A global assessment tool for evaluation of intraoperative laparoscopic skills.
BACKGROUND
There is a pressing need for an intraoperative assessment tool that meets high standards of reliability and validity to use as an outcome measure for different training strategies. The aim of this study was to develop a tool specific for laparoscopic skills and to evaluate its reliability and validity.


METHODS
The Global Operative Assessment of Laparoscopic Skills (GOALS) consists of a 5-item global rating scale. A 10-item checklist and 2 visual analogue scales (VAS) for competence and case difficulty were also used. During laparoscopic cholecystectomy, 21 participants were evaluated by the attending surgeon, by 2 trained observers and by self-assessment while dissecting the gallbladder from the liver bed.


RESULTS
The intraclass correlation coefficient (ICC) for the total GOALS score was .89 (95% confidence interval [CI] .74 to .95) between observers, .82 (95% CI .67 to .92) between observers and attending surgeons, and .70 (95% CI .37 to .87) between participants and attending surgeons. The ICCs (observers) for the VAS (competence) and the checklist were .69 and .70, respectively. The mean total GOALS score (observers) for novices (postgraduate years [PGYs] 1 through 3) was 13 (95% CI 10.3 to 15.7) compared with 19.4 (95% CI 17.2 to 21.5) for experienced (PGY 4 through attending surgeons, P = .0006). The VAS demonstrated a difference in scores between novice and experienced participants (P = .001); however, the task checklist did not (P = .09).


CONCLUSIONS
These data indicate that GOALS is feasible, reliable, and valid. They also suggest that it is superior to the task checklist and VAS for evaluation of technical skill by experienced raters. The findings support the use of GOALS in the training and evaluation of laparoscopic skills.
Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montreal, Quebec, Canada H3G 1A4.
Melina C
MC
Vassiliou
Liane S
LS
Feldman
Christopher G
CG
Andrew
Simon
S
Bergman
Karen
K
Leffondré
Donna
D
Stanbridge
Gerald M
GM
Fried
D002983:Clinical Competence / Q000592:standards*; D003162:Competency-Based Education; D016001:Confidence Intervals; D004503:Education, Medical, Graduate; D005260:Female; D013502:General Surgery / Q000592:standards / Q000639:trends; D019538:Health Care Surveys; D006801:Humans; D007391:International Cooperation; D007396:Internship and Residency; D010535:Laparoscopy / Q000592:standards* / Q000639:trends; D008297:Male; D015588:Observer Variation; D017410:Practice Guidelines as Topic; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity