title: Developing an Objective Structured Assessment of Technical Skills for Laparoscopic Suturing and Intracorporeal Knot Tying.
abstract: OBJECTIVE
  To develop a teaching and assessment tool for laparoscopic suturing and intracorporeal knot tying.
  
  
  METHODS
  We designed an Objective Structured Assessment of Technical Skills (OSATS) tool that includes a procedure-specific checklist (PSC) and global rating scale (GRS) to assess laparoscopic suturing and intracorporeal knot-tying performance. Obstetrics and Gynecology residents at our institution were videotaped while performing a laparoscopic suturing and intracorporeal knot-tying task at a surgical simulation workshop. A total of 2 expert reviewers assessed resident performance using the OSATS tool during live performance and 1 month later using the videotaped recordings. OSATS scores were analyzed using the Wilcoxon rank-sum test. Data are presented as median scores (interquartile range [IQR]). Intrarater and interrater reliabilities were assessed using a Spearman correlation and are presented as an r correlation coefficient and p value. An r ≥ 0.8 was considered as a high correlation. After testing, we received feedback from residents and faculty to improve the OSATS tool as part of an iterative design process.
  
  
  METHODS
  In all, 14 of 21 residents (66.7%) completed the study, with 9 junior residents and 5 senior residents.
  
  
  RESULTS
  Junior residents had a lower score on the PSC than senior residents did; however, this was not statistically significant (median = 6.0 [IQR: 4.0-10.0] and median = 13.0 [IQR: 10.0-13.0]; p = 0.09). There was excellent intrarater reliability with our OSATS tool (for PSC component, r = 0.88 for Rater 1 and 0.93 for Rater 2, both p < 0.0001; for GRS component, r = 0.85 for Rater 1 and 0.88 for Rater 2, both p ≤ 0.0002). The PSC also has high interrater reliability during live evaluation (r = 0.92; p < 0.0001), and during the videotape scoring with r = 0.77 (p = 0.001).
  
  
  CONCLUSIONS
  Our OSATS tool may be a useful assessment and teaching tool for laparoscopic suturing and intracorporeal knot-tying skills. Overall, good intrarater reliability was demonstrated, suggesting that this tool may be useful for longitudinal assessment of surgical skills.
authors.affiliation: Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Departmentof Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts.
authors.forename: Olivia H
authors.initials: OH
authors.lastname: Chang
authors.affiliation: Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Departmentof Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts.
authors.forename: Louise P
authors.initials: LP
authors.lastname: King
authors.affiliation: Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Modest
authors.affiliation: Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Departmentof Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts. Electronic address: hhur@bidmc.harvard.edu.
authors.forename: Hye-Chun
authors.initials: HC
authors.lastname: Hur
mesh_terms: D002983:Clinical Competence; D004503:Education, Medical, Graduate; D004521:Educational Measurement / Q000379:methods*; D005260:Female; D006176:Gynecology / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000193:education*; D009774:Obstetrics / Q000193:education*; D000066908:Simulation Training; D013536:Suture Techniques / Q000193:education*; D014743:Videotape Recording
keywords: Objective Structured Assessment of Technical Skills (OSATS); Practice-Based Learning and Improvement; intracorporeal knot tying; laparoscopic suturing; surgical education