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Eur J Cardiothorac Surg 2005;28:157-162
© 2005 Elsevier Science NL

Objective assessment of technical skills in cardiac surgery

^a Department of Surgical Oncology and Technology, Imperial College London, 10th Floor QEQM Building, St Mary's Hospital, Praed Street, London, UK
^b Academic Department of Cardiothoracic Surgery, Royal Brompton Hospital, Sydney Road, London SW3 6NP, UK
^c Department of Cardiothoracic Surgery, St Mary's Hospital, Praed Street, London, UK
^d Department of Cardiothoracic Surgery, Guy's and St Thomas Hospital, Lambeth Palace Road, London SE1 7EH, UK

Received 20 January 2005; received in revised form 10 March 2005; accepted 10 March 2005.

^* Corresponding author. Tel.: +44 207 886 1947; fax: +44 207 886 1810. (Email: j.hance{at}imperial.ac.uk).

Objective: Reduced training time combined with no rigorous assessment for technical skills makes it difficult for trainees to monitor their competence. We have developed an objective bench-top assessment of technical skills at a level commensurate with a junior registrar in cardiac surgery. Methods: Forty cardiothoracic surgeons were recruited for the study, consisting of 12 junior trainees (year 1–3), 15 senior trainees (year 4–6) and 13 consultants. The assessment consisted of four key tasks on standardised bench-top models: aortic root cannulation, vein-graft to aorta anastomosis, vein-graft to Left Anterior Descending (LAD) anastomosis and femoral triangle dissection. An expert surgeon was present at each station to provide passive assistance and rate performance on a validated global rating scale giving rise to a total possible score of 40. Three expert surgeons repeated the ratings retrospectively, using blinded video recordings. Data analysis employed non-parametric tests. Results: Both live and video scores differentiated significantly between performances of all groups of surgeons for all four stations (P<0.01) (median live and video score for LAD; Junior 19,17; Senior 29,22; Consultant 36,28). Correlations between live and blinded rating were high (r=0.67–0.84; P<0.001) as was inter-rater reliability between the three expert video raters (=0.81). Conclusions: The use of bench-top tasks to differentiate between cardiac surgeons of differing technical abilities has been validated for the first time. Furthermore, it is unnecessary to perform post-hoc video rating to obtain objective data. These measures can provide formative feedback for surgeons-in-training and lead to the development of a competency-based technical skills curriculum.

Key Words: Assessment • Competency-based • Operative skills • Technical competence