title: Self-appraisal hierarchical task analysis of laparoscopic surgery performed by expert surgeons.
abstract: BACKGROUND
  Evaluation of technical skill is notoriously difficult because of the subjectivity and time-consuming expert analysis. No ongoing evaluation scheme exists to assess the continuing competency of surgeons. This study examined whether surgeons' self-assessment accurately reflects their actual surgical technique.
  
  
  METHODS
  Hierarchical task analysis (HTA) of laparoscopic cholecystectomy was constructed. Ten expert surgeons were asked to modify the HTA for their own technique. The HTAs of these surgeons then were compared with their actual operations, which had been recorded and assessed by two observers.
  
  
  RESULTS
  A total of 40 operations were assessed. All the gallbladders subjected to surgery were classified as grades 1 to 3. The mean interrater reliability for the two observers had a k value of 0.84 (p < 0.05), and the mean intrarater reliability between surgeons and observers had a k value of 0.79 (p < 0.05).
  
  
  CONCLUSIONS
  Surgeons' self-evaluation is accurate for technical skills aspects of their operations. This study demonstrates that self-appraisal using HTA is feasible, accurate, and practical. The authors aim to increase the numbers in their study and also to recruit residents.
authors.affiliation: Department of Surgical Oncology and Technology, St Mary's Hospital, Imperial College London, London, W2 1NY, United Kingdom. s.sarker@imperial.ac.uk
authors.forename: S K
authors.initials: SK
authors.lastname: Sarker
authors.forename: R
authors.initials: R
authors.lastname: Hutchinson
authors.forename: A
authors.initials: A
authors.lastname: Chang
authors.forename: C
authors.initials: C
authors.lastname: Vincent
authors.forename: A W
authors.initials: AW
authors.lastname: Darzi
mesh_terms: D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000592:standards*; D002983:Clinical Competence; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012647:Self-Assessment; D013647:Task Performance and Analysis