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Biomedical subjects

Simon Bann

Publications and source records attributed to Simon Bann.

7 recordsLinked to original sources
PubMed2005

Surgical skill is predicted by the ability to detect errors.

BACKGROUND: Objective analysis methods of surgical performance are now available so comparison between surgeons is available. One such method is by direct observation using the Objective Structured Assessment of Technical Skills (OSATS), but this is a time-consuming process; therefore, a simple screening tool for the ability to detect errors (previously validated) was analyzed and considered as a predictor of qualitative performance. METHODS: Thirty-eight volunteer surgeons were recruited to the skills laboratory to undertake 3 exercises. Two were bench-top surgical tasks that were scored using the global rating of the OSATS technique. The third task was the ability to detect simple errors in 22 synthetic models of common surgical procedures, some of which contained purposefully made errors. P<.05 was deemed to be statistically significant. RESULTS: The scores (interquartile ranges in parentheses) for the 3 sections were excision of sebaceous cyst=21 (19,24), closure of small bowel enterotomy=23 (21,27), and identification of errors=31 (27,34). Three scorers blinded to the operative models exhibited an interobserver reliability of .9 and .91 for the video tasks, respectively. Spearman's rank correlations between the error examination and performance on the 2 tasks were both statistically significant at .69 (cystectomy) and .54 (enterotomy). CONCLUSIONS: The ability to detect simple surgical errors is a predictor of technical skill and performance of bench tasks. What must be answered is whether the use of such models and principles can shorten the qualitative surgical learning curve.

Clinical Competence↗
PubMed2005

The reliability of multiple objective measures of surgery and the role of human performance.

BACKGROUND: There is a need for reliable and valid objective methods of technical skills in surgery. Six-bench surgical top stations have been combined to assess basic surgical trainees (BSTs) objectively. The current study examines its reliability and validity across repeat sittings. METHODS: Eleven surgical trainees (6 senior BSTs and 5 higher surgical trainees [HSTs]) undertook 5 sittings of the 6-station assessment designed to be completed within 90 minutes. The 6 stations consisted of knot tying, suturing, closure of enterotomy, excision of sebaceous cyst, laparoscopic task, and instrument examination. Methods of analysis employed were motion analysis, observation with criteria, and inbuilt simulation metrics. RESULTS: On analysis 3 knot tying and suturing stations exhibited significant differences in either time or movement; any difference was over by the second run. The intertest reliabilities were .66, .74, .55, .51, and .65 for the 5 runs. The intratest reliability across repeated sittings varied from .56 to .96. The inter-rater reliability for video assessment varied from .77 to .94. CONCLUSION: The assessment is reliable and valid across repeated sittings. Its use in assessment of basic technical skills needs to be encouraged.

Clinical Competence↗
PubMed2004

Technical performance: relation between surgical dexterity and technical knowledge.

Technical performance consists of surgical knowledge, judgment, and dexterity. Although assessment of surgical dexterity is now possible, assessing technical knowledge and its relation to dexterity has not been elucidated. Surgeons of varying experience were recruited to the skills laboratory to undertake three assessments: simple surgical dexterity (at 14 stations scored by motion analysis), an operating room equipment examination, and a novel error analysis. The scores were correlated, and p < 0.05 was deemed to be significant. Thirty surgeons were recruited; and construct validity was exhibited in all areas. Correlations were shown to exist between the two knowledge examinations (Spearman's rho = 0.39). Correlations existed between all dexterity task parameters and the equipment examination, whereas they existed for only 15 of the 28 parameters of the error examination and were always weaker. The stronger correlations between dexterity and instrument and operating room (OR) equipment reflect greater surgical experience and time spent in the OR. The weaker correlations between the error analysis and dexterity suggest that these skills are learned at different times. The identification of common surgical errors should be more formally taught to ensure greater uniformity.

Anastomosis, Surgical↗
PubMed2004

Ceiling effect in technical skills of surgical residents.

BACKGROUND: Objective evaluation of technical skills is now possible. The aim of this study was to evaluate whether a previously validated assessment tool can discriminate between junior and senior higher surgical trainees (HST) with regard to their technical skills. METHODS: Fifteen junior trainees (years 1 to 3) and 15 senior (years 4 to 6) were asked to perform a series of bench-model tasks, which included knot-tie at depth, vertical mattress suturing, sebaceous cyst excision, small bowel anastomosis, and saphenofemoral junction dissection. Analysis of performance included the Imperial College Surgical Assessment Device, which analyzed positional data such as total number of movements, total distance traveled, and time taken, and video-based qualitative evaluation of performance using global rating scales. In addition, all participants were asked to complete a self-assessment using exactly the same scoring system used by the observers. Statistical analysis included nonparametric tests and Cronbach's alpha was used for interrater reliability (IRR) A P value less than 0.05 was deemed significant. RESULTS: There were no significant differences in performance between junior and senior trainees for most of the tasks (IRR was 0.8 to 0.9). However, significant differences in performance were noted, in favor of the junior group, for knot-tie at depth, for two of the three parameters measured (total number of movements, P = 0.004; time taken, P = 0.01). CONCLUSIONS: In the absence of any significant differences between the groups, we can conclude that there is a ceiling effect (years 3 to 4) in performance beyond which pure technical skills, as measured by this tool, can no longer discriminate between levels of experience. Increasing the sensitivity of future assessment tools is necessary for better evaluation of performance levels. This finding also may imply that for the evaluation of senior trainees, other aspects of surgical competence should be assessed.

Adult↗
PubMed2004

Comparison of bench test evaluations of surgical skill with live operating performance assessments.

BACKGROUND: Attempts at assessing surgical proficiency have generally used laboratory simulation to evaluate skill. The aim of this study was to compare technical ability as measured on a bench simulation with actual operative performance. STUDY DESIGN: Twenty-two general surgeons and trainees were recruited: consultants (n = 4), specialist registrars (n = 14), and senior house officers (n = 4). They were assessed while performing a saphenofemoral dissection on an anesthetized patient in the operating theater, and performing the same procedure on an inanimate model within the laboratory. The Objective Structured Assessment of Technical Skill method, consisting of a 7-parameter global rating (maximum score 35) and 17-point step-by-step checklist (maximum score 17) was used to measure performance in both environments. Face, content, and construct validity of the synthetic model were established as part of this study. RESULTS: There was a significant relationship between technical skill as measured on the bench test model and performance within the operating theater with respect to both global rating (Spearman correlation coefficient 0.824, p < 0.001; alpha coefficient 0.89) and checklist ratings (r = 0.514, p < 0.02; alpha coefficient 0.68) rating assessments. Global rating scores correlated with experience for both operative (r = 0.822, p < 0.001) and bench (r = 0.515, p < 0.05) settings. There was no difference in level of measured performance between operating theater and bench model (global rating mean 23.25 +/- 6.66 versus 23.75 +/- 5.62, respectively; paired t-test p = 0.559). CONCLUSIONS: Assessment of technical skill using inanimate procedural simulation translates to actual surgical performance within the operating theater. This further validates use of bench test evaluations to measure surgical technical ability.

Clinical Competence↗
PubMed2003

The surgical error examination is a novel method for objective technical knowledge assessment.

BACKGROUND: Objective analysis of surgical skill is necessary. A novel method of assessment using simple error analysis in synthetic models is examined for construct validity. METHODS: Two examination protocols were devised using synthetic models. These contained either a purpose made error or were representative of good surgical practice. Protocol one contained models of skin closure and minor operations. Protocol two in addition more complex procedures. Face validity was established by the approval of senior surgeons. Junior surgeons were recruited to undertake the assessment. A p value of less than 0.05 was deemed to be significant. RESULTS: Eighty-nine surgeons were recruited. Both protocol one and two were able to discriminate between groups at statistically significant levels. CONCLUSIONS: Construct validity has been established by showing that error analysis is able to distinguish surgeons with varying levels of experience.

Clinical Competence↗