de Montbrun Sandra, Roberts Patricia L, Satterthwaite Lisa, MacRae Helen
*Department of Surgery, University of Toronto, Division of General Surgery, St. Michael's Hospital Toronto, Toronto, Ontario, Canada†Division of Surgery Lahey Clinic, Tufts University School of Medicine, Burlington, MA‡University of Toronto, Surgical Skills Centre, Mount Sinai Hospital, Toronto, Ontario, Canada§Department of Surgery, University of Toronto, Division of General Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada.
Ann Surg. 2016 Jul;264(1):1-6. doi: 10.1097/SLA.0000000000001620.
To implement the Colorectal Objective Structured Assessment of Technical skill (COSATS) into American Board of Colon and Rectal Surgery (ABCRS) certification and build evidence of validity for the interpretation of the scores of this high stakes assessment tool.
Currently, technical skill assessment is not a formal component of board certification. With the technical demands of surgical specialties, documenting competence in technical skill at the time of certification with a valid tool is ideal.
In September 2014, the COSATS was a mandatory component of ABCRS certification. Seventy candidates took the examination, with their performance evaluated by expert colorectal surgeons using a task-specific checklist, global rating scale, and overall performance scale. Passing scores were set and compared using 2 standard setting methodologies, using a compensatory and conjunctive model. Inter-rater reliability and the reliability of the pass/fail decision were calculated using Cronbach alpha and Subkoviak methodology, respectively. Overall COSATS scores and pass/fail status were compared with results on the ABCRS oral examination.
The pass rate ranged from 85.7% to 90%. Inter-rater reliability (0.85) and reliability of the pass/fail decision (0.87 and 0.84) were high. A low positive correlation (r= 0.25) was seen between the COSATS and oral examination. All individuals who failed the COSATS passed the ABCRS oral examination.
COSATS is the first technical skill examination used in national surgical board certification. This study suggests that the current certification process may be failing to identify individuals who have demonstrated technical deficiencies on this standardized assessment tool.
将结直肠手术技术技能客观结构化评估（COSATS）纳入美国结直肠外科委员会（ABCRS）认证，并为解释这一高风险评估工具的分数建立有效性证据。
目前，技术技能评估并非委员会认证的正式组成部分。鉴于外科专业对技术的要求，使用有效的工具在认证时记录技术技能方面的能力是理想的做法。
2014年9月，COSATS成为ABCRS认证的强制组成部分。70名考生参加了考试，其表现由结直肠外科专家使用特定任务清单、整体评分量表和总体表现量表进行评估。使用补偿模型和联合模型这两种标准设定方法来设定及格分数并进行比较。分别使用克朗巴赫α系数和苏布科维亚克方法计算评分者间信度以及通过/未通过判定的信度。将COSATS的总体分数和通过/未通过状态与ABCRS口试结果进行比较。
通过率在85.7%至90%之间。评分者间信度（0.85）以及通过/未通过判定的信度（0.87和0.84）都很高。COSATS与口试之间存在低正相关（r = 0.25）。所有未通过COSATS的考生都通过了ABCRS口试。
COSATS是国家外科委员会认证中使用的首个技术技能考试。本研究表明，当前的认证过程可能未能识别出在这一标准化评估工具上表现出技术缺陷的人员。
