Assessment of surgical performance

Abstract

Surgical patient outcomes are related to technical and non-technical skills of the surgeon. Trauma patient operative and management experience has declined since trainee duty-hour restrictions were mandated in 2003 resulting in less experience in technical surgical skills. The Advanced Surgical Skills for Exposure in Trauma (ASSET) cadaver-based course, teaching vascular exposure and haemorrhage control, was developed to fill this training gap. The aim of this Thesis is to develop surgeon performance metrics and to test surgeons before and after taking the ASSET course to determine whether such training improves performance of peripheral vascular control. The importance of training in surgical vascular control in both civilian and military practice, and a description of current surgical training for trauma are described in Chapter 1. Reviews of existing trauma training courses and surgical performance metrics are provided in Chapters 2 and 3, and show limited testing of training courses and lack of trauma surgical performance metrics. Data collection methods, evaluator training and analysis are described in Chapter 4. Chapter 5 evaluates self-confidence of surgeons performing the vascular control procedures in cadavers compared to the performance evaluated by trained evaluators. Preliminary validation of vascular-control performance metrics and testing of a standardized script with item analysis and inter-rater reliability are discussed in Chapter 6. Testing 40 surgeons performing 3 extremity vascular control procedures before and after training is reported in Chapter 7. ASSET training improves performance, but large performance variability, repeated errors and no improvements were found in some surgeons. Chapter 8 reports how blind video analysis checklist, global rating metrics, error occurrence and recovery show convergent validity with co-located evaluators. Chapter 9 identifies the key findings and implications, innovation of the work described in the Thesis and concludes with the potential impact on military readiness and my personal reflection on what I learnt.