The Ottawa Surgical Competency Operating Room Evaluation (O-SCORE)

Abstract

Most assessment of surgical trainees is based on measures of knowledge, with limited evaluation of their competence to actually perform various surgical procedures. In this study, the authors evaluated a tool they designed to assess a trainee's competence to perform an entire surgical procedure independently, regardless of procedure type or postgraduate year (PGY). In phase 1, the Ottawa Surgical Competency Operating Room Evaluation (O-SCORE) was piloted in the University of Ottawa's Division of Orthopaedic Surgery. In phase 2, the refined 11-item tool (8 items rated on a 5-point competency scale, 1 item assessing procedural competence, 2 feedback items) was used in the Divisions of Orthopaedic Surgery and General Surgery to assess residents' performance on 11 common procedures. Quantitative and qualitative analyses were conducted. In phase 2, 34 orthopaedic and general surgeons assessed the performance of 37 residents in 163 procedures. ANOVA demonstrated an effect of PGY. Post hoc analysis found that total procedure scores for PGYs 1 and 2 were lower than those for PGY 3 (P<.001), and PGY 3 scores were lower than those for PGYs 4 and 5 (P<.02). Analysis of qualitative data indicated that the rating scale was practical and useful for surgeons and residents. This novel evaluation tool successfully discriminated between junior and senior residents and identified surgical competency across various PGY levels regardless of procedure type. Multiple sources of evidence support the O-SCORE as a valid tool for the assessment of trainee operative competency.