Assessing intraoperative judgment using script concordance testing through the gynecology continuum of practice

Area of Science:

• Medical Education
• Surgical Assessment
• Obstetrics and Gynecology

Background:

• Surgical judgment is crucial in Obstetrics and Gynecology (OBGYN).
• Assessing surgical judgment across the OBGYN continuum is essential for evaluating physician competency.
• Factors influencing surgical judgment require further investigation.

Purpose of the Study:

• To measure surgical judgment in OBGYN practitioners and trainees.
• To identify factors associated with enhanced surgical judgment.
• To compare surgical judgment across different career stages and subspecialties.

Main Methods:

• A 45-item script concordance examination was developed.
• The examination assessed responses to "ill-defined" surgical scenarios against expert benchmarks.
• Participants included OBGYN residents, fellows, practicing physicians, and experts.

Main Results:

• Practicing physicians' scores were similar to residents but lower than fellows and experts.
• Higher scores correlated with increased experience in vaginal hysterectomies, robotic hysterectomies, stress incontinence, and prolapse procedures.
• More years in practice showed an inverse correlation with test scores.

Conclusions:

• Intraoperative surgical judgment in practicing OBGYN physicians is comparable to that of residents.
• Practicing physicians specializing in Female Pelvic Medicine and Reconstructive Surgery (FPMRS) demonstrated lower surgical judgment scores.
• Lower performance in FPMRS specialists was associated with less surgical experience and longer duration in practice.