title: Use of decision-based simulations to assess resident readiness for operative independence.
abstract: BACKGROUND
  Recent literature has called into question resident readiness for operative independence at the end of general surgery training.
  
  
  METHODS
  We used a simulation-based exit examination to assess resident readiness. Six chief residents performed 3 simulated procedures: bowel anastomosis, laparoscopic ventral hernia (LVH) repair, and pancreaticojejunostomy. Faculty assessed resident performance using task-specific checklists, Objective Structured Assessment of Technical Skills (OSATS), and final product analysis.
  
  
  RESULTS
  Residents' individual task-specific checklist scores ranged from 25% to 100% across all 3 procedures. Mean OSATS scores ranged from 4.06 to 4.23/5.0. Residents scored significantly higher on "instrument knowledge" (mean = 4.78, standard deviation [SD] = 23) than "time and motion" (mean = 3.94, SD = .48, P = .025) and "ability to adapt to individual pathologic circumstances" (mean = 4.06, SD =.12, P = .002). Final product analysis revealed a range of errors, including incorrect technique and poor intraoperative planning.
  
  
  CONCLUSIONS
  Despite relatively high OSATS ratings, residents had a wide range of errors and procedure outcomes. Exit assessments using multiple evaluation metrics may improve awareness of residents' learning needs.
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue H4/385A CSC, Madison, WI 53792-3236, USA.
authors.forename: Anne-Lise D
authors.initials: AL
authors.lastname: D'Angelo
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue H4/385A CSC, Madison, WI 53792-3236, USA.
authors.forename: Elaine R
authors.initials: ER
authors.lastname: Cohen
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue H4/385A CSC, Madison, WI 53792-3236, USA.
authors.forename: Calvin
authors.initials: C
authors.lastname: Kwan
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue H4/385A CSC, Madison, WI 53792-3236, USA; Department of Electrical Engineering and Computer Science, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: Shlomi
authors.initials: S
authors.lastname: Laufer
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue H4/385A CSC, Madison, WI 53792-3236, USA.
authors.forename: Caprice
authors.initials: C
authors.lastname: Greenberg
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue H4/385A CSC, Madison, WI 53792-3236, USA.
authors.forename: Jacob
authors.initials: J
authors.lastname: Greenberg
authors.affiliation: Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Wiegmann
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue H4/385A CSC, Madison, WI 53792-3236, USA; Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA. Electronic address: pugh@surgery.wisc.edu.
authors.forename: Carla M
authors.initials: CM
authors.lastname: Pugh
mesh_terms: D057189:Checklist; D002983:Clinical Competence; D003198:Computer Simulation; D003657:Decision Making; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D017145:Models, Educational; D017009:Professional Autonomy; D013647:Task Performance and Analysis; D014922:Wisconsin
keywords: Assessment; Exit assessment; Exit examination; Operative independence; Resident readiness; Surgical education