Evaluation of surgical fellows’ laparoscopic performance using Global Operative Assessment of Laparoscopic Skills (GOALS)

Abstract

The acquisition of technical skills is one of the fundamental goals of postgraduate surgical training; however, validation and utilization of objective tools to assess the technical skills of trainees remains elusive. The objectives of this project are to develop models to identify predictive factors for fellow performance, validate the Global Operative Assessment of Laparoscopic Skills (GOALS) as an assessment tool for laparoscopic skills, and to define the learning curve for complex laparoscopic gastrointestinal surgery. Using previously recorded data from a centralized database of the Fellowship Council, we analyzed the voluntarily submitted performance scores of surgical fellows for three complex laparoscopic gastrointestinal operations: Roux-en-Y gastric bypass, LapBand placement, and Nissen fundoplication. We analyzed previous experience with complex cases, previous experience with the same type of case, case difficulty, and time of year in the fellowship as potential predictors of performance. Performance scores throughout the fellowship year were graphed to create learning curves for overall performance and each of five domains of performance. Ninety-eight performance assessments were submitted for 31 unique fellows. Overall performance (p < 0.01), bimanual dexterity (p < 0.01), efficiency (p < 0.01), and autonomy (p < 0.01) all improved significantly throughout the course of the fellowship year. Performance in the domains of depth perception and tissue handling improved, but the improvement did not reach statistical significance. Three predictor variables were significantly related to performance scores. This study documents that GOALS is able to differentiate novice fellows from graduating fellows and established construct validity. Models developed and tested confirmed that previous experience, case difficulty, and length of time as a fellow impacted performance.