Basic Surgical Skill Retention: Can Patriot Motion Tracking System Provide an Objective Measurement for it?

Knot tying is a fundamental skill that surgical trainees have to learn early on in their training. The aim of this study was to establish the predictive and concurrent validity of the Patriot as an assessment tool and determine the skill retention in first-year surgical trainees after 5 months of training. First-year surgical trainees were recruited in their first month of the training program. Experts were invited to set the proficiency level. The subjects performed hand knot tying on a bench model. The skill was assessed at baseline in the first month of training and at 5 months. The assessment tools were the Patriot electromagnetic tracking system and Objective Structured Assessment of Technical Skills (OSATS). The trainees' scores were compared to the proficiency score. The data were analyzed using paired t-test and Pearson correlation analysis. A total of 14 first-year trainees participated in this study. The time taken to complete the task and the path length (PL) were significantly shorter (p = 0.007 and p = 0.0085, respectively) at 5 months. OSATS scoring showed a significant improvement (p = 0.0004). There was a significant correlation between PL and OSATS at baseline (r = -0.873) and at Month 5 (r = -0.774). In all, 50% of trainees reached the proficiency PL at baseline and at Month 5. Among them, 3 trainees improved their PL to reach proficiency and the other 3 trainees failed to reach proficiency. The parameters from the Patriot motion tracker demonstrated a significant correlation with the classical observational assessment tool and were capable of highlighting the skill retention in surgical trainees. Therefore, the automated scoring system has a significant role in the surgical training curriculum as an adjunct to the available assessment tool.

Shaharan S ，Nugent E ，Ryan DM ，Traynor O ，Neary P ，Buckley D ... -  《-》

Developing an Objective Structured Assessment of Technical Skills for Laparoscopic Suturing and Intracorporeal Knot Tying.

To develop a teaching and assessment tool for laparoscopic suturing and intracorporeal knot tying. We designed an Objective Structured Assessment of Technical Skills (OSATS) tool that includes a procedure-specific checklist (PSC) and global rating scale (GRS) to assess laparoscopic suturing and intracorporeal knot-tying performance. Obstetrics and Gynecology residents at our institution were videotaped while performing a laparoscopic suturing and intracorporeal knot-tying task at a surgical simulation workshop. A total of 2 expert reviewers assessed resident performance using the OSATS tool during live performance and 1 month later using the videotaped recordings. OSATS scores were analyzed using the Wilcoxon rank-sum test. Data are presented as median scores (interquartile range [IQR]). Intrarater and interrater reliabilities were assessed using a Spearman correlation and are presented as an r correlation coefficient and p value. An r ≥ 0.8 was considered as a high correlation. After testing, we received feedback from residents and faculty to improve the OSATS tool as part of an iterative design process. In all, 14 of 21 residents (66.7%) completed the study, with 9 junior residents and 5 senior residents. Junior residents had a lower score on the PSC than senior residents did; however, this was not statistically significant (median = 6.0 [IQR: 4.0-10.0] and median = 13.0 [IQR: 10.0-13.0]; p = 0.09). There was excellent intrarater reliability with our OSATS tool (for PSC component, r = 0.88 for Rater 1 and 0.93 for Rater 2, both p < 0.0001; for GRS component, r = 0.85 for Rater 1 and 0.88 for Rater 2, both p ≤ 0.0002). The PSC also has high interrater reliability during live evaluation (r = 0.92; p < 0.0001), and during the videotape scoring with r = 0.77 (p = 0.001). Our OSATS tool may be a useful assessment and teaching tool for laparoscopic suturing and intracorporeal knot-tying skills. Overall, good intrarater reliability was demonstrated, suggesting that this tool may be useful for longitudinal assessment of surgical skills.

Chang OH ，King LP ，Modest AM ，Hur HC ... -  《-》

Skills acquisition and assessment after a microsurgical skills course for ophthalmology residents.

Ezra DG ，Aggarwal R ，Michaelides M ，Okhravi N ，Verma S ，Benjamin L ，Bloom P ，Darzi A ，Sullivan P ... -  《-》

Developing criteria for proficiency-based training of surgical technical skills using simulation: changes in performances as a function of training year.

Brydges R ，Kurahashi A ，Brümmer V ，Satterthwaite L ，Classen R ，Dubrowski A ... -  《-》

Video self-assessment of basic suturing and knot tying skills by novice trainees.

Self-assessment is important to learning but few studies have utilized video self-assessment of basic surgical skills. We compared a video self-assessment of suturing and knot tying skills by novice trainees to the assessment by a senior attending surgeon. Sixteen senior medical students and 7 beginner surgical interns were video-recorded while performing five suturing and knot tying tasks. All videos were analyzed using an objective structured assessment of technical skills (OSATS) metrics (1-5 scale; 1 = novice, 5 = expert). Video self-assessment was carried out within 4 weeks of an instructional session and subsequently by one senior surgery instructor (blinded to the individual). Both a Global score and total combined OSATS scores were analyzed. Total possible OSATS scores were: interrupted suture-30, subcuticular closure-30, one and two-handed knot tying-25 each, tying in a restricted space 20; maximum combined score-130 points). Confidence levels in performing the tasks pre-test and the value of video self-assessment were rated on a 1-5 Likert scale (1 = low and 5 = high). Data are mean±SD and statistical significance was evaluated using Friedman's test. Self-assessment scoring was significantly higher than the assessment by a senior instructor for three tasks by global score and all five tasks by combined OSATS score (self-assessment 71.8±16.7 vs attending assessment 56.7±11.0, p = 0.007). Mean self-assessment Global scores ranged from 2.5 to 2.8 for all tasks performed compared to 1.8-2.3 for attending surgeon assessment (p<0.05). Confidence levels demonstrated no correlation to performance speed or proficiency. The video self-assessment was rated as a highly valuable (mean 4.3±0.8) component to skills training. Novice trainees over-estimate their basic technical skills performance compared to the assessment by a senior surgeon. Video self-assessment may be a valuable addition to a pre-residency and surgical internship preparatory curriculum in basic suturing and knot tying.

Hu Y ，Tiemann D ，Michael Brunt L 《-》