Department of Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia.
J Surg Educ. 2009 Sep-Oct;66(5):255-63. doi: 10.1016/j.jsurg.2009.10.001.
We developed a convenient mechanism, Surgical Training and Assessment Tool (STAT), to accomplish detailed, continuous analysis of surgical trainees' operative abilities, and a simple method, Quality Based Surgical Training (QBST) for implementing it.
Using a web-accessed computer program, attending physicians and trainees independently assessed the trainee's operative performance after every operative (training) case. Global attributes of surgical knowledge, skill, and independence were assessed as well as the key technical maneuvers of each operation. A system of hierarchical, expandable menus specific to each of hundreds of different surgical procedures allowed the assessments to be made as detailed or as general as the users felt were necessary. In addition, freehand, unscripted commentary was recorded via an optional "remarks" box feature. Finally, an independently chosen, "overall" grade scaled F through A+ concluded each assessment.
Over a 31 month period, 72 different users (52 trainees, 20 attending physicians) submitted 3849 performance assessments on 2424 cases, including 132 different case types and amassing 68,260 distinct data points. The mean number of data points per trainee was 1313; the median time spent per assessment was 60 seconds. Graphic displays allowed formative review of individual cases in real time, and summative review of long term trends. Appraisals of knowledge, skill, and independence were strongly correlated with and independently predictive of the overall competency grade (model r(2) = 0.68; test of predictive significance p < 0.001 for each rating). Trainee and attending physician scores were highly correlated (> 0.7) with one another.
QBST/STAT achieves detailed, continuous analysis of surgical trainees' operative abilities, and facilitates timely, specific, and thorough feedback regarding their performance in theater. QBST/STAT promotes trainee self-reflection and generation of continuous, transparent, iterative training goals.
我们开发了一种便捷的机制，即手术培训和评估工具（STAT），以实现对手术受训者操作能力的详细、持续分析，并开发了一种简单的方法，即基于质量的手术培训（QBST）来实施。
使用可访问网络的计算机程序，主治医生和受训者在每次手术（培训）后都独立评估受训者的手术表现。评估了手术知识、技能和独立性的总体属性，以及每个手术的关键技术操作。一个特定于数百种不同手术的分层、可扩展菜单系统允许用户根据需要进行详细或一般的评估。此外，还通过可选的“备注”框功能记录了随意、非脚本的评论。最后，根据独立选择的“总体”等级，从 F 到 A+ 对每次评估进行评分。
在 31 个月的时间里，72 位不同的用户（52 位受训者，20 位主治医生）对 2424 例病例提交了 3849 次绩效评估，包括 132 种不同的病例类型，积累了 68260 个不同的数据点。每位受训者的平均数据点数为 1313 个；每次评估的中位数时间为 60 秒。图形显示允许实时对个别病例进行形成性审查，并对长期趋势进行总结性审查。知识、技能和独立性的评估与总体能力等级密切相关（模型 r²=0.68；每项评分的预测显著性检验 p<0.001），并可独立预测总体能力等级。受训者和主治医生的评分彼此高度相关（>0.7）。
QBST/STAT 实现了对手术受训者操作能力的详细、持续分析，并促进了他们在手术室中的表现的及时、具体和全面反馈。QBST/STAT 促进了受训者的自我反思，并生成了持续、透明、迭代的培训目标。
