Stepwise assessment tool of operative skills (SATOS): validity testing on a porcine training model of open gastrectomy.

Abstract

The aim of this prospective study was to evaluate and compare operative performance and technical improvement of surgical trainees learning open gastrectomy using an objective structured stepwise assessment tool of operative skills (SATOS) previously validated for open surgery. Thirty residents in general surgery performed 2 open partial gastrectomy training events on a porcine model. Earlier instruction was provided for the critical operative steps, with additional intraoperative instruction when required. Performance was assessed by postgraduate year (PGY) according to operative time, technical skills using a 23-step objective structured tool, and error rate. There were 11 PGY-3, 11 PGY-4, and 8 PGY-5 residents. At the initial assessment, performance significantly differentiated the 3 PGY grades according to technical skills and error rate. At the second assessment, all 3 PGY classes were still significantly differentiable by technical skills, with no difference in error rate. Comparing performances, residents improved operative time (p < 0.001), technical skills (p < 0.001), and error rate (p = 0.019) over the 2 training events. SATOS demonstrated relevant and accurate objective assessment of trainees' operative skills and improvement for open gastrectomy in a porcine model. This tool may be useful to standardize instruction, to expose weaknesses of trainees, and to determine minimal technical standards in residency programs.