Department of Gynaecology and Obstetrics, The Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, University Hospital of Copenhagen, Section 4074, Door 7248, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Surg Endosc. 2012 Jul;26(7):2054-60. doi: 10.1007/s00464-012-2155-1. Epub 2012 Jan 20.
It is known that structured assessment of an operation can provide trainees with useful knowledge and potentially shorten their learning curve. However, methods for objective assessment have not been widely adopted into the clinical setting. This might be because of a lack of expertise using an assessment tool. The aim of this present study was to investigate if a validated laparoscopic procedure-specific assessment tool could be used by doctors with different levels of experience.
The study was conducted as an observer-blinded, prospective cohort study. Three video recordings of a right-side laparoscopic salpingectomy were distributed to ten chief physicians, eight residents (fourth year trainees), and two expert assessors (all in gynecology) in order to be assessed using a validated procedure-specific assessment tool. The three salpingectomies were selected because they easily showed the different operational levels: novice, intermediate, and expert. The two expert assessors, i.e., our gold standard, were familiar with the OSA-LS assessment scale, but the chief physicians and the residents were not. All participants were blinded to the fact that surgeons with different experience had performed the salpingectomies.
No significant differences between the residents and chief physicians were observed in any of the three assessed operations: novice, p = 0.63; intermediate, p = 0.93; and expert, p = 0.93. The chief physicians and residents matched our gold standard in assessing the intermediate operation (p = 0.177), but not the novice operation (p = 0.005) or the expert operation (p = 0.001).
Residents and chief physicians generated similar performance scores when assessing operations using a laparoscopic procedure-specific assessment scale, and they could distinguish performance levels between the surgeons. They matched the assessment score of our expert on the intermediate operation. We conclude that a procedure-specific assessment scale can be used by both residents and chief physicians when giving formative feedback.
众所周知，对手术进行结构化评估可以为受训者提供有用的知识，并有可能缩短他们的学习曲线。然而，客观评估的方法尚未广泛应用于临床环境中。这可能是因为缺乏使用评估工具的专业知识。本研究旨在探讨经验水平不同的医生是否可以使用经过验证的腹腔镜手术特定评估工具。
本研究为观察者盲法、前瞻性队列研究。将三个右侧腹腔镜输卵管切除术的视频记录分发给 10 名主任医师、8 名住院医师（四年级受训者）和 2 名专家评估员（均为妇科医生），以便使用经过验证的手术特定评估工具进行评估。选择这三个输卵管切除术是因为它们很容易显示出不同的手术水平：新手、中级和专家。两位专家评估员（即我们的金标准）熟悉 OSA-LS 评估量表，但主任医师和住院医师不熟悉。所有参与者均不知道有不同经验的外科医生进行了输卵管切除术。
在三个评估手术中，住院医师和主任医师之间没有观察到任何差异：新手手术，p = 0.63；中级手术，p = 0.93；专家手术，p = 0.93。主任医师和住院医师在评估中级手术时与我们的金标准相符（p = 0.177），但在评估新手手术（p = 0.005）或专家手术（p = 0.001）时则不相符。
住院医师和主任医师在使用腹腔镜手术特定评估量表评估手术时得出了相似的绩效评分，并且他们可以区分外科医生的手术水平。他们在中级手术中的评估得分与我们的专家评估得分相符。我们得出结论，住院医师和主任医师都可以在形成性反馈中使用特定于手术的评估量表。
