Comparing self-assessment of laparoscopic technical skills with expert opinion for gynecological surgeons in an operative setting

Background: Competence in laparoscopic skills is important for all gynaecological surgeons. Most residency programmes teach technical skills in the operating room and through lectures, where the evaluation of surgical skills is usually done through subjective evaluation. After graduating residency, most surgeons depend on themselves to decide if they are competent in performing a certain procedure. The objective of this study is to evaluate the accuracy of surgeon self-assessment compared with expert assessment of competence in laparoscopic surgical skills. A double-blind prospective cohort study was undertaken at Prince Hamza Hospital between January 2016 and April 2016 in Amman, Jordan. Eight practicing gynecologists and obstetricians performed and recorded 88 laparoscopic procedures including ovarian cystectomy, salpingectomy for ectopic pregnancy, salpingoophorectomy, resection of endometriosis, adhesiolysis and ovarian drilling. Participating gynecologists recorded the procedures and were asked to complete a Global Rating Index of Technical Skills (GRITS) evaluation after the surgery testing across multiple areas with a lowest score of 8 and a highest score of 40. Two well-versed laparoscopic experts in objective structured assessment of technical skills (OSATS) also independently scored all procedures using the same parameters. The correlation coefficient and internal consistency were calculated. Results: The GRITS score was calculated for each participant with a mean assessment score of 3.47 for each parameter. Participants self-assessment scores were significantly higher than expert assessment scores (p<0.05). The correlation coefficient was calculated and it can be seen that there was high inter-expert correlation in assessment across all participants evaluations (ICC > 0.90). Conclusion: Self-assessment of surgical laparoscopic skills is higher than expert evaluation of these technical skills. Quality assurance measures need to be revisited and restructured through more frequent assessments using peer and expert assessment alongside self-assessment. Gynecologists also need to undergo proper assessment prior to starting independently performing procedures that require new skills.