Methods
We chose the scoping review methodology to characterises the quantity
and quality of existing assessment scales.8 Conducted
in accordance with Arksey and O’Malley,9 the review
was designed to cover all available literature on the topic, to
summarise existing knowledge and to identify research gaps in the
current literature. The underlying methodological framework comprised
five consecutively linked stages (Table S2). Levac et al., who further
developed Arksy and O’Malley’s approach in order to clarify and enhance
the various stages,10 recommend an optional sixth
stage that involves consulting stakeholders.
Evaluation of each study focused especially on stage four of Arksey and
O’Malley’s methodology and involved a careful examination of the design,
observation method and domains assessed in each of the included studies.
The review is reported using the principles laid out in Preferred
Reporting Items for Systematic reviews and Meta-Analyses extension for
Scoping Reviews (PRISMA-ScR).11 This method of
evidence synthesis was selected to summarise and disseminate research
findings, and the aim of this scoping review was to identify whether one
or more validated assessment tools exist that can be applied to assess
technical surgical skills at both trainee and specialist level in the
operating room in gynaecologic surgery. We excluded studies assessing
surgical performance on animals and ones that tested tools in a
simulated setting, which means that only studies analysing the
assessment tool in live surgery were included.
We applied Kane’s validity argument, which comprises four inferences
(Table S3) to evaluate the various assessment tools.12The four inferences link an observation to a score, which then estimates
the performance in a test setting. This performance provides an estimate
of performance in live surgery, which leads to an action/decision.
Inspired by a recent systematic review by Hatala et al. that used Kane’s
validity argument to evaluate an assessment tool, we chose Kane’s
framework approach as it offers key phases or inferences when planning
and evaluating the validity argument.13
In this review, the term assessment tool refers to a specific tool that
assesses specific surgical competencies, whereas the word scale refers
to a widely applicable assessment tool or a component of a specific
tool.