Comparing self-assessment of laparoscopic technical skills with expert opinion for gynecological surgeons in an operative setting

Abstract

Background: Competence in laparoscopic skills is important for all gynaecological surgeons. Most residency programmes teach technical skills in the operating room and through lectures, where the evaluation of surgical skills is usually done through subjective evaluation. After graduating residency, most surgeons depend on themselves to decide if they are competent in performing a certain procedure. The objective of this study is to evaluate the accuracy of surgeon self-assessment compared with expert assessment of competence in laparoscopic surgical skills. A double-blind prospective cohort study was undertaken at Prince Hamza Hospital between January 2016 and April 2016 in Amman, Jordan. Eight practicing gynecologists and obstetricians performed and recorded 88 laparoscopic procedures including ovarian cystectomy, salpingectomy for ectopic pregnancy, salpingoophorectomy, resection of endometriosis, adhesiolysis and ovarian drilling. Participating gynecologists recorded the procedures and were asked to complete a Global Rating Index of Technical Skills (GRITS) evaluation after the surgery testing across multiple areas with a lowest score of 8 and a highest score of 40. Two well-versed laparoscopic experts in objective structured assessment of technical skills (OSATS) also independently scored all procedures using the same parameters. The correlation coefficient and internal consistency were calculated. Results: The GRITS score was calculated for each participant with a mean assessment score of 3.47 for each parameter. Participants self-assessment scores were significantly higher than expert assessment scores (p<0.05). The correlation coefficient was calculated and it can be seen that there was high inter-expert correlation in assessment across all participants evaluations (ICC > 0.90). Conclusion: Self-assessment of surgical laparoscopic skills is higher than expert evaluation of these technical skills. Quality assurance measures need to be revisited and restructured through more frequent assessments using peer and expert assessment alongside self-assessment. Gynecologists also need to undergo proper assessment prior to starting independently performing procedures that require new skills.

Evaluating the Impact of Surgeon Self-awareness by Comparing Self Versus Peer Ratings of Surgical Skill and Outcomes for Bariatric Surgery

“…In the simulated environment, surgeons have been noted to assess their technical skills accurately but were also found to lack insight into their behaviors when evaluating nontechnical skills, such as interpersonal communication with the operative team 6 . When evaluating videos of laparoscopic procedures, surgeons have also been reported to rate their own skills significantly higher than peer experts 8 . Despite these findings, it is unclear if differences in self versus peer assessments of skill has an impact on patient outcomes.…”

“…6 When evaluating videos of laparoscopic procedures, surgeons have also been reported to rate their own skills significantly higher than peer experts. 8 Despite these findings, it is unclear if differences in self versus peer assessments of skill has an impact on patient outcomes.…”

Systematic Review of Intraoperative Assessment Tools in Minimally Invasive Gynecologic Surgery

“…Kilani [12] reported on the Global Rating Index of Technical Skills in gynecologic laparoscopy. Eight surgeons participated by recording their surgeries, and 2 blinded experts reviewed their edited videos and provided a score.…”

Accuracy of Surgeon Self-Reflection on Hysterectomy Quality Metrics

“…[9][10][11][12][13] Surgeons inaccurately judge their own performance, particularly with respect to self-reflection on surgical proficiency. [14][15][16] Among trainees, accuracy of reflection on operative skill is highly variable. 17,18 Among attending surgeons, Varban et al 15 found that those who were characterized as "confident" in their operative skills had lower ratings from peer experts.…”

“…21 Accuracy of self-reflection and opportunities for performance feedback in the context of these metrics are increasingly important. Although deficiencies in reflection on operative performance have been established, 14–18 surgeon awareness of performance across these more generalizable quality metrics has not been described. We performed a MEDLINE search (April 2021) for articles in the English language, limited to human research; we used the keywords “surgeon,” “surgical procedures,” “surgery,” “surgeries,” “health care,” “quality assessment,” “quality feedback,” “quality indicator,” “quality control,” “quality improvement,” “reportcard,” “report card,” “scorecard,” “score card,” “reflect,” “self reflect,” “self awareness,” “feedback,” “formative feedback,” “operative,” “doctor,” “physician,” “performance,” “clinical skill,” “clinical competence.” Our objective was to evaluate the accuracy of self-reflection among attending gynecologic surgeons for hysterectomy case volume, minimally invasive rate, and complication rate, with the null hypothesis that surgeons are overall accurate.…”