Objective surgical skill assessment: the diagonal operating matrix☆

There is an urgent need for structured surgical training and assessment due to the reduction in the training duration with the European Working Time Directive (EWTD). We propose a model for objective skill assessment, the PAR-Diagonal Operating Matrix (PAR-DOM) which breaks down the task of vascular anastomosis into clearly defined skills. The PAR-DOM is made up of a 3x5 table and progress is made along vectors defined on the x-axis as PAR and on the y-axis as four levels. PAR defines three skills at each level. Each skill is graded from 1-3 (this may be taken as below average, average, above average). The skills at various levels are: Level 0 - Posture, Address, Relaxation; Level 1 - Pick-up, Airtime, Rotation; Level 2 - Placing, Angles, Rhythm; Level 3 - Precision, Adaptability, Reproducibility; Level 4 - Pace, Awareness, Relations. The PAR-DOM matrix provides a graphic representation of the progress of trainees over their training period assigned for them to stay with the trainer and also help identify individual strengths and weaknesses.