title: Which Global Rating Scale? A Comparison of the ASSET, BAKSSS, and IGARS for the Assessment of Simulated Arthroscopic Skills.
abstract: BACKGROUND
  With the move to competency-based models of surgical training, a number of assessment methods have been developed. Of these, global rating scales have emerged as popular tools, and several are specific to the assessment of arthroscopic skills. Our aim was to determine which one of a group of commonly used global rating scales demonstrated superiority in the assessment of simulated arthroscopic skills.
  
  
  METHODS
  Sixty-three individuals of varying surgical experience performed a number of arthroscopic tasks on a virtual reality simulator (VirtaMed ArthroS). Performance was blindly assessed by two observers using three commonly used global rating scales used to assess simulated skills. Performance was also assessed by validated objective motion analysis.
  
  
  RESULTS
  All of the global rating scales demonstrated construct validity, with significant differences between each skill level and each arthroscopic task (p < 0.002, Mann-Whitney U test). Interrater reliability was excellent for each global rating scale. Correlations of global rating scale ratings with motion analysis were high and strong for each global rating scale when correlated with time taken (Spearman rho, -0.95 to -0.76; p < 0.001), and correlation with total path length was significant and moderately strong (Spearman rho, -0.94 to -0.64; p < 0.001).
  
  
  CONCLUSIONS
  No single global rating scale demonstrated superiority as an assessment tool.
  
  
  CONCLUSIONS
  For these commonly used arthroscopic global rating scales, none was particularly superior and any one score could therefore be used. Agreement on using a single score seems sensible, and it would seem unnecessary to develop further scales with the same domains for these purposes.
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom Rob.middleton@doctors.org.uk.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Middleton
authors.affiliation: Royal Berkshire Hospital, Reading, United Kingdom.
authors.forename: Mathew J
authors.initials: MJ
authors.lastname: Baldwin
authors.affiliation: Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom Department of Orthopaedics, Barts Health NHS Trust, London, United Kingdom.
authors.forename: Kash
authors.initials: K
authors.lastname: Akhtar
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.
authors.forename: Abtin
authors.initials: A
authors.lastname: Alvand
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Rees
mesh_terms: D001182:Arthroscopy / Q000009:adverse effects* / Q000379:methods; D002983:Clinical Competence; D003162:Competency-Based Education; D003198:Computer Simulation; D006785:Hospitals, University; D006801:Humans; D007719:Knee Joint / Q000473:pathology / Q000601:surgery*; D008953:Models, Anatomic; D015588:Observer Variation; D009985:Orthopedics / Q000193:education; D015203:Reproducibility of Results; D018709:Statistics, Nonparametric; D013647:Task Performance and Analysis; D014584:User-Computer Interface