Video-based assessment (VBA) of an open, simulated orthopedic surgical procedure: a pilot study using a single-angle camera to assess surgical skill and decision making.

BACKGROUND: Videos have been used in many settings including medical simulation. Limited information currently exists on video-based assessment in surgical training. Effective assessment tools have substantial impact on the future of training. The objectives of this study were as follows: to evaluate the inter-rater reliability of video-based assessment of orthopedic surgery residents performing open cadaveric simulation procedures and to explore the benefits and limitations of video-based assessment. METHODS: A multi-method technique was used. In the quantitative portion, four residents participated in a Surgical Objective Structured Clinical Examination in 2017 at a quaternary care training center. A single camera bird's-eye view was used to videotape the procedures. Five orthopedic surgeons evaluated the surgical videos using the Ottawa Surgical Competency Operating Room Evaluation. Interclass correlation coefficient was used to calculate inter-rater reliability. In the qualitative section, semi-structured interviews were used to explore the perceived strengths and limitations of video-based assessment. RESULTS AND DISCUSSION: The scores using video-based assessment demonstrated good inter-rater reliability (ICC = 0.832, p = 0.014) in assessing open orthopedic procedures on cadavers. Qualitatively, the strengths of video-based assessment in this study are its ability to assess global performance and/or specific skills, ability to reassess missed points during live assessment, and potential use for less common procedures. It also allows for detailed constructive feedback, flexible assessment time, anonymous assessment, multiple assessors and serves as a good coaching tool. The main limitations of video-based assessment are poor audio-video quality, and questionable feasibility for assessing readiness for practice. CONCLUSION: Video-based assessment is a potential adjunct to live assessment in orthopedic open procedures with good inter-rater reliability. Improving audio-video quality will enhance the quality of the assessment and improve the effectiveness of using this tool in surgical training.

Characteristics and Correlates of Woman Eligible for Targeted Screening Mammography in Oman.

OBJECTIVES: We sought to determine the characteristics of women eligible for a high-yield screening mammography program in Oman. METHODS: We conducted a retrospective review of women who underwent breast cancer screening at the Oman Cancer Association from 22 December 2009 to 6 February 2011. Women with a Breast Imaging Reporting and Data System (BI-RADS) score of 4-5 were compared with those with a score of 1-3 based on well-known breast cancer risk factors using the case-control approach analysis. RESULTS: A BI-RADS score of 4-5 was found in 16.2% of women screened for breast cancer. A higher likelihood of a BI-RADS score of 4 or 5 was observed among women who did not breastfeed (odds ratio (OR) = 2.564; 95% confidence interval (CI): 1.690, 3.890), had their first pregnancy at an older age (OR = 1.062; 95% CI: 1.041, 1.083), used oral contraceptives (OR = 1.397; 95% CI: 1.008, 1.938), and those who reported a positive family history of malignancies (OR = 1.633; 95% CI: 1.285, 2.076). A BI-RADS score of 4 or 5 was significantly less likely in women with a higher number of full-term pregnancies (OR = 0.919; 95% CI: 0.890, 0.948). BI-RADS 4-5 were independently predicted in women with a lower number of full-term pregnancies, did not breastfeed, used oral contraceptives, and who had a positive family history of malignancies. These variables explained 84.0% of the variation in mammogram results. CONCLUSIONS: In the absence of a national screening program for breast cancer, the high-risk approach for screening should be considered. Women with the above characteristics should be identified and motivated to seek mammogram regularly to warrant a better outcome.