Response to “An Addition to the Technical Skills Assessment Toolbox”

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To the Editor:
We read with interest the letter about our “Toolbox” paper.1 The authors indicate that their instrument, assessment of urethral catheterization, was not included in our paper. Although our toolbox was published in 2015, we collected our data before publication of Todsen et al's2 study on urethral catheterization skills and therefore, it was not included in our paper. It is worth noting that Todsen's study did not include assessment of skills for suprapubic catheterization, which was 1 of 2 procedures included in the ACS/APDS Surgical Skills curriculum for urinary catheterization.3 Moreover, the unitary framework of validity was not used in their study design. Nonetheless, their tool is definitely a worthy addition to the assessment toolbox considering each source of validity reported using our proposed rating scale.1 Before publication of our toolbox, 2 systematic reviews of assessment tools for technical surgical skills were published.4,5 Our study did not intend to be another systematic review or meta-analysis but rather was written to provide a blueprint for researchers and educators for the appropriate use of validity concepts in study design and application of assessment tools in training programs. Therefore, we used the keywords pertaining to the selected procedures as our search strategy. Assessment of operative performance is a dynamic and ever-growing field and we anticipate that medical education researchers will continue to publish their assessment tools to improve the quality of assessment in surgical training. This will require a frequent update of our toolbox. We are encouraged to see that authors are increasingly using the contemporary framework of validity in their study designs.
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