The surgical efficiency score: a feasible, reliable, and valid method of skills assessment
The surgical efficiency score: a feasible, reliable, and valid method of skills assessment
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DOI：
10.1016/j.amjsurg.2006.06.001
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发表时间：
2006-09-01
影响因子：
3
通讯作者：
Darzi, Ara
中科院分区：
文献类型：
--
作者：
Datta, Vivek;Bann, Simon;Darzi, Ara
背景资料：技术技能评估越来越多地用于外科住院医师项目，其中一些技术的客观性和有效性得到了很好的建立。然而，这些方法中的许多是劳动和时间密集型的，限制了它们的可行性。本研究的目的是比较更有效的技术技能评估与一个既定的黄金standard.Methods：30名外科医生完成了2个以前验证的实验室为基础的手术模型：小肠吻合术和静脉补片插入。金标准评估是技术技能的客观结构评估（OSATS）方法。使用的“有效”技术是（1）最终产品质量（FP）;（2）快照评估（SS），其中任务表现被编辑为2分钟的声音咬合并使用OSATS评分;以及（3）手术效率评分（SES），最终产品质量和手部动作分析的组合。所有人类观察者评价均使用回顾性视频分析，由3名经过培训的观察者进行。结果：小肠吻合术与OSATS的相关性如下：FP 0.341（P = 0.07），SS 0.577（P <0.001），SES 0.842（P <0.001）。对于静脉补片插入，相关性如下：FP 0.545（P = .001），SS 0.609（P < .001）和SES 0。700（P < .001）。两种模型在FP方面的观察者间一致性较高（小肠吻合术的Cronbach α为0.80，静脉补片插入术的Cronbach α为0.84）。关于SS，观察者间的可靠性是高静脉补片插入（Cronbach的α 0.80），但只有中等小肠吻合（0.59）。结论：手术效率评分和快照评估都显示出显着的相关性与传统的OSATS评价，并建议技能评估可以更可行。前者的相关性更接近，而后者的观察者间一致性更多变，这表明手术效率评分是评价方法中最可靠的。(c)2006 Excerpta Medica Inc. All rights reserved.
Background: Technical skills assessments are being increasingly used in surgical residency programs, with the objectivity and validity of several techniques well established. However, many of these methods are labor and time intensive, limiting their feasibility. This study aims to compare more efficient techniques of skills appraisals with an established gold standard.Methods: Thirty surgeons completed 2 previously validated laboratory-based surgical models: small bowel anastomosis and vein patch insertion. Gold standard evaluation was the Objective Structured Assessment of Technical Skills (OSATS) method. "Efficient" techniques used were (1) quality of final product (FP); (2) snapshot assessment (SS), in which task performance was edited to a 2-minute sound bite and scored with OSATS; and (3) the surgical efficiency score (SES), a combination of final product quality and hand-motion analysis. All human observer evaluations used retrospective video analysis with 3 trained observers. Nonparametric tests were used to analyze the results.Results: With respect to small bowel anastomosis, correlations with OSATS were as follows: FP 0.341 (P = .07), SS 0.577 (P < .001), and SES 0.842 (P < .001). For vein patch insertion, the correlations were as follows: FP 0.545 (P = .001), SS 0.609 (P < .001), and SES 0. 700 (P < .001). Interobserver concordance was high for both models with respect to FP (Cronbach's alpha 0.80 for small bowel anastomosis and 0.84 for vein patch insertion). With respect to SS, interobserver reliability was high for vein patch insertion (Cronbach's alpha 0.80) but only moderate for small bowel anastomosis (0.59).Conclusions: The surgical efficiency score and snap shot assessments both show significant correlations with the traditional OSATS appraisals and suggest that skills assessment can be made more feasible. Correlations were closer with the former and interobserver concordance more variable with the latter, suggesting the surgical efficiency score as the most reliable of the methods evaluated. (c) 2006 Excerpta Medica Inc. All rights reserved.