Vaginal Surgical Skills Index (VSSI)
Chen et al.17 introduced VSSI, which is a procedure-specific rating scale for evaluating surgeons while performing vaginal hysterectomies. VVSI is an expanded and modified form of the original seven-item Global Rating Scale (GRS). 14 They developed and adjusted GRS to contain items considered important for vaginal surgery, 13 in total, including: initial inspection, performance of an incision, maintenance of visibility, use of electro surgery, knot tying, maintenance of haemostasis, removing fluid and debris, completion of the procedure and forward planning.
Twenty-seven trainees performed 76 surgeries in the study period. The operating surgeon was evaluated using VSSI as soon as the hysterectomy was performed. VSSI was then compared with GRS scores and good construct validity was found. The procedure was videotaped, and to assess interrater reliability, a blinded reviewer evaluated the performing surgeon using VSSI, GRS and a 100-mm visual analogue scale, which was included as an additional measure to furnish the assessor with a global impression of the trainees’ surgical skills.
To assess intrarater reliability, the supervising surgeon watched and re-evaluated the video after four weeks. Internal consistency for VSSI and GRS was high (Cronbach’s alpha=0.95-0-97). Using intraclass correlation coefficient (ICC), the authors concluded that the VSSI interrater reliability (ICC=0.53) and intrarater reliability (ICC=0.82) were good.