Assessment of Resident’s Skills to Perform Endoscopic Sinus Surgery

Context: Although, endoscopic sinus surgery (ESS) is a standard procedure, in the hands of inexperienced trainees it may involve
risks for the patients.
Objective: To assess the surgical skills to perform ESS of Otolaryngology residents by year, in a tertiary referral center.
Methods: A cross-sectional study was performed. After designing an ad hoc tool of 9 items, with a 3 point Likert rating scale, 2 faculty rhinologists scored the performance of 35 residents during the first six months of their training year in a standard program.
Results: The assessment tool showed good internal consistency and construct validity, discriminating among residents by year  of training (ANOVA, p <0.05), with good reliability (Chronbach
alpha 0.85, p <0.05) and correlation among the items (Kaiser- Mayer-Olkin test 0.66, p <0.05), and two dimensions: the first one including the skills to manipulate the instruments, and to perform
nasal exploration and preparation for surgery, uncinectomy, maxillary antrostomy and anterior ethmoidectomy; the second one to perform posterior ethmoidectomy, sphenoidostomy and frontal
sinusotomy. Basic skills were achieved by 100% of the residents at the beginning of the 3rd year of training. The ability to perform uncinectomy, maxillary antrostomy and anterior ethmoidectomy
was observed in 100% of the residents at the 4th year of training. However, performance of the most challenging procedures was broadly variable among senior residents.
Conclusion: The assessment of skills of residents to perform ESS should be done systematically in order to provide individual feedback and to update training programs, within the context in which each program is executed.