• Eur J Cardiothorac Surg · Jul 2005

    Objective assessment of technical skills in cardiac surgery.

    • Julian Hance, Rajesh Aggarwal, Rex Stanbridge, Christopher Blauth, Yaron Munz, Ara Darzi, and John Pepper.
    • Department of Surgical Oncology and Technology, Imperial College London, 10th Floor QEQM Building, St Mary's Hospital, Praed Street, London, UK. jhance@imperial.ac.uk
    • Eur J Cardiothorac Surg. 2005 Jul 1; 28 (1): 157-62.

    ObjectiveReduced training time combined with no rigorous assessment for technical skills makes it difficult for trainees to monitor their competence. We have developed an objective bench-top assessment of technical skills at a level commensurate with a junior registrar in cardiac surgery.MethodsForty cardiothoracic surgeons were recruited for the study, consisting of 12 junior trainees (year 1-3), 15 senior trainees (year 4-6) and 13 consultants. The assessment consisted of four key tasks on standardised bench-top models: aortic root cannulation, vein-graft to aorta anastomosis, vein-graft to Left Anterior Descending (LAD) anastomosis and femoral triangle dissection. An expert surgeon was present at each station to provide passive assistance and rate performance on a validated global rating scale giving rise to a total possible score of 40. Three expert surgeons repeated the ratings retrospectively, using blinded video recordings. Data analysis employed non-parametric tests.ResultsBoth live and video scores differentiated significantly between performances of all groups of surgeons for all four stations (P < 0.01) (median live and video score for LAD; Junior 19,17; Senior 29,22; Consultant 36,28). Correlations between live and blinded rating were high (r = 0.67-0.84; P < 0.001) as was inter-rater reliability between the three expert video raters (alpha = 0.81).ConclusionsThe use of bench-top tasks to differentiate between cardiac surgeons of differing technical abilities has been validated for the first time. Furthermore, it is unnecessary to perform post-hoc video rating to obtain objective data. These measures can provide formative feedback for surgeons-in-training and lead to the development of a competency-based technical skills curriculum.

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