Objective assessment of technical skills in cardiac surgery.
OBJECTIVE
Reduced training time combined with no rigorous assessment for technical skills makes it difficult for trainees to monitor their competence. We have developed an objective bench-top assessment of technical skills at a level commensurate with a junior registrar in cardiac surgery.


METHODS
Forty cardiothoracic surgeons were recruited for the study, consisting of 12 junior trainees (year 1-3), 15 senior trainees (year 4-6) and 13 consultants. The assessment consisted of four key tasks on standardised bench-top models: aortic root cannulation, vein-graft to aorta anastomosis, vein-graft to Left Anterior Descending (LAD) anastomosis and femoral triangle dissection. An expert surgeon was present at each station to provide passive assistance and rate performance on a validated global rating scale giving rise to a total possible score of 40. Three expert surgeons repeated the ratings retrospectively, using blinded video recordings. Data analysis employed non-parametric tests.


RESULTS
Both live and video scores differentiated significantly between performances of all groups of surgeons for all four stations (P < 0.01) (median live and video score for LAD; Junior 19,17; Senior 29,22; Consultant 36,28). Correlations between live and blinded rating were high (r = 0.67-0.84; P < 0.001) as was inter-rater reliability between the three expert video raters (alpha = 0.81).


CONCLUSIONS
The use of bench-top tasks to differentiate between cardiac surgeons of differing technical abilities has been validated for the first time. Furthermore, it is unnecessary to perform post-hoc video rating to obtain objective data. These measures can provide formative feedback for surgeons-in-training and lead to the development of a competency-based technical skills curriculum.
Department of Surgical Oncology and Technology, Imperial College London, 10th Floor QEQM Building, St Mary's Hospital, Praed Street, London, UK. jhance@imperial.ac.uk
Julian
J
Hance
Rajesh
R
Aggarwal
Rex
R
Stanbridge
Christopher
C
Blauth
Yaron
Y
Munz
Ara
A
Darzi
John
J
Pepper
D006348:Cardiac Surgical Procedures / Q000592:standards*; D002983:Clinical Competence; D003162:Competency-Based Education; D004503:Education, Medical, Graduate / Q000379:methods*; D004521:Educational Measurement / Q000379:methods; D006801:Humans; D008131:London; D008505:Medical Staff, Hospital / Q000193:education / Q000592:standards; D008953:Models, Anatomic; D013903:Thoracic Surgery / Q000193:education*; D014741:Video Recording