Medical Council of Canada

Research in Clinical Assessment grant recipient (2012-2013) — Carol-anne Moulton

Research in Clinical Assessment grant recipient (2012-2013) — Carol-anne Moulton

Research in Clinical Assessment grant recipient (2012-2013) — Carol-anne Moulton

Assessing consistency of ‘slowing down’ moments in surgical expertise


Moulton, C.


Gallinger, S.
MacRae, H.
Sonnadara, R


The recent shift toward a competency-based model of surgical training was made possible through an expanding repertoire of assessment tools for motor and technical skill acquisition. Our ability to assess the effectiveness of teaching strategies is dependent upon our ability to assess. Teaching and assessment are therefore tightly linked. Despite the advances in surgical skills training of recent years, there remain concerns about the adequacy of the teaching and assessment of the more elusive constructs such as judgment. A recent study has characterized a phenomenon called ‘slowing down when you should’. This represents the transitions that occur from a routine mode of operating to a more effortful one in the critical or uncertain moments of surgery, and is suggested to be the hallmark of surgical judgment. The ability to ‘slow down’ appropriately relies on careful pre-operative planning as well as the detection of relevant perceptual cues as they arise intra-operatively. The phenomenon is observable in the operating room and presents an opportunity to formally assess the judgment of surgical trainees. However, if an assessment method based on ‘slowing down’ is to be developed, it must first be determined whether ‘slowing down’ moments are consistent among experts. Using the ‘think-aloud’ method, the proposed study will assess consistency in a) the planning of expert surgeons, and b) the thought processes of expert surgeons watching videotaped surgical procedures. ‘Slowing down’ moments will be identified and evaluated both quantitatively (types and numbers) and qualitatively (the cues and context that prompted them). Subjects’ responses will be scored using a weighted scoring system, and variations among subjects will be indicative of the degree of consistency among experts. This will be the first step toward a program of research that will seek to create an assessment tool for capturing this complex and nuanced form of clinical judgment.