Objective assessment of vaginal surgical skills

Chen, Grace; Korn, Abner P.; Klingele, Christopher J.; Barber, Matthew D.; Paraíso, Marie Fidela R.; Walters, Mark D.; Jelovsek, J. Eric

doi:10.1016/j.ajog.2010.01.072

Cited by 25 publications

(39 citation statements)

References 13 publications

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“…These included 25 tools in surgical specialties (four tools in obstetrics and gynaecology and two in anaesthesiology). The Global Rating Scale, originally developed for assessing basic general surgical procedures in a simulated setting, was the tool most commonly studied (12 studies) in different settings in different specialties using live performance . Many of the remaining instruments used some modification of this tool in respective specialties.…”

Section: Resultsmentioning

confidence: 99%

Tools for the direct observation and assessment of psychomotor skills in medical trainees: a systematic review

2013

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Context The Accreditation Council for Graduate Medical Education (ACGME) Milestone Project mandates programmes to assess the attainment of training outcomes, including the psychomotor (surgical or procedural) skills of medical trainees. The objectives of this study were to determine which tools exist to directly assess psychomotor skills in medical trainees on live patients and to identify the data indicating their psychometric and edumetric properties. Methods An electronic search was conducted for papers published from January 1948 to May 2011 using the PubMed, Education Resource Information Center (ERIC), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Web of Science electronic databases and the review of references in article bibliographies. A study was included if it described a tool or instrument designed for the direct observation of psychomotor skills in patient care settings by supervisors. Studies were excluded if they referred to tools that assessed only clinical or non‐technical skills, involved non‐medical health professionals, or assessed skills performed on a simulator. Overall, 4114 citations were screened, 168 (4.1%) articles were reviewed for eligibility and 51 (1.2%) manuscripts were identified as meeting the study inclusion criteria. Three authors abstracted and reviewed studies using a standardised form for the presence of key psychometric and edumetric elements as per ACGME and American Psychological Association (APA) recommendations, and also assigned an overall grade based on the ACGME Committee on Educational Outcome Assessment grading system. Results A total of 30 tools were identified. Construct validity based on associations between scores and training level was identified in 24 tools, internal consistency in 14, test–retest reliability in five and inter‐rater reliability in 20. The modification of attitudes, knowledge or skills was reported using five tools. The seven‐item Global Rating Scale and the Procedure‐Based Assessment received an overall Class 1 ACGME grade and are recommended based on Level A ACGME evidence. Conclusions Numerous tools are available for the assessment of psychomotor skills in medical trainees, but evidence supporting their psychometric and edumetric properties is limited.

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Section: Resultsmentioning

confidence: 99%

Tools for the direct observation and assessment of psychomotor skills in medical trainees: a systematic review

2013

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“…Recent literature contains suggestions for improving education through simulation models (22), objectively evaluating vaginal surgical skills (23), and techniques to address a difficult hysterectomy (24). Another way to improve trainee experience is to increase vaginal hysterectomies.…”

Section: Discussionmentioning

confidence: 99%

10: Determining the optimal route of hysterectomy for benign indications: A clinical decision tree algorithm

Schmitt

Carranza

Weaver

et al. 2016

American Journal of Obstetrics and Gynecology

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Objective-To evaluate practice change after initiation of a robotic surgery program using a clinical algorithm to determine the optimal surgical approach to benign hysterectomy.Methods-A retrospective post-robot cohort of benign hysterectomies (2009)(2010)(2011)(2012)(2013) was identified and the expected surgical route was determined from an algorithm using vaginal access and uterine size as decision tree branches. We excluded laparoscopic hysterectomy route. A prerobot cohort (2004)(2005) was used to evaluate a practice change after the addition of robotic technology (2007). Costs were estimated.Results-Cohorts were similar in regard to uterine size, vaginal parity, and prior laparotomy history. In the pre-robot cohort (n=473), 320 hysterectomies (67.7%) were performed vaginally and 153 (32.3%) through laparotomy, with 15.1% (46/305) performed abdominally when the algorithm specified vaginal hysterectomy. In the post-robot cohort (n=1,198), 672 hysterectomies (56.1%) were vaginal; 390 (32.6%), robot-assisted; and 136 (11.4%), abdominal. Of 743 procedures, 38 (5.1%) involved laparotomy and 154 (20.7%) involved robotic technique when vaginal approach was expected. Robotic hysterectomies had longer operations (141 vs 59 minutes, P<.001) and higher rates of surgical site infection (4.7% vs 0.2%, P<.001) and urinary tract infection (8.1% vs 4.1%, P=.05) but no difference in major complications (P=.27) or readmissions (P=.27) compared with vaginal hysterectomy. Algorithm conformance would have saved an estimated $800,000 in hospital costs over 5 years.Conclusion-When a decision tree algorithm indicated vaginal hysterectomy as the route of choice, vaginal hysterectomy was associated with shorter operative times, lower infection rate, and lower cost. Vaginal hysterectomy should be the route of choice when feasible. Financial Disclosure: Dr. Gebhart has served on the advisory board for Astora and received royalties from UpToDate, Inc, and Elsevier BV. The other authors did not report any potential conflicts of interest. Graphical Abstract HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptAn algorithm can be used for decision-making in determining the most appropriate route of hysterectomy to optimize patient outcomes and lower health care delivery costs.

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“…Assessment of surgical skills is a very important and contemporary concern for all teachers in surgical professions [20,21]. Although OSATS have been designed to assess skills objectively, an assessment by an individual person is by definition not free of subjectivity.…”

Section: Discussionmentioning

confidence: 99%

Are Minimally Invasive Procedures Harder to Acquire than Conventional Surgical Procedures?

Hiemstra

Kolkman²,

Cessie³

et al. 2010

Gynecol Obstet Invest

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Background: It is frequently suggested that minimally invasive surgery (MIS) is harder to acquire than conventional surgery. To test this hypothesis, residents’ learning curves of both surgical skills are compared. Methods: Residents had to be assessed using a general global rating scale of the OSATS (Objective Structured Assessment of Technical Skills) for every procedure they performed as primary surgeon during a 3-month clinical rotation in gynecological surgery. Results: Nine postgraduate-year-4 residents collected a total of 319 OSATS during the 2 years and 3 months investigation period. These assessments concerned 129 MIS (laparoscopic and hysteroscopic) and 190 conventional (open abdominal and vaginal) procedures. Learning curves (in this study defined as OSATS score plotted against procedure-specific caseload) for MIS and conventional surgery were compared using a linear mixed model. The MIS curve revealed to be steeper than the conventional curve (1.77 vs. 0.75 OSATS points per assessed procedure; 95% CI 1.19–2.35 vs. 0.15–1.35, p < 0.01). Conclusions: Basic MIS procedures do not seem harder to acquire during residency than conventional surgical procedures. This may have resulted from the incorporation of structured MIS training programs in residency. Hopefully, this will lead to a more successful implementation of the advanced MIS procedures.

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Objective assessment of vaginal surgical skills

Cited by 25 publications

References 13 publications

Tools for the direct observation and assessment of psychomotor skills in medical trainees: a systematic review

Tools for the direct observation and assessment of psychomotor skills in medical trainees: a systematic review

10: Determining the optimal route of hysterectomy for benign indications: A clinical decision tree algorithm

Are Minimally Invasive Procedures Harder to Acquire than Conventional Surgical Procedures?

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