What is the Role of Video-Based Assessment of Laparoscopic Surgical Skill in Residency Training? A Qualitative Study of Trainee and Faculty Perspectives.

OBJECTIVES: Surgical training programs are starting to experiment with video-based assessment (VBA) of residents' technical skills. VBA may limit the effect of interpersonal bias on assessment scores. However, before VBA is implemented widely, stakeholders' perceptions ought to be explored, including potential benefits and challenges. METHODS: Using the qualitative methods of hermeneutical phenomenology, the authors explored both trainee and faculty educators' perspectives on VBA using semi-structured interviews. Participants were recruited from the Department of Obstetrics and Gynecology at the University of Toronto. Data underwent thematic analysis and was validated by the investigator and theoretical triangulation. RESULTS: The authors interviewed 9 physicians (5 faculty and 4 residents). Four dominant themes were identified, including advantages compared to traditional methods, the role of feedback and coaching, challenges integrating VBA, and considerations for implementation. CONCLUSIONS: Surgical trainees and faculty feel that VBA is a worthy tool to advance equity and fairness in assessment, but felt it was better as a vehicle for feedback and coaching. VBA cannot be used as a standalone assessment metric without additional evidence for its validity. If implemented, residency programs can use VBA as an adjunct to other evaluation measures to facilitate coaching, provide asynchronous feedback, and limit assessment bias.

Effects of a Resident's Reputation on Laparoscopic Skills Assessment.

OBJECTIVE: To quantify the effect of a resident's reputation on the assessment of their laparoscopic skills. METHODS: Faculty gynecologists were randomized to receive one of three hypothetical resident scenarios: a resident with high, average, or low surgical skills. All participants were then asked to view the same video of a resident performing a laparoscopic salpingo-oophorectomy that differed only by the resident description and provide an assessment using a modified OSATS (Objective Structured Assessment of Technical Skills) and a global assessment scale. RESULTS: From September 6, 2020, to October 20, 2020, a total of 43 faculty gynecologic surgeons were recruited to complete the study. Assessment scores on the modified OSATS (out of 20) and global assessment (out of 5) differed significantly according to resident description, where the high-performing resident scored highest (median scores of 15 and 4, respectively), followed by the average-performing resident (13 and 3), and finally, the low-performing resident (11 and 3) (P=.008 and .043, respectively). CONCLUSION: Faculty assessment of residents in gynecologic surgery is influenced by the assessor's knowledge of the resident's past performance. This knowledge introduces bias that artificially increases scores given to those residents with favorable reputations and decreases scores given to those with reputed surgical skill deficits. These data quantify the effect of such bias in the assessment of residents in the workplace and serve as an impetus to explore systems-level interventions to mitigate bias.

Cervico-vaginal inflammatory cytokine alterations after intrauterine contraceptive device insertion: A pilot study.

In a prospective study of twenty sexually transmitted infection (STI)-free women, we examined the impact of an intrauterine contraceptive device (IUCD) insertion on cervico-vaginal cytokine levels. Nine women chose the levonorgestrel-containing IUCD and eight chose a copper IUCD. A cervico-vaginal swab was collected for cytokine analysis pre-insertion and four weeks post-insertion. Significant increases were noted in levels of IL-1α (median 483.4 versus 316.6 pg/mL, p = 0.046), IL-1ß (median 605.7 versus 147.3 pg/mL, p = 0.018), IL-6 (median 570.1 versus 157.3 pg/mL, p = 0.046), TNFα (median 1.19 versus 0.6 pg/mL, p = 0.029) and the chemokine MCP-1 (median 340.2 versus 135.2 pg/mL, p = 0.003). No significant changes were noted in the levels of GM-CSF, IL-8, MIG, MIP-3α, RANTES, IL-10, IL-17, IP-10, MIP-1ß. Whether this increase in pro-inflammatory cytokine levels decreases epithelial barrier integrity and enhances susceptibility to STIs, including HIV, merits further study.