title: Resident self-assessment of operative experience in primary total knee and total hip arthroplasty: Is it accurate?
abstract: BACKGROUND
  A prerequisite for a valuable surgical case log is the ability to perform an accurate self-assessment. Studies have shown mixed results when examining residents' ability to self-assess on varying tasks. We sought to examine the correlation between residents' self-assessment and staff surgeons' evaluation of surgical involvement and competence in performing primary total knee (TKA) and hip arthroplasty (THA).
  
  
  METHODS
  We used the intraclass correlation coefficient (ICC) to evaluate interobserver agreement between residents' self-perception and staff surgeons' assessment of involvement. An assessment of competency was performed using a categorical global scale and evaluated with the κ statistic. We piloted a structured surgical skills assessment form as an additional objective appraisal of resident involvement.
  
  
  RESULTS
  We analyzed assessment data from 65 primary TKA and THA cases involving 17 residents and 17 staff surgeons (93% response rate). The ICC for resident involvement between residents and staff surgeons was 0.80 (95% confidence interval [CI] 0.69-0.88), which represents substantial agreement. The agreement between residents and staff surgeons about residents' competency to perform the case had a κ value of 0.67 (95% CI 0.50-0.84). The ICC for resident, staff surgeon and third-party observer using the piloted skills assessment form was 0.82 (95% CI 0.75-0.88), which represents substantial agreement.
  
  
  CONCLUSIONS
  This study supports the ability of orthopedic residents to perform self-assessments of their degree of involvement and competency in primary TKA and THA. Staff surgeons' assessment of resident involvement correlated highly with the surgical skills assessment form. Self-assessment is a valuable addition to the surgical case log.
authors.affiliation: Department of Surgery, University of Toronto, Toronto, Ontario. tom.trajkovski@utoronto.ca
authors.forename: Tomce
authors.initials: T
authors.lastname: Trajkovski
authors.forename: Christian
authors.initials: C
authors.lastname: Veillette
authors.forename: David
authors.initials: D
authors.lastname: Backstein
authors.forename: Veronica M R
authors.initials: VM
authors.lastname: Wadey
authors.forename: Bill
authors.initials: B
authors.lastname: Kraemer
mesh_terms: D000328:Adult; D019644:Arthroplasty, Replacement, Hip / Q000193:education* / Q000379:methods; D019645:Arthroplasty, Replacement, Knee / Q000193:education* / Q000379:methods; D002983:Clinical Competence; D003162:Competency-Based Education; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D004503:Education, Medical, Graduate / Q000379:methods; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D015588:Observer Variation; D009864:Ontario; D012647:Self-Assessment; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D013647:Task Performance and Analysis