Objective surgical skill assessment: the diagonal operating matrix

There is an urgent need for structured surgical training and assessment due to the reduction in the training duration with the European Working Time Directive (EWTD). We propose a model for objective skill assessment, the PAR-Diagonal Operating Matrix (PAR-DOM) which breaks down the task of vascular anastomosis into clearly defined skills. The PAR-DOM is made up of a 3x5 table and progress is made along vectors defined on the x-axis as PAR and on the y-axis as four levels. PAR defines three skills at each level. Each skill is graded from 1-3 (this may be taken as below average, average, above average). The skills at various levels are: Level 0 - Posture, Address, Relaxation; Level 1 - Pick-up, Airtime, Rotation; Level 2 - Placing, Angles, Rhythm; Level 3 - Precision, Adaptability, Reproducibility; Level 4 - Pace, Awareness, Relations. The PAR-DOM matrix provides a graphic representation of the progress of trainees over their training period assigned for them to stay with the trainer and also help identify individual strengths and weaknesses.