title: Quantitative and qualitative analysis of performance during advanced laparoscopic fellowship: a curriculum based on structured assessment and feedback.
abstract: BACKGROUND
  The objective of this study was to examine the acquisition of advanced laparoscopic technical and cognitive skills during a fellowship.
  
  
  METHODS
  During a yearlong fellowship, consecutive assessments were completed by a fellow and 1 attending for 3 advanced procedures. The Global Operative Assessment of Laparoscopic Skills, Objective Structured Assessment of Technical Skills, and procedure-specific rating tools and free-text feedback were used. Descriptive statistics, the t test, linear mixed-effects regression, and qualitative analysis of feedback were performed.
  
  
  RESULTS
  Seventy-six cases were included. Average ratings increased for each assessment area every month (P < .001). There were significant differences between ratings by assessors with more stringent ratings by the fellow. While the attending focused on efficiency and safety, the fellow focused on technical issues, with later expanded attention to advanced cognitive aspects.
  
  
  CONCLUSIONS
  These assessment tools can be used as a quantitative index to monitor fellows' learning curve. In combination with narrative feedback, such data can provide measures to direct improvement during self-directed learning.
authors.affiliation: Section of Minimally Invasive and Robotic Surgery, Department of Surgery, College of Medicine, University of Arizona, 1501 N Campbell Avenue, PO Box 245066, Tucson, AZ 85724-5066, USA; Department of Surgery, University of North Carolina, Chapel Hill, NC, USA. Electronic address: iman.ghaderi@gmail.com.
authors.forename: Iman
authors.initials: I
authors.lastname: Ghaderi
authors.affiliation: Department of Surgery, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Lauriane
authors.initials: L
authors.lastname: Auvergne
authors.affiliation: Department of Medical Education, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: Yoon Soo
authors.initials: YS
authors.lastname: Park
authors.affiliation: Department of Surgery, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Farrell
mesh_terms: D002983:Clinical Competence; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000379:methods*; D030141:Feedback, Psychological; D005257:Fellowships and Scholarships; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D059032:Learning Curve; D016014:Linear Models; D009657:North Carolina; D011446:Prospective Studies; D036301:Qualitative Research; D012647:Self-Assessment
keywords: Assessment; Feedback; Instruction; Laparoscopic surgery fellowship; Operative performance analysis; Reflective practice