Scientific Foundations for Assessment of Surgical Technical Skills

项目摘要 手术技术技能直接影响患者结局。仍然需要客观、准确和 廉价的方法来衡量这种技能的方式，可以规模到大量的外科手术， 居民和从业者。这项研究计划的长期目标是改善外科培训， 通过建立更科学严谨的基础，准确，客观的评估， 外科技术技能及其与手术结果的关系。本研究的总体目标 一个建议是确定假定的金本位固有的偏差、局限性和绝对准确性 外科技术技能评估-由一组人类评分员审查视频片段-跨 三个外科专业的代表性手术：泌尿科、妇科和整形外科。的 中心假设是，专家和非专家评分者都受到无意识的偏见和限制， 客观、准确地评价手术技能的能力。这将产生积极影响， 推进外科住院医师计划的外科技能评估的科学和改进实践。 这项研究将回答以下问题，至少对于泌尿外科的代表性程序（机器人）， 子宫切除术）、妇科（机器人子宫切除术）和骨科（髋部骨折固定和椎弓根 螺钉放置）。 1.身份偏见的程度（性别、种族等）在评估外科技术技能方面 a.如何从控制条件（身份盲）到身份可见的性别，种族，年龄， 还是名声 B.这种偏见在不同的技能水平上是如何变化的？(e.g.初步证据显示， 在新手技能水平上，比男性更严重，但在熟练水平上则较低）。 C.有多少教师学期评估居民的技术技能（目前普遍的做法）不同 来自身份盲技能评估（视频匿名审查）？尤其是跨性别？ 2.什么是最佳的用户界面和条件，用于手术视频的身份盲网络启用审查 最大化技能歧视和最小化评审资源成本？ 3.人类评分员的绝对准确性是多少？也就是说，技术技能的黄金标准是多么不完美 评价

PROJECT SUMMARY Surgical technical skills directly impact patient outcomes. There remains a need for objective, accurate, and inexpensive methods to measure such skills in a manner that can scale to the large number of surgical residents and practitioners. The long term goal of this research program is to improve surgical training and assessment by establishing more scientifically-rigorous foundations for accurate, objective evaluation of surgical technical skills and their relationship to surgical outcomes. The overall objective of this research proposal is to determine the biases, limitations, and absolute accuracy inherent in the putative gold standard of surgical technical skill evaluation—review of video footage by a panel of human raters—across representative procedures in three surgical specialties: urology, gynecology, and orthopedic surgery. The central hypothesis is that both expert and non-expert raters are subject to unconscious bias and limitations in their capacity to evaluate surgical technical skills objectively and accurately. This will have positive impact on advancing the science and improving the practice of surgical skill evaluation for surgical residency programs. The research will answer the following questions, at least for representative procedures from urology (robotic prostatectomy), gynecology (robotic hysterectomy), and orthopedic surgery (hip fracture fixation and pedicle screw placement). 1. What is the magnitude of identity bias (gender, ethnicity, etc.) in the evaluation of surgical technical skills? a. How do ratings change from the control condition (identity-blind) to identity-visible for gender, race, age, or perceived reputation? b. How does this bias change across skill levels? (e.g. preliminary evidence shows that perceived females are docked more severely than males among novice skill levels, but less so at proficient levels). c. How much do faculty semester evaluations of resident technical skill (current widespread practice) differ from identity-blind skill evaluation (anonymized review of video)? Especially across gender? 2. What is the optimal user interface and conditions for identity-blind web-enabled review of surgical video that maximize skill discrimination and minimize reviewer resource cost? 3. What is the absolute accuracy of human raters? i.e., how imperfect is the gold-standard of technical skill evaluation