title: Measuring surgical competency in facial trauma: the Arch Bar Placement Assessment Scale.
abstract: BACKGROUND
  Surgical education is in a period of significant change. Assessment of surgical competency is imprecise compared with cognitive knowledge and judgment. A surgical competency measurement tool may be useful for plastic surgery training programs and certification societies. We present a validation study of a novel measurement instrument for arch bar placement and dental wire handling.
  
  
  METHODS
  An Arch Bar Placement Assessment Scale (ABPAS) was created via consensus by 2 craniofacial and 2 maxillofacial surgeons. Residents and faculty members of plastic and maxillofacial surgery (n = 20) then placed an arch bar on the lower jaw of a skull model. Performances were video recorded without revealing identities. Two study groups were created based on subjects experience level: group 1 (n = 10) previously placed fewer than 25 arch bars; group 2 (n = 10) previously placed more than 25 arch bars. Two craniofacial surgeons used the ABPAS to blindly grade surgical performance.
  
  
  RESULTS
  The ABPAS consisted of a 48-point rating scale that included a 23-point task-specific work list and a 25-point global rating scale. Pearson coefficient showed limited intraobserver (P = 0.97) and interobserver (P = 0.95) variance of test scores. The ABPAS demonstrated superior performance in group 2 in the task-specific work list [12.6 (5.5) vs 17.6 (1.5), P = 0.02], global rating scale [17.4 (4.4) vs 22 (2.1), P = 0.01], and ABPAS score [30 (9.8) and 39.6 (3.2), P = 0.01].
  
  
  CONCLUSIONS
  The ABPAS is a novel measurement tool which assesses technical surgical skill and can identify surgical competency in arch bar placement and dental wire handling. This tool may have future use in residency training and continuing education.
authors.affiliation: From the *Division of Plastic Surgery, Riley Hospital for Children, Indiana University Medical Center, Indianapolis, IN; †Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada; and ‡Division of Oral and Maxillofacial Surgery, Indiana University School of Dentistry, Indianapolis, IN.
authors.forename: Roberto L
authors.initials: RL
authors.lastname: Flores
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Havlik
authors.forename: Matthew
authors.initials: M
authors.lastname: Choi
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Heidelman
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Bennett
authors.forename: Sunil
authors.initials: S
authors.lastname: Tholpady
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D005147:Facial Bones / Q000293:injuries* / Q000601:surgery*; D006801:Humans; D008437:Maxilla / Q000293:injuries / Q000601:surgery; D012886:Skull / Q000293:injuries / Q000601:surgery; D013518:Surgery, Plastic