Resident self-assessment of operative experience in primary total knee and total hip arthroplasty: Is it accurate?

BACKGROUND: A prerequisite for a valuable surgical case log is the ability to perform an accurate self-assessment. Studies have shown mixed results when examining residents' ability to self-assess on varying tasks. We sought to examine the correlation between residents' self-assessment and staff surgeons' evaluation of surgical involvement and competence in performing primary total knee (TKA) and hip arthroplasty (THA).
METHODS: We used the intraclass correlation coefficient (ICC) to evaluate interobserver agreement between residents' self-perception and staff surgeons' assessment of involvement. An assessment of competency was performed using a categorical global scale and evaluated with the κ statistic. We piloted a structured surgical skills assessment form as an additional objective appraisal of resident involvement.
RESULTS: We analyzed assessment data from 65 primary TKA and THA cases involving 17 residents and 17 staff surgeons (93% response rate). The ICC for resident involvement between residents and staff surgeons was 0.80 (95% confidence interval [CI] 0.69-0.88), which represents substantial agreement. The agreement between residents and staff surgeons about residents' competency to perform the case had a κ value of 0.67 (95% CI 0.50-0.84). The ICC for resident, staff surgeon and third-party observer using the piloted skills assessment form was 0.82 (95% CI 0.75-0.88), which represents substantial agreement.
CONCLUSION: This study supports the ability of orthopedic residents to perform self-assessments of their degree of involvement and competency in primary TKA and THA. Staff surgeons' assessment of resident involvement correlated highly with the surgical skills assessment form. Self-assessment is a valuable addition to the surgical case log.