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Integrated Approach Assesses Residents' Surgical Ability

Use of four assessment tools accurately measures competence at carpal tunnel release surgery

MONDAY, Dec. 21 (HealthDay News) -- An integrated approach can effectively assess orthopedic residents' competence in the performance of carpal tunnel release surgery, according to a study in the Dec. 1 issue of the Journal of Bone & Joint Surgery.

Ann Van Heest, M.D., of the University of Minnesota in Minneapolis, and colleagues tested the competence of 28 orthopedic residents with six levels of surgical training in the performance of carpal tunnel release on cadaver specimens. They used the following four assessment tools: a Web-based knowledge test of surgical anatomy, surgical indications, surgical steps, operative report dictation, and surgical complications; an Objective Structured Assessment of Technical Skills; an independent evaluation by two board-certified orthopedic surgeons with a subspecialty certificate in hand surgery who used a detailed checklist score, a global rating scale, and a pass/fail assessment; and time for completion of the surgery.

The researchers observed significant differences between year of training and knowledge test scores, detailed checklist scores, global rating scale, and the percentage pass rate. However, they found no significant difference between year of training and time to completion of the carpal tunnel release procedure.

"The results of the present study suggest that both knowledge and cadaver testing discriminate between novice and accomplished residents," the authors conclude. "However, although failure of the knowledge test can predict failure on technical skills testing, the presence of knowledge does not necessarily ensure successful performance of technical skills, as cognitive testing and technical skills testing are separate domains."

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