title: Surgical training in the 48-h week: a novel simulation and educational tool. From amateur golfer to professional pilot.
abstract: BACKGROUND
  Compliance with the European Working Time Directive has made obvious the need for a surgical skills training system that will produce surgeons fast and reliably. We have previously proposed a model for objective assessment of surgical dexterity. In this paper we aim to place an updated version of that model into the context of a holistic approach on assessment of a trainee's progress towards becoming an independently operating surgeon.
  
  
  METHODS
  The PAR matrix breaks down an operation into clearly defined skills that need to be successively acquired. It consists of a 3 x 6 table depicting 18 skill-goals. The y-axis is divided into six levels and the x-axis into three columns. The initials of the three skills on each level form the acronym PAR. Each skill is further graded from 1 to 3 (unsatisfactory, competent, good). The levels are: Level 1--posture, address, relaxation; Level 2--pick-up, airtime, rotation; Level 3--placing, angles, rhythm; Level 4--precision, adaptability, reproducibility; Level 5--pace, awareness, relations; Level 6--planning, announce, review/reflexion.
  
  
  RESULTS
  The format of the PAR model is such that it allows trainer and trainee to objectively assess progress, identify deficiencies and strengths and formulate an appropriate plan of action.
  
  
  CONCLUSIONS
  Ergonomics and crew resource management skills are essential for a safe operating environment. The PAR matrix may prove helpful in selection of trainees and revalidation of trainee surgeons as a competence and performance testing method, placed in the appropriate training curriculum.
authors.affiliation: The Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Great George Street, Leeds, LS13EX, United Kingdom.
authors.forename: Sotiris C
authors.initials: SC
authors.lastname: Papaspyros
authors.forename: Kalyana C
authors.initials: KC
authors.lastname: Javangula
authors.forename: David J
authors.initials: DJ
authors.lastname: O'Regan
mesh_terms: D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000379:methods*; D004521:Educational Measurement / Q000379:methods*; D006804:Ergonomics; D013502:General Surgery / Q000193:education*; D006801:Humans; D019300:Medical Errors / Q000517:prevention & control; D016544:Patient Simulation; D011597:Psychomotor Performance