Objective measures of operating room wire navigation performance

There is no widely accepted tool to assess an orthopedic surgeon’s technical skill in the operating room. With changes in surgical education, simulators are being investigated for learning and assessing technical skills, but a link between the actual operating room is needed to ensure they are effective. Hip fracture surgery is a good starting point to develop these measures because hip fractures are common and fixation is a difficult task.

Resident orthopedic surgeons wore a head-mounted video camera during hip fracture surgery. Data collected included: duration, number of x-ray images, the supervising surgeon intervention, and tip-apex distance (TAD, a measure of how accurate the implant is placed). To determine the reliability of these measurements, four raters performed them for two cases. Ten raters measured the tip-apex distance (TAD) on 7 cases. These performance metrics for 15 cases were compared to experience of the residents, both point in residency and number of previous cases. A composite performance score was computed using the four metrics. The metrics were also compared to two practicing surgeons’ assessment of skill.

The inter-rater reliability of the performance metrics was high (0.97-0.99) showing these measures are consistent between different raters and useful for assessment. There was a significant relationship between resident experience and the metrics of duration and TAD. Expert opinion was related to duration.

These metrics provide objective assessment of resident technical performance in the operating room by a non-expert, an important step towards competency based education. Their validity is shown with correlation to surgical experience.