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In the past few years, considerable developments have been made in the objective assessment of technical proficiency of surgeons. Technical skills should be assessed during training, and various methods have been developed for this purpose 

Surgical competence entails a combination of knowledge, technical skills, decision making, communication skills, and leadership skills. Of these, dexterity or technical proficiency is considered to be of paramount importance among surgical trainees. The assessment of technical skills during training has been considered to be a form of quality assurance for the future.1 Typically surgical learning is based on an apprenticeship model. In this model the assessment of technical proficiency is the responsibility of the trainers. However, their assessment is largely subjective.2 Objective assessment is essential because deficiencies in training and performance are difficult to correct without objective feedback.3

The introduction of the Calman system in the United Kingdom, the implementation of the European Working Time Directive, and the financial pressures to increase productivity4 have reduced the opportunity to learn surgical skills in the operating theatre. Studies have shown that these changes have resulted in nearly halving the surgical case load that trainees are exposed to.5 Surgical proficiency must therefore be acquired in less time, with the risk that some surgeons may not be sufficiently skilled at the completion of training.6 This and increasing attention of the public and media on the performance of doctors have given rise to an interest in the development of robust methods of assessment of technical skills.7 We review the research in this field in the past decade. Our objectives are to explore all the available methods, establish their validity and reliability, and examine the possibility of using these methods on the basis of the available evidence.

We collected information for this review from …

/pdf/objective-assessment-of-technical-skills-in-surgery-2zjt7ye7k4.pdf

Objective assessment of technical skills in surgery

In the past few years, considerable developments have been made in the objective assessment of technical proficiency of surgeons. Technical skills should be assessed during training, and various methods have been developed for this purpose 

Surgical competence entails a combination of knowledge, technical skills, decision making, communication skills, and leadership skills. Of these, dexterity or technical proficiency is considered to be of paramount importance among surgical trainees. The assessment of technical skills during training has been considered to be a form of quality assurance for the future.1 Typically surgical learning is based on an apprenticeship model. In this model the assessment of technical proficiency is the responsibility of the trainers. However, their assessment is largely subjective.2 Objective assessment is essential because deficiencies in training and performance are difficult to correct without objective feedback.3

The introduction of the Calman system in the United Kingdom, the implementation of the European Working Time Directive, and the financial pressures to increase productivity4 have reduced the opportunity to learn surgical skills in the operating theatre. Studies have shown that these changes have resulted in nearly halving the surgical case load that trainees are exposed to.5 Surgical proficiency must therefore be acquired in less time, with the risk that some surgeons may not be sufficiently skilled at the completion of training.6 This and increasing attention of the public and media on the performance of doctors have given rise to an interest in the development of robust methods of assessment of technical skills.7 We review the research in this field in the past decade. Our objectives are to explore all the available methods, establish their validity and reliability, and examine the possibility of using these methods on the basis of the available evidence.

We collected information for this review from … 

We present a review of algorithms and their performance for determining three-dimensional (3D) motion and structure of rigid objects when their corresponding features are known at different times or are viewed by different cameras. Three categories of problems are considered, depending upon whether the features are two (2D) or three-dimensional (3D) and the type of correspondence: a) 3D to 3D (i.e., locations of corresponding features in 3D space are known at two different times), b) 2D to 3D (i.e., locations of features in 3D space and their projection on the camera plane are known, and c) 2D to 2D (i.e., projections of features on the camera plane are known at two different times). Features considered include points, straight lines, curved lines, and corners. Emphasis is on problem formulation, efficient algorithms for solution, existence and uniqueness of solutions, and sensitivity of solutions to noise in the observed data. Algorithms described have been used in a variety of applications. Some of these are: a) positioning and navigating 3D objects in a 3D world, b) camera calibration, i.e., determining location and orientation of a camera by observing 3D features whose location is known, c) estimating motion and structure of moving objects relative to a camera. We mention some of the mathematical techniques borrowed from algebraic geometry, projective geometry, and homotopy theory that are required to solve these problems, list unsolved problems, and give some directions for future research. >

Motion and structure from feature correspondences: a review

BACKGROUND: Surgeons are increasingly being scrutinized for their performance and there is growing interest in objective assessment of technical skills. The purpose of this study was to review all evidence for these methods, in order to provide a guideline for use in clinical practice. METHODS: A systematic search was performed using PubMed and Web of Science for studies addressing the validity and reliability of methods for objective skills assessment within surgery and gynaecology only. The studies were assessed according to the Oxford Centre for Evidence-based Medicine levels of evidence. RESULTS: In total 104 studies were included, of which 20 (19.2 per cent) had a level of evidence 1b or 2b. In 28 studies (26.9 per cent), the assessment method was used in the operating room. Virtual reality simulators and Objective Structured Assessment of Technical Skills (OSATS) have been studied most. Although OSATS is seen as the standard for skills assessment, only seven studies, with a low level of evidence, addressed its use in the operating room. CONCLUSION: Based on currently available evidence, most methods of skills assessment are valid for feedback or measuring progress of training, but few can be used for examination or credentialing. The purpose of the assessment determines the choice of method.

Objective assessment of technical surgical skills

Background: The ability to make an objective evaluation of a surgeon's operative ability remains an elusive goal. In this study, we used motion analysis as a measure of dexterity in the performance of a simulated operation. Methods: Fifteen surgeons performed a total of 45 laboratory-based laparoscopic cholecystectomies on a cadaveric porcine liver model. Subjects were assigned to one of three groups according to their level of experience in human laparoscopic cholecystectomy. Electromagnetic tracking devices were used to analyze the surgeon's hand movements as they performed the procedure. Movement data (time, distance, number of movements, and speed of movement) were then compared. Results: Analysis of variance (ANOVA) movement scores across the three groups showed significantly better performance among the experienced laparoscopic surgeons than the novices. Learning curves across repetitions of procedures were plotted. Novices made more improvement than experts. Conclusions: Motion analysis provides useful data for the assessment of laparoscopic dexterity, and the porcine liver model is a valid simulation of the real procedure.

Motion analysis: A tool for assessing laparoscopic dexterity in the performance of a laboratory-based laparoscopic cholecystectomy

Flexible nasopharyngoscopy (FNP) is a specialized skill commonly used by otolaryngologists as an important component of the head and neck examination. FNP can be diagnostic and therapeutic for many head and neck pathologies. Mastering this skill facilitates the effective performance of other specialized skills and procedures such as fibreoptic nasal intubations and flexible bronchoscopies. During otolaryngology rotations and electives, medical students are exposed to a high volume of FNP. Often, they are also asked to perform this procedure in clinic and on-call. There is currently no widely available simulation tool for medical students to practice using FNP, and medical students at our institution do not receive any formal training prior to performing FNP. The following is an introductory guide for medical students to become proficient at performing FNP while on their otolaryngology rotation.

/pdf/a-medical-students-guide-to-flexible-nasal-pharyngoscopy-3gv5i8vt.pdf

A medical student’s guide to flexible nasal pharyngoscopy

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Motion analysis: A tool for assessing laparoscopic dexterity in the performance of a laboratory-based laparoscopic cholecystectomy

A medical student’s guide to flexible nasal pharyngoscopy