Twelve tips for assessing surgical performance and use of technical assessment scales

Using validated assessment scales for technical competence can help structure and standardize assessment and feedback for both the trainee and the supervisor and thereby avoid bias and drive learning. Correct assessment of operative skills can establish learning curves and allow adequate monitoring. However, the assessment of surgical performance is not an easy task, since it includes many proxy parameters, which are hard to measure. Although numerous technical assessment scales exist, both within laparoscopic and open surgery, the validity evidence is often sparse, and this can raise doubts about reliability and educational outcome. Furthermore, the implementation of technical assessment scales varies due to several obstacles and doubts about accurate use. In this 12-tips article, we aim to give the readers a critical and useful appraisal of some of the common questions and misunderstandings regarding the use of surgical assessment scales and provide tips to ease and overcome potential pitfalls

Tools for measuring technical skills during gynaecologic surgery:a scoping review

BACKGROUND: Standardised assessment is key to structured surgical training. Currently, there is no consensus on which surgical assessment tool to use in live gynaecologic surgery. The purpose of this review is to identify assessment tools measuring technical skills in gynaecologic surgery and evaluate the measurement characteristics of each tool. METHOD: We utilized the scoping review methodology and searched PubMed, Medline, Embase and Cochrane. Inclusion criteria were studies that analysed assessment tools in live gynaecologic surgery. Kane’s validity argument was applied to evaluate the assessment tools in the included studies. RESULTS: Eight studies out of the 544 identified fulfilled the inclusion criteria. The assessment tools were categorised as global rating scales, global and procedure rating scales combined, procedure-specific rating scales or as a non-procedure-specific error assessment tool. CONCLUSION: This scoping review presents the current different tools for observational assessment of technical skills in intraoperative, gynaecologic surgery. This scoping review can serve as a guide for surgical educators who want to apply a scale or a specific tool in surgical assessment

Validity of a cross-specialty test in basic laparoscopic techniques (TABLT)

BACKGROUND: Box trainer systems have been developed that include advanced skills such as suturing. There is still a need for a portable, cheap training and testing system for basic laparoscopic techniques that can be used across different specialties before performing supervised surgery on patients. The aim of this study was to establish validity evidence for the Training and Assessment of Basic Laparoscopic Techniques (TABLT) test, a tablet‐based training system. METHODS: Laparoscopic surgeons and trainees were recruited from departments of general surgery, gynaecology and urology. Participants included novice, intermediate and experienced surgeons. All participants performed the TABLT test. Performance scores were calculated based on time taken and errors made. Evidence of validity was explored using a contemporary framework of validity. RESULTS: Some 60 individuals participated. The TABLT was shown to be reliable, with an intraclass correlation coefficient of 0·99 (P < 0·001). ANOVA showed a difference between the groups with different level of experience (P < 0·001). The Bonferroni correction was used to confirm this finding. A Pearson's r value of 0·73 (P < 0·001) signified a good positive correlation between the level of laparoscopic experience and performance score. A reasonable pass–fail standard was established using contrasting groups methods. CONCLUSION: TABLT can be used for the assessment of basic laparoscopic skills and can help novice surgical trainees in different specialties gain basic laparoscopic competencies

Implementation of a Cross-specialty Training Program in Basic Laparoscopy

BACKGROUND AND OBJECTIVES: Several surgical specialties use laparoscopy and share many of the same techniques and challenges, such as entry approaches, equipment, and complications. However, most basic training programs focus on a single specialty. The objective of this study was to describe the implementation of a regional cross-specialty training program for basic laparoscopy, to increase the flexibility of educational courses, and to provide a more efficient use of simulation equipment. METHODS: Using a regional training program in basic laparoscopy for gynecology as a model, we developed a cross-specialty training program for residents in surgery, gynecology, urology, and thoracic surgery. We reviewed data on training for the first year of the program and evaluated the program by using a scoring system for quality criteria for laparoscopic curricula and skills. RESULTS: We held 6 full-day theoretical courses involving 67 residents between September 1, 2013, and August 31, 2014. In the weeks following each course, residents practiced in a self-directed, distributed, and proficiency-based manner at a simulation center and in local hospital departments. A total of 57 residents completed the self-practice and a subsequent practical animal laboratory–based course. The structure of the training program was evaluated according to identified quality criteria for a skills laboratory, and the program scored 38 of a maximum 62 points. DISCUSSION: Implementation of a regional cross-specialty training program in basic laparoscopy is feasible. There are several logistic benefits of using a cross-specialty approach; however, it is important that local departments include specialty-specific components, together with clinical departmental follow-up