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A New, Validated Instrument to Evaluate Competency in Microsurgery: The University of Western Ontario Microsurgical Skills Acquisition/Assessment Instrument [Outcomes Article]

2011; Lippincott Williams & Wilkins; Volume: 127; Issue: 1 Linguagem: Inglês

10.1097/prs.0b013e3181f95adb

1529-4242

Claire Temple, Douglas C. Ross,

Digital Imaging in Medicine

Background: The authors present a model for microsurgery learning as well as a validated instrument to evaluate microsurgical competency. Methods: Novice microsurgeons participated in three 3-hour sessions wherein they completed a number of increasingly complex, standardized microsurgical tasks. Performance was recorded and graded using a newly developed University of Western Ontario Microsurgery Skills Acquisition/Assessment (UWOMSA) instrument. The knot-tying and anastomosis modules contained three categories with five-point Likert scales. Each learner's performance was assessed by two blinded surgeons. Reznick's validated global rating scale for operative performance was utilized to establish criterion validity. Within-scale scores were compared via intraclass correlation and between-scale scores with Pearson correlation coefficient. Linear regression was used to evaluate the effect of various predictors on UWOMSA scores. Results: Thirty-seven videos (9.6 hours) were reviewed, including 20 knot-tying sessions and 17 anastomoses. Interrater reliability of UWOMSA was high, with an intraclass correlation coefficient of 0.75 (0.57, 0.87). The intraclass correlation of the global rating scale was 0.79 (0.62, 0.89). Intrarater reliability of the UWOMSA was also high, with an intraclass correlation of 0.69 (0.48, 0.83). The intraclass correlation of the global rating scale was 0.69 (0.47, 0.84). Measures of criterion validity demonstrated strong agreement between UWOMSA and the global rating scale (Pearson correlation coefficient, 0.96; p < 0.001). Measures of construct validity demonstrated that higher scores on the UWOMSA were associated with faster knot tying (p < 0.0001) and higher postgraduate year level (p = 0.05). Conclusions: The UWOMSA instrument performed well in terms of reliability and validity. Further study is planned to assess the instrument's ability to predict microsurgical skills translation to the clinical setting.