Difficult or high risk? Objective task assessment vs. faculty perceptions of surgical skills

Purpose With increasing competency demands within limited training opportunities, instruction must be efficient. We compared intern performance and faculty expectations to identify opportunities to optimize basic surgical skills instruction. Methods After completing a basic surgical skills curriculum, 35 surgical interns were scored (5-point Likert scale) on ten suturing, knot-tying, and vessel ligation tasks. Thirteen surgical faculty was surveyed on their perceptions of difficulty and risk of patient harm associated with each task. Correlation between faculty-perceived difficulty and risk was evaluated using Pearson’s coefficient. The difference between actual score and expected score based on faculty perception of difficulty was assessed for each task. Results Among participating interns, mean scores were lowest for atraumatic tying at-depth, tying under tension, and running subcuticular suturing and highest for simple running suture (superficially). Faculty perceived ligation with suture, tying under tension, atraumatic tying (superficially and at-depth) and tying around clamp to be the hardest and highest-risk tasks. Simple running suture (superficially and at-depth), running subcuticular suture, vertical mattress suture, and 2-handed tie were considered the easiest and lowest-risk tasks. Faculty perceptions of task difficulty and risk were strongly correlated ( r (8) = 0.75, p = 0.01). Interns performed better than expected on ligation with suture and tying around clamp and worse than expected on running subcuticular and vertical mattress sutures. Conclusions Our findings suggest differential task difficulty and misalignment between intern performance and faculty expectations, which may be influenced by risk of patient harm. These findings provide insights for refining learning progression and instruction of these skills.