title: Knowing the operative game plan: a novel tool for the assessment of surgical procedural knowledge.
abstract: BACKGROUND
  What is the source of inadequate performance in the operating room? Is it a lack of technical skills, poor judgment or a lack of procedural knowledge? We created a surgical procedural knowledge (SPK) assessment tool and evaluated its use.
  
  
  METHODS
  We interviewed medical students, residents and training program staff on SPK assessment tools developed for 3 different common general surgery procedures: inguinal hernia repair with mesh in men, laparoscopic cholecystectomy and right hemicolectomy. The tools were developed as a step-wise assessment of specific surgical procedures based on techniques described in a current surgical text. We compared novice (medical student to postgraduate year [PGY]-2) and expert group (PGY-3 to program staff) scores using the Mann-Whitney U test. We calculated the total SPK score and defined a cut-off score using receiver operating characteristic analysis.
  
  
  RESULTS
  In all, 5 participants in 7 different training groups (n = 35) underwent an interview. Median scores for each procedure and overall SPK scores increased with experience. The median SPK for novices was 54.9 (95% confidence interval [CI] 21.6-58.8) compared with 98.05 (95% CP 94.1-100.0) for experts (p = 0.012). The SPK cut-off score of 93.1 discriminates between novice and expert surgeons.
  
  
  CONCLUSIONS
  Surgical procedural knowledge can reliably be assessed using our SPK assessment tool. It can discriminate between novice and expert surgeons for common general surgical procedures. Future studies are planned to evaluate its use for more complex procedures.
authors.affiliation: Department of Surgery, Jewish General Hospital, McGill University, Lady Davis Institute for Medical Research, 3755 Chemin de la Côte-Sainte-Catherine,Montréal, QC.
authors.forename: Jacques
authors.initials: J
authors.lastname: Balayla
authors.forename: Simon
authors.initials: S
authors.lastname: Bergman
authors.forename: Gabriela
authors.initials: G
authors.lastname: Ghitulescu
authors.forename: Liane S
authors.initials: LS
authors.lastname: Feldman
authors.forename: Shannon A
authors.initials: SA
authors.lastname: Fraser
mesh_terms: D000328:Adult; D002170:Canada; D002983:Clinical Competence; D016001:Confidence Intervals; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000458:organization & administration*; D004504:Education, Medical, Undergraduate / Q000458:organization & administration*; D004521:Educational Measurement; D005260:Female; D013502:General Surgery / Q000193:education* / Q000458:organization & administration; D006801:Humans; D007396:Internship and Residency; D007407:Interviews as Topic; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D009873:Operating Rooms / Q000458:organization & administration*; D016730:Program Development; D015397:Program Evaluation; D012372:ROC Curve; D018709:Statistics, Nonparametric; D013337:Students, Medical; D055815:Young Adult