Efforts Seek to Develop Systematic Ways to Objectively Assess Surgeons’ Skills
Authors: Tracy Hampton
Journal: JAMA (2015)

Imagine a surgeon is hired based on strong professional recommendations and qualifications, yet subsequent to being hired,many of the surgeon’s patients arereadmittedtotheclinicwithseriouspostoperative complications. It is later discoveredthat thesurgeon lackssufficientmanual dexterity and was therefore making critical technical errorsduringsurgery thatcompromised surgical success and patient health. Suchanoccurrence, thoughsurprising, isnot unheard of. Surgical skills, which include both technical and nontechnical abilities, are often acquired through an apprenticeshipbased system that hasn’t changed considerably over the past century. Although there are systematic processes to assess competencies during training, certification, and recertification of surgeons, they tend to be subjective, inconsistent, and focused primarily on nontechnical skills. This can lead to high variability in surgical performance across surgical specialties, potentially compromising patient care and introducing ethical quandaries. To address the issue, experts have initiatedefforts todevelopand implementobjective, standardized methods for surgical training and assessment of technical surgical skills. Undoubtedly, better skillswill lead to improved patient care and more effective and efficient health care, which will ultimately benefit physicians, patients, and payers. Designing Standards for Residency Training Inadequate assessment of technical surgical skills has been an ongoing topic of debate, and like all aspects of quality of patient care, it has been under increasing scrutiny in recent years (Moorthy K et al. BMJ. 2003;327[7422]:1032-1037; vanHove PD et al. Br J Surg. 2010;97[7]:972-987). “Current assessment of operative skills is based partly on the numbers of procedures that residents participate in without establishing their level of involvement and performance in the case,” said Jonathan Fryer,MD, a professor of surgery and transplantationatNorthwesternUniversityFeinberg School of Medicine, in Chicago. “Faculty assessment of a resident’s overall surgical performance is commonlydone remotelywhenmemorydecay canbeamajor factor.” Rajesh Aggarwal, MD, PhD, who directs the Arnold and Blema Steinberg Medical Simulation Centre at McGill University in Montreal, Canada, and received his surgical training in London, agreed that most countries use references and reports on residents that are subjective, and there’s no guarantee that having to perform a certain number of surgeries will lead to adequate skills. “Quantity doesn’t equal quality,” he said. “But there are efforts to change these things [competency standards], and residency is different today from just 5 years ago.” The focus of assessing residents’ skills in surgery, as well as in other areas of medicine, is evolving into a milestones paradigm, in which trainees are evaluated on whether they have achieved structured learning goals at different points in their education and whether they are progressing toward autonomy with each procedure; however, this often requires more work by busy surgeons who perform resident evaluations. To address this challenge, Fryer and his colleagues have developed the Procedural Autonomy and Supervision System (PASS), which uses what’s called the A variety of research efforts and clinical programs are aimed at developing objective, standardized methods for surgical training and assessment. Medical News&Perspectives .......p782