Systems intended to assess surgical skill of residents fail to detail errors

Checklists, ratings scales and pass/fail feedback designed to assess the surgical prowess of orthopedic residents fail to adequately capture the nature of critical errors, according to a recent study published in the Journal of Surgical Education.

For the study, a research team used three measures to assess surgical skill as residents performed shoulder procedures on cadavers: a well-established checklist designed to assess a surgeons motor skills called the Objective Structured Assessment of Technical Skills, a ratings scale created to determine procedural knowledge and proper instrument usage, and a pass/fail system designed to fail residents that commit egregious errors.

The small study enrolled 23 medical residents ranging from their first to fifth year of residency. Researchers found that the OSATS and the ratings scale were useful in measuring surgical performance and skill. The pass/fail system gave residents straightforward feedback.

Overall, 11 egregious incidents occurred in which residents damaged nerves or veins while performing surgery on the cadavers. None of the ratings scales provided precise details or feedback on the errors.

Dawn LaPorte, MD, professor of orthopedic surgery at the Johns Hopkins University School of Medicine in Baltimore, said, "The takeaway message is that checklists of procedural steps are a good way to assess the technical skills of these surgical residents. But they don't measure quality, highlighting a need to measure and give feedback on errors as part of the training."

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