Laparoscopic skills assessment of senior obstetrics and gynecologic residents: a city wide experience

Abstract

To establish feasibility and reliability of a laparoscopic skills assessment when administered to senior obstetrics and gynecologic residents trained at multiple programs. Multi-center, prospective, cohort study. An Objective Structured Assessment of Technical Skills (OSATS) containing 8 skills was administered to 27 senior obstetric and gynecology residents from 5 residency programs in Chicago, IL. The laparoscopic skills station evaluated competency and efficiency of laparoscopic suturing, intracorporeal and extracorporeal knot tying, and usage of endostitch in a specific case scenario. Residents were timed and assessed with 3 types of measures: task-specific checklist, global rating scale of operative performance, and pass/fail grade. Each resident was evaluated by one examiner blinded as to the postgraduate year and program. Two types of reliability were evaluated. Construct validity was assessed using one-way MANOVA with year of clinical training as the independent variable (4 or 5 years) and the station scores as the dependent variables. Ten PGY-3 and 17 PGY-4 residents participated in the exam. Eight of the residents had no experience with laparoscopic suturing. Global rating scale (GRS) of operative performance ranged from 6 to 25 with a maximum score of 30 possible. Those who had no experience in laparoscopic suturing scored the lowest with scores between 6 and 17. The mean score for the GRS was found to be 16.33 ± 1.18 (mean ± standard error of the mean). The overall pass rate was 50%. The mean score for the task-specific checklist was found to be 3.33 ± 0.41 with a maximum score of 7 possible. Mean time of skills completion was 9.97 ± 0.53 minutes. The overall inter-station reliability for the OSATS was 0.55. Controlling for year of training, overall pass rates were similar between programs. Feedback from residents and faculty was universally positive. Developing a multiple program OSATS affords the opportunity to achieve economies of scale and draw from multiple colleagues with a wide variety of experiences. It allows for resident assessment using a regional benchmark and can indicate areas of deficiency in training. Thirty percent of senior residents had no endoscopic suturing experience and 50 percent were unable to complete a single interrupted stitch in the space of 12 minutes. In contrast to our general surgery colleagues, laparoscopic suturing does not appear to be a priority skill among the gynecologic residencies sampled.