Video-based surgical quality assessment of minimally invasive right hemicolectomy by medical students after specific training

Background: Recently, a competency assessment tool has been developed within the RIGHT project, a national quality improvement program for minimally invasive right hemicolectomy in patients with colon cancer. This study aimed to evaluate whether trained medical students can reliably evaluate minimally invasive right hemicolectomy videos using a competency assessment tool.

Methods: Nine expert colorectal surgeons, 13 trained medical students, and 17 untrained medical students assessed the surgical quality of 6 full-length minimally invasive right hemicolectomy videos with the competency assessment tool. The expert surgeons were trained using the competency assessment tool by the RIGHT project leaders, who were also involved in the development and validation of the competency assessment tool. Training for medical students included anatomy, step-by-step procedure explanation, and competency assessment tool review with 2 supervised video assessments. The untrained students were taught only anatomy and minimally invasive right hemicolectomy steps. The intraclass correlation coefficient was calculated to determine inter-rater reliability, and analysis of variance with the Bonferroni correction for multiple testing was used to assess potential differences between the groups per video.

Results: The trained students demonstrated an overall excellent inter-rater reliability (intraclass correlation coefficient score of 0.885). When their scores were combined with those of the expert surgeons, a high inter-rater reliability was also demonstrated (intraclass correlation coefficient score of 0.945). Trained students consistently aligned with surgeons' mean total scores, also accurately identifying lower quality surgeries. Untrained students assigned statistically significantly higher scores to the 3 lower quality surgeries as compared with expert surgeons and trained students.

Conclusion: Among trained students, excellent inter-rater reliability and concordance with expert colorectal surgeons was found. The study highlights the potential to engage trained medical students for objective minimally invasive right hemicolectomy video assessment.