In:
ANZ Journal of Surgery, Wiley, Vol. 88, No. 5 ( 2018-05)
Abstract:
Training in medicine must move to an outcome‐based approach. A proficiency‐based progression outcome approach to training relies on a quantitative estimation of experienced operator performance. We aimed to develop a method for dealing with atypical expert performances in the quantitative definition of surgical proficiency. Methods In study one, 100 experienced laparoscopic surgeons’ performances on virtual reality and box‐trainer simulators were assessed for two similar laparoscopic tasks. In study two, 15 experienced surgeons and 16 trainee colorectal surgeons performed one simulated hand‐assisted laparoscopic colorectal procedure. Performance scores of experienced surgeons in both studies were standardized (i.e. Z ‐scores) using the mean and standard deviations (SDs). Performances 〉 1.96 SDs from the mean were excluded in proficiency definitions. Results In study one, 1–5% of surgeons’ performances were excluded having performed significantly below their colleagues. Excluded surgeons made significantly fewer correct incisions (mean = 7 (SD = 2) versus 19.42 (SD = 4.6), P 〈 0.0001) and a greater proportion of incorrect incisions (mean = 45.71 (SD = 10.48) versus 5.25 (SD = 6.6), P 〈 0.0001). In study two, one experienced colorectal surgeon performance was 〉 4 SDs for time to complete the procedure and 〉 6 SDs for path length. After their exclusions, experienced surgeons’ performances were significantly better than trainees for path length: P = 0.031 and for time: P = 0.002. Conclusion Objectively assessed atypical expert performances were few. Z ‐score standardization identified them and produced a more robust quantitative definition of proficiency.
Type of Medium:
Online Resource
ISSN:
1445-1433
,
1445-2197
DOI:
10.1111/ans.2018.88.issue-5
Language:
English
Publisher:
Wiley
Publication Date:
2018
detail.hit.zdb_id:
2095927-8
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