Use of Performance Measures to Evaluate, Document Competence and Deterioration of ASSET Surgical Skills
Technical Report,15 Feb 2013,14 Feb 2016
University of Maryland Baltimore United States
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Reduced clinical opportunities for open surgical control of hemorrhage and lack of surgeon technical skills performance metrics are large capability gaps. Validation of Advanced Surgical Skills Exposure in Trauma ASSET Course training was undertaken. We enrolled 106 surgeons to develop, test, and validate surgeon performance metricsindividual procedure score IPS for non-technical and technical skills acquired in ASSET, using both cadavers and realistic models, by testing surgeons before and after ASSET training and up to 4 years later. Improvement occurred across all metrics with ASSET procedural skills training. Benefits from training were correct incision landmarks, procedural steps, including less time to vascular control, error reduction and increased error recognition. Fasciotomy was inadequately performed by the majority of surgeons. Generally, interval experience NOT time since training was correlated with reduced performance and more errors. Regression lines for technical performance vs up to 4 years since ASSET training in 85 surgeons show no skill degradation vs threshold of time. Physical model-based assessments could not identify skill degradation, as the same surgeons have 13rd less errors and take procedural time in the models than in the cadaver. Recommendations1 IPS scoring should be used during ASSET course training to provide performance feedback for formative evaluation and to determine readiness for surgeon deployment.2Video recorded formative performance evaluations can replace co-located evaluations 3 technical skills refreshers should be targeted to landmarks, procedural steps, anatomy 4 database de-identification and distribution5 fielding of data collection tool.
- Medicine and Medical Research