Novel quantitative and objective structured assessment of technical skill for slip knotting

Gen Thorac Cardiovasc Surg. 2020 Jun;68(6):557-564. doi: 10.1007/s11748-019-01222-3. Epub 2019 Oct 15.


Objective: Currently, no quantitative and objective method has been established for evaluating competencies in basic surgical techniques. The aim of this study was to develop a structured assessment tool for slip knotting and verify how well current board certification system discriminates the level of basic surgical skill.

Methods: We examined 171 cardiovascular surgical fellows using a novel assessment method for slip knotting that was developed by the committee of the Under-Forty of the Japanese Society of Cardiovascular Surgery. We compared the scores and examinees' surgical experience for validation. We analyzed the relationship between board certification and the scores.

Results: The scores differentiated the general surgical board-certified surgeons from those without certification. Surgical experiences such as training years and number of operated cases and scores were correlated. Among the board-certified surgeons, the group with daily off-the-job training, or simulator-based skill training had a significantly higher mean score (67.4 ± 3.0 vs 55.4 ± 3.1, p = 0.008) and lower rate of poor scorers (7.1% vs 38.5%, p = 0.004). A multivariate analysis revealed that board certification did not predict high scores. Daily off-the-job training was the only independent predictor of high scores (odds ratio: 2.41, 95% confidence interval: 0.01-1.20, p = 0.014).

Conclusions: This novel quantitative and objective assessment tool for technical skill in slip knotting was found to be valid to examine the skill for slip knotting. In this study, current board certification discriminated the level of basic surgical skill. However, it could not distinguish extremely low scorers perfectly. Some board-certified surgeons showed poor technical competency, especially those without off-the-job training.

Keywords: Board certification; Competency; Off-the-job training; Slip knotting; Technical skill.

Publication types

  • Validation Study

MeSH terms

  • Adult
  • Attitude of Health Personnel
  • Cardiovascular Surgical Procedures
  • Certification
  • Clinical Competence*
  • Educational Measurement
  • Fellowships and Scholarships
  • Female
  • General Surgery / education*
  • General Surgery / standards*
  • Humans
  • Male
  • Surveys and Questionnaires
  • Suture Techniques / education*
  • Suture Techniques / standards*
  • Young Adult