Surgical skills assessment for trainees?

Previously, i quoted Adelaide-based surgeon Mr Comus Whalan, BMBS, MD, FRACS (Visiting Surgeon, Noarlunga Health Service, Adelaide, South Australia). He edited a practical guide to assisting any surgical operation.

 

ON SURGEONS’ STEADY HANDS …

• Contrary to what Hollywood scriptwriters may think, to do most operations properly, probably requires no more than average manual dexterity. In the author’s opinion, anyone who can write neatly probably has enough manual dexterity to do most surgical operations. The qualities that distinguish a superior surgeon from an average one are far more subtle, reside in the cerebral cortex rather than the cerebellum, and mainly involve complex decision-making and judgement

Addenum [15/4/09]

• The ANZ Journal of Surgery published a special edition in March 2009 (Vol. 79, Iss. 3) on surgical education.
• An article seems to portray differing opinions from Mr Whalan.

 

Gallagher, Leonard and Traynor wrote about the “Role and feasibility of psychomotor and dexterity testing in selection for surgical training”.

 

They believe: 

• “knowledge, judgement and good technical skills will no longer be enough to safely practice surgery and interventional procedures” and that 
• other “fundamental abilities (e.g. psychomotor skills, visuospatial ability and depth perception) are critically important for catheter-based interventions, NOTES, robotic surgery and other procedural interventions of the future.”

Well obviously not everyone is well endowed with the same amount of these “innate fundamental abilities”. Gallagher et al opine that “those less endowed are likely to struggle during surgical training and thereafter in surgical practice.”

To be honest, if they struggle during surgical training, its fair game. But thereafter in surgical practice? Wouldn’t that reflect so badly on the teaching hospital, superiors, mentors, and ultimately the governing body for that country’s surgeons (e.g. American College of Surgery, Intercollegiate Royal College of Surgeons, Royal Australasian College of Surgeons, Academy of Medicine Singapore, etc.)? Is it possible that training can overcome such “deficits” in innate fundamental abilities? Can surgical skills be imparted REGARDLESS of innate talent?  

They go on to attempt to compare surgery to other professions. “In contrast to other high-skill professions/industries (e.g. aviation) we do not have a tradition of testing prospective surgical trainees for abilities/attributes that we now recognize as being important for surgical practice. Instead, we continue to rely on surrogate markers of future potential (e.g. academic record)”

Then they attempt to push their case further. “… many studies have shown that psychomotor ability is an important predictor of both learning rate and performance for complex laparoscopic tasks. Psychomotor skills, visuospatial ability and depth perception can all be tested objectively by validated tests.”

Finally they reveal what is done at the Royal College of Surgeons in Ireland. “… all short-listed candidates for Higher Surgical Training now undergo formal testing of both technical skills and fundamental abilities (psychomotor skills, visuospatial ability and depth perception). Reports on each candidate’s performance are supplied to the interview committee. Furthermore, a prospective database is being kept for correlation with future surgical performance. We believe that selection into surgical training should take account of attributes that we know are important for safe and efficient surgical practice.”

 

 

Grantcharov and Reznick

, in their article entitled “Training tomorrow’s surgeons: what are we looking for and how can we achieve it?”, states their assertions clearly.

“Although technical proficiency is definitely an important prerequisite for a successful outcome, other qualities such as intellectual abilities, personality and communication skills, and a commitment to practice are important elements in the profile of a competent surgeon.”

They then highlight this new trend of using psychometric assessment as an objective assessment possibility during the foundational education period for future surgeons. (Bann and Darzi, 2005)

Assessment like Ability Testing in Surgery, Cognitive Testing, Manual Dexterity, Visual Spatial Ability, Personality Testing are discussed.

~ ~ ~

E.g. of visual spatial assessment: (source)

Which figure is identical to the first?

Which pattern can be folded to make the cube shown?

Traditionally speaking, those whose manual dexterity are superior (e.g. being able to pick up rice grains with chop sticks, or can cross stitch, or knit very quickly and skilfully) are touted as the “future surgeons” by casual observers. Will these talented individuals have a substantial competitive advantage? 

Somehow, i suspect one’s opinion will depend on previous surgeons or surgical trainees one has worked before, or even one’s own progress through surgical training? 

 

I’m certain those who are pretty good at the above skills are likely to say these ALL should be part of surgical assessment and be the BIGGEST ever criteria for entrance into a surgical program.

Those who are not, may say otherwise, emphasising other attributes like compassion, academic ability, and sound clinical judegement, and attainable-through-hard-work CV items, e.g. medical school grades, research, community work, letters of recommendations from previous superiors.

he wasn’t the most talented student at musical school

what he lacked in natural ability, he made up in discipline

he practiced

all the time

all the time he practiced

Dr Preston Burke talks about a violinist musical legend, the best there was, whom he always admired, on whom he operated, but unfortunately died on the table. Quote from Grey’s Anatomy

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