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ADVANCED SURGICAL SKILL ASSESSMENT:
TASK ANALYSIS AS MODEL FOR THE DEVELOPMENT OF A VALID AND
RELIABLE OBJECTIVE PROCEDURAL CHECKLIST
by
Sarah Elizabeth Peyré
A Dissertation Presented to the
FACULTY OF THE ROSSIER SCHOOL OF EDUCATION
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF EDUCATION
May 2008
Copyright 2008 Sarah Elizabeth Peyré
Object Description
| Title | Advanced surgical skill assessment: task analysis as a model for the development of a valid and reliable objective procedural checklist |
| Author | Peyré, Sarah Elizabeth |
| Author email | speyre@usc.edu |
| Degree | Doctor of Education |
| Document type | Dissertation |
| Degree program | Education (Psychology & Technology) |
| School | Rossier School of Education |
| Date defended/completed | 2008-02-26 |
| Date submitted | 2008 |
| Restricted until | Unrestricted |
| Date published | 2008-03-25 |
| Advisor (committee chair) | Sullivan, Maura |
| Advisor (committee member) |
Nyquist, Julie Goodyear, Rodney |
| Abstract | The purpose of this study was to: 1) determine the procedural steps necessary for completion of a laparoscopic Nissen fundoplication through expert opinion, 2) to validate and determine the reliability of a procedural checklist assessment tool as a measurement of technical skill, and 3) to propose a model for future development of surgical skill assessment instruments.; A behavioral task analysis was conducted using five national surgical experts to deconstruct the procedural steps of a laparoscopic Nissen fundoplication. A modified Delphi technique was used to facilitate group opinion to reach consensus on the 65 task steps of this advanced surgical procedure. Results however were inconclusive. Following a final group interview of all experts, the resulting procedural checklist is comprised of 28 steps that are considered essential, 32 that are considered recommended and 5 that are defined as optional. This process created a valid procedural checklist, but the advanced nature of the operative procedure left variation in the order of steps and stylistic differences between each expert that prohibited consensus.; The second stage of this study measured the inter-rater reliability of the instrument when used to assess operative performance of a laparoscopic Nissen fundoplication on a human patient. Five surgical evaluators were trained and independently evaluated two video recordings of operative cases. Percent agreement reflected a high level of reliability with 62 of the 65 steps having a 80% or higher agreement. However, the instruments reliability using Kappa correlation as a measure of inter rater agreement for the entire instrument had a range of reliability from 0.20 to 1.00, for the essential steps 0.47 to 1.00, and for the essential and recommended steps 0.20 to 1.00. These variable results of inter rater reliability indicate that the instrument could not be used for high stakes surgical skill assessment. The high level of percent agreement does indicate the instrument could be used for formative feedback or as a teaching tool for surgical trainees learning how to perform a laparoscopic Nissen fundoplication.; In developing objective assessment instruments for surgical education, this behavior task analysis utilizing a modified Delphi technique was successful in creating a valid instrument, but not a reliable assessment tool. Further research needs to be done on the implementation of this instrument with trainees as a feedback tool and instructional aide. Ultimately, cognitive task analysis is needed to fully understand the expertise knowledge needed for completing a laparoscopic Nissen fundoplication and decision making can be incorporated into the assessment instrument. |
| Keyword | task analysis; assessment; surgical skill |
| Language | English |
| Part of collection | University of Southern California dissertations and theses |
| Publisher (of the original version) | University of Southern California |
| Place of publication (of the original version) | Los Angeles, California |
| Publisher (of the digital version) | University of Southern California. Libraries |
| Type | texts |
| Legacy record ID | usctheses-m1056 |
| Rights | Peyré, Sarah Elizabeth |
| Repository name | Libraries, University of Southern California |
| Repository address | Los Angeles, California |
| Repository email | http://www.usc.edu/isd/libraries/services/ask_a_librarian/email/ |
| Filename | etd-Peyre-20080325 |
| Archival file | uscthesesreloadpub_Volume17/etd-Peyre-20080325.pdf |
Description
| Title | Page 1 |
| Full text | ADVANCED SURGICAL SKILL ASSESSMENT: TASK ANALYSIS AS MODEL FOR THE DEVELOPMENT OF A VALID AND RELIABLE OBJECTIVE PROCEDURAL CHECKLIST by Sarah Elizabeth Peyré A Dissertation Presented to the FACULTY OF THE ROSSIER SCHOOL OF EDUCATION UNIVERSITY OF SOUTHERN CALIFORNIA In Partial Fulfillment of the Requirements for the Degree DOCTOR OF EDUCATION May 2008 Copyright 2008 Sarah Elizabeth Peyré |
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