Shortcut assessment: Can residents' operative performance be determined in the first five minutes of an operative task?

Abstract

Background: The aim was to validate the potential use of a single, early procedure, operative task as a predictive metric for overall performance. The authors hypothesized that a shortcut psychomotor assessment would be as informative as a total procedural psychomotor assessment when evaluating laparoscopic ventral hernia repair performance on a simulator.

Methods: Using electromagnetic sensors, hand motion data were collected from 38 surgery residents during a simulated laparoscopic ventral hernia repair procedure. Three time-based phases of the procedure were defined: Early Phase (start time through completion of first anchoring suture), Mid Phase (start time through completion of second anchoring suture), and Total Operative Time. Correlations were calculated comparing time and motion metrics for each phase with the final laparoscopic ventral hernia repair score.

Results: Analyses revealed that execution time and motion, for the first anchoring suture, predicted procedural outcomes. Greater execution times and path lengths correlated to lesser laparoscopic ventral hernia repair scores (r = -0.56, P = .0008 and r = -0.51, P = .0025, respectively). Greater bimanual dexterity measures correlated to Greater LVH repair scores (r = + 0.47, P = .0058).

Conclusions: This study provides validity evidence for use of a single, early operative task as a shortcut assessment to predict resident performance during a simulated laparoscopic ventral hernia repair procedure. With the continued development and decreasing costs of motion technology, faculty should be well-versed in the use of motion metrics for performance measurements. The results strongly support the use of dexterity and economy of motion (path length + execution time) metrics as early predictors of operative performance.