Chatterjee Suman, Ng Jon, Kwan Kevin, Matsumoto Edward D
Department of Urology, McMaster University, St. Joseph's Hospital, Hamilton, Ontario, Canada.
J Urol. 2009 May;181(5):2251-6. doi: 10.1016/j.juro.2009.01.032. Epub 2009 Mar 17.
We examined whether the Surgical Decision Making Rating Scale can measure a difference in surgical judgment among urologists at various levels of training.
A total of 25 medical students, urology residents and staff urologists viewed clips from 8 select urological procedures and verbalized their thought processes. The clips were ordered in increasing complexity from lower level tasks (catheterization and cystoscopy) to more advanced procedures (laser lithotripsy, and open and laparoscopic prostatectomy and nephrectomy). Performance was transcribed and blindly rated using the previously validated rating scale. Subjects were also asked to self-evaluate their performance using this scale.
Overall the rating scale distinguished the training level across knowledge domains (anatomy and management of the current task) and judgment domains (avoiding complications, higher reasoning and immediate surgical planning). The mean score across all training levels was 112 of 200 (range 51 to 161). Scale performance showed a significant correlation with seniority (rho = 0.96, p <0.05). This trend persisted when performance was analyzed separately for knowledge and judgment domain elements (rho = 0.95 and 0.96, respectively, each p <0.05). Self-evaluation correlated well with blinded evaluation across all levels of training (rho = 0.87, p = 0.01).
The Surgical Decision Making Rating Scale can reliably detect differences in knowledge and surgical judgment among medical students, urology residents and staff urologists. This tool has potential applications for evaluating trainees and determining subjects with proficient decision making abilities. It also shows a significant correlation between self-rated performance and blinded evaluation.
我们研究了手术决策评分量表是否能够衡量不同培训水平的泌尿科医生在手术判断方面的差异。
共有25名医学生、泌尿外科住院医师和泌尿外科 staff 医生观看了8个选定泌尿外科手术的视频片段，并阐述了他们的思维过程。这些视频片段按照从较低难度任务（导尿和膀胱镜检查）到更高级手术（激光碎石术、开放性和腹腔镜前列腺切除术及肾切除术）的顺序排列，难度逐渐增加。对他们的表现进行转录，并使用先前验证的评分量表进行盲法评分。还要求受试者使用该量表对自己的表现进行自我评估。
总体而言，评分量表在知识领域（当前任务的解剖学和管理）和判断领域（避免并发症、更高层次的推理和即时手术规划）区分了培训水平。所有培训水平的平均得分是200分中的112分（范围为51至161分）。量表表现与资历呈显著相关性（rho = 0.96，p <0.05）。当分别对知识和判断领域元素的表现进行分析时，这种趋势仍然存在（rho分别为0.95和0.96，每个p <0.05）。在所有培训水平上，自我评估与盲法评估的相关性良好（rho = 0.87，p = 0.01）。
手术决策评分量表能够可靠地检测医学生、泌尿外科住院医师和泌尿外科 staff 医生在知识和手术判断方面的差异。该工具在评估学员和确定具有熟练决策能力的受试者方面具有潜在应用价值。它还显示出自我评估表现与盲法评估之间存在显著相关性。
