Abstract
Purpose
Case logs have been utilized as a means of assessing residents surgical exposure and involvement in cases. It can be argued that the degree of involvement in operative cases is as important as absolute number of cases logged. A log which contains accurate information on actual participation in surgical cases in addition to self reported competency, is a powerful tool in obtaining a true reflection of surgical experience. Thus a prerequisite for a valuable log is the ability to perform an accurate self-assessment. Numerous studies have shown mixed results when examining residents ability to perform self-assessment on varying tasks. The purpose of the study was to examine the correlation between residents self-assessment and staff surgeons evaluation of surgical involvement and competence in performing primary hip and knee arthroplasty surgery.
Method
Self assessment data from 65 primary hip and knee arthroplasty cases involving 17 residents and 17 staff surgeons (93% response rate) was analyzed. Interobserver agreement between residents self perception and staff surgeons assessment of involvement was evaluated using the Intraclass Correlation Coefficient (ICC). An assessment of competency was performed utilizing a categorical global scale and evaluated with the Kappa statistic (k). Furthermore, a structured surgical skills assessment form was piloted as an objective appraisal of resident involvement and comparisons were made to resident and staff perception.
Results
The Intraclass Correlation Coefficient for resident involvement between Resident and Staff was 0.80 (0.69–0.88) which represents substantial agreement between the groups. The agreement between resident and staff with regard to residents competency to perform case was k = 0.67 (0.50–0.84). The ICC for Resident, Staff, and Third Party observer utilizing the piloted skills assessment form was 0.82 (0.75–0.88) which represents substantial agreement and helps to confirm the agreement between various members of the surgical team.
Conclusion
This study may help to confirm the ability of orthopaedic residents to perform a self-assessment of their degree of involvement and performance competency in primary hip and knee arthroplasty surgery. Furthermore, the staff surgeons assessment of resident involvement was highly correlated with the surgical skills assessment form. The inclusion of a self-assessment is a valuable addition to the surgical case log.
