Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
Laryngoscope. 2012 Jan;122(1):103-9. doi: 10.1002/lary.22381.
OBJECTIVES/HYPOTHESIS: To test the validity, reliability, and feasibility of an evaluation tool designed to measure the development of trainees' surgical skills in the operating room for thyroid surgery.
Prospective validation study.
A modified Delphi technique was employed to develop a new Objective Structured Assessment of Technical Skills-based instrument for thyroid surgery. During a 1-year period, 16 otolaryngology-head and neck surgery residents (ranging from postgraduate year 2 to 6) and one endocrine surgery fellow were evaluated by one faculty member obtaining a total of 94 evaluations. Performance was rated using a task-based checklist (TBC) and a global rating scale (GRS). The TBC measured trainees' thyroidectomy technical skills, and the GRS assessed their overall surgical performance.
Based on four clinical levels (junior, intermediate, senior, and surgical fellow) our tool demonstrated construct validity for both components of the assessment instrument, specifically for the TBC showing a mean difference of 0.9 (95% confidence interval: 0.5-1.3, P<.001) between the contiguous clinical levels senior versus intermediate. Cronbach α, a measure of internal consistency, was 0.96 for both components of the instrument. The correlation between the TBC and GRS was also high within trainee (r=0.62, n=94, P<.001) and across trainees (r=0.96, n=17, P<.001).
Our tool proved to be a valid, reliable, and feasible instrument for assessing competency in thyroid surgery. It is effective in providing timely formative feedback during and upon the conclusion of the surgical procedure by identifying procedural tasks for which additional training is necessary. In addition, it enables longitudinal tracking of residents' surgical performance, thus ensuring their appropriate development.
目的/假设：测试一种专为评估甲状腺手术中受训者手术技能发展而设计的评估工具的有效性、可靠性和可行性。
前瞻性验证研究。
采用改良 Delphi 技术制定一种新的基于客观结构化评估技术的甲状腺手术技能评估工具。在为期 1 年的时间里，由 1 名教员对 16 名耳鼻喉头颈外科住院医师（从第 2 年到第 6 年）和 1 名内分泌外科研究员进行评估，共进行了 94 次评估。使用基于任务的检查表（TBC）和整体评分量表（GRS）进行评估。TBC 衡量受训者的甲状腺切除术技术技能，GRS 评估他们的整体手术表现。
基于四个临床水平（初级、中级、高级和外科研究员），我们的工具在评估工具的两个组成部分均表现出结构有效性，特别是在 TBC 中，高级与中级之间的平均差异为 0.9（95%置信区间：0.5-1.3，P<.001）。两个组成部分的 Cronbach α 内部一致性测量值均为 0.96。TBC 与 GRS 之间的相关性在受训者内（r=0.62，n=94，P<.001）和跨受训者（r=0.96，n=17，P<.001）之间也很高。
我们的工具被证明是一种评估甲状腺手术能力的有效、可靠且可行的工具。它通过确定需要额外培训的程序任务，在手术过程中和手术后提供及时的形成性反馈，效果很好。此外，它还能够对住院医师的手术表现进行纵向跟踪，从而确保他们的适当发展。
