2049 Video-Based Assessment of Operative Proficiency: A New Model for Neurosurgical Skill Assessment

INTRODUCTION: Tools for assessing trainee progress and performance are an important part of competency-based education. Neurosurgical residencies do not yet have standardized assessment instruments for this purpose. METHODS: Neurosurgical residents at our institution from postgraduate year (PGY) 1-5 were recruited. Participants performed a lumbar decompression with facetectomy and a unilateral cervicothoracic decompression and fusion on a cadaver specimen, which was recorded using a head-mounted camera. This video was then evaluated by blinded reviewers using our investigational assessment tool. The qualitative component of the assessment tool includes both a general surgical skill evaluation as well as a checklist for the minimum necessary steps for that specific procedure. The quantitative component examines how participants utilize their time in order to better characterize areas that may be refined. The correlation between operative time (OT), instrument efficiency (IE), and overall operative efficiency (OE) from the quantitative assessment and experience level (measured as PGY level) was evaluated using linear regression models and Mann-Whitney U tests. RESULTS: There were 12 residents enrolled. Increasing PGY correlated with decreased OT (ß= -18.50, p <0.01), improved IE (ß = -23.26, p < 0.01), and OE (ß = -41.76, p < 0.01). PGY3 residents performed the procedure with more OT (p<0.05), less IE (p = 0.01), and less OE (p = 0.01) compared to more senior residents. CONCLUSIONS: Preliminary analysis of this pilot study suggests that this assessment instrument may accurately discriminate between early and more advanced learners. Further evidence of internal and external validity is needed, as well as correlations with actual operative performance.