Introduction
Assessment can be used to establish a current proficiency level, track progress over time and facilitate a learning process. When given as constructive feedback, assessment motivates development, and standardised assessment aids structured surgical training. Therefore, there is a need for assessment of surgical competencies. Without assessment, important knowledge and the potential for progression can be lost. The value of assessing a surgeon’s competencies is hence indisputable, but requires a trained assessor and an objective structured assessment tool.1 Currently, there is no consensus on the effectiveness of surgical assessment tools in gynaecology.
Surgical training has been shown to improve surgical skills, and several assessment tools have been validated in both live surgical settings and in a simulated environment.2 When assessing surgical or procedural skills, the choice of assessment tool depends on whether the performance is evaluated in a simulated or live surgical setting. More than 20 years ago Van der Vleuten explored and described five criteria (reliability, validity, impact on future behaviour, acceptability and costs) to take into consideration when choosing an assessment method in the clinical setting.3 They remain highly relevant, but especially reliability and validity must be thoroughly tested when applying an assessment tool.
Both task-specific and global rating tools are widely used in a variety of specialties. The tools use various scoring systems, e.g. binary checklists or anchors, such as a Likert scale. In general surgery, a number of task-specific checklists exist, but recent reviews showed a lack of validity and reliability.4,5
Implementation of objective assessment in clinical practice is difficult due to challenges on many levels: lack of time, lack of resources and often also lack of knowledge on how and when to use an assessment tool. To overcome these challenges it is important that the chosen assessment tool is acceptable, feasible, valid, well-described and easy to apply in a surgical setting.3There is an ongoing debate on when assessment should be performed and which form of assessment should be used to evaluate a given performance.1,6 Kane states that a procedure evaluated in simulation settings cannot be transferred to the operating room, indicating the importance of validating an assessment tool in the environment it will be used in.7
The aim was to conduct a systematic scoping review to identify assessment tools measuring technical skills during gynaecologic surgery and to assess the measurement characteristics of the tools used in a clinical setting in the operating room.