L. J. Southgate

Bio: L. J. Southgate is an academic researcher from General Medical Council. The author has an hindex of 1, co-authored 1 publications receiving 135 citations.

Assessing the technical skills of surgical trainees.

Abstract: Background: The aims were to determine whether tests of technical skill on simple simulations can predict competence in the operating theatre and whether objective assessment in the operating theatre by direct observation and video recording is feasible and reliable. Methods: Thirty-three general surgical trainees undertook five simple skill simulations (knotting, skin incision and suturing, tissue dissection, vessel ligation and small bowel anastomosis). The operative competence of each trainee was then assessed during two or three saphenofemoral disconnections (SFDs) by a single surgeon. Video recordings of the operations were also assessed by two surgeons. Results: The inter-rater reliability between direct observation and blinded videotape assessment was high (α = 0·96 (95 per cent confidence interval 0·92 to 0·98)). Backward stepwise regression analysis revealed that the best predictors of operative competence were the number of SFDs performed previously plus the simulation scores for dissection and ligation, the key components of SFD (64 per cent of variance explained; P = 0·001). Conclusion: Deconstruction of operations into their component parts enables trainees to practise on simple simulations representing each component, and be assessed as competent, before undertaking the actual operation. Assessment of surgical competence by direct observation and video recording is feasible and reliable; such assessments could be used for both formative and summative assessment. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Objective assessment of technical surgical skills

Abstract: BACKGROUND: Surgeons are increasingly being scrutinized for their performance and there is growing interest in objective assessment of technical skills. The purpose of this study was to review all evidence for these methods, in order to provide a guideline for use in clinical practice. METHODS: A systematic search was performed using PubMed and Web of Science for studies addressing the validity and reliability of methods for objective skills assessment within surgery and gynaecology only. The studies were assessed according to the Oxford Centre for Evidence-based Medicine levels of evidence. RESULTS: In total 104 studies were included, of which 20 (19.2 per cent) had a level of evidence 1b or 2b. In 28 studies (26.9 per cent), the assessment method was used in the operating room. Virtual reality simulators and Objective Structured Assessment of Technical Skills (OSATS) have been studied most. Although OSATS is seen as the standard for skills assessment, only seven studies, with a low level of evidence, addressed its use in the operating room. CONCLUSION: Based on currently available evidence, most methods of skills assessment are valid for feedback or measuring progress of training, but few can be used for examination or credentialing. The purpose of the assessment determines the choice of method.

Postgame Analysis: Using Video-Based Coaching for Continuous Professional Development

Abstract: Background The surgical learning curve persists for years after training, yet existing continuing medical education activities targeting this are limited. We describe a pilot study of a scalable video-based intervention, providing individualized feedback on intraoperative performance. Study Design Four complex operations performed by surgeons of varying experience—a chief resident accompanied by the operating senior surgeon, a surgeon with less than 10 years in practice, another with 20 to 30 years in practice, and a surgeon with more than 30 years of experience—were video recorded. Video playback formed the basis of 1-hour coaching sessions with a peer-judged surgical expert. These sessions were audio recorded, transcribed, and thematically coded. Results The sessions focused on operative technique—both technical aspects and decision-making. With increasing seniority, more discussion was devoted to the optimization of teaching and facilitation of the resident's technical performance. Coaching sessions with senior surgeons were peer-to-peer interactions, with each discussing his preferred approach. The coach alternated between directing the session (asking probing questions) and responding to specific questions brought by the surgeons, depending on learning style. At all experience levels, video review proved valuable in identifying episodes of failure to progress and troubleshooting alternative approaches. All agreed this tool is a powerful one. Inclusion of trainees seems most appropriate when coaching senior surgeons; it may restrict the dialogue of more junior attendings. Conclusions Video-based coaching is an educational modality that targets intraoperative judgment, technique, and teaching. Surgeons of all levels found it highly instructive. This may provide a practical, much needed approach for continuous professional development.

Linking simulation-based educational assessments and patient-related outcomes: a systematic review and meta-analysis.

Abstract: PurposeTo examine the evidence supporting the use of simulation-based assessments as surrogates for patient-related outcomes assessed in the workplace.MethodThe authors systematically searched MEDLINE, EMBASE, Scopus, and key journals through February 26, 2013. They included original studies that as

Fifteen-year follow-up of a randomized clinical trial of ultrasonographic screening for abdominal aortic aneurysms.

Abstract: Background: Long-term benefits of screening for abdominal aortic aneurysm (AAA) are uncertain. These are the final results of a randomized controlled screening trial for AAA in men, updating those reported previously. Benefit and compliance over a median 15-year interval were examined. Methods: One group of men were invited for ultrasonographic AAA screening, and another group, who received standard care, acted as controls. A total of 6040 men aged 65–80 years were randomized to one of the two groups. Outcome was monitored in terms of AAA-related events (surgery or death). Results: In the group invited for screening, AAA-related mortality was reduced by 11 per cent (from 1·8 to 1·6 per cent, hazard ratio 0·89) over the follow-up interval. Screening detected an AAA in 170 patients; 17 of these died from an AAA-related cause, seven of which might have been preventable. The incidence of AAA rupture after an initially normal scan increased after 10 years of follow-up, but was still low overall (0·56 per 1000 person-years). Conclusion: Screening with a single ultrasonography scan still conferred a benefit at 15 years, although the results were not significant for this population size. Fewer than half of the AAA-related deaths in those screened positive could be prevented. Registration number: ISRCTN 00079388 (http://www.controlled-trials.com). Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Framework for Systematic Training and Assessment of Technical Skills

Abstract: K A s b he purpose of training programs for all medical specilities is to produce competent individuals who are able o meet the health-care needs of society. Recent editorils have commented on the crisis in medical education nd the requirement for defined competencies to assess erformance before new physicians begin independent edical practice. Effective since July 2002, the Acreditation Council for Graduate Medical Education ACGME) listed 6 categories of competence, defined as he ACGME Outcomes Project (Table 1). This article does not address the specific need for emonstration of proficiency in technical skills. This is ot an issue for the surgical specialities only but also for hysicians training in cardiology, anaesthesiology, gasrointestinal medicine, chest medicine, and intervenional radiology, together with allied health specialists. he introduction of new techniques and instruments to hese specialities requires training of not just residents, ut also of independent practitioners. This was clearly vident with the increased rate of complications associted with the introduction of laparoscopic cholecystecomy and has led to the development of training prorams at many centers around the globe. Although there is a transfer of skills to the trainee, urrent training programs have not been designed from background of scientific research to ensure the curriclum is valid, efficient, and competency based. The aim f a surgical residency program is to produce competent rofessionals, displaying the cognitive, technical, and ersonal skills required to meet the needs of society. ithin the context of surgical procedures, patients can xpect satisfactory outcomes in terms of cure, complicaion rates, and return to daily activities. Technical profi-