Objective evaluation of the performance of surgical trainees on a porcine model of open colectomy.

Abstract

Evaluation of surgical trainee operative performance is rarely objective. A rating system is proposed that assesses trainee performance objectively and quantifies technical improvement. General surgery trainees were evaluated while performing porcine segmental colectomy. Initial instruction was provided for the critical operative steps. Evaluations were later repeated without additional instruction. Performance in 17 critical areas was scored. Twenty-three trainees were evaluated. Performance was divided into thirds, with a significant difference detected between tertiles (P < 0.001). Postgraduate year 2 trainees scored lower than those in years 3 and 4 (P < 0.001), but there was no difference between year 3 and 4 trainees (P = 0.557). Mean repeat scores were improved by 35 per cent, with most improvement at postgraduate year 2 level (71 per cent). Mean time taken to complete the operation was reduced by 23 per cent, with the largest reduction in the year 2 group. The results support the use of this rating system as a tool for the objective evaluation of trainee operative skill. Instruction in the performance of segmental colectomy using deconstructed, step-by-step direction improved the ability of junior trainees to complete the operation. This evaluation system may be useful in the assessment, instruction and technical development of surgical trainees.