Surgical training in the 48-h week: a novel simulation and educational tool. From amateur golfer to professional pilot.

Introduction: Compliance with the European Working Time Directive has made obvious the need for a surgical skills training system that will produce surgeons fast and reliably. We have previously proposed a model for objective assessment of surgical dexterity. In this paper we aim to place an updated version of that model into the context of a holistic approach on assessment of a trainee's progress towards becoming an independently operating surgeon.

Methods: The PAR matrix breaks down an operation into clearly defined skills that need to be successively acquired. It consists of a 3 x 6 table depicting 18 skill-goals. The y-axis is divided into six levels and the x-axis into three columns. The initials of the three skills on each level form the acronym PAR. Each skill is further graded from 1 to 3 (unsatisfactory, competent, good). The levels are: Level 1--posture, address, relaxation; Level 2--pick-up, airtime, rotation; Level 3--placing, angles, rhythm; Level 4--precision, adaptability, reproducibility; Level 5--pace, awareness, relations; Level 6--planning, announce, review/reflexion.

Results: The format of the PAR model is such that it allows trainer and trainee to objectively assess progress, identify deficiencies and strengths and formulate an appropriate plan of action.

Conclusion: Ergonomics and crew resource management skills are essential for a safe operating environment. The PAR matrix may prove helpful in selection of trainees and revalidation of trainee surgeons as a competence and performance testing method, placed in the appropriate training curriculum.