Computer-assisted assessment of one-handed knot tying skills performed within various contexts: a construct validity study.

BACKGROUND The widespread use of computer-assisted assessment of technical proficiency in surgical residents shows the need for further investigations of the construct validity of these devices (eg, hand motion analysis) before implementation into competency testing. METHODS Thirty general surgery residents performed 1-handed knot tying in 2 contexts: superficial and deep. The Imperial College Surgical Assessment Device (ICSAD) was used to evaluate performance. It was hypothesized that senior residents (postgraduate year [PGY] 4-5) would perform better then junior residents (PGY 1-3) and that the superficial version of the skill would be easier than the deep. RESULTS Technical efficiency scores were better for seniors than for juniors (P < .001) and on the superficial versus the deep model (P < .001). Both groups were equally affected by the contextual changes to the skill, suggesting a consistent impact on the skill-specific movement patterns. CONCLUSIONS Additional evidence for the validity of ICSAD as a competency assessment tool has been shown. First, it distinguished senior and junior residents. Second, it discerned differences on the same skill performed in 2 different contexts.