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 completion.
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.
Topics: 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,
Victoria Wang, MD; Tufts Medical Center; Katherine Hicks-Courant, MD; John Schorge, MD
