Sarker S K, Hutchinson R, Chang A, Vincent C, Darzi A W
Department of Surgical Oncology and Technology, St Mary's Hospital, Imperial College London, London, W2 1NY, United Kingdom.
Surg Endosc. 2006 Apr;20(4):636-40. doi: 10.1007/s00464-005-0312-5. Epub 2006 Jan 30.
Evaluation of technical skill is notoriously difficult because of the subjectivity and time-consuming expert analysis. No ongoing evaluation scheme exists to assess the continuing competency of surgeons. This study examined whether surgeons' self-assessment accurately reflects their actual surgical technique.
Hierarchical task analysis (HTA) of laparoscopic cholecystectomy was constructed. Ten expert surgeons were asked to modify the HTA for their own technique. The HTAs of these surgeons then were compared with their actual operations, which had been recorded and assessed by two observers.
A total of 40 operations were assessed. All the gallbladders subjected to surgery were classified as grades 1 to 3. The mean interrater reliability for the two observers had a k value of 0.84 (p < 0.05), and the mean intrarater reliability between surgeons and observers had a k value of 0.79 (p < 0.05).
Surgeons' self-evaluation is accurate for technical skills aspects of their operations. This study demonstrates that self-appraisal using HTA is feasible, accurate, and practical. The authors aim to increase the numbers in their study and also to recruit residents.
由于技术评估具有主观性且专家分析耗时，因此对技术技能的评估非常困难。目前不存在用于评估外科医生持续能力的现行评估方案。本研究调查了外科医生的自我评估是否准确反映了他们实际的手术技术。
构建了腹腔镜胆囊切除术的层次任务分析（HTA）。邀请了10位专家外科医生根据自己的技术修改HTA。然后将这些外科医生的HTA与他们实际的手术操作进行比较，手术操作已由两名观察者记录和评估。
共评估了40台手术。所有接受手术的胆囊被分类为1至3级。两名观察者之间的平均评分者间信度的k值为0.84（p<0.05），外科医生与观察者之间的平均评分者内信度的k值为0.79（p<0.05）。
外科医生对其手术操作的技术技能方面的自我评估是准确的。本研究表明，使用HTA进行自我评估是可行、准确且实用的。作者旨在增加研究中的样本数量，并招募住院医师。
