title: Establishing cutoff scores on assessments of surgical skills to determine surgical competence.
abstract: OBJECTIVE
  The aim of this study was to establish minimum cutoff scores on intraoperative assessments of surgical skills to determine surgical competence for vaginal hysterectomy.
  
  
  METHODS
  Two surgical rating scales, the Global Rating Scale of Operative Performance and the Vaginal Surgical Skills Index, were used to evaluate trainees while performing vaginal hysterectomy. Cutoff scores were determined using the Modified Angoff method.
  
  
  RESULTS
  Two hundred twelve evaluations were analyzed on 76 surgeries performed by 27 trainees. Trainees were considered minimally competent to perform vaginal hysterectomy if total absolute scores (95% confidence interval) on Global Rating Scale = 18 (16.5-20.3) and Vaginal Surgical Skills Index = 32 (27.7-35.5). On average, trainees met new cutoffs after performing 21 and 27 vaginal hysterectomies, respectively. With the new cutoffs applied to the same cohort of fourth-year obstetrics and gynecology trainees, all residents achieved competency in performing vaginal hysterectomy by the end of their gynecology rotations.
  
  
  CONCLUSIONS
  Standard-setting methods using cutoff scores may be used to establish competence in vaginal surgery.
authors.affiliation: Obstetrics, Gynecology and Women's Health Institute, Department of Obstetrics and Gynecology, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA. jelovsj@ccf.org
authors.forename: J Eric
authors.initials: JE
authors.lastname: Jelovsek
authors.forename: Mark D
authors.initials: MD
authors.lastname: Walters
authors.forename: Abner
authors.initials: A
authors.lastname: Korn
authors.forename: Christopher
authors.initials: C
authors.lastname: Klingele
authors.forename: Nikki
authors.initials: N
authors.lastname: Zite
authors.forename: Beri
authors.initials: B
authors.lastname: Ridgeway
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Barber
mesh_terms: D004503:Education, Medical, Graduate / Q000379:methods*; D004521:Educational Measurement / Q000379:methods; D006176:Gynecology / Q000193:education*; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000193:education*; D010147:Pain Measurement; D013337:Students, Medical