Development of a Comprehensive Vascular Skills Assessment (CVSA) for Surgical Trainees  

RS Sidhu MD MEd FRCS(C), J Chen MD FRCS(C), K Baxter MD FRCS(C), H Wu MD FRCS(C)
Division of Vascular Surgery, University of British Columbia, Vancouver, BC

Background:  The assessment of surgical residents is often limited to assessment of knowledge by examinations and of technical skills based on the subjective opinion of consultants (accumulated during unsystematic observation).  Although vascular surgical skills are important to practicing general surgeons, vascular surgery has been removed from the RCPSC General Surgery Objectives.  Hence, there may be an erosion of requisite vascular skills required of general surgical (GS) trainees.  There is a growing need to establish the level of proficiency of current trainees so that deficiencies in skill or knowledge can be identified and addressed.

Purpose:  To develop a reliable and valid Comprehensive Vascular Skills Assessment (CVSA) addressing both knowledge and technical skills of GS residents.
Methods:  Twenty-four of 38 GS residents at the University of British Columbia participated in this REB approved study.  Participants completed a two-part CVSA.  Part 1 was a short answer question examination (1 hour).  Content validity was ensured during question development by inclusion a panel of vascular and general surgeons.  Part 2 was a series of 4 vascular surgical skills stations in a skills lab (IVC trauma, embolectomy, femoral anastomosis, US guided line insertion) (1 hour).  Technical performance was rated using previously validated Global Rating Scales (Objective Structured Assessment of Technical Skills). 

Results:  The mean overall CVSA score was 50% with the Part 1 and 2 scores being 46.9% and  52.8%.  The CVSA demonstrated excellent construct validity with significant improvement in scores with increasing PGY level (p=.01, ANOVA).  The CVSA demonstrated excellent overall reliability with cronbach’s alpha 0.9 (0.81 for Part 1 and 0.72 for Part 2). 

Conclusion:  The CVSA is a comprehensive assessment of vascular skills that is both valid and reliable.  Hence, it offers an objective, feasible, and rapid assessment of GS trainee vascular skills.  The results from this study (overall 50% score) indicate significant deficiencies in current general surgical training.  Educators and surgeons must decide if this situation is acceptable.