Self-estimation of surgical skills and competencies based on the learning curve theory in medical residents and fellows.

ABSTRACT

OBJECTIVE: The aim was to explore how in-training junior physicians perceive their surgical performance compared with the one externally rated by their senior surgeon trainers, using a general learning curve model. METHODS: Between April and June 2018, a prospective study was conducted at a community hospital associated with a school of medicine. To assess how in-training physicians estimated their surgical performance, 48 surgical residents and fellows were invited to choose one among six options using a scale ranging from "novice" to "automatic expert." In addition, five senior surgeons who supervised the residents/fellows were asked to give their own opinions on each surveyed physician's expertise level, according to the same categories. Concordance analysis was done to compare residents' and fellows' self-perceived skills and their actual performance as estimated by senior surgeons. RESULTS: Self-assessments tended to overestimate residents' and fellows' position on the learning curve; particularly for "proficient" over "competent," and for "automatic expert" over "expert" categories (p = 0.025). The average degree of agreement among senior physicians was 50.0%. Comparison between residents' and fellows' perceived skills and their performances as estimated by senior surgeons showed a weak concordance (kappa = 0.494, 95% confidence interval 0.359-0.631, p < 0.0001). CONCLUSIONS: Nearly 51% of the residents/fellows included in some surgical specialty training program overestimated his/her actual performance as evaluated by classical learning curve categories. Underestimation of self-assessed performance was also observed in 17% of respondents. A better feedback from expert observers to in-training surgeons could result in a more accurate self-perception of their real surgical skills and competencies.

RESUMEN

OBJETIVO: Evaluar cómo los médicos en formación (juniors) perciben su propio desempeño quirúrgico en comparación con la calificación otorgada por sus instructores (seniors) según un modelo de curva de aprendizaje. MÉTODOS: Entre abril y junio de 2018 se realizó un estudio prospectivo en un hospital comunitario. Para evaluar cómo los médicos juniors estimaban su propio desempeño, 48 residentes/becarios de especialidades quirúrgicas eligieron una entre seis opciones excluyentes en una escala entre «novicio¼ y «experto automático¼. Además, cinco cirujanos que supervisaban a los residentes/becarios dieron sus propias opiniones sobre el nivel de desempeño de cada médico encuestado, usando las mismas categorías. Se realizó un análisis de concordancia para comparar las habilidades autopercibidas y el desempeño real según lo estimado por los cirujanos seniors. RESULTADOS: Cuarenta y siete juniors y 50 seniors completaron la encuesta. El 51% sobrestimó y el 17% subestimó su ubicación en la curva de aprendizaje con respecto a los observadores externos (p = 0.025). El grado promedio de acuerdo entre seniors fue del 50%. La comparación entre la autopercepción de los juniors con respecto a sus observadores seniors mostró una concordancia pobre (kappa = 0.494; intervalo de confianza del 95% [IC 95%] 0.359-0.631; p < 0.0001; sesgo promedio de Bland-Altman 0.40; IC 95% 0.11-0.70). CONCLUSIONES: La mitad de los residentes/fellows sobrestimó, y uno de cada seis subestimó, su verdadera ubicación en la curva de aprendizaje en comparación a la opinión de los seniors. Un mejor conocimiento de la existencia de este sesgo de estimación del propio desempeño podría redundar en una mejor confiabilidad del juicio médico.