Scientific Foundations for Assessment of Surgical Technical Skills

项目总结 手术技能直接影响患者的预后。仍然需要客观、准确和 以一种可以扩展到大量外科手术的方式来衡量这种技能的廉价方法 住院医生和从业者。这项研究计划的长期目标是改善外科培训和 通过建立更科学、更严谨的基础，准确、客观地评估 外科技术技能及其与手术结果的关系。这项研究的总体目标是 建议是确定假定的金本位制固有的偏见、局限性和绝对准确性 外科技术技能评估.由人类评分员组成的小组对视频片段的审查 三个外科专业的代表性手术：泌尿外科、妇科和整形外科。这个 中心假设是，专家和非专家评分者都会受到无意识的偏见和限制 客观、准确地评价外科手术技能的能力。这将对以下方面产生积极影响 提高外科实习医师外科技能评估的科学性和实践性。 这项研究将回答以下问题，至少对于泌尿外科(机器人)的代表性程序而言 前列腺切除术)、妇科(机器人子宫切除术)和整形外科手术(髋部骨折固定和椎弓根 螺丝放置)。 1.身份偏见的大小(性别、种族等)在外科技术技能的评估中？ A.评级如何从控制条件(身份盲目)更改为身份-性别、种族、年龄、 或者感知到的声誉？ B.这种偏见如何在不同的技能水平上发生变化？(例如，初步证据表明，被认为是女性 在新手技能水平上比男性停靠得更严重，但在熟练水平上则不那么严重)。 C.教师学期对常驻人员技能的评估(目前普遍的做法)有多大不同 从身份盲目的技能评估(匿名视频审查)？尤其是跨性别？ 2.对手术视频进行身份盲目网络审查的最佳用户界面和条件是什么 最大限度地提高技能辨别力，最大限度地降低评审者资源成本？ 3.人类评分员的绝对精确度是多少？也就是说，技术技能的黄金标准有多不完美 评估

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