Outlier experienced surgeon's performances impact on benchmark for technical surgical skills training.
ANZ J Surg
; 88(5): E412-E417, 2018 May.
Article
en En
| MEDLINE
| ID: mdl-29569819
ABSTRACT
BACKGROUND:
Training in medicine must move to an outcome-based approach. A proficiency-based progression outcome approach to training relies on a quantitative estimation of experienced operator performance. We aimed to develop a method for dealing with atypical expert performances in the quantitative definition of surgical proficiency.METHODS:
In study one, 100 experienced laparoscopic surgeons' performances on virtual reality and box-trainer simulators were assessed for two similar laparoscopic tasks. In study two, 15 experienced surgeons and 16 trainee colorectal surgeons performed one simulated hand-assisted laparoscopic colorectal procedure. Performance scores of experienced surgeons in both studies were standardized (i.e. Z-scores) using the mean and standard deviations (SDs). Performances >1.96 SDs from the mean were excluded in proficiency definitions.RESULTS:
In study one, 1-5% of surgeons' performances were excluded having performed significantly below their colleagues. Excluded surgeons made significantly fewer correct incisions (mean = 7 (SD = 2) versus 19.42 (SD = 4.6), P < 0.0001) and a greater proportion of incorrect incisions (mean = 45.71 (SD = 10.48) versus 5.25 (SD = 6.6), P < 0.0001). In study two, one experienced colorectal surgeon performance was >4 SDs for time to complete the procedure and >6 SDs for path length. After their exclusions, experienced surgeons' performances were significantly better than trainees for path length P = 0.031 and for time P = 0.002.CONCLUSION:
Objectively assessed atypical expert performances were few. Z-score standardization identified them and produced a more robust quantitative definition of proficiency.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Competencia Clínica
/
Laparoscopía
/
Cirugía Colorrectal
/
Benchmarking
/
Entrenamiento Simulado
Tipo de estudio:
Prognostic_studies
Límite:
Humans
Idioma:
En
Revista:
ANZ J Surg
Año:
2018
Tipo del documento:
Article
País de afiliación:
Irlanda