Asif Hassaan, Wang Jessie, Qiu Mary
Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
Department of Ophthalmology and Visual Sciences, University of Chicago, Chicago, IL, USA.
Am J Ophthalmol Case Rep. 2024 Feb 17;34:102012. doi: 10.1016/j.ajoc.2024.102012. eCollection 2024 Jun.
To illustrate the utility of a previously published stepwise rubric for evaluating a resident's progress learning aqueous tube shunt surgery.
Using a stepwise rubric, a single PGY3 ophthalmology resident and attending glaucoma surgeon evaluated the resident's performance after each aqueous tube shunt surgery. The rubric subdivides the surgery into 12 consecutive steps and scores the resident's proficiency in each step with either a 0 (observation), 2 (novice), 3 (beginner), 4 (advanced beginner), or 5 (competent).
The resident's cumulative score increased significantly throughout the 17 surgeries performed, with the resident's self-evaluated score and attending's score increasing from 12 to 27 and 14 to 27 from the first to last surgery, respectively. Scores were consistent between the resident and attending; for any given surgery, the resident's own score never deviated from the attending's score by more than 1 point. The resident completed at least 50% of the steps in 11 of the 17 cases. While some surgical steps were mastered earlier on ("tube tying" and "suture implantation"), other steps were more challenging to master ("tunnel in sclera and enter the AC" and "close conjunctiva", as demonstrated by fewer overall attempts or never attaining a score of '5' despite multiple attempts.
This study demonstrates the utility of the stepwise rubric in tracking resident surgical scores chronologically via self and attending assessment. The ability to compare their own scores to that of an attending allows the resident to learn how to effectively evaluate their own performance. Most importantly, statistics obtained for each step provides the resident with personalized and real-time feedback for learning specific surgical steps. In conclusion, the stepwise rubric is a useful add-on to a resident's aqueous tube shunt surgery education.
阐述先前发表的用于评估住院医师学习房水引流管分流手术进展的逐步评分标准的实用性。
使用逐步评分标准，一名PGY3眼科住院医师和青光眼主治医生在每次房水引流管分流手术后评估该住院医师的表现。该评分标准将手术细分为12个连续步骤，并以0（观察）、2（新手）、3（初学者）、4（高级初学者）或5（胜任）对住院医师在每个步骤中的熟练程度进行评分。
在进行的17例手术中，住院医师的累计分数显著提高，住院医师的自我评估分数和主治医生的评分分别从第一次手术到最后一次手术从12分提高到27分和从14分提高到27分。住院医师和主治医生的评分一致；对于任何给定的手术，住院医师自己的评分与主治医生的评分偏差从不超过1分。在17例病例中的11例中，住院医师完成了至少50%的步骤。虽然一些手术步骤较早掌握（“系管”和“植入缝线”），但其他步骤更具挑战性（“巩膜隧道并进入前房”和“关闭结膜”，整体尝试次数较少或尽管多次尝试仍未达到“5”分表明了这一点）。
本研究证明了逐步评分标准在通过自我和主治医生评估按时间顺序跟踪住院医师手术评分方面的实用性。将自己的评分与主治医生的评分进行比较的能力使住院医师能够学习如何有效地评估自己的表现。最重要的是，每个步骤获得的统计数据为住院医师提供了学习特定手术步骤的个性化实时反馈。总之，逐步评分标准是住院医师房水引流管分流手术教育的有用补充。
