Surgical education
A global assessment tool for evaluation of intraoperative laparoscopic skills

Presented in part at the Society of American Gastrointestinal and Endoscopic Surgeons Meeting, Denver, CO, March 31 to April 3, 2004
https://doi.org/10.1016/j.amjsurg.2005.04.004Get rights and content

Abstract

Background

There is a pressing need for an intraoperative assessment tool that meets high standards of reliability and validity to use as an outcome measure for different training strategies. The aim of this study was to develop a tool specific for laparoscopic skills and to evaluate its reliability and validity.

Methods

The Global Operative Assessment of Laparoscopic Skills (GOALS) consists of a 5-item global rating scale. A 10-item checklist and 2 visual analogue scales (VAS) for competence and case difficulty were also used. During laparoscopic cholecystectomy, 21 participants were evaluated by the attending surgeon, by 2 trained observers and by self-assessment while dissecting the gallbladder from the liver bed.

Results

The intraclass correlation coefficient (ICC) for the total GOALS score was .89 (95% confidence interval [CI] .74 to .95) between observers, .82 (95% CI .67 to .92) between observers and attending surgeons, and .70 (95% CI .37 to .87) between participants and attending surgeons. The ICCs (observers) for the VAS (competence) and the checklist were .69 and .70, respectively. The mean total GOALS score (observers) for novices (postgraduate years [PGYs] 1 through 3) was 13 (95% CI 10.3 to 15.7) compared with 19.4 (95% CI 17.2 to 21.5) for experienced (PGY 4 through attending surgeons, P = .0006). The VAS demonstrated a difference in scores between novice and experienced participants (P = .001); however, the task checklist did not (P = .09).

Conclusions

These data indicate that GOALS is feasible, reliable, and valid. They also suggest that it is superior to the task checklist and VAS for evaluation of technical skill by experienced raters. The findings support the use of GOALS in the training and evaluation of laparoscopic skills.

Section snippets

Development of the tool

The first step in the development of GOALS was the identification of important aspects of technical skills unique to laparoscopy. This was done by watching videotapes of a variety of laparoscopic procedures and by conferring with expert laparoscopists. The tool was developed based on a Global Rating Scale (GRS) introduced by Reznick et al for open surgery [15].

Reliability

The internal consistency of GOALS was excellent for all 4 groups of raters (Cronbach’s alpha ranged from .91 to .93; Table 4). Each item correlated highly with the total score (correlations were all >.70), and internal consistency was not improved with deletion of any single item (data not shown).

The ICC for total GOALS score was highest for the 2 trained observers at .89 (95% CI.74 to .95). The inclusion of attending surgeons or participants decreased the ICCs only slightly to .82 (95% CI .67

Comments

Surgical simulators are convenient, flexible, and easier to standardize than their real-life counterparts. Simulators claiming to be effective in the acquisition and evaluation of laparoscopic skill are not lacking [7], [18]. For minimally invasive surgery, they range from mirrored boxes to costly virtual reality interfaces [7], [19], [20]. It is clear that practice on simulators improves performance on that simulator [21]. Studies have also shown that training on certain simulators correlates

Acknowledgments

This research was funded by Tyco Healthcare Canada and by a Medical Education Research Grant from the Royal College of Physicians and Surgeons of Canada.

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