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Ann Surg. 2013 Dec;258(6):1001-6. doi: 10.1097/SLA.0b013e31829b32b8.

A novel approach to assessing technical competence of colorectal surgery residents: the development and evaluation of the Colorectal Objective Structured Assessment of Technical Skill (COSATS).

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  • 1*Division of General Surgery, University of Toronto, St. Michael's Hospital, Toronto, Ontario, Canada; †Department of Surgery, Lahey Clinic, Tufts University School of Medicine, Burlington, MA ‡Department of Surgery, University of Minnesota, Minneapolis, MN §Department of Surgery, University of Southern California, Los Angeles, CA ¶Department of Surgery, University of Vermont College of Medicine, Burlington, VT ‖Department of Surgery, Mayo Clinic, Rochester, MN **Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK ††Department of Surgery, Washington University School of Medicine, St. Louis, MO ‡‡Department of Surgery, Thomas Jefferson University, Philadelphia, PA §§Department of Surgery, University of Pennsylvania, Philadelphia, PA ¶¶Department of Surgery, Queen's University, Kingston, Ontario, Canada ‖‖Division of General Surgery, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada ***Department of Surgery, Cleveland Clinic Florida, Weston, FL.



To develop and evaluate an objective method of technical skills assessment for graduating subspecialists in colorectal (CR) surgery-the Colorectal Objective Structured Assessment of Technical Skill (COSATS).


It may be reasonable for the public to assume that surgeons certified as competent have had their technical skills assessed. However, technical skill, despite being the hallmark of a surgeon, is not directly assessed at the time of certification by surgical boards.


A procedure-based, multistation technical skills examination was developed to reflect a sample of the range of skills necessary for CR surgical practice. These consisted of bench, virtual reality, and cadaveric models. Reliability and construct validity were evaluated by comparing 10 graduating CR residents with 10 graduating general surgery (GS) residents from across North America. Expert CR surgeons, blinded to level of training, evaluated performance using a task-specific checklist and a global rating scale. The mean global rating score was used as the overall examination score and a passing score was set at "borderline competent for CR practice."


The global rating scale demonstrated acceptable interstation reliability (0.69) for a homogeneous group of examinees. Both the overall checklist and global rating scores effectively discriminated between CR and GS residents (P < 0.01), with 27% of the variance attributed to level of training. Nine CR residents but only 3 GS residents were deemed competent.


The Colorectal Objective Structured Assessment of Technical Skill effectively discriminated between CR and GS residents. With further validation, the Colorectal Objective Structured Assessment of Technical Skill could be incorporated into the colorectal board examination where it would be the first attempt of a surgical specialty to formally assess technical skill at the time of certification.

[PubMed - indexed for MEDLINE]
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