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Procedure-based assessment for laparoscopic cholecystectomy can replace global rating scales
Tom H van Zwieten1,2, Sietske Okkema1, Kelvin H Kramp1
1Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
Summary
Procedure-Based Assessment (PBA) better distinguishes surgical skill levels than global rating scales (GRSs) like OSATS and GOALS. PBA effectively differentiates novice from experienced surgeons in laparoscopic cholecystectomy.
Area of Science:
- Surgical Education and Assessment
- Medical Simulation and Training
- Laparoscopic Surgery Techniques
Background:
- Global Rating Scales (GRSs), including Objective Structured Assessment of Technical Skills (OSATS) and Global Operative Assessment of Laparoscopic Surgery (GOALS), are established methods for evaluating surgical performance.
- The need for robust assessment tools that accurately reflect a surgeon's proficiency, particularly in minimally invasive procedures, remains a critical area in surgical training.
Purpose of the Study:
- To establish the construct validity of Procedure-Based Assessment (PBA) as a novel tool for surgical skill evaluation.
- To compare the discriminative ability of PBA against traditional GRSs (OSATS and GOALS) in the context of laparoscopic cholecystectomy.
Main Methods:
- Three groups of surgical trainees (novice, intermediate, experienced) were defined based on the number of laparoscopic cholecystectomies performed (1-10, 11-20, >20 respectively).
- Performance scores using PBA, OSATS, and GOALS were collected and compared across the three experience groups.
- Statistical analysis, including Kruskal-Wallis and Mann-Whitney U tests, was employed to assess differences in scores between groups and between assessment methods.
Main Results:
- Both GRSs and PBA scores demonstrated a significant positive correlation with increasing surgical experience (p < .001).
- PBA showed a significantly higher ability to discriminate between novice and intermediate trainees (p = .03) compared to OSATS (p = .1) and GOALS (p = .1), where scores overlapped substantially.
- Experienced surgeons achieved higher median scores with less variability using PBA (97.2%) compared to OSATS (82.1%) and GOALS (80%).
Conclusions:
- Procedure-Based Assessment (PBA) exhibits superior discriminative validity for assessing surgical skill levels in laparoscopic cholecystectomy compared to traditional Global Rating Scales.
- PBA is a more effective tool for differentiating between varying levels of surgical competency, particularly in distinguishing between early-stage trainees and those with more experience.