A. Assessing surgical skills. Plastic Reconstruct Surg 2003;112:1886-1889.

8. Reznick RK. Teaching and testing technical skills. Am J Surg 1993;165:358-361.

9. Beard JD, Jolly BC, Newble DI, Thomas WEG, Donnelly J, Southgate LJ. Assessing the technical skills of surgical trainees. Br J Surg 2005;92:778-782.

10. Siddighi S, Kleeman SD, Baggish MS, Rooney CM, Pauls RN, Karram MM. Effects of an educational workshop on performance of fourth-degree perineal lacerations repair. Obstet Gynecol 2007;109:289-294.

11. Goff BA, Lentz GM, Lee D, Fenner D, Morris J, Mandel LS. Devel - opment of a bench station objective structured assessment of technical skills. Obstet Gynecol 2001;98:412-416.

12. Weg T. Teaching and assessing surgical competence. Ann R Coll Surg Engl 2006;88:429-432.

13. Pitts D, Rowley DI, Sher JL. Assessment of performance in orthopaedic training. J Bone Joint Surg 2005;87:1187-1191.

14. Faulkner H, Regehr G, Martin J, Reznick R. Validation of an objective structured assessment of technical skill for surgical residents. Acad Med 1996;71:1363-1365.

15. Datta V, Mackay S, Mandalia M, Darzi A. The use of electromagnetic motion tracking analysis to objectively measure open surgical skill in the laboratory-based model. J Am Coll Surg 2001;193:479-485.

16. McCloy R, Stone R. Science, medicine and the future. Virtual reality in surgery. BMJ 2001;323(7318):912-915.

17. Archivos del Consejo Mexicano de Cirugía General. (consulted 2011 March 12). Available at: http://www.cmcgac.org.mx/entrenamiento.html

18. Miller GE. The assessment of clinical skills/competence/performance. Acad Med 1990;65:S63-S67.

19. Scott DJ, Reger RV, Bergen PC, Guo WA, Laycock R, Tesfay ST, et al. Measuring operative performance alters laparoscopic skills training: edited videotape versus direct observation. J Laparoendosc Adv Surg Tech A 2000;10:183-190.

20. Martin JA, Regehr G, Reznick R, MacRae H, Murnaghan J, Hutchison C, et al. Objective structured assessment of technical skill (OSATS) for surgical residents. Br J Surg 1997;84:273-278.

21. Szalay D, MacRae H, Regehr G, Reznick R. Using operative outcome to assess technical skill. Am J Surg 2000;180:234-237.

22. Kopta JA. Art approach to the evaluation of operative skills. Surgery 1971;70:293-303.

23. Vassiliou MC, Feldman LS, Andrew CG, Bergman S, Leffondré K, Stanbridge D, et al. A global assessment tool for evaluation of intraoperative laparoscopic skills. Am J Surg 2005;190:107-113.

24. Winckel CP, Reznick RK, Cohen R, Taylor B. Reliability and construct validity of a Structured Technical Skills Assessment Form. Am J Surg 1994;167:423-427.

25. Reznick R, Regehr G, MacRae H, Martin J, McCulloch W. Testing technical skills via an innovative “bench station” examination. Am J Surg 1997;173:226-230.

26. Gallagher AG, Satava RM. Virtual reality as a metric for the assessment of laparoscopic psychomotor skills. Surg Endosc 2002;16:1732-1746.

27. Francis NK, Hanna GB, Cuschieri A. The performance of master surgeons on the advanced Dundee endoscopic psychomotor tester. Arch Surg 2002;137:841-844.

28. VanBlaricom AL, Goff BA, Chinn M, Icasiano MM, Nielsen P, Mandel L. A new curriculum for hysteroscopy training as demonstrated by an objective structured assessment of technical skills (OSATS). Am J Obstet Gynecol 2005;193:1856–1865.