New research from Johns Hopkins has identified a potentially fatal flaw in the current methods used to evaluate surgeons in training. The study followed 23 Johns Hopkins medical residents, ranging from their first to fifth year of residency, as they performed three different approaches to a common shoulder surgery on cadavers. The results were encouraging in that fifth-year residents were more proficient and scored higher than first- and second-year residents; however, despite multiple types of evaluations, residents remained mostly in the dark about the types of errors committed during a procedure.
There are a number of methods that instructors use to evaluate surgeons in training. The Objective Structured Assessment of Technical Skills (OSATS) awards points for completion of steps in a checklist in the proper order; out-of-sequence or failed steps are scored as zeros. The Global Rating Scale provides feedback about whether surgical instruments are used appropriately and properly, and how well a procedure is understood. One of the most basic evaluations, which can also be the most useful, is a simple pass/fail scenario. The study examined the effectiveness of all three of these methods.
Healthleaders Media reported:
“Across all three procedures, examiners observed 11 incidents in which residents damaged the nerves or veins… The researchers found that none of the three evaluations adequately captured those mistakes. The pass/fail scheme came closest, in that residents received a failing score for severing a nerve or major blood vessel, but it is not set up to subsequently inform residents of the precise nature of their mistakes. And residents could theoretically perform well on the OSATS checklist even if they made an egregious error because points are not deducted, only earned in the grading system” (emphasis ours).
Repetition vs. mastery
Dr. Dawn LaPorte, professor of orthopedic surgery at the Johns Hopkins University School of Medicine believes that checklists are useful to assess technical skills, “But they don’t measure quality, highlighting a need to measure and give feedback on errors as part of the training.” Under the current system, residents are evaluated by the number of times they have performed a procedure; this system does not acknowledge the difference between repetition and mastery.
While surgical residents can practice safely on cadavers, a lack of institutional ability to assess proficiency can result in dangerous circumstances. When surgeons make mistakes, patients and their families are affected forever. At Rocky McElhaney Law, we fight every day to protect the rights of the injured and ill. If you or your loved one has been a victim of surgical malpractice, you may be entitled to compensation. Our experienced Tennessee medical malpractice attorneys can evaluate your case and help get you the compensation you deserve. Call 615.246.5549, visit our offices in Nashville, Gallatin, or Knoxville, or contact us today for a free consultation.