Assessing Mastery of Laparoscopic Skills for a Junior Resident Prior to Entering the Operating Room

Background: Simulation has become a standard for developing laparoscopic skills. Common training programs base their passing scores on comparing noncompetent to competent surgeons (Fraser et al., 2003; Thinggaard et al., 2015). With the era of competency-based medical education (CBME), passing scores should be based on the expected skills from the resident for the next stage of training. Purpose: The purpose of this study was to develop a passing score for the CanTAB test which is reflective of the skill expected of a “well-prepared” obs/gyn resident about to start assisting in the OR. The CanTAB test is a modified version of the Training and Assessment of Basic Laparoscopic Techniques (TABLT) test using supplies available in Canada (Thinggaard et al., 2014/2018, 2015). The “well-prepared” resident was operationalized as a resident who could follow explicit instructions, a 2.0 on the Ottawa Surgical Competency Operating Room Evaluation (OSCORE) (Gofton et al., 2012). Methods: Residents and faculty at the University of Manitoba (UofM) obs/gyn department were recruited. Participants could complete any or all of the following: an OR assessment based on the OSCORE and Global Objective Assessment of Laparoscopic Skills (GOALS) tools, the CanTAB test, and/or the mastery Angoff standard-setting exercises informed by a participant’s individual results or the cumulative study results. CanTAB passing scores were calculated using two standard-setting methods: The mastery Angoff and “well-prepared” borderline regression. Results: Eleven participants completed the study: 6 residents and 5 fellows/attendings. The CanTAB scores ranged from 723(123.5) to 1625(503.4), with senior residents scoring the highest. The CanTAB passing scores were 602 for mastery Angoff-1, 862 for mastery Angoff-2, 993 (p=0.005) for the “well-prepared” regression line between the OSCORE and CanTAB scores, and 1270 (p=0.469) for the “well-prepared” regression line between the GOALS and CanTAB scores. The passing rates ranged from 25 to 100%, with the OSCORE-based regression line having the second-lowest passing rate with 25% of junior residents and 100% of senior residents and attendings passing. Conclusion: A CanTAB passing score of 993, based on the OSCORE level of 2.0 well-prepared borderline regression method, can best identify resident well-prepared to assist laparoscopic surgery with explicit instructions in the OR.