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The Objective Structured Assessment of Technical Skills (OSATS). Helen M. MacRae, M.D., FRCSC, D.H. Gales Director Technical Skills Centre, University of Toronto. Certifying competence of new trainees. The Need for a Reliable and Valid Measure. Certifying Competence

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the objective structured assessment of technical skills osats

The Objective Structured Assessment of Technical Skills (OSATS)

Helen M. MacRae, M.D., FRCSC,

D.H. Gales Director

Technical Skills Centre, University of Toronto

slide2
Certifying competence of new trainees

The Need

for a

Reliable and Valid Measure

Certifying

Competence

in New Technology (for example laparoscopic surgery or robotic surgery)

Assessing the impact of interventions

the osats
The OSATS
  • A multi-station “bell-ringer” examination
  • Segments of 6 to 8 procedures
  • Performed on “bench models” simulating relevant anatomical structures
  • Knowledgeable OR nurses assisting
the osats continued
The OSATS (continued)
  • 15 minutes per procedure
  • Candidates move from station to station
  • Each station marked by qualified surgeon
  • Examiner uses two marking systems
    • Task-specific checklists
    • Global rating scales
slide5

Sample of Checklist Scoring (5 of 24)

Vascular Anastamosis Station

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1

  • Selects appropriate suture
  • Avoids excessive trauma / handling of artery with instruments
  • Guides suture down to desired position following bites
  • Uses correct needle angle >80% time.
  • Follows curve of needle on entrance / exit > 80% time

1

0

1

0

0

1

0

1

slide6

Sample of Global Rating (3 of 5)

Vascular Anastamosis Station

Respect for tissue

1 2 3 4 5

Frequently caused damage by inappropriate use of instruments

Careful handling of tissue but occasionally caused inadvertent damage

Consistently handled tissue appropriately with minimal damage to tissue

Time and motion

1 2 3 4 5

Many unnecessary moves

Efficient time/motion but some unnecessary moves

Clear economy of movement and maximum efficiency

Flow of Operation

1 2 3 4 5

Frequently stopped operating and seemed unsure of next move

Demonstrated some forward planning with reasonable progression of procedure

Obviously planned course of operation with effortless flow from one move to the next

osats reliability
OSATS - Reliability
  • Internal consistency (across stations)
  • Inter-rater reliability (within stations)
validity measures
Validity Measures
  • Clinical PGY level
      • are more senior trainees scoring higher?
  • Live animal version of exam
      • are better “live model” operators scoring higher?
  • Evaluation of final product
      • are those with better outcomes scoring higher?
  • Faculty rankings of clinical performance
      • are better ranked trainees scoring higher?
slide9

OSATS - Validity

  • Correlation with PGY level
  • Correlation with other measures
summary of osats
Summary of OSATS
  • A non-patient lab-based platform for testing technical skills which shows:
    • Good Reliability
    • Good Validity
    • Widespread Feasibility
    • Widespread Applicability
conclusions
Conclusions

We can reliably and validly test some of the procedural skills of medicine in a formal, structured manner outside of the clinical setting