Relationship between skill and outcome in the laboratory-based model

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Background.Recent attention has been directed at developing quantitative assessments of surgical skill. This study aims to demonstrate whether objectively measuring differences in manual dexterity has an impact on a simulated surgical procedure.Methods.Six general surgical trainees performed 5 polytetrafluoroethylene graft to artery anastomoses on a vascular model by using a standardized technique. Manual dexterity was objectively measured with (1) electromagnetic motion analysis: trackers applied to the backs of hands recorded and analyzed both hand movements and procedural time and (2) 4-parameter evaluation of the final product. Outcome parameters were assessed by (1) rate of anastomotic leakage and (2) smallest cross-sectional area of the anastomosis.Results.The 2 objective measures of manual dexterity correlated closely (Pearson coefficient, 0.423; P < .02). Trainees with better manual dexterity scores produced better outcome measures. Those with better motion analysis scores produced anastomoses that leaked less (Pearson coefficient, 0.514; P < .01) and those with higher global evaluation scores had a larger anastomotic cross-sectional area (Pearson coefficient, 0.495; P < .01). Time taken for the procedure did not appear to influence either outcome measure.Conclusions.There is a significant correlation between objective measures of manual dexterity and the outcome measures in this model. This suggests that the outcome of a procedure can be predicted by measuring surgical skill. (Surgery 2002;131:318-23.)

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