Assessing the surgical decision making abilities of novice and proficient urologists.

Abstract

We examined whether the Surgical Decision Making Rating Scale can measure a difference in surgical judgment among urologists at various levels of training. A total of 25 medical students, urology residents and staff urologists viewed clips from 8 select urological procedures and verbalized their thought processes. The clips were ordered in increasing complexity from lower level tasks (catheterization and cystoscopy) to more advanced procedures (laser lithotripsy, and open and laparoscopic prostatectomy and nephrectomy). Performance was transcribed and blindly rated using the previously validated rating scale. Subjects were also asked to self-evaluate their performance using this scale. Overall the rating scale distinguished the training level across knowledge domains (anatomy and management of the current task) and judgment domains (avoiding complications, higher reasoning and immediate surgical planning). The mean score across all training levels was 112 of 200 (range 51 to 161). Scale performance showed a significant correlation with seniority (rho = 0.96, p <0.05). This trend persisted when performance was analyzed separately for knowledge and judgment domain elements (rho = 0.95 and 0.96, respectively, each p <0.05). Self-evaluation correlated well with blinded evaluation across all levels of training (rho = 0.87, p = 0.01). The Surgical Decision Making Rating Scale can reliably detect differences in knowledge and surgical judgment among medical students, urology residents and staff urologists. This tool has potential applications for evaluating trainees and determining subjects with proficient decision making abilities. It also shows a significant correlation between self-rated performance and blinded evaluation.