Quantitative and qualitative analysis of performance during advanced laparoscopic fellowship: a curriculum based on structured assessment and feedback

Published:October 20, 2014DOI:



      The objective of this study was to examine the acquisition of advanced laparoscopic technical and cognitive skills during a fellowship.


      During a yearlong fellowship, consecutive assessments were completed by a fellow and 1 attending for 3 advanced procedures. The Global Operative Assessment of Laparoscopic Skills, Objective Structured Assessment of Technical Skills, and procedure-specific rating tools and free-text feedback were used. Descriptive statistics, the t test, linear mixed-effects regression, and qualitative analysis of feedback were performed.


      Seventy-six cases were included. Average ratings increased for each assessment area every month (P < .001). There were significant differences between ratings by assessors with more stringent ratings by the fellow. While the attending focused on efficiency and safety, the fellow focused on technical issues, with later expanded attention to advanced cognitive aspects.


      These assessment tools can be used as a quantitative index to monitor fellows' learning curve. In combination with narrative feedback, such data can provide measures to direct improvement during self-directed learning.


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      1. Fellowship Council website. Retrieved May 6, 2014 from:

      2. ACGME website. Retrieved May 6, 2014 from

        • Ghaderi I.
        • Manji F.
        • Park Y.S.
        • et al.
        Technical skills assessment toolbox: a review using the unitary framework of validity.
        Ann Surg. 2014; ([Epub ahead of print])
        • Reznick R.K.
        • MacRae H.
        Teaching surgical skills—changed in the wind.
        N Engl J Med. 2006; 355: 2664-2669
        • Porte M.C.
        • Xeroulis G.
        • Reznick R.K.
        • et al.
        Verbal feedback from an expert is more effective than self-accessed feedback about motion efficiency in learning new surgical skills.
        Am J Surg. 2007; 193: 105-110
        • Horner R.H.
        • Carr E.G.
        • Halle J.
        • et al.
        The use of single-subject research to identify evidence-based practice in special education.
        Exceptional Child. 2005; 71: 165-179
        • Vassiliou M.C.
        • Feldman L.S.
        • Andrew C.G.
        • et al.
        A global assessment tool for evaluation of intraoperative laparoscopic skills.
        Am J Surg. 2005; 190: 107-113
        • Martin J.A.
        • Regehr G.
        • Reznick R.K.
        • et al.
        Objective structured assessment of technical skill (OSATS) for surgical residents.
        BMJ. 1997; 84: 273-278
        • Dath D.
        • Regehr G.
        • Birch D.
        • et al.
        Toward reliable operative assessment: the reliability and feasibility of videotaped assessment of laparoscopic technical skills.
        Surg Endosc. 2004; 18: 1800-1804
        • Aggarwal R.
        • Boza C.
        • Hance J.
        • et al.
        Skills acquisition for laparoscopic gastric bypass in the training laboratory: an innovative approach.
        Obes Surg. 2007; 17: 19-27
        • Dermer M.L.
        • Hoch T.A.
        Improving descriptions of single-subject experiments in research texts written for undergraduates.
        Psychol Rec. 2012; 49: 4
        • Backman C.L.
        • Harris S.R.
        Case studies, single-subject research, and N of 1 randomized trials: comparisons and contrasts.
        Am J Phys Med Rehabil. 1999; 78: 170-176
        • Schön D.A.
        The Reflective Practitioner: How Professionals Think in Action.
        Basic books, New York1983
        • Tsuda S.
        • Scott D.
        • Doyle J.
        • et al.
        Surgical skills training and simulation.
        Curr Prob Surg. 2009; 46: 261-372
        • Boud D.
        Avoiding the traps: seeking good practice in the use of self assessment and reflection in professional courses.
        Soc Work Educ. 1999; 18: 121-132
        • Eva K.W.
        • Regehr G.
        “I'll never play professional football” and other fallacies of self-assessment.
        J Contin Educ Health Prof. 2008; 28: 14-19
        • Handfield-Jones R.
        MAINPRO. Self-regulation, professionalism, and continuing professional development.
        Can Fam Physician. 2002; 48: 856-858
        • Davis D.A.
        • Mazmanian P.E.
        • Fordis M.
        • et al.
        Accuracy of physician self-assessment compared with observed measures of competence: a systematic review.
        JAMA. 2006; 288: 1057-1060