models such as the O-SCORE may take a central role in resident assessment and teaching.
Video-based post-procedural analyses of residents’ operative performances provide yet another method for assessing
residents’ surgical competence and for providing instructive feedback. Video assessments add flexibility to both the
evaluation and the instruction process. Skills, performance,
and operative technique may be viewed and rated at a later
date, allowing for more extensive debriefing and analysis.
A video assessment system has been implemented recently
at a tertiary care training institution in Pennsylvania. In this
model, residents are videotaped while performing selected
index cases. Feedback is given in the form of two separate
rating systems, assessing both the residents’ performance
and level of autonomy in the OR using the Zwisch model, as
well as nontechnical criterion including situational awareness, decision making, communication and teamwork, and
leadership. 10, 17 Such models, which evaluate multiple aspects
of overall surgical competence, are another way to facilitate
Surgical training and education has evolved substantially
over the last several decades in response to new technologies, regulations, and practices. In an effort to address these
changes, a multitude of teaching and assessment methods
were created to maximize teaching opportunities in the OR.
Educators and institutions that embrace these new methods
of teaching place themselves in an optimal position to train
the next generation of surgeons. Each of these methods varies
in terms of focus and mode of implementation, but they all
share a common goal of maximizing the development of the
surgical resident by encouraging proficiency in surgery. ♦
10. DaRosa DA, Zwischenberger JB, Meyerson SL,
et al. A theory-based model for teaching and
assessing residents in the operating room. J Surg
Educ. 2013; 70( 1): 24-30.
11. George BC, Teitelbaum EN, Meyerson SL.
Reliability, validity, and feasibility of the Zwisch
scale for the assessment of intraoperative
performance. J Surg Educ. 2014; 71( 6):e90-e96.
12. Meyerson SL, Teitelbaum EN, George BC, et al.
Defining the autonomy gap: When expectations
do not meet reality in the operating room. J Surg
Educ. 2014; 71( 6):e64-e72.
13. Roberts NK, Brenner MJ, Williams RG, Kim
MJ, Dunnington GL. Capturing the teachable
moment: A grounded theory study of verbal
teaching interactions in the operating room.
Surgery. 2012;151( 5):643-650.
14. Honneth A. Work and instrumental action. New
German Critique. 1982; 26(Spring-Summer): 31-52.
15. van Hove PD, Tuijthof GJ, Verdaasdonk EG,
Stassen LP, Dankelman J. Objective assessment of
technical surgical skills. Br J Surg. 2010; 97( 7):972-
16. Gofton WT, Dudek NL, Wood TJ, Balaa F,
Hamstra SJ. The Ottawa Surgical Competency
Operating Room Evaluation (O-SCORE): A
tool to assess surgical competence. Acad Med.
2012; 87( 10):1401-1407.
17. Yule S, Rowley D, Flin R, Maran N. Experience
matters: Comparing novice and expert ratings
of non-technical skills using the NOTSS system.
ANZ J Surg. 2009; 79( 3):154-160.