Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota.
Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont.
J Bone Joint Surg Am. 2019 Mar 6;101(5):e18. doi: 10.2106/JBJS.17.01512.
Evaluation of surgical skill competency is necessary as graduate medical education moves toward a competency-based curriculum. This study by the American Board of Orthopaedic Surgery (ABOS) and the Council of Orthopaedic Residency Directors (CORD) compares 2 web-based evaluation tools that assess the level of autonomy that is demonstrated by residents during surgical procedures in the operating room as measured by faculty.
Two hundred and ninety-four residents from 16 orthopaedic surgery residency programs were evaluated by 370 faculty using 2 web-based evaluation tools in a crossover design in which residents requested faculty review of their surgical skills before starting a case. One thousand, one hundred and fifty Ottawa Surgical Competency Operating Room Evaluation (O-Score) assessments, which included a 9-question evaluation of 8 steps of the surgical procedure, were compared with 1,186 P-score evaluations, which included a single-question summative evaluation. Twenty-five different surgical procedures were evaluated.
There were no significant differences in rates of resident requests or faculty completion of the 2 scores. The most common surgical procedures that were assessed were total knee arthroplasty (n = 254, 11%), carpal tunnel release (n = 191, 8%), open reduction and internal fixation (ORIF) of stable hip fractures (n = 170, 7%), ORIF of simple ankle fractures (n = 169, 7%), and total hip arthroplasty (n = 166, 7%). Both instruments disclosed significant differences in competency among entry, intermediate, and advanced-level residents. The findings support the construct validity of the evaluation method. The survey results indicated that >70% of the faculty were confident that use of either the P-score or the O-score allowed them to distinguish a resident who can perform the surgery independently from one who needs additional training.
This research has led to the modification of the O-score and the P-score into a combined OP-score instrument. The ABOS envisions that the OP-score instrument can be used with an expanded number of surgical procedures as a required element of residency training in the near future.
This study allows the profession of orthopaedic surgery education to take a leadership role in the measurement of competence for surgical skills for orthopaedic surgeons in residency training, an important clinically relevant topic to the practice of orthopaedic surgery.
随着研究生医学教育向以能力为基础的课程发展，评估手术技能能力是必要的。美国骨科委员会（ABOS）和骨科住院医师主任委员会（CORD）的这项研究比较了两种基于网络的评估工具，这些工具评估了学员在手术室手术过程中表现出的自主程度，由教员进行测量。
16 个骨科住院医师培训计划的 294 名住院医师在交叉设计中接受了 370 名教员的 2 种基于网络的评估工具的评估，在这种设计中，住院医师在开始手术前要求教员审查他们的手术技能。1150 次渥太华手术能力手术室评估（O 评分）评估，包括对手术过程的 8 个步骤的 9 个问题评估，与 1186 次 P 评分评估进行了比较，后者包括一个单一问题总结性评估。评估了 25 种不同的手术程序。
学员请求和教员完成这两个分数的比率没有显著差异。评估的最常见手术程序是全膝关节置换术（n=254，11%）、腕管松解术（n=191，8%）、稳定型髋部骨折切开复位内固定术（n=170，7%）、简单踝关节骨折切开复位内固定术（n=169，7%）和全髋关节置换术（n=166，7%）。两种仪器都显示出不同水平的学员在能力方面存在显著差异。研究结果支持评估方法的结构有效性。调查结果表明，超过 70%的教员有信心，使用 P 评分或 O 评分都可以区分出能够独立进行手术的学员和需要额外培训的学员。
这项研究导致了 O 评分和 P 评分的修改，形成了一个综合的 OP 评分仪器。ABOS 设想，在不久的将来，OP 评分仪器可以与更多的手术程序一起使用，作为住院医师培训的一个必要元素。
这项研究使骨科手术教育专业能够在评估住院医师培训中骨科外科医生手术技能的能力方面发挥领导作用，这是一个对骨科手术实践具有重要临床意义的主题。
