1411. OR Reflections - Individualized Evaluations and Targeted Interventions

Authors: Benjamin R. Hartley, MD; Jeffrey Greenfield, MD, PhD (New York, NY)


Technical surgical skill directly correlates with patient outcomes, and in turn, educational interventions targeting operative aptitude improve surgical ability. Thus, myriad efforts focus on developing methods for improving and evaluating these skills in surgical trainees. Most utilize simulations, arguing that changing standards for efficiency and patient safety hinder intraoperative training and feedback.  Others focus on general assessment tools for all types of surgery. Herein, we describe a novel tool for assessing, tracking, and analyzing neurosurgical trainee performance, providing targeted feedback and interventions in a case- and skill-specific manner.


Study objectives are to develop a smartphone application that generates a mutual, case-specific evaluation between operative resident and attending surgeon, assessing metrics for mastery in all procedural steps and requisite knowledge using a 5-level system modeled on the neurosurgical Milestones. Said application tracks metrics for all categories of surgical procedures, analyze results, and recommend specific, targeted interventions for individual users. The tool will be validated using several established surgical skill evaluation criteria. Two groups of neurosurgical residents at Weill-Cornell will be randomly selected. One will utilize the application over a three-month trial period for technical performance evaluation, the other will utilize extant general feedback forms. Attending physicians will complete three established surgical skills evaluations for each participating resident in both groups before and after the trial period.


Improvement in the established assessment schemes between groups will be compared, averaging both the aggregate scores between evaluations and between residents. Assuming no statistical difference as the null hypothesis, a chi-square analysis will be utilized to establish significance.


Several studies suggest the present paradigm of subjective, general, sporadic feedback for operative surgical education is inadequate. We present a granular, targeted, individualized solution, with a plan to collect and analyze valuable performance data and validate said solution against established surgical evaluation criteria.