Assessment of surgical competence at carotid endarterectomy under local anaesthesia in a simulated operating theatre

Br J Surg. 2010 Apr;97(4):511-6. doi: 10.1002/bjs.6938.


Background: Methods of surgical training that do not put patients at risk are desirable. A high-fidelity simulation of carotid endarterectomy under local anaesthesia was tested as a tool for assessment of vascular surgical competence, as an adjunct to training.

Methods: Sixty procedures were performed by 30 vascular surgeons (ten junior trainees, ten senior trainees and ten consultants) in a simulated operating theatre. Each performed in a non-crisis scenario followed by a crisis scenario. Performance was assessed live by means of rating scales for technical and non-technical skills.

Results: There was a significant difference in technical skills with ascending grade for both generic and procedure-specific technical skill scores in both scenarios (P < 0.001 for all comparisons). Similarly, there was also a significant difference in non-technical skill with ascending grade for both scenarios (P < 0.001). There was a highly significant correlation between technical and non-technical performance in both scenarios (non-crisis: r(s) = 0.80, P < 0.001; crisis: r(s) = 0.85, P < 0.001). Inter-rater reliability was high (alpha > or = 0.80 for all scales).

Conclusion: High-fidelity simulation offers competency-based assessment for all grades and may provide a useful training environment for junior trainees and more experienced surgeons.

Publication types

  • Evaluation Study
  • Validation Study

MeSH terms

  • Anesthesia, Local / standards*
  • Clinical Competence / standards*
  • Competency-Based Education
  • Computer Simulation / standards*
  • Consultants
  • Education, Medical, Graduate / methods*
  • Endarterectomy, Carotid / standards*
  • General Surgery / education*
  • General Surgery / standards
  • Humans
  • Medical Staff, Hospital / standards
  • Observer Variation
  • Operating Rooms
  • Patient Simulation
  • Self-Assessment