Mohammed Al Mahroos, MD, FRCSC1, Amin Madani, MD, PhD1, Pepa Kaneva, MSc1, Elif Bilgic, MSc1, Julio F Fiore Jr, PhD1, Gabriella Ghitulescu, MD, FRCSC2, Gerlad M Fried, MD, FRCSC, FACS1, Melina Vassilou, MD, MED, FRCSC, FACS1, Liane S Feldman, MD, FRCSC, FACS1. 1Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 2Jewish General Hospital, McGill University
Introduction: Measuring performance in the operating room (OR) is challenging. Performance is a multifaceted construct a complex interaction of many behaviors and actions that reflect an individual's knowledge and skill. No assessment tool to date provides an expertise-based, comprehensive evaluation of the various aptitudes necessary to excel in the OR, especially with respect to advanced cognitive skills. Using qualitative methodologies, we previously defined behavioral themes that guide surgeons’ behaviors, decisions, and actions, within a universal framework of 5 domains that reflect intra-operative performance. The purpose of this pilot study was to use this framework to derive a comprehensive assessment tool and to obtain evidence for its validity as a measure of intra-operative performance.
Methods: An assessment tool was developed by a panel of 9 surgeons and 5 surgical trainees based on the five-domain model of intra-operative performance: 1) Psychomotor skills; 2) Declarative knowledge; 3) Interpersonal skills (two items); 4) Personal resourcefulness, and 5) Advanced cognitive skills (ten items). All items were rated on an ordinal scale of 1 (inadequate) to 5 (expert) and equally weighted. Surgical residents and surgeons from a single academic center were evaluated on their performance during standard general surgery operations, for example, Open inguinal hernia repair and Laparoscopic cholecystectomy. For residents, there were 2 evaluators – the attending surgeon and an observing surgeon. Attending surgeons evaluated their own performances and were also assessed by 2 observing surgeons. Internal consistency, inter-rater reliability, and correlation of total scores with training level (junior residents, senior residents, staff surgeons) were calculated. Likert scale questionnaires were administered to evaluate the tool’s usability, feasibility, and educational value.
Results: Fifteen subjects (5 junior residents, 5 senior residents, 5 surgeons) participated. The total score on the assessment demonstrated significant differences between training levels (Figure). Inter-rater reliability was high (interclass correlation coefficient = 0.87), as were internal consistency between each domain score (Cronbach’s alpha = 0.95), internal consistency amongst items in the Advanced cognitive skill domain (Cronbach’s alpha = 0.99), and internal consistency amongst items in the Interpersonal skills domain (Cronbach’s alpha = 0.99). All assessments required less than five minutes to complete. Overall, evaluators agreed that the assessment tool was easy to use, was comprehensive, and should be used routinely throughout training to track performance and provide formative feedback.
Conclusion: In this pilot study, we developed a comprehensive assessment tool for intra-operative performance and provide preliminary validity evidence for the score.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87417
Program Number: P312
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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