Passing a Technical Skills Examination in the First Year of Surgical Residency Can Predict Future Performance

Medical specialty certification exams studied according to the Ottawa Quality Criteria: a systematic review

BACKGROUND

Medical specialty certification exams are high-stakes summative assessments used to determine which doctors have the necessary skills, knowledge, and attitudes to treat patients independently. Such exams are crucial for patient safety, candidates' career progression and accountability to the public, yet vary significantly among medical specialties and countries. It is therefore of paramount importance that the quality of specialty certification exams is studied in the scientific literature.

METHODS

In this systematic literature review we used the PICOS framework and searched for papers concerning medical specialty certification exams published in English between 2000 and 2020 in seven databases using a diverse set of search term variations. Papers were screened by two researchers independently and scored regarding their methodological quality and relevance to this review. Finally, they were categorized by country, medical specialty and the following seven Ottawa Criteria of good assessment: validity, reliability, equivalence, feasibility, acceptability, catalytic and educational effect.

RESULTS

After removal of duplicates, 2852 papers were screened for inclusion, of which 66 met all relevant criteria. Over 43 different exams and more than 28 different specialties from 18 jurisdictions were studied. Around 77% of all eligible papers were based in English-speaking countries, with 55% of publications centered on just the UK and USA. General Practice was the most frequently studied specialty among certification exams with the UK General Practice exam having been particularly broadly analyzed. Papers received an average of 4.2/6 points on the quality score. Eligible studies analyzed 2.1/7 Ottawa Criteria on average, with the most frequently studied criteria being reliability, validity, and acceptability.

CONCLUSIONS

The present systematic review shows a growing number of studies analyzing medical specialty certification exams over time, encompassing a wider range of medical specialties, countries, and Ottawa Criteria. Due to their reliance on multiple assessment methods and data-points, aspects of programmatic assessment suggest a promising way forward in the development of medical specialty certification exams which fulfill all seven Ottawa Criteria. Further research is needed to confirm these results, particularly analyses of examinations held outside the Anglosphere as well as studies analyzing entire certification exams or comparing multiple examination methods.

Competency-Based Education in Minimally Invasive and Robotic Colorectal Surgery

Minimally invasive and robotic techniques have become increasingly implemented into surgical practice and are now an essential part of the foundational skills of training colorectal surgeons. Over the past 5 years there has been a shift in the surgical educational paradigm toward competency-based education (CBE). CBE recognizes that trainees learn at different rates but regardless, are required to meet a competent threshold of performance prior to independent practice. Thus, CBE attempts to replace the traditional "time" endpoint of training with "performance." Although conceptually sensible, implementing CBE has proven challenging. This article will define competence, outline appropriate assessment tools to assess technical skill, and review the literature on the number of cases required to achieve competence in colorectal procedures while outlining the barriers to implementing CBE.

Validation of the Omni: A Novel, Multimodality, and Longitudinal Surgical Skills Assessment

OBJECTIVE

The breadth of technical skills included in general surgery training continues to expand. The current competency-based training model requires assessment tools to measure acquisition, learning, and mastery of technical skill longitudinally in a reliable and valid manner. This study describes a novel skills assessment tool, the Omni, which evaluates performance in a broad range of skills over time.

DESIGN

The 5 Omni tasks, consisting of open bowel anastomosis, knot tying, laparoscopic clover pattern cut, robotic needle drive, and endoscopic bubble pop, were developed by general surgery faculty. Component performance metrics assessed speed, accuracy, and quality, which were scaled into an overall score ranging from 0 to 10 for each task. For each task, ANOVAs with Scheffé's post hoc comparisons and Pearson's chi-squared tests compared performance between 6 resident cohorts (clinical years (CY1-5) and research fellows (RF)). Paired samples t-tests evaluated changes in performance across academic years. Cronbach's alpha coefficient determined the internal consistency of the Omni as an overall assessment.

SETTING

The Omni was developed by the Department of Surgery at Duke University. Annual assessment and this research study took place in the Surgical Education and Activities Lab.

PARTICIPANTS

All active general surgery residents in 2 consecutive academic years spanning 2015 to 2017.

RESULTS

A total of 62 general surgery residents completed the Omni and 39 (67.2%) of those residents completed the assessment in 2 consecutive years. Based on data from all residents' first assessment, statistically significant differences (p < 0.05) were observed among CY cohorts for bowel anastomosis, robotic, and laparoscopic task metrics. By pair-wise comparisons, mean bowel anastomosis scores distinguished CY1 from CY3-5 and CY2 from CY5. Mean robotic scores distinguished CY1 from RF, and mean laparoscopic scores distinguished CY1 from RF, CY3, and CY5 in addition to CY2 from CY3. Mean scores in performance on the knot tying and endoscopic tasks were not significantly different. Statistically significant improvement in mean scores was observed for all tasks from year 1 to year 2 (all p < 0.02). The internal consistency analysis revealed an alpha coefficient of 0.656.

CONCLUSIONS

The Omni is a novel composite assessment tool for surgical technical skill that utilizes objective measures and scoring algorithms to evaluate performance. In this pilot study, 3 tasks demonstrated discriminative ability of performance by CY, and all 5 tasks demonstrated construct validity by showing longitudinal improvement in performance. Additionally, the Omni has adequate internal consistency for a formative assessment. These results suggest the Omni holds promise for the evaluation of resident technical skill and early identification of outliers requiring intervention.