Shanley B Deal, MD1, Dimitrios Stefanidis, MD, PhD, FACS, FASMBS2, L. Michael Brunt, MD3, Adnan A Alseidi, MD, EdM1. 1Virginia Mason Medical Center, 2Indiana University, 3Washington University St. Louis
Introduction: Both faculty experts (FE) and crowd workers (CW) can be used to assess surgical skill. Whether greater technical performance translates to a surgeon’s ability to perform a task in an operation safely has not been explored. We sought to evaluate the relationship between technical performance, using the Global Objective Assessment of Laparoscopic Skills (GOALS) tool, and judgment as assessed by the critical view of safety (CVS) criteria in laparoscopic cholecystectomy.
Methods and Procedures: We prepared 160, blinded surgical videos of laparoscopic cholecystectomy from public domain websites. Videos were edited to ≤60 seconds and ended when a structure was cut/clipped. CW analyzed 160 videos using GOALS and the CVS modified doublet criteria in which points would be awarded if the component was seen in either the anterior or posterior view. We required a minimum of 50 crowd ratings per video. Videos were stratified into performance quartiles and 10 videos were randomly generated from each quartile (n=40 videos) that were rated by five FE from the SAGES Safe Cholecystectomy Task Force, using both GOALS and the CVS criteria. Linear mixed effects models derived an average CW rating and FE rating for both GOALS and CVS for each video. Spearman correlation coefficients were used to assess the correlation between performance measures. We did subset analysis of videos scoring an average CVS ≥5, which we defined as satisfactory completion of CVS. Videos with an averages GOALS ≥15 were considered top technical performers.
Results: A total of 617 CW generated 8,462 ratings across 160 videos in 24 hours. Five FE generated 200 ratings in 5 days and 6 hours. Average GOALS ratings and CVS ratings had a positive correlation with a Spearman correlation coefficient of 0.77 (p<0.001) for CW and 0.71 (p<0.001) for FE. Sixteen videos were assigned a top technical performer rating by both CW and FE but the average CVS was inadequate (3.8 and 3.6 respectively) and the percentage of CVS≥5 was low (0% and 31% respectively). Performers with a CVS ≥5, as rated by FE, had an average GOALS score of 18.3.
Conclusions: Whether evaluated by FE or CW, there is a positive correlation between GOALS technical performance and completing more components of the CVS in laparoscopic cholecystectomy. However, it is critical to note that in this video analysis, high technical performers still did not achieve a complete CVS.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80514
Program Number: S113
Presentation Session: Education Technology, Teaching and Learning
Presentation Type: Podium