Khan Mansoor S, Bann S D, Darzi A, Butler P E M
Academic Surgical Unit, St Mary's Hospital, London, UK.
Ann Plast Surg. 2003 Mar;50(3):304-8; discussion 308-9. doi: 10.1097/01.sap.0000037271.26659.f4.
There is an ongoing demand for surgeons to demonstrate that they can operate well, maintain their performance, and deliver acceptable results. Currently, surgeons are assessed by a series of subjective and peer-reviewed interviews, but at no stage is the objective assessment of surgical competence measured. The authors have introduced an objective test of suturing skill as one of an array of tests used to assess technical ability. A range of surgeons with differing surgical skill was tested. The candidates were asked to suture a 4-cm wound on a latex skin pad. They were videotaped during the procedure and were scored by four independent observers using the Objective Structured Assessment of Technical Skill scoring system. Their movements were also monitored using an electromagnetic tracking system. Forty-three plastic surgeons and 46 general surgeons were divided into four groups, depending on grade, and were assessed. The difference in scores among the plastic surgeons gave a value of p < 0.001, whereas the general surgeons gave a value of p = 0.001. However, when similar grade but different specialties were compared, plastic surgeons scored significantly higher (down to senior house officer [resident year 1-2] level; mean p value = 0.019). Interrater reliability was also high (Cronbach alpha = 0.89). This task has shown that technical ability can be assessed objectively. The task has also been shown to exhibit face, construct, and concurrent validity. This has important implications for the future of surgical training in that it allows one to identify whether the fundamentals of surgical technique have been passed on to the trainee and to monitor their progress continually. It also may be used in revalidation of surgeons.
对外科医生持续存在这样的要求，即证明他们能够熟练手术、保持手术水平并取得可接受的结果。目前，外科医生是通过一系列主观的同行评审面试来评估的，但在任何阶段都没有对手术能力进行客观评估。作者引入了一项缝合技能的客观测试，作为用于评估技术能力的一系列测试之一。对一系列手术技能不同的外科医生进行了测试。要求候选人在乳胶皮肤垫上缝合一个4厘米的伤口。在手术过程中对他们进行录像，并由四名独立观察员使用客观结构化技术技能评估评分系统进行评分。他们的动作也使用电磁跟踪系统进行监测。43名整形外科医生和46名普通外科医生根据级别分为四组并接受评估。整形外科医生得分的差异得出p < 0.001的值，而普通外科医生得出p = 0.001的值。然而，当比较级别相似但专业不同的医生时，整形外科医生的得分明显更高（低至住院医师第一年至第二年水平；平均p值 = 0.019）。评分者间信度也很高（克朗巴哈系数 = 0.89）。这项任务表明技术能力可以被客观评估。该任务还被证明具有表面效度、结构效度和同时效度。这对手术培训的未来具有重要意义，因为它使人们能够确定手术技术的基本原理是否已传授给受训者，并持续监测他们的进展。它也可用于外科医生的重新认证。
