title: Crowd-Sourced Assessment of Technical Skills: a novel method to evaluate surgical performance.
abstract: BACKGROUND
  Validated methods of objective assessments of surgical skills are resource intensive. We sought to test a web-based grading tool using crowdsourcing called Crowd-Sourced Assessment of Technical Skill.
  
  
  METHODS
  Institutional Review Board approval was granted to test the accuracy of Amazon.com's Mechanical Turk and Facebook crowdworkers compared with experienced surgical faculty grading a recorded dry-laboratory robotic surgical suturing performance using three performance domains from a validated assessment tool. Assessor free-text comments describing their rating rationale were used to explore a relationship between the language used by the crowd and grading accuracy.
  
  
  RESULTS
  Of a total possible global performance score of 3-15, 10 experienced surgeons graded the suturing video at a mean score of 12.11 (95% confidence interval [CI], 11.11-13.11). Mechanical Turk and Facebook graders rated the video at mean scores of 12.21 (95% CI, 11.98-12.43) and 12.06 (95% CI, 11.57-12.55), respectively. It took 24 h to obtain responses from 501 Mechanical Turk subjects, whereas it took 24 d for 10 faculty surgeons to complete the 3-min survey. Facebook subjects (110) responded within 25 d. Language analysis indicated that crowdworkers who used negation words (i.e., "but," "although," and so forth) scored the performance more equivalently to experienced surgeons than crowdworkers who did not (P < 0.00001).
  
  
  CONCLUSIONS
  For a robotic suturing performance, we have shown that surgery-naive crowdworkers can rapidly assess skill equivalent to experienced faculty surgeons using Crowd-Sourced Assessment of Technical Skill. It remains to be seen whether crowds can discriminate different levels of skill and can accurately assess human surgery performances.
authors.affiliation: University of Washington, School of Medicine, Seattle, Washington.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Chen
authors.affiliation: Department of Bioengineering, University of Washington, Seattle, Washington.
authors.forename: Lee
authors.initials: L
authors.lastname: White
authors.affiliation: Department of Mechanical Engineering, University of Minnesota, Seattle, Washington.
authors.forename: Timothy
authors.initials: T
authors.lastname: Kowalewski
authors.affiliation: Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Aggarwal
authors.affiliation: Department of Physics, University of Oxford, Oxford, United Kingdom.
authors.forename: Chris
authors.initials: C
authors.lastname: Lintott
authors.affiliation: Department of Biostatistics, University of Washington, Seattle, Washington.
authors.forename: Bryan
authors.initials: B
authors.lastname: Comstock
authors.affiliation: Department of Computer Science Engineering, University of Washington, Seattle, Washington.
authors.forename: Katie
authors.initials: K
authors.lastname: Kuksenok
authors.affiliation: Department of Computer Science Engineering, University of Washington, Seattle, Washington.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Aragon
authors.affiliation: University of Washington, School of Medicine, Seattle, Washington. Electronic address: dholst12@gmail.com.
authors.forename: Daniel
authors.initials: D
authors.lastname: Holst
authors.affiliation: Department of Urology, University of Washington, Seattle Children's Hospital, Seattle, Washington.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lendvay
mesh_terms: D000328:Adult; D003162:Competency-Based Education / Q000379:methods* / Q000592:standards; D063045:Crowdsourcing / Q000379:methods* / Q000592:standards; D003625:Data Collection; D003867:Depth Perception; D004521:Educational Measurement / Q000379:methods* / Q000592:standards; D013502:General Surgery / Q000193:education*; D006801:Humans; D020407:Internet; D007396:Internship and Residency / Q000379:methods / Q000592:standards; D012015:Reference Standards; D012371:Robotics / Q000193:education*; D013536:Suture Techniques / Q000193:education; D055815:Young Adult
keywords: Crowdsourcing; Education; GEARS; OSATS; Robotic surgery; Training