Development of a novel formative assessment tool to assess
intraoperative decision-making in colorectal surgery.

Intraoperative decision-making has been identified as a key component
of surgical expertise by many authors. However, it
remains difficult to teach and assess in the current clinical context.
Multiple conflicting priorities limit the amount of teaching
possible during surgical procedures. Furthermore, it can be challenging
for expert surgeons to explain their decision-making process.
Our aim was to develop a formative assessment modality
using operative video clips to assess and improve intraoperative
decision-making skills during laparoscopic right hemicolectomy.
A formative assessment tool was developed using Downing’s test
development model. Interviews with expert surgeons and a literature
review were conducted to identify content. Items were then
developed following the principle of script concordance and formative
evaluation. Items included a short video clip from a real
surgical procedure, a multiple-choice questionnaire related to
decision-making, and experts’ answers and explanation of their
choice. Fifteen experts provided answers to the questions.
Experts’ answers were presented as a frequency graph. Explanations
were obtained from 3 expert surgeons and included in the
final formative assessment tool. A total of 2 surgeons and 6 trainees
from PGY2 to PGY7 were asked to use the formative assessment
tool and to give feedback through an electronic survey on
its potential use and logistics considerations. Overall, the feedback
was very positive, with participants suggesting that this
assessment tool provided a unique learning opportunity that
could enhance learning in the operating room. Participants also
indicated that a tool like this would have to be easily accessible on
mobile devices to be used in a sustainable fashion by trainees.
This project presents a proof of concept of the use of operative
video clips to teach surgical decision-making. As a next step, the
impact of this formative assessment tool on surgical decision making
should be formally investigated.

Development of a novel formative assessment tool to assess intraoperative decision-making in colorectal surgery