Mickael Chevallay, Emilie Liot, MD, Ian Fournier, MD, Monika Hagen, MD, Stefan Mönig, Professor, Philippe Morel, Professor, Christian Toso, Professor, Frederic Ris, Professor, Minoa Jung, PD, MD. Geneva university hospital
INTRODUCTION: To achieve proficiency in performing a surgical procedure is a milestone in the career of a trainee. Objective measures to assess the surgical skills are emphasized in the medical education. We suggest an objective assessment tool which was based on a competency assessment tool developed for colorectal surgery and adapted for the standardized procedure of laparoscopic cholecystectomy (LCAT)(Figure 1). We aimed to assess the feasibility of the implementation of the LCAT and to evaluate this tool by comparison of intraoperative assessors scores with scores submitted by independent experts after reviews of video records
METHODS: Laparoscopic cholecystectomy was divided into 4 steps (exposition, calot dissection, cholangiography, resection). Steps were subdivided in 4 task including instrument use, tissue handling, execution and end result. Scoring system went from 1 to 4 with 4 representing the best performance. For general assessment, we added visual analog scale (VAS) and objective structured assessment of technical skills (OSATS) and an overall autonomy score. We included laparoscopic cholecystectomies which were performed by residents under the supervision of board-certified surgeons from 2013 to 2015. Every procedure was assessed by means of the LCAT filled at the end of the procedure by the supervising surgeon (live). Video records of the same procedures were then anonymized and analyzed by two independent reviewers (reviewer A and B) which were blinded from the performing trainees and patients identity. Scores of assessments were compared between the supervising surgeons and the respective reviewers A and B and between the two reviewers A and B.
RESULTS: We identified 42 cholecystectomies performed by 21 trainees which were assessed by 15 surgeons. Scoring results were comparable between the live assessor and Reviewer A with a mean value for exposition of 3.21(SD 0.46)vs 3.23(0.43), Calot dissection:3.20(0.42)vs3.0(0.46), cholangiography 3.26(0.53)vs3.23(0.52), gallbladder resection 3.18(0.49)vs3.19(0.45), OSATS3.77(0.65)vs3.75(0.73), VAS5.29(0.80)vs5.4(0.73), autonomy 5.17(1.17)vs5.19(1.44). Scores between the live reviewer and reviewer B were comparable except for gallbladder resection (3.18(0.49)vs2.89(0.63), p=0.01) and VAS(5.29(0.8)vs4.64(1.19), p=0.01).
Comparison of scores of reviewer A and reviewer B showed significantly different means in gallbladder resection(3.19(0.55)vs2.89(0.63), p=0.004) and VAS(5.45(0.73)vs4.64(1.19), p=0.004), whereas the other procedural steps as well as OSATS and overall autonomy scored comparably.
CONCLUSION: Implementation of a competency assessment tool for evaluation of surgical skills during laparoscopic cholecystectomy is feasible. Comparable scoring between live assessors and blinded reviewers may demonstrate the objectivity of this tool to measure trainee performance. General assessment showed significant interrater differences and might be less suitable for objective evaluation.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95220
Program Number: P407
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster