LAUSR

Surgical training involves learning operative skills as an essential training component. These operative skills are developed and evaluated during training rotations. Measuring and evaluating the operative skills of trainees is essential. Currently, assessing resident trainees typically relies heavily on evaluators’ assessment, where a residents’ performance is judged at the end of a given rotation. However, a resident’s surgical skills acquisition and performance may show high variability that could be underrepresented in the direct-observation assessment. The performance variability observed between residents reflects the variability in their skills. Assessing competency in surgical training and practice imposes a challenge to surgical educators, the Accreditation Council for Graduate Medical Education (ACGME), and the profession as a whole. There has been a significant paradigm shift in graduate medical education to competency-based measures of performance. The adoption of competency-based training programs in surgical education includes significant changes to the assessment of trainees. These changes in assessment necessitate careful consideration of the implications of skills performance variability for individual trainees. Therefore, in response to the need to evaluate surgical skills more objectively, there is a need to develop more reliable and valid measures of surgical competence. Educators are required to make high-stake decisions in evaluating residents’ competency and performance. This requires modifying the performance evaluation method to meet the outcome and competency-based training. Assessment can be used to formulate inferences of performance, competence, or readiness for practice. The available assessment tools provided by the ACGME and the American Board of Medical Specialties focus primarily onmeasuring 6 core competencies, namely, patient care, medical knowledge, professionalism, systemsbased practice, practice-based learning and improvement, and interpersonal and communication skills. However, operative skills should be assessed to validate the curricula in terms of their reliability and efficiency assessments. Nevertheless, specific assessment tools for evaluating surgical performance and operative competency are simply not available. Therefore, an objective, standardized tool provides the assessment and achieves the goal. Over the last decade, various evaluation methods of operative skills including simulation, virtual reality, and video based methods have been developed to improve assessment accuracy and objectivity. Video based assessment has been used to assess operative skills by recording performance for a later assessment. This approach has gained interest and popularity with various modifications. Collected video data of minimally invasive procedures were analyzed in various ways. Some uses added computer analysis of the recorded videos. Others added videos and accelerometer data to analyze objective structured assessment of technical skills-like surgical skills. A video-recording-aided test (VRAT) is introduced here as a novel assessment of non-technical skills (NTS). VRAT uses standardized multiple-choice questions aided by brief operative videos to evaluate NTS objectively (Figure A1). These questions are designed to evaluate the observational, evaluation, and decision-making skills during various operative procedures. The questions include short videos (5-15 seconds) of operative situations such as small bowel viability, tumor and resection margins, and anastomosis integrity that require interpretation and decision making. VRATcan also be used to evaluate the cognitive part of the psychomotor skills such as evaluating the precision, safety, approach, and necessity of surgical techniques. The required technology is simple. It employs the currently used computer-based exams. The adoption of competency-based training programs in surgical education mandates adjusting the assessment to consider the implications of psychomotor skills variability for individual trainees. VRAT is a standardized