Wohaibi Eyad M, Earle David B, Ansanitis Francis E, Wait Richard B, Fernandez Gladys, Seymour Neal E
Baystate Medical Center, Department of Surgery, Tufts University School of Medicine, Springfield, Massachusetts 01199, USA.
J Surg Educ. 2007 Nov-Dec;64(6):333-41. doi: 10.1016/j.jsurg.2007.06.015.
The study aim was to demonstrate that a new database tool for assessment of surgical resident operative skills discerns predictable progression in those skills over successive residency years for specific index case types.
A Web-based interactive database (OpRate) was used to assess selected aspects of resident operative performance as determined by supervising attending surgeons in a medium-sized residency (5-6 residents per postgraduate year [PGY]). This assessment consisted of (1) 3 questions pertaining to patient information, technical, and disease-specific preparedness; (2) 4 laparoscopic technical skills questions pertaining to tissue handling, dexterity, planning, and ability to function independently; and (3) similar open technical skills questions, with the addition of 2 questions defining knot tying ability. Two years of assessment data were examined for cholecystectomy (CH), appendectomy (AP), colon resection (CR), ventral hernia repair (VH), and inguinal hernia repair (IH). Mean scores for total, technical, and preparedness responses, as well as each response area were compared for successive training years for each case type. Mean performance data between postgraduate years were compared by ANOVA, and interitem reliability was assessed by Cronbach's alpha determinations.
OpRate data for 579 cases (142 CH, 67 AP, 73 CR, 202 IH, and 95 VH) were examined. Significant incremental increases in open and laparoscopic technical skills scores by training year were observed for all case types (ANOVA, p < 0.0001). Individual technical skills as well as technical and disease-specific preparedness response areas also demonstrated significant improvement by successive training year. Cronbach's alpha determinations were 0.80-0.94 for the preparedness test items and the skills performance scores for all assessed procedures.
Our early results show that the OpRate assessment tool is effective in identifying expected changes in operative performance across successive training years, with a satisfactory level of internal consistency for the test items. As such, the use of this database tool may offer the opportunity to (1) define performance benchmarks for specific levels of training and (2) identify areas where focused training may be required for specific residents.
本研究旨在证明一种用于评估外科住院医师手术技能的新型数据库工具能够识别特定索引病例类型在连续住院医师培训年份中这些技能的可预测进展情况。
使用基于网络的交互式数据库（OpRate）来评估住院医师手术表现的选定方面，这些方面由一所中型住院医师培训项目（每年有5 - 6名住院医师）的指导主治医生确定。该评估包括：（1）3个与患者信息、技术和疾病特异性准备相关的问题；（2）4个与组织处理、灵活性、规划和独立操作能力相关的腹腔镜技术技能问题；（3）类似的开放性技术技能问题，另外还有2个定义打结能力的问题。对两年的胆囊切除术（CH）、阑尾切除术（AP）、结肠切除术（CR）、腹疝修补术（VH）和腹股沟疝修补术（IH）的评估数据进行了检查。比较了每种病例类型连续培训年份的总体、技术和准备情况回答的平均得分，以及每个回答领域的平均得分。研究生年份之间的平均表现数据通过方差分析进行比较，项目间信度通过Cronbach's alpha系数测定进行评估。
检查了579例病例（142例CH、67例AP、73例CR、202例IH和95例VH）的OpRate数据。所有病例类型在培训年份中，开放性和腹腔镜技术技能得分均有显著的逐步提高（方差分析，p < 0.0001）。个体技术技能以及技术和疾病特异性准备情况回答领域在连续培训年份中也显示出显著改善。所有评估程序的准备情况测试项目和技能表现得分的Cronbach's alpha系数测定值为0.80 - 0.94。
我们的早期结果表明，OpRate评估工具能够有效地识别连续培训年份中手术表现的预期变化，测试项目的内部一致性水平令人满意。因此，使用该数据库工具可能有机会：（1）为特定培训水平定义表现基准；（2）识别特定住院医师可能需要集中培训的领域。
