Skip to main content
SpringerLink
Log in

Difficult or high risk? Objective task assessment vs. faculty perceptions of surgical skills

Global Surgical Education - Journal of the Association for Surgical Education Aims and scope Submit manuscript

Cite this article

Abstract

Purpose

With increasing competency demands within limited training opportunities, instruction must be efficient. We compared intern performance and faculty expectations to identify opportunities to optimize basic surgical skills instruction.

Methods

After completing a basic surgical skills curriculum, 35 surgical interns were scored (5-point Likert scale) on ten suturing, knot-tying, and vessel ligation tasks. Thirteen surgical faculty was surveyed on their perceptions of difficulty and risk of patient harm associated with each task. Correlation between faculty-perceived difficulty and risk was evaluated using Pearson’s coefficient. The difference between actual score and expected score based on faculty perception of difficulty was assessed for each task.

Results

Among participating interns, mean scores were lowest for atraumatic tying at-depth, tying under tension, and running subcuticular suturing and highest for simple running suture (superficially). Faculty perceived ligation with suture, tying under tension, atraumatic tying (superficially and at-depth) and tying around clamp to be the hardest and highest-risk tasks. Simple running suture (superficially and at-depth), running subcuticular suture, vertical mattress suture, and 2-handed tie were considered the easiest and lowest-risk tasks. Faculty perceptions of task difficulty and risk were strongly correlated (r(8) = 0.75, p = 0.01). Interns performed better than expected on ligation with suture and tying around clamp and worse than expected on running subcuticular and vertical mattress sutures.

Conclusions

Our findings suggest differential task difficulty and misalignment between intern performance and faculty expectations, which may be influenced by risk of patient harm. These findings provide insights for refining learning progression and instruction of these skills.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

The datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request.

References

  1. Lewis FR, Klingensmith ME. Issues in general surgery residency training—2012. Ann Surg. 2012;256(4):553–9. https://doi.org/10.1097/SLA.0b013e31826bf98c.

    Article  PubMed  Google Scholar 

  2. Supplemental Guide: Surgery. ACGME, Jan. 2019. [Online]. Available: https://www.acgme.org/specialties/surgery/milestones/. Accessed: 11 Sep 2022.

  3. Choo KJ, Arora VM, Barach P, Johnson JK, Farnan JM. How do supervising physicians decide to entrust residents with unsupervised tasks? A qualitative analysis. J Hosp Med. 2014;9(3):169–75. https://doi.org/10.1002/jhm.2150.

    Article  PubMed  Google Scholar 

  4. Sterkenburg A, Barach P, Kalkman C, Gielen M, ten Cate O. When do supervising physicians decide to entrust residents with unsupervised tasks? Acad Med. 2010;85(9):1408–17. https://doi.org/10.1097/ACM.0b013e3181eab0ec.

    Article  PubMed  Google Scholar 

  5. Chung RS, Ahmed N. The impact of minimally invasive surgery on residents’ open operative experience: analysis of two decades of national data. Ann Surg. 2010;251(2):205–12. https://doi.org/10.1097/SLA.0b013e3181c1b18e.

    Article  PubMed  Google Scholar 

  6. Chung RS, Wojtasik L, Pham Q, Chari V, Chen P. The decline of training in open biliary surgery. Surg Endosc Interv Tech. 2003;17(2):338–40. https://doi.org/10.1007/s00464-002-8621-4.

    Article  CAS  Google Scholar 

  7. Park J, Parker SH, Safford S. Surgical trainees’ confidence in the operating room improves over time with a corresponding increase in responsibility. Am Surg. 2017;83(11):421–3. https://doi.org/10.1177/000313481708301102.

    Article  Google Scholar 

  8. Klingensmith ME, Lewis FR. General surgery residency training issues. Adv Surg. 2013;47(1):251–70. https://doi.org/10.1016/j.yasu.2013.05.001.

    Article  PubMed  Google Scholar 

  9. Jamal MH, Rousseau MC, Hanna WC, Doi SAR, Meterissian S, Snell L. Effect of the ACGME duty hours restrictions on surgical residents and faculty: a systematic review. Acad Med. 2011;86(1):34–42. https://doi.org/10.1097/ACM.0b013e3181ffb264.

    Article  PubMed  Google Scholar 

  10. Sandhu G, Teman NR, Minter RM. Training autonomous surgeons: more time or faculty development? Ann Surg. 2015;261(5):843–5. https://doi.org/10.1097/SLA.0000000000001058.

    Article  PubMed  Google Scholar 

  11. Sen S, et al. Effects of the 2011 duty hour reforms on interns and their patients: a prospective longitudinal cohort study. JAMA Intern Med. 2013;173(8):657–62. https://doi.org/10.1001/jamainternmed.2013.351.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Kairys JC, McGuire K, Crawford AG, Yeo CJ. Cumulative operative experience is decreasing during general surgery residency: a worrisome trend for surgical trainees? J Am Coll Surg. 2008;206(5):804–11. https://doi.org/10.1016/j.jamcollsurg.2007.12.055.

    Article  PubMed  Google Scholar 

  13. Reznick RK, MacRae H. Teaching surgical skills—changes in the wind. N Engl J Med. 2006;355(25):2664–9. https://doi.org/10.1056/NEJMra054785.

    Article  CAS  PubMed  Google Scholar 

  14. Bingmer K, Ofshteyn A, Stein SL, Marks JM, Steinhagen E. Decline of open surgical experience for general surgery residents. Surg Endosc. 2020;34(2):967–72. https://doi.org/10.1007/s00464-019-06881-0.

    Article  PubMed  Google Scholar 

  15. Sheetz KH, Claflin J, Dimick JB. Trends in the adoption of robotic surgery for common surgical procedures. JAMA Netw Open. 2020;3(1):e1918911. https://doi.org/10.1001/jamanetworkopen.2019.18911.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kelley WE. The evolution of laparoscopy and the revolution in surgery in the decade of the 1990s. JSLS. 2008;12(4):351–7.

    PubMed  PubMed Central  Google Scholar 

  17. Alkhoury F, Martin JT, Contessa J, Zuckerman R, Nadzam G. The impact of laparoscopy on the volume of open cases in general surgery training. J Surg Educ. 2010;67(5):316–9. https://doi.org/10.1016/j.jsurg.2010.08.001.

    Article  PubMed  Google Scholar 

  18. McCoy AC, Gasevic E, Szlabick RE, Sahmoun AE, Sticca RP. Are open abdominal procedures a thing of the past? An analysis of graduating general surgery residents’ case logs from 2000 to 2011. J Surg Educ. 2013;70(6):683–9. https://doi.org/10.1016/j.jsurg.2013.09.002.

    Article  PubMed  Google Scholar 

  19. Eckert M, Cuadrado D, Steele S, Brown T, Beekley A, Martin M. The changing face of the general surgeon: national and local trends in resident operative experience. Am J Surg. 2010;199(5):652–6. https://doi.org/10.1016/j.amjsurg.2010.01.012.

    Article  PubMed  Google Scholar 

  20. Mattar SG, et al. General surgery residency inadequately prepares trainees for fellowship: results of a survey of fellowship program directors. Ann Surg. 2013;258(3):440–9. https://doi.org/10.1097/SLA.0b013e3182a191ca.

    Article  PubMed  Google Scholar 

  21. Napolitano LM, et al. Are general surgery residents ready to practice? A survey of the American College of Surgeons Board of Governors and Young Fellows Association. J Am Coll Surg. 2014;218(5):1063-1072.e31. https://doi.org/10.1016/j.jamcollsurg.2014.02.001.

    Article  PubMed  Google Scholar 

  22. Ericsson K, Lehmann A. Expert and exceptional performance: evidence of maximal adaptation to task constraints. Annu Rev Psychol. 1996;47:273–305. https://doi.org/10.1146/annurev.psych.47.1.273.

    Article  CAS  PubMed  Google Scholar 

  23. Sadideen H, Alvand A, Saadeddin M, Kneebone R. Surgical experts: born or made? Int J Surg. 2013;11(9):773–8. https://doi.org/10.1016/j.ijsu.2013.07.001.

    Article  PubMed  Google Scholar 

  24. Schaverien MV. Development of expertise in surgical training. J Surg Educ. 2010;67(1):37–43. https://doi.org/10.1016/j.jsurg.2009.11.002.

    Article  PubMed  Google Scholar 

  25. Roberts KE, Bell RL, Duffy AJ. Evolution of surgical skills training. World J Gastroenterol WJG. 2006;12(20):3219–24. https://doi.org/10.3748/wjg.v12.i20.3219.

    Article  PubMed  Google Scholar 

  26. Sloth SB, Jensen RD, Seyer-Hansen M, Christensen MK, De Win G. Remote training in laparoscopy: a randomized trial comparing home-based self-regulated training to centralized instructor-regulated training. Surg Endosc. 2022;36(2):1444–55. https://doi.org/10.1007/s00464-021-08429-7.

    Article  PubMed  Google Scholar 

  27. Bashankaev B, Baido S, Wexner SD. Review of available methods of simulation training to facilitate surgical education. Surg Endosc. 2011;25(1):28–35. https://doi.org/10.1007/s00464-010-1123-x.

    Article  PubMed  Google Scholar 

  28. Pentiak PA, et al. Barriers to adoption of the surgical resident skills curriculum of the American College of Surgeons/Association of Program Directors in Surgery. Surgery. 2013;154(1):23–8. https://doi.org/10.1016/j.surg.2013.04.058.

    Article  PubMed  Google Scholar 

  29. Bridges M, Diamond DL. The financial impact of teaching surgical residents in the operating room. Am J Surg. 1999;177(1):28–32. https://doi.org/10.1016/S0002-9610(98)00289-X.

    Article  CAS  PubMed  Google Scholar 

  30. Nasca TJ, Day SH, Amis ES. The new recommendations on duty hours from the ACGME task force. N Engl J Med. 2010;363(2):e31–6. https://doi.org/10.1056/NEJMsb1005800.

    Article  Google Scholar 

  31. Acton RD, Chipman JG, Lunden M, Schmitz CC. Unanticipated teaching demands rise with simulation training: strategies for managing faculty workload. J Surg Educ. 2015;72(3):522–9. https://doi.org/10.1016/j.jsurg.2014.10.013.

    Article  PubMed  Google Scholar 

  32. Stefanidis D, et al. Simulation in surgery: what’s needed next? Ann Surg. 2015;261(5):846–53. https://doi.org/10.1097/SLA.0000000000000826.

    Article  PubMed  Google Scholar 

  33. Pritchett L, Beatty A. Slow down, you’re going too fast: matching curricula to student skill levels. Int J Educ Dev. 2015;40:276–88. https://doi.org/10.1016/j.ijedudev.2014.11.013.

    Article  Google Scholar 

  34. Andrietti V, Su X. Education curriculum and student achievement: theory and evidence. Educ Econ. 2019;27(1):4–19. https://doi.org/10.1080/09645292.2018.1527894.

    Article  Google Scholar 

  35. Greenberg AL, et al. Assessment of surgeon performance of advanced open surgical skills using a microskills-based novel curriculum. JAMA Netw Open. 2022;5(9):e2229787. https://doi.org/10.1001/jamanetworkopen.2022.29787.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. STROBE. https://www.strobe-statement.org/checklists/ accessed 11 Sep 2022.

  37. Gonzalez-Vargas JM, et al. Objective assessment metrics for central line simulators: an exploration of causal factors. Proc Hum Factors Ergon Soc Annu Meet. 2020;64(1):2008–12. https://doi.org/10.1177/1071181320641487.

    Article  PubMed  Google Scholar 

  38. Gumbs AA, Hogle NJ, Fowler DL. Evaluation of resident laparoscopic performance using global operative assessment of laparoscopic skills. J Am Coll Surg. 2007;204(2):308–13. https://doi.org/10.1016/j.jamcollsurg.2006.11.010.

    Article  PubMed  Google Scholar 

  39. Thorne CH. Techniques and Principles in Plastic Surgery, 6th ed., vol. Grabb and Smith’s Plastic Surgery. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2007. [Online]. Available: https://doctorlib.info/surgery/plastic/1.html. Accessed: 11 Sep 2022.

  40. Kil I, Groff RE, Singapogu RB. Surgical Suturing with Depth Constraints: Image-based Metrics to Assess Skill. In: Annu. Int. Conf. IEEE Eng. Med. Biol. Soc. IEEE Eng. Med. Biol. Soc. Annu. Int. Conf., vol. 2018, pp. 4146–4149, 2018, https://doi.org/10.1109/EMBC.2018.8513266.

  41. Tillo O, Nawinne M, Oudit D. Approximating tissue under tension using the slipped square sliding knot. Ann R Coll Surg Engl. 2008;90(3):258–9. https://doi.org/10.1308/003588408X285720g.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Sanfey HA, Dunnington GL. Basic surgical skills testing for junior residents: current views of general surgery program directors. J Am Coll Surg. 2011;212(3):406–12. https://doi.org/10.1016/j.jamcollsurg.2010.12.012.

    Article  PubMed  Google Scholar 

  43. Biggs J, Tang C. Teaching for quality learning at university. McGraw-Hill Education; 2011.

    Google Scholar 

  44. Greenberg AL et al. Faculty entrustment of residents in the operating room: the role for surgical simulation. Global Surg Educ. 2023;2(1):48. https://doi.org/10.1007/s44186-023-00128-2.

  45. Wijngaards-de-Meij L, Merx S. Improving curriculum alignment and achieving learning goals by making the curriculum visible. Int J Acad Dev. 2018;23(3):219–31. https://doi.org/10.1080/1360144X.2018.1462187.

    Article  Google Scholar 

  46. Kahneman D, Slovic SP, Slovic P, Tversky A, Press CU. Judgment under uncertainty: heuristics and biases. Cambridge University Press; 1982.

    Book  Google Scholar 

  47. MacLeod C, Campbell L. Memory accessibility and probability judgments: an experimental evaluation of the availability heuristic. J Pers Soc Psychol. 1992;63:890–902. https://doi.org/10.1037/0022-3514.63.6.890.

    Article  CAS  PubMed  Google Scholar 

  48. Mamede S, et al. ‘Immunising’ physicians against availability bias in diagnostic reasoning: a randomised controlled experiment. BMJ Qual Saf. 2020;29(7):550–9. https://doi.org/10.1136/bmjqs-2019-010079.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Prakash S, Sladek RM, Schuwirth L. Interventions to improve diagnostic decision making: a systematic review and meta-analysis on reflective strategies. Med Teach. 2019;41(5):517–24. https://doi.org/10.1080/0142159X.2018.1497786.

    Article  PubMed  Google Scholar 

  50. Hirt ER, Markman KD. Multiple explanation: a consider-an-alternative strategy for debiasing judgments. J Pers Soc Psychol. 1995;69:1069–86. https://doi.org/10.1037/0022-3514.69.6.1069.

    Article  Google Scholar 

  51. Kahneman D, Sibony O, Sunstein CR. Noise: a flaw in human judgment. Little, Brown, 2021.

  52. Schill M, Tiemann D, Klingensmith ME, Brunt LM. Year one outcomes assessment of a masters suturing and knot-tying program for surgical interns. J Surg Educ. 2011;68(6):526–33. https://doi.org/10.1016/j.jsurg.2011.04.005.

    Article  PubMed  Google Scholar 

  53. Shippey SH, Chen TL, Chou B, Knoepp LR, Bowen CW, Handa VL. Teaching subcuticular suturing to medical students: video versus expert instructor feedback. J Surg Educ. 2011;68(5):397–402. https://doi.org/10.1016/j.jsurg.2011.04.006.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

CYH is part of the Biostatistics Core that is generously supported by the UCSF Department of Surgery.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Surgery, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143, USA

    Anya L. Greenberg, Katherine E. Barnes, Mohammad M. Karimzada, Adnan Alseidi, Joseph H. Rapp, Patricia S. O’Sullivan, Hueylan Chern & Shareef M. Syed

  2. Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA

    Chiung-Yu Huang

  3. Department of Medicine, University of California, San Francisco, San Francisco, CA, USA

    Patricia S. O’Sullivan

Authors
  1. Anya L. Greenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Katherine E. Barnes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mohammad M. Karimzada
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chiung-Yu Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Adnan Alseidi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Joseph H. Rapp
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Patricia S. O’Sullivan
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hueylan Chern
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Shareef M. Syed
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by AG and C-YH. The first draft of the manuscript was written by AG and KB, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Shareef M. Syed.

Ethics declarations

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethics

Our Institutional Review Board (IRB) declared the study exempt.

Informed consent

A waiver of informed consent was granted by our IRB given exempt status.

Supplementary Information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Greenberg, A.L., Barnes, K.E., Karimzada, M.M. et al. Difficult or high risk? Objective task assessment vs. faculty perceptions of surgical skills. Global Surg Educ 2, 50 (2023). https://doi.org/10.1007/s44186-023-00131-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s44186-023-00131-7

Keywords

search

Navigation