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Assessing residents' operative skills for external ventricular drain placement and shunt surgery in pediatric neurosurgery.
J Neurosurg Pediatr 2017; 19(4):377-383JN

Abstract

OBJECTIVE

The authors previously demonstrated the use of a validated Objective Structured Assessment of Technical Skills (OSATS) tool for evaluating residents' operative skills in pediatric neurosurgery. However, no benchmarks have been established for specific pediatric procedures despite an increased need for meaningful assessments that can either allow for early intervention for underperforming trainees or allow for proficient residents to progress to conducting operations independently with more passive supervision. This validated methodology and tool for assessment of operative skills for common pediatric neurosurgical procedures-external ventricular drain (EVD) placement and shunt surgery- was applied to establish its procedure-based feasibility and reliability, and to document the effect of repetition on achieving surgical skill proficiency in pediatric EVD placement and shunt surgery.

METHODS

A procedure-based technical skills assessment for EVD placements and shunt surgeries in pediatric neurosurgery was established through the use of task analysis. The authors enrolled all residents from 3 training programs (Baylor College of Medicine, Houston Methodist Hospital, and University of Texas-Medical Branch) who rotated through pediatric neurosurgery at Texas Children's Hospital over a 26-month period. For each EVD placement or shunt procedure performed with a resident, the faculty and resident (for self-assessment) completed an evaluation form (OSATS) based on a 5-point Likert scale with 7 categories. Data forms were then grouped according to faculty versus resident (self) assessment, length of pediatric neurosurgery rotation, postgraduate year level, and date of evaluation ("beginning of rotation," within 1 month of start date; "end of rotation," within 1 month of completion date; or "middle of rotation"). Descriptive statistical analyses were performed with the commercially available SPSS statistical software package. A p value < 0.05 was considered statistically significant.

RESULTS

Five attending evaluators (including 2 fellows who acted as attending surgeons) completed 260 evaluations. Twenty house staff completed 269 evaluations for self-assessment. Evaluations were completed in 562 EVD and shunt procedures before the surgeons left the operating room. There were statistically significant differences (p < 0.05) between overall attending (mean 4.3) and junior resident (self; mean 3.6) assessments, and between overall attending (mean 4.8) and senior resident (self; mean 4.6) assessment scores on general performance and technical skills. The learning curves produced for the residents demonstrate a stereotypical U- or V-shaped curve for acquiring skills, with a significant improvement in overall scores at the end of the rotation compared with the beginning. The improvement for junior residents (Δ score = 0.5; p = 0.002) was larger than for senior residents (Δ score = 0.2; p = 0.018).

CONCLUSIONS

The OSATS is an effective assessment tool as part of a comprehensive evaluation of neurosurgery residents' performance for specific pediatric procedures. The authors observed a U-shaped learning curve, contradicting the idea that developing one's surgical technique and learning a procedure represents a monotonic, cumulative process of repetitions and improvement.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

28128705

Citation

"Assessing Residents' Operative Skills for External Ventricular Drain Placement and Shunt Surgery in Pediatric Neurosurgery." Journal of Neurosurgery. Pediatrics, vol. 19, no. 4, 2017, pp. 377-383.
Assessing residents' operative skills for external ventricular drain placement and shunt surgery in pediatric neurosurgery. J Neurosurg Pediatr. 2017;19(4):377-383.
(2017). Assessing residents' operative skills for external ventricular drain placement and shunt surgery in pediatric neurosurgery. Journal of Neurosurgery. Pediatrics, 19(4), pp. 377-383. doi:10.3171/2016.10.PEDS16471.
Assessing Residents' Operative Skills for External Ventricular Drain Placement and Shunt Surgery in Pediatric Neurosurgery. J Neurosurg Pediatr. 2017;19(4):377-383. PubMed PMID: 28128705.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Assessing residents' operative skills for external ventricular drain placement and shunt surgery in pediatric neurosurgery. Y1 - 2017/01/27/ PY - 2017/1/28/pubmed PY - 2017/4/7/medline PY - 2017/1/28/entrez KW - EVD = external ventricular drain KW - OR = operating room KW - OSATS = Objective Structured Assessment of Technical Skills KW - PGY = postgraduate year KW - education assessment KW - hydrocephalus KW - neurosurgery KW - operative skills KW - resident education KW - shunt surgery SP - 377 EP - 383 JF - Journal of neurosurgery. Pediatrics JO - J Neurosurg Pediatr VL - 19 IS - 4 N2 - OBJECTIVE The authors previously demonstrated the use of a validated Objective Structured Assessment of Technical Skills (OSATS) tool for evaluating residents' operative skills in pediatric neurosurgery. However, no benchmarks have been established for specific pediatric procedures despite an increased need for meaningful assessments that can either allow for early intervention for underperforming trainees or allow for proficient residents to progress to conducting operations independently with more passive supervision. This validated methodology and tool for assessment of operative skills for common pediatric neurosurgical procedures-external ventricular drain (EVD) placement and shunt surgery- was applied to establish its procedure-based feasibility and reliability, and to document the effect of repetition on achieving surgical skill proficiency in pediatric EVD placement and shunt surgery. METHODS A procedure-based technical skills assessment for EVD placements and shunt surgeries in pediatric neurosurgery was established through the use of task analysis. The authors enrolled all residents from 3 training programs (Baylor College of Medicine, Houston Methodist Hospital, and University of Texas-Medical Branch) who rotated through pediatric neurosurgery at Texas Children's Hospital over a 26-month period. For each EVD placement or shunt procedure performed with a resident, the faculty and resident (for self-assessment) completed an evaluation form (OSATS) based on a 5-point Likert scale with 7 categories. Data forms were then grouped according to faculty versus resident (self) assessment, length of pediatric neurosurgery rotation, postgraduate year level, and date of evaluation ("beginning of rotation," within 1 month of start date; "end of rotation," within 1 month of completion date; or "middle of rotation"). Descriptive statistical analyses were performed with the commercially available SPSS statistical software package. A p value < 0.05 was considered statistically significant. RESULTS Five attending evaluators (including 2 fellows who acted as attending surgeons) completed 260 evaluations. Twenty house staff completed 269 evaluations for self-assessment. Evaluations were completed in 562 EVD and shunt procedures before the surgeons left the operating room. There were statistically significant differences (p < 0.05) between overall attending (mean 4.3) and junior resident (self; mean 3.6) assessments, and between overall attending (mean 4.8) and senior resident (self; mean 4.6) assessment scores on general performance and technical skills. The learning curves produced for the residents demonstrate a stereotypical U- or V-shaped curve for acquiring skills, with a significant improvement in overall scores at the end of the rotation compared with the beginning. The improvement for junior residents (Δ score = 0.5; p = 0.002) was larger than for senior residents (Δ score = 0.2; p = 0.018). CONCLUSIONS The OSATS is an effective assessment tool as part of a comprehensive evaluation of neurosurgery residents' performance for specific pediatric procedures. The authors observed a U-shaped learning curve, contradicting the idea that developing one's surgical technique and learning a procedure represents a monotonic, cumulative process of repetitions and improvement. SN - 1933-0715 UR - https://www.unboundmedicine.com/medline/citation/28128705/Assessing_residents'_operative_skills_for_external_ventricular_drain_placement_and_shunt_surgery_in_pediatric_neurosurgery_ L2 - https://thejns.org/doi/10.3171/2016.10.PEDS16471 DB - PRIME DP - Unbound Medicine ER -