VSSI 17 was developed as a
procedure-specific rating tool to assess surgeons while performing
vaginal hysterectomies. Interestingly, the 13 items in the Likert scale
are not procedure specific and can be applied to laparoscopic surgery in
general. A limitation is that this transfer of general competencies to a
specific rating tool did not prove to be appropriate. Importantly, the
authors focus on case mix, where a specific (patient) characteristic is
known to potentially effect (surgical) outcome. A recent review on
case-mix variables and predictors for outcomes of laparoscopic
hysterectomy showed that body mass index, previous operations, adhesions
and age were predominate case-mix characteristics.25This knowledge on case mix is important when choosing a surgical case
for assessment.
Chou et al. modified an existing global rating scale by adding procedure
specific items to develop HASC 18, which targets
gynaecologic trainees and aims to evaluate all surgical competencies in
gynaecologic surgery. This procedure-specific rating tool is applicable
to all types of laparoscopic surgery. The generalizability and lack of a
task-specific checklist makes HASC applicable to other gynaecologic
programmes. To our knowledge, this applicability has not been
demonstrated in other validated studies. The study was not blinded, only
trainees were tested and data were collected for all types of surgical
procedures, lowering the strength of the study.
The OSALS rating tools is incorporated in the Danish curriculum for
assessment of OBGYN trainees. 1926.It comprises five general and five task-specific
items and was developed and validated in a blinded study19. There was a wide performance range in the expert
group and a narrow performance range in the novice group, which could be
explained by case mix and by the fact that categorising surgeons as
intermediate or expert can be difficult. The study is limited by a small
sample size.
Arguably, a disadvantage of video evaluation is that it is
time-consuming, but Larsen et al. underline it as a strength for the
objective assessment, an assertion that Langermann et al. support,
arguing that video recording in the operating theatre enhances and
supports surgical training and can be performed equally good by doctors
with different expeince.27 28
Six of the included studies used video recording and blinded observers
when evaluating the surgeon’s performance. All of the studies found
significant discriminative validity, demonstrating that the assessor can
differentiate between novices, advanced beginners and experts. This
indicates that video-recorded assessment is a good choice when
validating an assessment tool, but as it is time-consuming, it may not
be an obvious choice for implementation in daily clinical
practice.29