Assessment Of Technical Skills Research Articles

Crowd-Sourced Assessment of Laparoscopic Surgical Skills for Ob/Gyn Residents

Importance Feedback is an essential part of graduate medical education. With increasing demands on time and fewer opportunities for formal feedback in residency, there is an increasing need for objective and actionable feedback. Objective To understand how the Crowd-Sourced Assessment of Technical Skills (CSATS) assessment of residents’ laparoscopic skills compares with the current faculty assessment in an obstetrics/gynecology residency program. Design, Setting, and Participants This was a prospective educational intervention study involving residents from a single academic obstetrics/gynecology residency program at a large tertiary teaching hospital. Individual performance videos of hysterectomies, myomectomies, and endometriosis resections were recorded and uploaded to the CSATS database where they were analyzed. Formal written feedback reports from the CSATS system were sent to the residents. Residents then completed a survey addressing satisfaction, timeliness, and utility of the CSATS feedback method overall and in comparison with the residency’s in-person feedback and with the standard written, electronic feedback evaluation. Results A total of 16 residents submitted 65 videos of operations. Overall comparison of CSATS vs faculty evaluation was equivalent. Residents found that CSATS response time was slower than receiving in-person feedback from faculty. When comparing CSATS with the standard feedback form, residents felt strongly that CSATS was superior for both surgical skill feedback and procedure evaluation, with both categories having a mean top score. When comparing low-volume CSATS utilization vs high-volume CSATS utilization, there were no statistical differences. Overall, residents reported high satisfaction with CSATS evaluation. Conclusions Residents were generally satisfied with CSATS as an overall feedback tool. CSATS could be a possible addition to help improve resident education.

Deep learning prediction of error and skill in robotic prostatectomy suturing.

Manual objective assessment of skill and errors in minimally invasive surgery have been validated with correlation to surgical expertise and patient outcomes. However, assessment and error annotation can be subjective and are time-consuming processes, often precluding their use. Recent years have seen the development of artificial intelligence models to work towards automating the process to allow reduction of errors and truly objective assessment. This study aimed to validate surgical skill rating and error annotations in suturing gestures to inform the development and evaluation of AI models. SAR-RARP50 open data set was blindly, independently annotated at the gesture level in Robotic-Assisted Radical Prostatectomy (RARP) suturing. Manual objective assessment tools and error annotation methodology, Objective Clinical Human Reliability Analysis (OCHRA), were used as ground truth to train and test vision-based deep learning methods to estimate skill and errors. Analysis included descriptive statistics plus tool validity and reliability. Fifty-four RARP videos (266min) were analysed. Strong/excellent inter-rater reliability (range r = 0.70-0.89, p < 0.001) and very strong correlation (r = 0.92, p < 0.001) between objective assessment tools was demonstrated. Skill estimation of OSATS and M-GEARS had a Spearman's Correlation Coefficient 0.37 and 0.36, respectively, with normalised mean absolute error representing a prediction error of 17.92% (inverted "accuracy" 82.08%) and 20.6% (inverted "accuracy" 79.4%) respectively. The best performing models in error prediction achieved mean absolute precision of 37.14%, area under the curve 65.10% and Macro-F1 58.97%. This is the first study to employ detailed error detection methodology and deep learning models within real robotic surgical video. This benchmark evaluation of AI models sets a foundation and promising approach for future advancements in automated technical skill assessment.

Gathering Validity Evidence for a Simulation-Based Test of Otoscopy Skills.

Otoscopy is a key clinical examination used by multiple healthcare providers but training and testing of otoscopy skills remain largely uninvestigated. Simulator-based assessment of otoscopy skills exists, but evidence on its validity is scarce. In this study, we explored automated assessment and performance metrics of an otoscopy simulator through collection of validity evidence according to Messick's framework. Novices and experienced otoscopists completed a test program on the Earsi otoscopy simulator. Automated assessment of diagnostic ability and performance were compared with manual ratings of technical skills. Reliability of assessment was evaluated using Generalizability theory. Linear mixed models and correlation analysis were used to compare automated and manual assessments. Finally, we used the contrasting groups method to define a pass/fail level for the automated score. A total of 12 novices and 12 experienced otoscopists completed the study. We found an overall G-coefficient of .69 for automated assessment. The experienced otoscopists achieved a significantly higher mean automated score than the novices (59.9% (95% CI [57.3%-62.6%]) vs. 44.6% (95% CI [41.9%-47.2%]), P < .001). For the manual assessment of technical skills, there was no significant difference, nor did the automated score correlate with the manually rated score (Pearson's r = .20, P = .601). We established a pass/fail standard for the simulator's automated score of 49.3%. We explored validity evidence supporting an otoscopy simulator's automated score, demonstrating that this score mainly reflects cognitive skills. Manual assessment therefore still seems necessary at this point and external video-recording is necessary for valid assessment. To improve the reliability, the test course should include more cases to achieve a higher G-coefficient and a higher pass/fail standard should be used.

Video Review Can Measure Surgical Robotic Skill Development in a Resident Robotic Hernia Curriculum: A Retrospective Cohort Study

Background: Hernia repairs are one of the most common general surgery procedures and an essential part of training for general surgery residents. The widespread incorporation of robotic hernia repairs warrants the development of a procedure-specific robotic curriculum to assist novice surgeons in improving technical skills. Objective: To evaluate a robotic hernia simulation-based curriculum for general surgery residents using video review. Methods: Retrospective cohort study of PGY-3 general surgery residents from the University of Chicago from 2019 to 2021. The residents completed inguinal hernia repair (IHR) and ventral hernia repair (VHR) drills as part of a robotic simulation curriculum. The drills were recorded and graded according to the modified objective structured assessment of technical skills (OSATS) and time to completion. The drills were completed by 3 attending surgeons to establish gold-standard benchmarks. Results: In total, 20 residents started the curriculum, 19 completed all IHR drills and 17 completed all VHR drills. Attending surgeon total OSATS scores and time to completion were significantly better than the trainees on the first attempt (P &lt; 0.05). When comparing 1st to 4th attempt, resident OSATS scores improved significantly for IHR (15.5 vs 23.3; P &lt; 0.001) and VHR (16.8 vs 23.3; P &lt; 0.001). Time also improved over 4 attempts (IHR: 28.5 vs 20.5 minutes; P &lt; 0.001 and VHR: 29.6 vs 21.2 minutes; P &lt; 0.001). Residents achieved attending-level OSATS scores by their fourth attempt for VHR, but not for IHR. Residents did not achieve attending-level times for either hernia drills. Conclusions: The robotic hernia curriculum improved resident performance on hernia repair drills and was well-received by the residents.

Validation of a 3D-Printed Silicone-Based Laryngeal Model for Resident Education.

We sought to validate a laryngeal simulation model and subsequently demonstrate its efficacy in improving surgical technique. Pre-post interventional study. Otolaryngology Program at a Tertiary Care Center. A low-cost, high-fidelity laryngeal model was created using a 3-dimensional-printed cast and multilayered silicone to mimic vocal fold lesions. Participants (attendings and trainees) were first given a series of tasks including mucosal vocal fold lesion resection and microflap excision of a submucosal lesion. Trainees were then provided with an instructional video from a laryngologist and asked to repeat the same tasks on the model. Performance data was then assessed using validated surveys and blinded expert reviewers. Eighteen participants completed the simulation. All subjects agreed that the "simulation experience was useful" and 93% agreed "the simulator helped improve my ability to do microsurgical tasks." In the postinstruction self-evaluation, trainees reported a significant decrease in mental demand (95% confidence interval [CI]: 0.37-0.91; P = .038) and significant increase in subjective performance (95% CI: 1.51-51.89; P = .016) compared to the preinstruction self-evaluation. On the postinstruction attempt, there was a significant improvement in all domains of the adapted objective structured assessment of technical skills as measured by 3 blinded, expert reviewers. This study demonstrates the usefulness of a silicone larynx model and the value of instructional video in developing laryngeal microsurgical skills. Participants positively reviewed the laryngeal model and trainees saw both a subjective and objective improvement indicating tangible operative benefits from the use of this laryngeal simulation.

Evaluation of a Web-Based Surgical Training Approach and Insights from Distal Bypass Competition 2021 Using a Simulator Kit

ObjectiveThe study aimed to assess a novel web-based surgical training approach among young vascular surgeons and validate web-based evaluation methods for assessing anastomosis skills through the online Distal Bypass Competition (DBC). MethodsThe Objective Structured Assessment of Technical Skill (OSATS) was utilized to assess anastomosis proficiency using a simulator among 42 participants (17 junior and 25 senior surgeons) in the DBC 2021. Initial evaluation of basic anastomosis skills was conducted via recorded videos, comparing OSATS scores with instructor-derived impression-based scores (Comprehensive Evaluation Score: CES) during the nomination round. Real-time evaluations conducted over Zoom focused on assessing technical and composition scores of the anastomoses to determine finalists. The ice-skating method addresses potential variability among judges by excluding the highest and lowest scores for each procedural element from the final evaluation. This method, demonstrated in real-time, provides trainees with valuable feedback on which movements are highly rated, enhancing the educational impact. Evaluation criteria included precision in needlework, external appearance, handling of the intima, and internal morphology of the anastomosis. Furthermore, voluntary survey questionnaires were administered to gather participant feedback on their experience with DBC 2021. ResultsThe OSATS was associated with a lower coefficient of variation (CV) than was the CES (0.19 ± 0.07 vs. 0.24 ± 0.09, P=0.01) with regard to the evaluation of basic anastomotic skills in the nomination round. Interestingly, there was no significant difference in CV between PES based on OSATS and CES in the senior class (0.16 ± 0.06 vs. 0.22 ± 0.09, P=0.13), but a significant difference was particularly evident in the junior class (0.12 ± 0.07 vs. 0.27 ± 09, P=0.03). Lower scores were associated with higher CVs in both classes, but the OSATS improved the CV among participants who had inadequate anastomosis skills. In real-time evaluation, composition scores exhibited higher CVs compared to technical scores, even among high-scoring participants. Notably, the internal morphology of the anastomosis had the largest CV in the composition scores. The ice-skating method reduced the CV as compared to the original data evaluated using the OSATS (0.15 ± 0.04 vs. 0.09 ± 0.02 for the technical score, P<0.01 and 0.18 ± 1.00 vs. 0.07 ± 0.05 for the composition score, P=0.03); accordingly, the ice-skating method was more conducive to objective, real-time evaluation. The results of the post-DBC survey indicated that 89% of participants reported increased training time, and half of these participants indicated that their confidence in their clinical skills related to this procedure increased due to the process of training for the DBC. ConclusionsThe OSATS yielded more detailed evaluations of anastomosis skill with lower variability compared to the instructor’s impression-based evaluation in this web-based training. Real-time evaluation methods, such as the ice-skating method, have proven to be valuable tools for standardized assessment of web-based surgical education.

High-stakes Technical Performance Assessments Across the Continuum of Surgical Training.

The aim of this article to outline proposals for the use of high stakes technical performance assessments, defined as assessments of technical skill that take place outside of the operating theatre, across the continuum of surgical training. Technological advancements have allowed for the assessment of operative technical skill outside of the workplace environment, developed and evaluated in line with modern concepts of assessment validity. With the introduction of competency-based education principles across surgical training curricula, increasing scrutiny is being placed on the validity and reliability of assessments used to inform high-stakes training decisions regarding selection, progression through training, autonomy granting and end-of-training certification. The role of performance assessments, conducted outside of the workplace environment, is yet to be fully established. This article discusses the use of high-stakes performance assessments across the continuum of surgical training, with reference to relevant theories of surgical skill acquisition and assessment, along with contemporary evidence from the performance science literature. Assessments of increasing professional authenticity are required across the continuum of surgical training. In an attempt to capture inherent ability rather than skill at the time of trainee selection, assessments should be of deliberately low levels of professional authenticity. Assessment in early surgical training should focus on ensuring competence in core surgical skills, and then assessing for canonical competence across a series of commonly encountered procedures. Baseline competence in these procedures should ideally be assessed prior to the transition to (supervised) lead operator, with a view to ensuring patient safety and improving the efficiency of in-theatre training. Assessment later in training relies more heavily on the workplace, with simulation offering a complimentary role in ensuring a minimum competency standard in procedures less likely to be encountered in the workplace. High-stakes performance assessments can play an important role as part of a programmatic approach to surgical training and certification. They can and should be designed with an appropriate level of professional authenticity to ensure adequate and appropriate representation of the assessment construct.

Multi-Modal Fusion Network with Multi-Head Self-Attention for Injection Training Evaluation in Medical Education

The COVID-19 pandemic has significantly disrupted traditional medical training, particularly in critical areas such as the injection process, which require expert supervision. To address the challenges posed by reduced face-to-face interactions, this study introduces a multi-modal fusion network designed to evaluate the timing and motion aspects of the injection training process in medical education. The proposed framework integrates 3D reconstructed data and 2D images of hand movements during the injection process. The 3D data are preprocessed and encoded by a Long Short-Term Memory (LSTM) network to extract temporal features, while a Convolutional Neural Network (CNN) processes the 2D images to capture detailed image features. These encoded features are then fused and refined through a proposed multi-head self-attention module, which enhances the model’s ability to capture and weigh important temporal and image dynamics in the injection process. The final classification of the injection process is conducted by a classifier module. The model’s performance was rigorously evaluated using video data from 255 subjects with assessments made by professional physicians according to the Objective Structured Assessment of Technical Skill—Global Rating Score (OSATS-GRS)[B] criteria for time and motion evaluation. The experimental results demonstrate that the proposed data fusion model achieves an accuracy of 0.7238, an F1-score of 0.7060, a precision of 0.7339, a recall of 0.7238, and an AUC of 0.8343. These findings highlight the model’s potential as an effective tool for providing objective feedback in medical injection training, offering a scalable solution for the post-pandemic evolution of medical education.

2024 Updated EHRA core curriculum for physicians and allied professionals. A statement of the European Heart Rhythm Association (EHRA) of the ESC

Abstract Heart Rhythm management is a continuously evolving sub-speciality of cardiology. Every year, many physicians and allied professionals start and complete their training in Cardiac Implantable Electronic Devices (CIED) or Electrophysiology (EP) across the EHRA member countries. While this training ideally ends with an EHRA certification, the description of the learning pathway (what, how, when and where) through an EHRA Core Curriculum is also a prerequisite for a successful training. The first EHRA core curriculum for physicians was published in 2009. Due to the huge developments in the field of electrophysiology and device therapy, this document needed updating. In addition, a certification process for allied professionals has been introduced, as well as a recertification process and accreditation of EHRA recognised training centres. Learning pathways are more individualised now, with Objective Structured Assessment of Technical Skills (OSATS) to monitor learning progression of trainees. The 2024 Updated EHRA Core Curriculum for physicians and allied professionals describes, for both CIED and EP, the syllabus, OSATS, training program and certification and recertification for physicians and allied professionals and stresses the importance of continued medical education after certification. In addition, requirements for accreditation of training centres and trainers are given. Finally, suggested reading lists for CIED and EP are attached as online supplements.

Technical skills of endoscopic sinus surgery for performance assessment using the Delphi methodology.

In surgical residency, competence has traditionally been defined by a specified number of surgical procedures. Modern advances in medical education and surgical fellowships have challenged this approach. It is widely accepted that a definition of a skill set, enabling a systematic, competency-based assessment is mandatory in surgical education. We conducted an international Delphi study with panelists from the European Rhinologic Society, representing 27 countries. Through four rounds, the panel reached consensus on the phrasing of an assessment tool-, for the technical skills of endoscopic sinus surgery (ESS). Thirty panelists participated throughout the study. The median age of the panelists was 54 years (range 31-66 years) with a median experience of 25 years (range 6-40 years). All were experts in the field of endoscopic sinus surgery. Consensus was reached. The final assessment tool consists of 21 items with descriptive anchors. The assessment tool, European Endoscopic Sinus Surgery - Technical Skills Assessment (EE-TSA), enables a competency-based approach to acquiring and maintaining essential elements of endoscopic sinus surgery. The international Delphi panel makes the tool internationally applicable. Further research should gather validity evidence for EE-TSA, enhancing the assessment of ESS by setting a pass/fail-standard ultimately improving surgical outcomes and patient safety.

Development of an Objective Structured Assessment of Technical Skills for Sclerotherapy

Development of an Objective Structured Assessment of Technical Skills for Sclerotherapy

From FUSE to a hands-on electrosurgery course using a cadaveric model.

Surgical procedures in contemporary practice frequently employ energy-based devices, yet comprehensive education surrounding their safety and effectiveness remains deficient. We propose an innovative course for residents that aims to provide basic electrosurgery knowledge and promote the safe use of these devices. We developed a simulated training course for first-year general surgery and orthopedic residents. First, a survey was conducted regarding their knowledge perception about energy devices. The course consisted of two online theoretical sessions, followed by three in-person practical sessions. First-year residents performed three video-recorded attempts using a cadaveric model and were assessed through a digital platform using the Objective Structured Assessment of Technical Skill (OSATS), a Specific Rating Scale (SRS), and a surgical energy-based devices scale (SEBS). Third-year residents were recruited as a control group. The study included 20 first-year residents and 5 third-year residents. First-year residents perceived a knowledge gap regarding energy devices. Regarding practical performance, both OSATS and checklist scores were statistically different between novices at their first attempt and the control group. When we analyzed the novice's performance, we found a significant increase in OSATS (13 vs 21), SRS (13 vs 17.5), and SEBS (5 vs 7) pre- and post-training scores. The amount of feedback referred to skin burns with the electro-scalpel reduced from 18 feedbacks in the first attempt to 2 in the third attempt (p-value = 0.0002). When comparing the final session of novices with the control group, no differences were found in the SRS (p = 0.22) or SEBS (p = 0.97), but differences remained in OSATS (p = 0.017). This study supports the implementation of structured education in electrosurgery among surgical trainees. By teaching first-year residents about electrosurgery, they can acquire a skill set equivalent to that of third-year residents. The integration of such courses can mitigate complications associated with energy device misuse, ultimately enhancing patient safety.

52991 Objective Structured Assessment of Technical Skills (OSATS) for layered repair, adjacent tissue transfer, and full-thickness skin graft

52991 Objective Structured Assessment of Technical Skills (OSATS) for layered repair, adjacent tissue transfer, and full-thickness skin graft

A Novel Simulation Model and Training Program for Minimally Invasive Surgery of Hallux Valgus.

Minimally invasive surgery (MIS) for hallux valgus (HV) has gained popularity. However, adopting this technique faces the challenges of a pronounced learning curve. This study aimed to address these challenges by developing and validating an innovative simulation model and training program, targeting enhanced proficiency in HV MIS. A training program and a high-fidelity simulation model for HV MIS were designed based on experts' recommendations. Four foot and ankle surgeons without experience in MIS formed the novice group and took the program that encompassed six-session instructional lessons, hands-on practice on simulated models, and immediate feedback. The program concluded with a cadaveric surgery. Four foot and ankle experienced MIS surgeons formed the expert group and underwent the same procedure with one simulated model. Participants underwent blind assessment, including Objective Structured Assessment of Technical Skills (OSATS), surgical time, and radiograph usage. Expert evaluation of the simulation model indicated high satisfaction with anatomical representation, handling properties, and utility as a training tool. The expert group consistently outperformed novices at the initial assessment across all outcomes, demonstrating OSATS scores of 24 points (range, 23 to 25) versus 15.5 (range, 12 to 17), median surgical time of 22.75 minutes (range, 12 to 27) versus 48.75 minutes (range, 38 to 60), and median radiograph usage of 70 (range, 53 to 102) versus 232.5 (range, 112 to 280). Novices exhibited a significant improvement in OSATS scores from the fifth session onward (P = 0.01), reaching the desired performance of 20 points. Performance at the final training with the simulated model did not differ from cadaveric surgery outcomes for all parameters. This study validated a simulation model and training program, allowing nonexperienced HV MIS foot and ankle surgeons to enhance their surgical proficiency and effectively complete a substantial portion of the learning curve at the fifth session, and this performance was successfully transferred to a cadaver model. III.

Video-Based Performance Analysis in Pituitary Surgery - Part 2: Artificial Intelligence Assisted Surgical Coaching

Superior surgical skill improves surgical outcomes in endoscopic pituitary adenoma surgery. Video-based coaching programs, pioneered in professional sports, have shown promise in surgical training. In this study, we developed and assessed a video-based coaching program using artificial intelligence (AI) assistance. An AI-assisted video-based surgical coaching was implemented over 6months with the pituitary surgery team. The program consisted of 1) monthly random video analysis and review; and 2) quarterly 2-hour educational meetings discussing these videos and learning points. Each video was annotated for surgical phases and steps using AI, which improved video interactivity and allowed the calculation of quantitative metrics. Primary outcomes were program feasibility, acceptability, and appropriateness. Surgical performance (via modified Objective Structured Assessment of Technical Skills) and early surgical outcomes were recorded for every case during the 6-month coaching period, and a preceding 6-month control period. Beta and logistic regression were used to assess the change in modified Objective Structured Assessment of Technical Skills scores and surgical outcomes after the coaching program implementation. All participants highly rated the program's feasibility, acceptability, and appropriateness. During the coaching program, 63 endoscopic pituitary adenoma cases were included, with 41 in the control group. Surgical performance across all operative phases improved during the coaching period (P < 0.001), with a reduction in new postoperative anterior pituitary hormone deficit (P= 0.01). We have developed a novel AI-assisted video surgical coaching program for endoscopic pituitary adenoma surgery - demonstrating its viability and impact on surgical performance. Early results also suggest improvement in patient outcomes. Future studies should be multicenter and longer term.

Initial surgical performance in robot-assisted radical prostatectomy is associated with clinical outcomes and learning curves.

The association between surgical performance ratings and clinical outcomes in robotic surgery is poorly understood. Additionally, no studies have reported on the relationship between the surgeon's initial case-skill evaluation and the learning curve in robot-assisted surgery. We evaluated whether an objective surgical technique evaluation score for initial robot-assisted radical prostatectomy (RARP) was associated with clinical outcomes and surgeons' learning curves. Six surgeons who were trained in and started to perform RARP at our institution were included. Anonymized, unedited videos of each surgeon's 10th RARP case were evaluated by three reviewers, using modified Objective Structured Assessment of Technical Skill (OSATS) scores. We then divided the surgeons into two groups on the basis of these OSATS scores. We retrospectively compared the clinical outcomes and learning curves of the console time of the two groups for consecutive RARPs, performed from March 2018 to July 2023. We analyzed 258 RARPs (43 cases/surgeon), including 129 cases performed by high-OSATS score surgeons (18.2-19.3 points) and 129 cases performed by low-OSATS score surgeons (11.9-16.0 points). Overall, the high-OSATS score group had significantly shorter operation and console times than the low-OSATS score group did (both P < 0.01) and their patients' rate of continence recovery by 3months post-RARP was significantly higher (P = 0.03). However, complications, blood loss, and positive margins did not differ between the groups (P = 0.08, P = 0.51, and P = 0.90, respectively). The high-OSATS score group had a significantly shorter console time than the low-OSATS score group did after the 11-20 cases. The OSATS score in early RARP cases can predict subsequent surgical outcomes and surgeons' learning curves.

Editorial Comment on "Association of Crowd-Sourced Assessment of Technical Skills (CSATSTM) and Outcomes of Robotic Assisted Radical Prostatectomy".

Editorial Comment on "Association of Crowd-Sourced Assessment of Technical Skills (CSATSTM) and Outcomes of Robotic Assisted Radical Prostatectomy".

The Impact of Simulator Training of Vascular Anastomosis and Video Assessment for Surgical Residents

IntroductionThe rapid increase of minimally invasive surgery and the shortened training period for surgical residents has resulted in limited opportunities to acquire proficiency in open surgical techniques, such as vascular anastomosis. However, vascular anastomosis remains an essential skill in every surgery for bleeding control. This study aimed to validate the effectiveness of surgical education model for vascular anastomosis and assess the impact on the comprehension, skill, and confidence of surgical residents in performing vascular anastomosis. MethodsA total of 21 surgical residents with 1st to 3rd years of experience at Seoul National University Hospital participated in a four-week vascular anastomosis training program. The program included an educational lecture and the performance of an end-to-side anastomosis on a procedural model, with evaluations being conducted using the Objective Structured Assessment of Technical Skills (OSATS) and the End Product Rating Score (EPRS) in pre- and post-training surveys. ResultsSignificant improvement was observed in the OSATS score (from 9.22 ± 2.4 in week 1 to 12.87 ± 3.1 in week 4; P < 0.001) and the EPRS score (from 12.47 ± 4.1 in week 1 to 17.57 ± 2.2 in week 4; P < 0.001). Additionally, the surgical performance time significantly decreased from 20.99 ± 4.6 minutes to 16.33 ± 4.2 minutes (P = 0.019) ConclusionsSimulator training of in vitro vascular anastomosis, when accompanied by expert-led instruction, can effectively enhance the surgical proficiency, confidence, and overall surgical outcomes of residents, as inferred from the observed improvements in OSATS and EPRS scores. The results suggest that integration of this training model into surgical curricula could be a promising strategy for enhancing vascular surgical training.

Video-Based Performance Analysis in Pituitary Surgery—Part 1: Surgical Outcomes

Endoscopic pituitary adenoma surgery has a steep learning curve, with varying surgical techniques and outcomes across centers. In other surgeries, superior performance is linked with superior surgical outcomes. This study aimed to explore the prediction of patient-specific outcomes using surgical video analysis in pituitary surgery. Endoscopic pituitary adenoma surgery videos from a single center were annotated by experts for operative workflow (3 surgical phases and 15 surgical steps) and operative skill (using modified Objective Structured Assessment of Technical Skills [mOSATS]). Quantitative workflow metrics were calculated, including phase duration and step transitions. Poisson or logistic regression was used to assess the association of workflow metrics and mOSATS with common inpatient surgical outcomes. 100 videos from 100 patients were included. Nasal phase mean duration was 24minutes and mean mOSATS was 21.2/30. Mean duration was 34minutes and mean mOSATS was 20.9/30 for the sellar phase, and 11minutes and 21.7/30, respectively, for the closure phase. The most common adverse outcomes were new anterior pituitary hormone deficiency (n= 26), dysnatremia (n= 24), and cerebrospinal fluid leak (n= 5). Higher mOSATS for all 3 phases and shorter operation duration were associated with decreased length of stay (P= 0.003 &P < 0.001). Superior closure phase mOSATS were associated with reduced postoperative cerebrospinal fluid leak (P < 0.001), and superior sellar phase mOSATS were associated with reduced postoperative visual deterioration (P= 0.041). Superior surgical skill and shorter surgical time were associated with superior surgical outcomes, at a generic and phase-specific level. Such video-based analysis has promise for integration into data-driven training and service improvement initiatives.

Reply to Editorial Comment on "Association of Crowd-Sourced Assessment of Technical Skills (CSATSTM) and Outcomes of Robotic Assisted Radical Prostatectomy"

Reply to Editorial Comment on "Association of Crowd-Sourced Assessment of Technical Skills (CSATSTM) and Outcomes of Robotic Assisted Radical Prostatectomy"