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Assessing intraoperative judgment using script concordance testing through the gynecology continuum of practice

机译：通过妇科连续练习使用脚本一致性测试评估术中判断

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Objective: To measure surgical judgment across the Obstetrics and Gynecology (OBGYN) continuum of practice and identify factors that correlate with improved surgical judgment. Methods: A 45-item written examination was developed using script concordance theory, which compares an examinee's responses to a series of "ill-defined" surgical scenarios to a reference panel of experts. The examination was administered to OBGYN residents, Female Pelvic Medicine and Reconstructive Surgery (FPMRS) fellows, practicing OBGYN physicians and FPMRS experts. Surgical judgment was evaluated by comparing scores against the experts. Factors related to surgical experience were measured for association with scores. Results: In total, 147 participants including 11 residents, 37 fellows, 88 practicing physicians and 11 experts completed the 45-item examination. Mean scores for practicing physicians (65.2 ± 7.4) were similar to residents (67.2 ± 7.1), and worse than fellows (72.6 ± 4.2, p < 0.001) and experts (80 ± 5, p < 0.001). Positive correlations between scores and surgical experience included: annual number of vaginal hysterectomies (r = 0.32, p = <0.001), robotic hysterectomies (r = 0.17, p = 0.048), stress incontinence (r = 0.29, p < 0.001) and prolapse procedures (r = 0.37, p < 0.001). Inverse correlation was seen between test scores and years in practice. (r = -0.19, p = 0.02). Conclusion: Intraoperative judgment in practicing OBGYN physicians appears similar to resident physicians. Practicing physicians who perform FPMRS procedures perform poorly on this examination of surgical judgment; lower performance correlates with less surgical experience and the greater amount of time in practice.
机译：目的：衡量整个妇产科（OBGYN）实施实践中的手术判断，并确定与改善手术判断相关的因素。方法：使用脚本一致性理论开发了45个项目的笔试，该笔试将受检者对一系列“不确定”外科手术方案的反应与专家参考小组进行比较。这项检查适用于OBGYN居民，女性盆腔医学和重建外科（FPMRS）研究员，实践OBGYN医师和FPMRS专家。通过与专家比较分数来评估手术判断。测量与手术经验有关的因素与得分的关联。结果：总共有147名参与者完成了45个项目的检查，其中包括11名住院医师，37名研究员，88名执业医师和11名专家。从业医生的平均得分（65.2±7.4）与住院医师（67.2±7.1）相似，但比同伴（72.6±4.2，p <0.001）和专家（80±5，p <0.001）差。评分与手术经验之间的正相关包括：阴道子宫切除术的年数（r = 0.32，p = <0.001），机器人子宫切除术（r = 0.17，p = 0.048），压力性尿失禁（r = 0.29，p <0.001）和脱垂程序（r = 0.37，p <0.001）。考试成绩和实践年数之间存在反相关关系。 （r ＝ -0.19，p ＝ 0.02）。结论：OBGYN执业医师的术中判断似乎与住院医师相似。进行FPMRS程序的执业医师在这种手术判断检查中表现不佳;较低的性能与较少的手术经验和更长的实践时间相关。

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