Measuring Surgical Competency in Hysterectomies

Abstract

INTRODUCTION: Quantifying surgical skills needed for a given procedure allows for identification of opportunities for improvement and ascertainment of competency. The Hopkins Assessment of Surgical Competency checklist is used to assess individual surgical skills but does not help determine the level at which competence is achieved. Use of a competency scale in addition to the Hopkins Assessment of Surgical Competency checklist will provide a measure of overall competency. METHODS: A retrospective analysis of data was done on hysterectomies performed at the University of Kansas from July 2012 to May 2013. We compared the Hopkins Assessment of Surgical Competency checklist, a validated tool, with the Dreyfus Model of Skill Acquisition. Residents were assessed by faculty who completed the checklist and assigned a concurrent Dreyfus score plotted along a continuum of skill acquisition ranging from novice (1) to expert (5). Each individual surgical skill on the checklist was scored on a Likert scale (1=lowest skill, 5=highest skill). Dreyfus scores were compared with individual surgical skill scores. RESULTS: Data were collected on 47 hysterectomies (total laryngoscopic hysterectomy=22, total abdominal hysterectomy=14, total vaginal hysterectomy=11). All surgical skill categories examined showed significant correlation with Dreyfus scores; the knowledge of complications score (r=0.82, P<.001) was most highly correlated. Among the hysterectomies in which the resident was rated competent (14), the median Hopkins Assessment of Surgical Competency skill score was 4 on 10 of 12 measured surgical skills (83.3%). CONCLUSION: Using the Dreyfus model, competence in hysterectomies reflects a score of 4 on most surgical skills measured on the Hopkins Assessment of Surgical Competency checklist, suggesting that an attainment of an average score of 3 is not sufficient for surgical competence.