title: A systematic review of performance assessment tools for laparoscopic cholecystectomy.
abstract: BACKGROUND
  Multiple tools are available to assess clinical performance of laparoscopic cholecystectomy (LC), but there are no guidelines on how best to implement and interpret them in educational settings. The purpose of this systematic review was to identify and critically appraise LC assessment tools and their measurement properties, in order to make recommendations for their implementation in surgical training.
  
  
  METHODS
  A systematic search (1989-2013) was conducted in MEDLINE, Embase, Scopus, Cochrane, and grey literature sources. Evidence for validity (content, response process, internal structure, relations to other variables, and consequences) and the conditions in which the evidence was obtained were evaluated.
  
  
  RESULTS
  A total of 54 articles were included for qualitative synthesis. Fifteen technical skills and two non-technical skills assessment tools were identified. The 17 tools were used for either: recorded procedures (nine tools, 60%), direct observation (five tools, 30%), or both (three tools, 18%). Fourteen (82%) tools reported inter-rater reliability and one reported a Generalizability Theory coefficient. Nine (53%) had evidence for validity based on clinical experience and 11 (65%) compared scores to other assessments. Consequences of scores, educational impact, applications to residency training, and how raters were trained were not clearly reported. No studies mentioned cost.
  
  
  CONCLUSIONS
  The most commonly reported validity evidence was inter-rater reliability and relationships to other known variables. Consequences of assessments and rater training were not clearly reported. These data and the evidence for validity should be taken into consideration when deciding how to select and implement a tool to assess performance of LC, and especially how to interpret the results.
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650, Cedar Avenue, L9. 316, Montreal, QC, H3G 1A4, Canada. ywatanabe328@gmail.com.|Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan. ywatanabe328@gmail.com.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Watanabe
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650, Cedar Avenue, L9. 316, Montreal, QC, H3G 1A4, Canada.
authors.forename: Elif
authors.initials: E
authors.lastname: Bilgic
authors.affiliation: The Henry K.M. De Kuyper Education Centre, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Ekaterina
authors.initials: E
authors.lastname: Lebedeva
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650, Cedar Avenue, L9. 316, Montreal, QC, H3G 1A4, Canada.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: McKendy
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650, Cedar Avenue, L9. 316, Montreal, QC, H3G 1A4, Canada.
authors.forename: Liane S
authors.initials: LS
authors.lastname: Feldman
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650, Cedar Avenue, L9. 316, Montreal, QC, H3G 1A4, Canada.
authors.forename: Gerald M
authors.initials: GM
authors.lastname: Fried
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650, Cedar Avenue, L9. 316, Montreal, QC, H3G 1A4, Canada. melina.vassiliou@mcgill.ca.
authors.forename: Melina C
authors.initials: MC
authors.lastname: Vassiliou
mesh_terms: D017081:Cholecystectomy, Laparoscopic / Q000592:standards*; D002983:Clinical Competence; D006801:Humans; D011785:Quality Assurance, Health Care; D015203:Reproducibility of Results
keywords: Cholecystectomy; Clinical competence; Laparoscopy; Reliability; Validity; Workplace-based assessment