Assessing the Surgical Decision Making Abilities of Novice and Proficient Urologists

Purpose: We examined whether the Surgical Decision Making Rating Scale can measure a difference in surgical judgment among urologists at various levels of training.Materials and Methods: A total of 25 medical students, urology residents and staff urologists viewed clips from 8 select urological procedures and verbalized their thought processes. The clips were ordered in increasing complexity from lower level tasks (catheterization and cystoscopy) to more advanced procedures (laser lithotripsy, and open and laparoscopic prostatectomy and nephrectomy). Performance was transcribed and blindly rated using the previously validated rating scale. Subjects were also asked to self-evaluate their performance using this scale.Results: Overall the rating scale distinguished the training level across knowledge domains (anatomy and management of the current task) and judgment domains (avoiding complications, higher reasoning and immediate surgical planning). The mean score across all training levels was 112 of 200 (ran...