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Assessment of Chief Resident Laparoscopic Hysterectomy Performance Using Global Operative Assessment of Laparoscopic Skills (GOALS)
Purpose: To implement a validated, standardized tool to assess
resident performance during laparoscopic hysterectomy.
Background: Surgical feedback is critical to resident
education, but it is often subjective and sporadically given. GOALS is a
validated tool consisting of a 10-item checklist, 5-item global rating score,
and an overall satisfaction score that is widely used in general surgery to
assess resident skills during laparoscopic cholycystectomy and appendectomy.
Methods: Chief residents and one attending performing
laparoscopic hysterectomies together filled out blinded evaluations after each
case. The checklist was constructed by identifying 10 critical steps in
completing the operation independently. Five laparoscopic domains (depth
perception, bimanual dexterity, efficiency, tissue handling, and autonomy) and
an assessment of case difficulty were scored on a 5-point scale. Overall
satisfaction with the resident performance was rated on a 10-point scale.
Paired t-tests were used to compare resident and attending scores. A regression
analysis demonstrated an association between case difficulty and resident step
Results: 56 hysterectomies were performed during the study interval
with a mean step completion resident score of 6.9 (attending score 6.8; P =
0.56). Residents rated themselves lower in laparoscopic skills than the
attending (3.25 vs 3.6; P = 0.0001), even though estimation of case difficulty
was similar (2.81 vs 3.13; P = 0.03).
Discussions: We describe here a method for standardizing feedback
and evaluation in the performance of laparoscopic hysterectomies. Residents
consistently perform about 7 of the 10 steps required to independently perform
laparoscopic hysterectomy. Trainees were more critical than the attending in
assessing their own performance.
CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Residency Director, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Assessment, Gynecologic Oncology, Minimally Invasive Surgery, General Ob-Gyn,