Introduction. There is an on going demand for Plastic surgeons to demonstrate that they can operate well, maintain their performance and deliver acceptable results. The acquisition of surgical competence and dexterity is a fundamental part of good surgery and must be one of the main objectives in a surgeon’s training. There is also increasing pressure from the Government to introduce testing of surgical competency for all surgeons. Currently surgeons are assessed by a series of subjective and peer reviewed interviews, but at no stage is the objective assessment of surgical competence measured. It is believed that a system where the trainees are assessed as they perform specific tasks may produce a more accurate reflection of their ability than a trainer’s subjective evaluation. We have introduced objective assessment of an array of key tasks in plastic surgery, which will be used to assess technical ability.
Method. A range of Plastic surgeons with differing surgical skill were tested. They performed three tasks designed to assess their ability to suture skin, take a medium thickness skin graft and repair a tendon. The candidates were videoed during the procedures and they were scored by four independent observers using the OSATS scoring system. Their movements were also monitored using an electromagnetic tracking system. Their performance was also then included in a normogram of scores versus skill level.
Results. Sixty-five candidates were tested with an experience range from consultant to junior SHO. Results showed significant differences in technical ability between all levels of seniority. Suturing gave a p value of <0.001, skin grafting gave a p value of 0.021; tendon repair gave a p value of 0.031 with consultants performing the tasks with greater competency than their juniors. Inter-relater reliability using Cronbach’s alpha=0.89.
Discussion. These tasks show that technical ability can be objectively assessed. The use of objective, structured assessment with feedback allows the deficiencies of the trainee to be highlighted early and therefore corrected early. It can therefore be seen that the tasks give us the ability to not only measure the technical competence of an individual, but also to allow instruction on the technique and then the ability to see an improvement in their technique and level of competence. These tasks have also been shown to exhibit face, construct and concurrent validity.
Conclusion. We have demonstrated a valid and reliable method of objectively measuring the surgical skill of Plastic surgeons. This array of tests generates normograms of plastic surgical competence that predicts levels of skill. This has important implications for the future of surgical training, in that it allows us to identify whether the fundamentals of surgical technique have been passed on to the trainee, and to continually monitor their progress. These tests can therefore be used to objectively measure technical skill before, during and after plastic surgical training and may also be used for a revalidation program.
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