Introducing Operative Skills Testing in Urology Board Examinations: Results of 8 Years Experience

Export Objective: Operative surgical skills are among the most crucial competencies required for independent practice in surgical specialties, yet they are rarely assessed as part of specialty-training exit/board examinations. Although tools such as logbooks and work-place-based assessments are used to evaluate surgical training singularly, these tools may not be sufficient to guarantee adequate operative competency upon completion of training. The current report describes the introduction of operative skills testing as part of the national urology board final examinations and evaluates the performance of “operative skills” stations in comparison to other standardized elements. Methods: Starting in 2013, an “operative skills” station was introduced as part of the Objective Structured Practical/Clinical Examination (OSPE/OSCE) of the Egyptian Board of Urology’s final examinations. Candidates were asked to perform a surgical task in a wet lab setting, such as suturing a urinary bladder laceration or an intestinal anastomosis, while being assessed for various technical aspects. Feedback was obtained from candidates and assessors in the form of a quantitative/qualitative questionnaire, and the performance of the “operative skills” station in terms of discriminating ability and reliability was compared to the remaining stations of the examination. Results: Across eight examination sessions between 2014 and 2021, the OSPE/OSCE stations had high internal reliability (average Cronbach’s alpha 0.853), with the “operative skills” station having relatively high item-total correlation (above 0.75), and very high correlation with other practical stations focusing on the use of instruments, interpretation, and reporting of operative findings. Assessors and candidates’ feedback was consistent with high validity, with most responding “agree” or “strongly agree” to questions on “able to assess surgical competency” and “simulates real-life situation.” Conclusions: Testing surgical operative skills as part of urology specialty exit examinations is feasible and can add an important dimension to candidates’ assessments. Well-designed operative OSPE stations have high reliability and discriminating ability, complementing the evaluation of other clinical skills and domains.