Self-appraisal hierarchical task analysis of laparoscopic surgery performed by expert surgeons

BackgroundEvaluation of technical skill is notoriously difficult because of the subjectivity and time-consuming expert analysis. No ongoing evaluation scheme exists to assess the continuing competency of surgeons. This study examined whether surgeons’ self-assessment accurately reflects their actual surgical technique.MethodsHierarchical task analysis (HTA) of laparoscopic cholecystectomy was constructed. Ten expert surgeons were asked to modify the HTA for their own technique. The HTAs of these surgeons then were compared with their actual operations, which had been recorded and assessed by two observers.ResultsA total of 40 operations were assessed. All the gallbladders subjected to surgery were classified as grades 1 to 3. The mean interrater reliability for the two observers had a k value of 0.84 (p < 0.05), and the mean intrarater reliability between surgeons and observers had a k value of 0.79 (p < 0.05).ConclusionsSurgeons’ self-evaluation is accurate for technical skills aspects of their operations. This study demonstrates that self-appraisal using HTA is feasible, accurate, and practical. The authors aim to increase the numbers in their study and also to recruit residents.

[1]  Sir Ara W Darzi,et al.  Development of assessing generic and specific technical skills in laparoscopic surgery. , 2006, American journal of surgery.

[2]  D. Newble,et al.  Assessing the technical skills of surgical trainees , 2005, The British journal of surgery.

[3]  C G Cao,et al.  Hierarchical decomposition of laparoscopic procedures. , 1999, Studies in health technology and informatics.

[4]  P S White,et al.  Using human reliability analysis to detect surgical error in endoscopic DCR surgery. , 2003, Clinical otolaryngology and allied sciences.

[5]  Peter Johnson,et al.  Human computer interaction: Psychology, task analysis, and software engineering , 1992 .

[6]  K. Moorthy,et al.  Laparoscopic skills training and assessment , 2004, The British journal of surgery.

[7]  Ara Darzi,et al.  Comparison of bench test evaluations of surgical skill with live operating performance assessments. , 2004, Journal of the American College of Surgeons.

[8]  Alfred Cuschieri.  a new approach forimproving surgical performance and clinicaloutcome , 2000 .

[9]  J. Ponsky,et al.  Minimal access general surgery: the dawn of a new era , 1991 .

[10]  A. Darzi,et al.  Technical skills errors in laparoscopic cholecystectomy by expert surgeons , 2005, Surgical Endoscopy And Other Interventional Techniques.

[11]  S. Horgan,et al.  An objective scoring system for laparoscopic cholecystectomy. , 1999, Journal of the American College of Surgeons.

[12]  A Cuschieri,et al.  Identification and categorization of technical errors by Observational Clinical Human Reliability Assessment (OCHRA) during laparoscopic cholecystectomy. , 2004, Archives of surgery.

[13]  Barry Kirwan,et al.  A Guide to Practical Human Reliability Assessment , 1994 .

[14]  M. Frecker,et al.  Sequence and task analysis of instrument use in common laparoscopic procedures , 2002, Surgical Endoscopy And Other Interventional Techniques.

[15]  A. Darzi,et al.  Objective assessment of technical skills in surgery , 2003, BMJ : British Medical Journal.

[16]  D. Newble,et al.  Developing assessments of surgical skills for the GMC Performance Procedures. , 2005, Annals of the Royal College of Surgeons of England.

[17]  A. Cuschieri,et al.  Errors enacted during endoscopic surgery--a human reliability analysis. , 1998, Applied ergonomics.

[18]  A Cuschieri,et al.  Human reliability assessment in surgery--a new approach for improving surgical performance and clinical outcome. , 2000, Annals of the Royal College of Surgeons of England.