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.