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Right Case, Right Time: Which Procedures Best Differentiate General Surgery Trainees' Operative Performance?

Rebecca Moreci1, Rebecca S Gates1, Kayla M Marcotte2

  • 1Department of Surgery, Center for Surgical Training and Research, University of Michigan, Ann Arbor, Michigan.

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Identifying key surgical procedures can improve trainee assessment. This study found specific high-volume procedures that best differentiate performance across general surgery postgraduate year (PGY) levels, enhancing assessment efficiency.

Keywords:
Targeted assessmentdiscrimination indexoperative performance assessment

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Area of Science:

  • Medical Education
  • Surgical Training Assessment
  • Performance Metrics

Background:

  • Surgical resident operative performance assessment is resource-intensive.
  • Optimizing assessment requires identifying procedures that best inform trainee performance.
  • Current methods may not efficiently pinpoint skill differentiation across postgraduate year (PGY) levels.

Purpose of the Study:

  • To identify specific surgical procedures that effectively differentiate operative performance for each general surgery PGY level.
  • To provide data-driven recommendations for targeted assessment strategies in surgical residency.

Main Methods:

  • Utilized operative performance ratings from the Society for Improving Medical Professional Learning (SIMPL) collaborative.
  • Applied a multilevel Rasch model to identify high and low performing trainees per PGY level.
  • Calculated a procedural performance discrimination index based on 'practice-ready' ratings for high vs. low performers.

Main Results:

  • Analyzed 54,790 evaluations from 70 general surgery residency programs (2015-2021).
  • Generated discrimination values for 51-105 procedures per PGY level.
  • Identified 12 (PGY1), 15 (PGY2), 22 (PGY3), 21 (PGY4), and 28 (PGY5) 'highly differentiating, high volume' procedures.

Conclusions:

  • National data reveals procedures that best distinguish surgical trainee performance at each PGY level.
  • A curated list of high-differentiating, high-volume procedures can guide targeted assessment.
  • Implementing these findings can enhance the efficiency and effectiveness of surgical training evaluations.