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Assessing operative competence in core surgical training: A reliability analysis.

Conor Toale1, Marie Morris2, Dara O'Keeffe1

  • 1Department of Surgical Affairs, Royal College of Surgeons in Ireland, Ireland.

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Summary

Four assessors observing 10 cases each reliably evaluate surgical trainee competence. Focusing on core procedures enhances the reliability of operative performance assessments for surgical education.

Keywords:
AssessmentCompetency-based educationPerformance of operations or proceduresReliabilitySurgeryTechnical skillWorkplace-based assessment

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Area of Science:

  • Surgical Education
  • Medical Assessment
  • Competency-Based Training

Background:

  • Assessing operative competence is crucial for surgical trainees.
  • The Supervised Structured Assessment of Operative Performance (SSAOP) tool is utilized.
  • Reliable assessment metrics are needed for high-stakes evaluations.

Purpose of the Study:

  • To determine the number of observations needed for reliable assessment of Core Surgical Trainees (CSTs).
  • To establish dependability indices for high-stakes surgical assessments.
  • To optimize the use of the SSAOP tool in surgical training.

Main Methods:

  • Analysis of 2,294 SSAOPs from April 2016 to February 2021.
  • Inclusion of undifferentiated and core general surgery procedures (appendicectomy, hernia repair, lesion excision).
  • Application of Generalizability and Decision studies to calculate required observations for dependability indices ≥0.8.

Main Results:

  • Four assessors observing 10 cases each achieve sufficient reliability for high-stakes assessments.
  • A focused approach on core procedures improves reliability indices.
  • 2,294 SSAOPs were analyzed to support these findings.

Conclusions:

  • Repeated assessments across fewer procedures enhance reliability.
  • Increasing assessor diversity improves dependability indices for high-stakes evaluations.
  • Recommendations for optimizing surgical trainee assessment strategies.