title: Strategies for increasing the feasibility of performance assessments during competency-based education: Subjective and objective evaluations correlate in the operating room.
abstract: BACKGROUND
  Competency-based education necessitates assessments that determine whether trainees have acquired specific competencies. The evidence on the ability of internal raters (staff surgeons) to provide accurate assessments is mixed; however, this has not yet been directly explored in the operating room. This study's objective is to compare the ratings given by internal raters vs an expert external rater (independent to the training process) in the operating room.
  
  
  METHODS
  Raters assessed general surgery residents during a laparoscopic cholecystectomy for their technical and nontechnical performance.
  
  
  RESULTS
  Fifteen cases were observed. There was a moderately positive correlation (rs= .618, P = .014) for technical performance and a strong positive correlation (rs= .731, P = .002) for nontechnical performance. The internal raters were less stringent for technical (mean rank 3.33 vs 8.64, P = .007) and nontechnical (mean rank 3.83 vs 8.50, P = .01) performances.
  
  
  CONCLUSIONS
  This study provides evidence to help operationalize competency-based assessments.
authors.affiliation: Department of Surgery, St. Michael's Hospital, Toronto, Canada. Electronic address: peter.szasz@utoronto.ca.
authors.forename: Peter
authors.initials: P
authors.lastname: Szasz
authors.affiliation: Department of Surgery, St. Michael's Hospital, Toronto, Canada.
authors.forename: Marisa
authors.initials: M
authors.lastname: Louridas
authors.affiliation: Royal College Physicians and Surgeons of Canada, Ottawa, Canada.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Harris
authors.affiliation: Department of Surgery, St. Michael's Hospital, Toronto, Canada.
authors.forename: Teodor P
authors.initials: TP
authors.lastname: Grantcharov
mesh_terms: D017081:Cholecystectomy, Laparoscopic / Q000592:standards*; D002983:Clinical Competence; D003162:Competency-Based Education; D005240:Feasibility Studies; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D009873:Operating Rooms; D000066477:Work Performance
keywords: Competency-based assessment; Competency-based education; Formative assessment; General surgery; Residents; Summative assessment