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. 2015 Jan;209(1):132-9.
doi: 10.1016/j.amjsurg.2014.10.002. Epub 2014 Oct 22.

Use of decision-based simulations to assess resident readiness for operative independence

Anne-Lise D D'Angelo  1 , Elaine R Cohen  1 , Calvin Kwan  1 , Shlomi Laufer  2 , Caprice Greenberg  1 , Jacob Greenberg  1 , Douglas Wiegmann  3 , Carla M Pugh  4
Affiliations

Use of decision-based simulations to assess resident readiness for operative independence

Anne-Lise D D'Angelo et al. Am J Surg. 2015 Jan.

Abstract

Background: Recent literature has called into question resident readiness for operative independence at the end of general surgery training.

Methods: We used a simulation-based exit examination to assess resident readiness. Six chief residents performed 3 simulated procedures: bowel anastomosis, laparoscopic ventral hernia (LVH) repair, and pancreaticojejunostomy. Faculty assessed resident performance using task-specific checklists, Objective Structured Assessment of Technical Skills (OSATS), and final product analysis.

Results: Residents' individual task-specific checklist scores ranged from 25% to 100% across all 3 procedures. Mean OSATS scores ranged from 4.06 to 4.23/5.0. Residents scored significantly higher on "instrument knowledge" (mean = 4.78, standard deviation [SD] = 23) than "time and motion" (mean = 3.94, SD = .48, P = .025) and "ability to adapt to individual pathologic circumstances" (mean = 4.06, SD =.12, P = .002). Final product analysis revealed a range of errors, including incorrect technique and poor intraoperative planning.

Conclusions: Despite relatively high OSATS ratings, residents had a wide range of errors and procedure outcomes. Exit assessments using multiple evaluation metrics may improve awareness of residents' learning needs.

Keywords: Assessment; Exit assessment; Exit examination; Operative independence; Resident readiness; Surgical education.

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Figures

Figure 1
Figure 1
Laparoscopic ventral hernia (A), bowel anastomosis (B), and pancreaticojejunostomy (C) simulators.
Figure 2
Figure 2
Example of the created injury for the bowel anastomosis station.
See this image and copyright information in PMC

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