Structured assessment of minor surgical skills (SAMSS) for family medicine residents.

Abstract

To develop a valid and reliable examination to assess the technical proficiency of family medicine residents' performance of minor surgical office procedures. A multi-station OSCE-style examination using bench-model simulations of minor surgical procedures was developed. Participants were a randomly selected group of 33 family medicine residents (PGY-1 = 16, PGY-2 = 17) and 14 senior surgical residents who functioned as a validation group. Examiners were qualified surgeons and family physicians who used both checklists and global rating scales to score the participants' performances. When family medicine residents were evaluated by family physicians, interstation reliabilities were .29 for checklists and .42 for global ratings. When family medicine residents were evaluated by surgeons, the reliabilities were .53 for checklists and .75 for global ratings. Interrater reliability, measured as a correlation for total examination scores, was .97. Mean scores on the examination were 60%, 64%, and 87% for PGY-1 family medicine, PGY-2 family medicine, and surgery residents, respectively. The difference in scores between family medicine and surgery residents was significant (p < .001), providing evidence of construct validity. A new examination developed for assessing family medicine residents' skills with minor surgical office procedures is reliable and has evidence for construct validity. The examination has low reliability when family physicians serve as examiners, but moderate reliability when surgeons are the evaluators.