title: Assessment of surgery residents' operative skills in the operating theater using a modified Objective Structured Assessment of Technical Skills (OSATS): a prospective multicenter study.
abstract: BACKGROUND
  With the implementation of competency-based curricula, Objective Structured Assessment of Technical Skills (OSATS) increasingly is being used for the assessment of operative skills. Although evidence for its usefulness has been demonstrated in experimental study designs, data supporting OSATS application in the operating room are limited. This study evaluates the validity and reliability of the OSATS instrument to assess the operative skills of surgery residents in the operating theater.
  
  
  METHODS
  Twenty-four residents were recruited from seven hospitals within a general surgical training region and classified equally into three groups according to postgraduate training year (PGY). Each resident had to perform five different types of operations. Surgical performance was measured using a modified OSATS consisting of three scales: Global Rating Scale, Overall Performance Scale, and Alphabetic Summary Scale. Validity and reliability metrics included construct validity (Kruskal-Wallis test) and internal consistency reliability (Cronbach's α coefficient). Spearman's correlation coefficients were calculated to determine correlations between the different scales.
  
  
  RESULTS
  Eighteen residents (PGY 1-2 [n = 7]; PGY 3-4 [n = 8]; PGY 5-6 [n = 3]) performed 249 operations. Comparisons of the performance scores revealed that evidence for construct validity depended on the difficulty level of the selected procedures. For individual operations, internal consistency reliability of the Global Rating Scale ranged from 0.93 to 0.95. Scores on the different scales correlated strongly (r = 0.62-0.76, P < .001).
  
  
  CONCLUSIONS
  Assessment of operative skills in the operating theater using this modified OSATS instrument has the potential to establish learning curves, allowing adequate monitoring of residents' progress in achieving operative competence. The Alphabetic Summary Scale seems to be of additional value. Use of the Overall Performance Scale should be reconsidered.
authors.affiliation: Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands. Electronic address: c.hopmans@erasmusmc.nl.
authors.forename: Cornelis J
authors.initials: CJ
authors.lastname: Hopmans
authors.affiliation: Department of Surgery, Ikazia Hospital, Rotterdam, The Netherlands.
authors.forename: Pieter T
authors.initials: PT
authors.lastname: den Hoed
authors.affiliation: Department of Surgery, Amphia Hospital, Breda, The Netherlands.
authors.forename: Lijckle
authors.initials: L
authors.lastname: van der Laan
authors.affiliation: Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands.
authors.forename: Erwin
authors.initials: E
authors.lastname: van der Harst
authors.affiliation: Department of Surgery, Reinier de Graaf Groep, Delft, The Netherlands.
authors.forename: Maarten
authors.initials: M
authors.lastname: van der Elst
authors.affiliation: Department of Surgery, Sint Franciscus Gasthuis, Rotterdam, The Netherlands.
authors.forename: Guido H H
authors.initials: GH
authors.lastname: Mannaerts
authors.affiliation: Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, The Netherlands.
authors.forename: Imro
authors.initials: I
authors.lastname: Dawson
authors.affiliation: Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: Reinier
authors.initials: R
authors.lastname: Timman
authors.affiliation: Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: Bas P L
authors.initials: BP
authors.lastname: Wijnhoven
authors.affiliation: Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: Jan N M
authors.initials: JN
authors.lastname: IJzermans
mesh_terms: D001943:Breast Neoplasms / Q000601:surgery; D017081:Cholecystectomy, Laparoscopic / Q000592:standards; D002983:Clinical Competence; D004521:Educational Measurement / Q000379:methods*; D013502:General Surgery / Q000193:education* / Q000592:standards; D059685:Herniorrhaphy / Q000592:standards; D006620:Hip Fractures / Q000601:surgery; D006801:Humans; D007396:Internship and Residency; D011446:Prospective Studies