The objective assessment of surgical skill

There are many facets to being a skilful surgeon. Knowledge of anatomy, pathophysiology, operative theory and practice are all of vital importance. In addition, skills in decision-making, communication and team-leadership are all needed. Psychomotor manual dexterity is also of importance, particularly when considering the field of minimal-access surqery (MAS). There is a growing need to be able to assess surgical ‘skill’, both for the purposes of training and for the maintenance of exemplary practice. Attempts by academia and industry to produce systems to give an objective assessment of surgical ‘skill’ have been fraught with difficulty. Objectively assessing such a multifaceted phenomenon as ‘surgical skill’ produces many problems. This article aims to highlight some of the difficulties encountered when trying to produce a system of objective assessment, with a particular focus on MAS, and describes some of the solutions that have been described.

[1]  D. Jones,et al.  Complications of laparoscopic cholecystectomy. , 1996, Annual review of medicine.

[2]  A Cuschieri,et al.  Assessment of innate ability and skills for endoscopic manipulations by the Advanced Dundee Endoscopic Psychomotor Tester: predictive and concurrent validity. , 1999, American journal of surgery.

[3]  C. Wickens,et al.  Visual scanning and pilot expertise: the role of attentional flexibility and mental model development. , 1997, Aviation, space, and environmental medicine.

[4]  A Cuschieri,et al.  Ergonomic evaluation of laparoscopic bowel suturing. , 1998, American journal of surgery.

[5]  A. Darzi,et al.  Validation of virtual reality to teach and assess psychomotor skills in laparoscopic surgery: results from randomised controlled studies using the MIST VR laparoscopic simulator. , 1998, Studies in health technology and informatics.

[6]  A Cuschieri,et al.  Objective assessment of endoscopic knot quality. , 1997, American journal of surgery.

[7]  A. Cuschieri,et al.  Optimal port locations for endoscopic intracorporeal knotting , 1997, Surgical Endoscop.

[8]  J. Rosser,et al.  Skill acquisition and assessment for laparoscopic surgery. , 1997, Archives of surgery.

[9]  A. Cuschieri,et al.  Influence of direction of view, target‐to‐endoscope distance and manipulation angle on endoscopic knot tying , 1997, The British journal of surgery.

[10]  A. Leppäniemi,et al.  Indications for early mandatory laparotomy in abdominal stab wounds , 1999, The British journal of surgery.

[11]  R. Reznick,et al.  Testing technical skill via an innovative "bench station" examination. , 1997, American journal of surgery.

[12]  A Darzi,et al.  Early experience and validation work with Procedicus VA--the Prosolvia virtual reality shoulder arthroscopy trainer. , 1999, Studies in health technology and informatics.

[13]  J. Rosser,et al.  Objective evaluation of a laparoscopic surgical skill program for residents and senior surgeons. , 1998, Archives of surgery.

[14]  R. Reznick,et al.  Assessment of technical skills transfer from the bench training model to the human model. , 1999, American journal of surgery.

[15]  R. Johnston,et al.  Analysis of virtual reality technology applied in education , 1997 .

[16]  J. L. Ordóñez,et al.  The effect of training and duration of surgery on adhesion formation in the rabbit model. , 1997, Human reproduction.

[17]  M B Donnelly,et al.  The Objective Structured Clinical Examination The New Gold Standard for Evaluating Postgraduate Clinical Performance , 1995, Annals of surgery.

[18]  A. Darzi,et al.  Skill transfer from virtual reality to a real laparoscopic task , 2001, Surgical Endoscopy.

[19]  A. Cuschieri,et al.  Randomised study of influence of two-dimensional versus three-dimensional imaging on performance of laparoscopic cholecystectomy , 1998, The Lancet.

[20]  B. Wolfe,et al.  Training for minimally invasive surgery. Need for surgical skills. , 1993, Surgical endoscopy.

[21]  P Littlejohns,et al.  Cumulative risk adjusted mortality chart for detecting changes in death rate: observational study of heart surgery , 1998, BMJ.

[22]  R Berguer,et al.  A comparison of forearm and thumb muscle electromyographic responses to the use of laparoscopic instruments with either a finger grasp or a palm grasp. , 1999, Ergonomics.

[23]  T. Mori,et al.  Significance of ``hands-on training'' in laparoscopic surgery , 1998, Surgical Endoscopy.

[24]  R. Berguer,et al.  Surgical technology and the ergonomics of laparoscopic instruments , 1998, Surgical Endoscopy.

[25]  R. Reznick,et al.  Objective structured assessment of technical skill (OSATS) for surgical residents , 1997, The British journal of surgery.

[26]  R. Reznick,et al.  Reliability and construct validity of a structured technical skills assessment form. , 1994, American journal of surgery.

[27]  T. Drew,et al.  Technology for Psychomotor Skills Testing in Endoscopic Surgery , 1997, Seminars in laparoscopic surgery.

[28]  A. Darzi,et al.  The effect of a second-generation 3D endoscope on the laparoscopic precision of novices and experienced surgeons , 1999, Surgical Endoscopy.

[29]  A. Gallagher,et al.  Virtual Reality Training in Laparoscopic Surgery: A Preliminary Assessment of Minimally Invasive Surgical Trainer Virtual Reality (MIST VR) , 1999, Endoscopy.