1Clinical Trials Unit, Warwick Medical School, Coventry, United Kingdom 2Department of Trauma & Orthopedic Surgery, University Hospitals Coventry & Warwickshire, Coventry, United Kingdom.
JBJS Rev. 2020 Jun;8(6):e1900167. doi: 10.2106/JBJS.RVW.19.00167.
Robust assessment of skills acquisition and surgical performance during training is vital to ensuring operative competence among orthopaedic surgeons. A move to competency-based surgical training requires the use of tools that can assess surgical skills objectively and systematically. The aim of this systematic review was to describe the evidence for the utility of assessment tools used in evaluating operative performance in trauma and orthopaedic surgical training.
We performed a comprehensive literature search of MEDLINE, Embase, and Google Scholar databases to June 2019. From eligible studies we abstracted data on study aim, assessment format (live theater or simulated setting), skills assessed, and tools or metrics used to assess surgical performance. The strengths, limitations, and psychometric properties of the assessment tools are reported on the basis of previously defined utility criteria.
One hundred and five studies published between 1990 and 2019 were included. Forty-two studies involved open orthopaedic surgical procedures, and 63 involved arthroscopy. The majority (85%) were used in the simulated environment. There was wide variation in the type of assessment tools in used, the strengths and weaknesses of which are assessor and setting-dependent.
Current technical skills-assessment tools in trauma and orthopaedic surgery are largely procedure-specific and limited to research use in the simulated environment. An objective technical skills-assessment tool that is suitable for use in the live operative theater requires development and validation, to ensure proper competency-based assessment of surgical performance and readiness for unsupervised clinical practice.
Trainers and trainees can gain further insight into the technical skills assessment tools that they use in practice through the utility evidence provided.
在培训过程中对技能习得和手术表现进行有力评估对于确保骨科医生的手术能力至关重要。向基于能力的手术培训转变需要使用能够客观和系统地评估手术技能的工具。本系统评价的目的是描述用于评估创伤和骨科外科培训中手术绩效的评估工具的效用证据。
我们对 MEDLINE、Embase 和 Google Scholar 数据库进行了全面的文献检索，检索时间截至 2019 年 6 月。从合格的研究中，我们提取了关于研究目的、评估形式（现场剧院或模拟环境）、评估的技能以及用于评估手术表现的工具或指标的数据。根据先前定义的效用标准，报告了评估工具的优势、局限性和心理测量特性。
1990 年至 2019 年期间发表了 105 项研究。42 项研究涉及开放性骨科手术，63 项研究涉及关节镜检查。大多数（85%）在模拟环境中进行。使用的评估工具类型差异很大，其优缺点取决于评估者和环境。
目前创伤和骨科手术中的技术技能评估工具在很大程度上是特定于程序的，并且仅限于模拟环境中的研究使用。需要开发和验证一种适合在现场手术环境中使用的客观技术技能评估工具，以确保对手术表现进行适当的基于能力的评估，并为无监督的临床实践做好准备。
通过提供的实用性证据，培训师和学员可以更深入地了解他们在实践中使用的技术技能评估工具。
