title: Validity and reliability of global operative assessment of laparoscopic skills (GOALS) in novice trainees performing a laparoscopic cholecystectomy.
abstract: OBJECTIVE
  Global Operative Assessment of Laparoscopic Skills (GOALS) assessment has been designed to evaluate skills in laparoscopic surgery. A longitudinal blinded study of randomized video fragments was conducted to estimate the validity and reliability of GOALS in novice trainees.
  
  
  METHODS
  In total, 10 trainees each performed 6 consecutive laparoscopic cholecystectomies. Sixty procedures were recorded on video. Video fragments of (1) opening of the peritoneum; (2) dissection of Calot's triangle and achievement of critical view of safety; and (3) dissection of the gallbladder from the liver bed were blinded, randomized, and rated by 2 consultant surgeons using GOALS. Also, a grade was given for overall competence. The correlation of GOALS with live observation Objective Structured Assessment of Technical Skills (OSATS) scores was calculated. Construct validity was estimated using the Friedman 2-way analysis of variance by ranks and the Wilcoxon signed-rank test. The interrater reliability was calculated using the absolute and consistency agreement 2-way random-effects model intraclass correlation coefficient.
  
  
  RESULTS
  A high correlation was found between mean GOALS score (r = 0.879, p = 0.021) and mean OSATS score. The GOALS score increased significantly across the 6 procedures (p = 0.002). The trainees performed significantly better on their sixth when compared with their first cholecystectomy (p = 0.004). The consistency agreement interrater reliability was 0.37 for the mean GOALS score (p = 0.002) and 0.55 for overall competence (p < 0.001) of the 3 video fragments.
  
  
  CONCLUSIONS
  The validity observed in this randomized blinded longitudinal study supports the existing evidence that GOALS is a valid tool for assessment of novice trainees. A relatively low reliability was found in this study.
authors.affiliation: Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands. Electronic address: k.h.kramp@gmail.com.
authors.forename: Kelvin H
authors.initials: KH
authors.lastname: Kramp
authors.affiliation: Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands; Department of Surgery, Hospital Group Twente, Almelo, The Netherlands.
authors.forename: Marc J
authors.initials: MJ
authors.lastname: van Det
authors.affiliation: Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands.
authors.forename: Christiaan
authors.initials: C
authors.lastname: Hoff
authors.affiliation: Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
authors.forename: Bas
authors.initials: B
authors.lastname: Lamme
authors.affiliation: Department of Epidemiology, Medical Center Leeuwarden, Leeuwarden, The Netherlands; Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Nic J G M
authors.initials: NJ
authors.lastname: Veeger
authors.affiliation: Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands; Post Graduate School of Medicine, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Jean-Pierre E N
authors.initials: JP
authors.lastname: Pierie
mesh_terms: D017081:Cholecystectomy, Laparoscopic / Q000193:education*; D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000379:methods*; D004521:Educational Measurement; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D008137:Longitudinal Studies; D008297:Male; D009426:Netherlands; D015203:Reproducibility of Results; D016037:Single-Blind Method; D018709:Statistics, Nonparametric; D014741:Video Recording
keywords: Interpersonal and Communication Skills; Practice-Based Learning and Improvement; Systems-Based Practice; assessment; laparoscopic cholecystectomy; laparoscopy; trainee; videotape recording