Evaluation of otolaryngology residents' attainment of the expected proficiency level in tonsillectomy skills through the "Objective Structured Assessment of Technical Skills"

Objective: To evaluate surgical competency in tonsillectomy, determining the number of cases achieving competency using the "Objective structured assessment of technical skills" (OSATS) Evaluating the learning curves of expertise students in tonsillectomy through cumulative sum analysis graphs. Method: The research was conducted between August 2021 and June 2023. The surgical performances of eight residents and two new specialists were assessed by consultants with OSATS. Operative time, competency decisions of consultants and residents were recorded. To establish a standard criteria for operative time, the operative times of tonsillectomies performed by consultants were recorded. The competency of residents was assessed based on surgical durations. Considering a competency criterion as achieving 3 and 4 points and above, the number of cases in which residents reached competency was calculated. Cumulative sum analysis was used to assess learning curves. Surgical steps of tonsillectomy where residents encountered difficulties were identified through the analysis OSATS' items. Results: The number of cases performed by residents is 345, by consultants is 40, and by new specialists is 7. Due to the considerable variability in surgical durations, the number of cases achieving competence could not be determined based on operative time. Through assessments conducted using OSATS, the residents' numbers of tonsillectomy proficiency were determined. The number of tonsillectomy cases reaching competence for specialty students, using T-CBC, ranged between 22 and 52, according to the decisions of consultants, it varied between 17 and 42. In the cumulative sum analysis graph, it was observed that each resident has a different learning process and reached competency at different numbers of cases. Conclusion: The learning curve for tonsillectomy varies for each resident. Instead of criteria with low validity such as duration of operations or observational decisions by consultants to determine the surgical competence of the residents, the use of OSATS is suggested as an evidence-based and objective structurel assessment.