Assessment of surgical competence at carotid endarterectomy under local anaesthesia in a simulated operating theatre.
BACKGROUND
Methods of surgical training that do not put patients at risk are desirable. A high-fidelity simulation of carotid endarterectomy under local anaesthesia was tested as a tool for assessment of vascular surgical competence, as an adjunct to training.


METHODS
Sixty procedures were performed by 30 vascular surgeons (ten junior trainees, ten senior trainees and ten consultants) in a simulated operating theatre. Each performed in a non-crisis scenario followed by a crisis scenario. Performance was assessed live by means of rating scales for technical and non-technical skills.


RESULTS
There was a significant difference in technical skills with ascending grade for both generic and procedure-specific technical skill scores in both scenarios (P < 0.001 for all comparisons). Similarly, there was also a significant difference in non-technical skill with ascending grade for both scenarios (P < 0.001). There was a highly significant correlation between technical and non-technical performance in both scenarios (non-crisis: r(s) = 0.80, P < 0.001; crisis: r(s) = 0.85, P < 0.001). Inter-rater reliability was high (alpha > or = 0.80 for all scales).


CONCLUSIONS
High-fidelity simulation offers competency-based assessment for all grades and may provide a useful training environment for junior trainees and more experienced surgeons.
Black
S A
SA
St Mary's Hospital London Regional Vascular Unit, London, UK. drsablack@hotmail.com
Nestel
D F
DF
Kneebone
R L
RL
Wolfe
J H N
JH
D000772:Anesthesia, Local / Q000592:standards*; D002983:Clinical Competence / Q000592:standards*; D003162:Competency-Based Education; D003198:Computer Simulation / Q000592:standards*; D003253:Consultants; D004503:Education, Medical, Graduate / Q000379:methods*; D016894:Endarterectomy, Carotid / Q000592:standards*; D013502:General Surgery / Q000193:education* / Q000592:standards; D006801:Humans; D008505:Medical Staff, Hospital / Q000592:standards; D015588:Observer Variation; D009873:Operating Rooms; D016544:Patient Simulation; D012647:Self-Assessment