Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland.
Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, UK.
Surg Endosc. 2022 Nov;36(11):8261-8269. doi: 10.1007/s00464-022-09264-0. Epub 2022 Jun 15.
Achieving proficiency in a surgical procedure is a milestone in the career of a trainee. We introduced a competency assessment tool for laparoscopic cholecystectomy in our residency program. Our aim was to assess the inter-rater reliability of this tool.
We included all laparoscopic cholecystectomies performed by residents under the supervision of board certified surgeons. All residents were assessed at the end of the procedure by the supervising surgeon (live reviewer) using our competency assessment tool. Video records of the same procedure were analyzed by two independent reviewers (reviewer A and B), who were blinded to the performing trainee's. The assessment had three parts: a laparoscopic cholecystectomy-specific assessment tool (LCAT), the objective structured assessment of technical skills (OSATS) and a 5-item visual analogue scale (VAS) to address the surgeon's autonomy in each part of the cholecystectomy. We compared the assessment scores of the live supervising surgeon and the video reviewers.
We included 15 junior residents who performed 42 laparoscopic cholecystectomies. Scoring results from live and video reviewer were comparable except for the OSATS and VAS part. The score for OSATS by the live reviewer and reviewer B were 3.68 vs. 4.26 respectively (p = 0.04) and for VAS (5.17 vs. 4.63 respectively (p = 0.03). The same difference was found between reviewers A and B with OSATS score (3.75 vs. 4.26 respectively (p = 0.001)) and VAS (5.56 vs. 4.63 respectively; p = 0.004)).
Our competency assessment tool for the evaluation of surgical skills specific to laparoscopic cholecystectomy has been shown to be objective and comparable in-between raters during live procedure or on video material.
熟练掌握手术操作是住院医师职业生涯中的一个里程碑。我们在住院医师培训计划中引入了腹腔镜胆囊切除术的能力评估工具。我们的目的是评估该工具的评分者间信度。
我们纳入了所有在经过认证的外科医生监督下由住院医师完成的腹腔镜胆囊切除术。所有住院医师在手术结束时都由主管外科医生（现场评审员）使用我们的能力评估工具进行评估。同一次手术的视频记录由两位独立的评审员（评审员 A 和 B）进行分析，他们对进行手术的受训者一无所知。评估分为三个部分：腹腔镜胆囊切除术专用评估工具（LCAT）、客观结构化手术技能评估（OSATS）和 5 项视觉模拟量表（VAS），以评估外科医生在胆囊切除术各个部分的自主性。我们比较了现场主管外科医生和视频评审员的评估分数。
我们纳入了 15 名初级住院医师，他们共完成了 42 例腹腔镜胆囊切除术。现场和视频评审员的评分结果除 OSATS 和 VAS 部分外，其他部分都具有可比性。现场评审员和评审员 B 的 OSATS 评分分别为 3.68 和 4.26（p=0.04），VAS 评分分别为 5.17 和 4.63（p=0.03）。评审员 A 和 B 的 OSATS 评分（分别为 3.75 和 4.26（p=0.001））和 VAS 评分（分别为 5.56 和 4.63（p=0.004））也存在相同的差异。
我们评估腹腔镜胆囊切除术特定手术技能的能力评估工具已被证明在现场手术或视频材料中具有客观性和评分者间的可比性。
