An objective assessment tool for basic surgical knot-tying skills

Abstract

Objective: To determine if a knot-tying checklist can provide a valid score and if the checklist can be used by novice surgeons in a reliable manner.

Methods: This study was conducted at the Surgical Skills Center at the University of California, San Francisco. A knot-tying checklist was developed from a kinesthetic knot-tying curriculum. Novice (67 first-year medical students) and experienced surgeons (8 residents postgraduate year 3 and higher and 2 attending physicians) were videotaped performing 4 knot-tying tasks, and the videotapes were rated with a global score and a checklist by interns (n = 3) and experienced (n = 3) surgeons.

Results: Both interns and experienced surgeons can use the knot-tying checklist with acceptable reliabilities (>0.8 with 3 raters). The checklist is able to differentiate between novice and experienced surgeons, when used by both interns and experienced raters. The expert knot-tying score correlated with the global score overall (r = 0.88) and for each task (r was 0.82 for task 1, 0.85 for task 2, 0.80 for task 3, and 0.81 for task 4).

Conclusions: The knot-tying checklist provides a valid score for basic surgical knot-tying and can be used by novice and experienced raters. Its use supports peer assessment of performance in a surgical skills laboratory setting.

Keywords: Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; checklist; knot tying; medical education; surgical skills; validated assessment.