Surgical Skill Evaluation of Trainees

We surveyed all operations, in which postgraduate year 3, 4, and 5 surgical trainees participated as the main surgeon or as the first assistant in Hiroshima City Asa Hospital, between January, 2007 and December, 2010. The surgical skills were evaluated using the global rating scale of the OSATS (Fig. 1).Fig. 1

The global rating scale used in the Objective Structured Assessment of Technical Skills (OSATS) [2 (link)], which we used to score the skills of each surgical trainee in performing or assisting in real operations. Full marks are 35 points on 7 items and 30 points on 6 items, respectively, as a surgeon and as an assistant (in the case of assistant, ‘Use of Assistant’ is excluded from the scoring)

Operations were classified according to whether the trainee was acting as the surgeon or the first assistant and were based on the level of difficulty of the surgical procedure. The surgical procedures were arbitrarily classified into three groups (Table 1). The scores of each trainee evaluated with the global rating scale were collected and studied in relation to each postgraduate year.Table 1

Example of the operation classification according to the degree of difficulty

Degree of difficulty	Operations
Low	Thyroidectomy
	Breast surgery
	Bullectomy, VATS
	Appendectomy (open or lap.)
	Inguinal hernioplasty
Intermediate	Open lung surgery (such as lobectomy)
	Open distal gastrectomy
	Lap. local resection of the stomach
	Open colectomy
	Lap. cholecystectomy
	Distal pancreatectomy
High	Esophagectomy
	Lobectomy of lung (VATS)
	Open or lap. total gastrectomy
	Lap. distal gastrectomy
	Lap. colectomy
	Open or lap. proctectomy
	Hepatectomy
	Pancreatoduodenectomy

Evaluations were carried out by staff surgeons who participated in the operation in a supervisory role, rather than as a third-party evaluator who watched the operation or its video, because the main purpose of our method was to educate based on feedback, rather than to simply evaluate. To ensure objectivity of the evaluation, before starting this assessment system, all evaluators watched three videos of laparoscopic cholecystectomy being performed by three different trainees, and made a standard matching of the scores.
The scores of each trainee were analyzed as the median during each of nine terms, being the first term (from April to July), second term (from August to November), and third term (from December to March) in each postgraduate year. To examine the correlation between the postgraduate year and the surgical skill evaluated by the global rating scale, the scores in the second term of each year were statistically analyzed as follows: The Kruskal–Wallis test was used to compare the three groups and the Mann–Whitney U test was used to compare differences between two groups. Analyses were performed using the SPSS software application and p values <0.05 and 0.05/3 were considered to indicate significance.