Van Heest Ann, Putnam Matthew, Agel Julie, Shanedling Janet, McPherson Scott, Schmitz Constance
Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN 55454, USA.
J Bone Joint Surg Am. 2009 Dec;91(12):2811-7. doi: 10.2106/JBJS.I.00024.
Motor skills assessment is an important part of validating surgical competency. The need to test surgical skills competency has gained acceptance; however, assessment methods have not yet been defined or validated. The purpose of the present study was to evaluate the reliability and validity of four testing measures for the integrated assessment of orthopaedic surgery residents with regard to their competence in performing carpal tunnel release.
Twenty-eight orthopaedic residents representing six levels of surgical training were tested for competence in performing carpal tunnel release on cadaver specimens. Four measures were used to assess competency. First, a web-based knowledge test of surgical anatomy, surgical indications, surgical steps, operative report dictation, and surgical complications was administered. Second, residents participated in an Objective Structured Assessment of Technical Skills; each resident performed surgery on a cadaver specimen. All residents were evaluated independently by two board-certified orthopaedic surgeons with a subspecialty certificate in hand surgery with use of a detailed checklist score, a global rating scale, and a pass/fail assessment. The time for completion of the surgery was also recorded. Each assessment tool was correlated with the others as well as with the resident's level of training.
Significant differences were found between year of training and knowledge test scores (F = 7.913, p < 0.001), year of training and detailed checklist scores (F = 5.734, p = 0.002), year of training and global rating scale (F = 2.835, p = 0.040), and year of training and percentage pass rate (F = 26.3, p < 0.001). No significant differences were found between year of training and time to completion of the carpal tunnel release (F = 2.482, p < 0.063).
The results of the present study suggest that both knowledge and cadaver testing discriminate between novice and accomplished residents. However, although failure of the knowledge test can predict failure on technical skills testing, the presence of knowledge does not necessarily ensure successful performance of technical skills, as cognitive testing and technical skills testing are separate domains.
运动技能评估是验证手术能力的重要组成部分。测试手术技能能力的需求已得到认可；然而，评估方法尚未确定或验证。本研究的目的是评估四种测试方法在综合评估骨科住院医师腕管松解手术能力方面的可靠性和有效性。
对代表六个手术培训水平的28名骨科住院医师进行了在尸体标本上进行腕管松解手术能力的测试。使用四种方法评估能力。首先，进行了一项基于网络的关于手术解剖学、手术适应症、手术步骤、手术报告听写和手术并发症的知识测试。其次，住院医师参加了客观结构化技术技能评估；每位住院医师在尸体标本上进行手术。所有住院医师均由两名具有手外科亚专业证书的骨科认证外科医生独立评估，使用详细的检查表评分、整体评分量表和通过/失败评估。还记录了手术完成时间。将每个评估工具相互关联，并与住院医师的培训水平相关联。
在培训年份与知识测试分数之间（F = 7.913，p < 0.001）、培训年份与详细检查表分数之间（F = 5.734，p = 0.002）、培训年份与整体评分量表之间（F = 2.835，p = 0.040）以及培训年份与通过率之间（F = 26.3，p < 0.001）发现了显著差异。在培训年份与腕管松解手术完成时间之间未发现显著差异（F = 2.482，p < 0.063）。
本研究结果表明，知识测试和尸体测试都能区分新手和经验丰富的住院医师。然而，尽管知识测试不及格可以预测技术技能测试失败，但知识的掌握并不一定能确保技术技能的成功表现，因为认知测试和技术技能测试是不同的领域。
