Evaluating a trainee’s progress in surgical dexterity

Abstract

The local cardiac surgical training program is modelled on a one-to-one apprenticeship encompassing a number of years. Trainee progress is regularly audited and work of increasing complexity is provided, commensurate with the trainee's ability. Speed and accuracy are desirable surgical goals and reflect a high level of decision-making and dexterity. The trainee's surgical speed over a period of time was monitored as one measure of progress. The mean time required to complete a coronary anastomosis (graft time) decreased from 12.8±1.9minutes in the first year of training to 9.0±1.9minutes in year four, inter-group variance (ANOVA) was highly significant from year two to year three and from year three to year four (p<0.001). Risk stratification was utilised in the selection of patients for the trainee. Parsonnet score increased from 5.1±3.5 in year one to 6.0±5.0 in year four. Similarly, EuroSCORE increased from 2.1±1.8 to 2.4±2.1. Additionally, variable life-adjusted display (VLAD) plots were constructed in order to provide a visual representation of performance against predicted outcome by EuroSCORE. Successive VLAD plots demonstrate the changing practice of the trainee as it came to resemble more closely that of his instructor and this was achieved without jeopardising patient outcome.