Tracking and assessment of technical skills acquisition among urology residents for open, laparoscopic, and robotic skills over 4 years: is there a trend?

Background And Purpose: Tracking the progression of technical skill acquisition during urology residency training is an essential yet challenging task that has been mostly based on anecdotal and subjective performance assessment. We evaluated five surgical tasks used at our institution to assess skill acquisition among residents over 4 consecutive years in an effort to determine appropriate skill testing for resident proficiency relative to level of training for future performance testing.

Methods: Urology residents were tested yearly throughout the course of their residency with five surgical tasks in an open, laparoscopic, and robotic format. The five tasks were: (1) rings on a peg, (2) thread the rings, (3) cut the line, (4) hexagonal suturing, and (5) suture and knot tying. Evaluation was performed by a trained instructor to assess quantity and quality of the skill task performance.

Results: The highest scores were obtained on all open tasks regardless of training level. Residents performed second best on robotic and lowest on the laparoscopic skill tasks. The score difference among surgery platforms was statistically significant P<0.0005 across all tasks. It was Tasks 2 and 5, however, that showed a statistically significant difference in overall quantity×quality score between different postgraduate year (PGY) residents (P=0.03 and P=0.02). In addition, the quantity score for Task 5 also showed a statistically significant difference among PGY residents (P=0.04). There was no statistically significant difference in time to perform tasks among PG years.

Conclusions: The high-level Tasks 2 and 5 were the most useful in differentiating different levels of skill task competency among urology residents and appear to be most useful in assessing the degree of improvement among residents during training. These tasks have subsequently been worked into our institution's testing curriculum.