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Am J Surg. 2010 Jan;199(1):110-4. doi: 10.1016/j.amjsurg.2009.10.003.

Reliability of a procedural checklist as a high-stakes measurement of advanced technical skill.

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  • 1Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Neville House, Boston, MA 02115, USA.



The purpose of this study was to determine the reliability of a previously validated laparoscopic Nissen fundoplication procedural checklist as a measurement of advanced technical skill.


Five surgeons, using a 65-step procedural checklist, independently evaluated 2 video recordings of expert surgeon operative performances of a laparoscopic Nissen fundoplication. Results were analyzed for percent agreement and Fleiss kappa correlation for each operation independently and combined as a whole.


Sixty-four of the 65 steps had 80% or higher percent agreement for both operative case A and B independently and when considered overall. The Fleiss kappa coefficients for operative case A (kappa = .95) and operative case B (kappa = .96) and overall (operative case A + B) (kappa = .95).


The percentage agreement and kappa coefficients for all 3 analyses indicate a high degree of reliability (>.80) that would support the use of this instrument for high-stakes assessment of a laparoscopic Nissen fundoplication.

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