Measuring Surgical Competency in Facial Trauma: The Arch Bar Placement Assessment Scale

• Published in: Annals of plastic surgery Vol. 73; no. 3; pp. 299 - 303
• Main Authors: Flores, Roberto L, Havlik, Robert J, Choi, Matthew, Heidelman, Joseph F, Bennett, Jeffrey D, Tholpady, Sunil
• Format: Journal Article
• Language: English
• Published: United States by Lippincott Williams & Wilkins 01-09-2014
• Subjects: Clinical Competence - standards; Facial Bones - injuries; Facial Bones - surgery; Humans; Maxilla - injuries; Maxilla - surgery; Skull - injuries; Skull - surgery; Surgery, Plastic
• ISSN: 0148-7043; 1536-3708
• DOI: 10.1097/SAP.0b013e31827aeb37

BACKGROUNDSurgical education is in a period of significant change. Assessment of surgical competency is imprecise compared with cognitive knowledge and judgment. A surgical competency measurement tool may be useful for plastic surgery training programs and certification societies. We present a validation study of a novel measurement instrument for arch bar placement and dental wire handling.
METHODSAn Arch Bar Placement Assessment Scale (ABPAS) was created via consensus by 2 craniofacial and 2 maxillofacial surgeons. Residents and faculty members of plastic and maxillofacial surgery (n = 20) then placed an arch bar on the lower jaw of a skull model. Performances were video recorded without revealing identities. Two study groups were created based on subjects experience levelgroup 1 (n = 10) previously placed fewer than 25 arch bars; group 2 (n = 10) previously placed more than 25 arch bars. Two craniofacial surgeons used the ABPAS to blindly grade surgical performance.
RESULTSThe ABPAS consisted of a 48-point rating scale that included a 23-point task-specific work list and a 25-point global rating scale. Pearson coefficient showed limited intraobserver (P = 0.97) and interobserver (P = 0.95) variance of test scores. The ABPAS demonstrated superior performance in group 2 in the task-specific work list [12.6 (5.5) vs 17.6 (1.5), P = 0.02], global rating scale [17.4 (4.4) vs 22 (2.1), P = 0.01], and ABPAS score [30 (9.8) and 39.6 (3.2), P = 0.01].
CONCLUSIONSThe ABPAS is a novel measurement tool which assesses technical surgical skill and can identify surgical competency in arch bar placement and dental wire handling. This tool may have future use in residency training and continuing education.