Alkhayal Abdullah, Aldhukair Shahla, Alselaim Nahar, Aldekhayel Salah, Alhabdan Sultan, Altaweel Waleed, Magzoub Mohi Elden, Zamakhshary Mohammed
Department of Surgery, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Adv Med Educ Pract. 2012 Oct 10;3:97-104. doi: 10.2147/AMEP.S31720. Print 2012.
After almost a decade of implementing competency-based programs in postgraduate training programs, the assessment of technical skills remains more subjective than objective. National data on the assessment of technical skills during surgical training are lacking. We conducted this study to document the assessment tools for technical skills currently used in different surgical specialties, their relationship with remediation, the recommended tools from the program directors' perspective, and program directors' attitudes toward the available objective tools to assess technical skills.
This study was a cross-sectional survey of surgical program directors (PDs). The survey was initially developed using a focus group and was then sent to 116 PDs. The survey contains demographic information about the program, the objective assessment tools used, and the reason for not using assessment tools. The last section discusses the recommended tools to be used from the PDs' perspective and the PDs' attitude and motivation to apply these tools in each program. The associations between the responses to the assessment questions and remediation were statistically evaluated.
Seventy-one (61%) participants responded. Of the respondents, 59% mentioned using only nonstandardized, subjective, direct observation for technical skills assessment. Sixty percent use only summative evaluation, whereas 15% perform only formative evaluations of their residents, and the remaining 22% conduct both summative and formative evaluations of their residents' technical skills. Operative portfolios are kept by 53% of programs. The percentage of programs with mechanisms for remediation is 29% (19 of 65).
The survey showed that surgical training programs use different tools to assess surgical skills competency. Having a clear remediation mechanism was highly associated with reporting remediation, which reflects the capability to detect struggling residents. Surgical training leadership should invest more in standardizing the assessment of surgical skills.
在研究生培训项目中实施基于能力的项目近十年后，技术技能评估仍主观多于客观。缺乏关于外科培训期间技术技能评估的全国性数据。我们开展这项研究，以记录目前不同外科专业使用的技术技能评估工具、它们与补救措施的关系、项目主任认为推荐使用的工具，以及项目主任对可用的客观技术技能评估工具的态度。
本研究是对外科项目主任的横断面调查。该调查最初通过焦点小组制定，然后发送给116名项目主任。调查包含有关项目的人口统计学信息、使用的客观评估工具，以及不使用评估工具的原因。最后一部分讨论了从项目主任角度推荐使用的工具，以及项目主任在每个项目中应用这些工具的态度和动机。对评估问题的回答与补救措施之间的关联进行了统计学评估。
71名（61%）参与者做出了回应。在受访者中，59%提到仅使用非标准化的主观直接观察来评估技术技能。60%仅进行总结性评估，而15%仅对住院医师进行形成性评估，其余22%对住院医师的技术技能同时进行总结性和形成性评估。53%的项目保存手术档案袋。有补救机制的项目占29%（65个项目中的19个）。
调查显示，外科培训项目使用不同工具评估手术技能能力。拥有明确的补救机制与报告补救措施高度相关，这反映了发现有困难住院医师的能力。外科培训领导层应在规范手术技能评估方面加大投入。
