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Validation of a global rating scale for shoulder arthroscopy: A pilot study

Authors: Hoyle A C, Whelton C, Umaar R, Funk L

References: Shoulder and Elbow Journal, 2011

Background
Reliable, valid, feasible and objective assessment is desirable in all aspects of medical training, to monitor progress and ensure high standards.  At present, no assessment model for shoulder arthroscopy exists which indisputably meets these criteria.  The global rating scale has been validated as a measure of technical performance in various surgical procedures.  We have developed and aim to validate a global rating scale for shoulder arthroscopy (GRSSA).

Methods
Thirteen shoulder surgeons using the global rating scale rated ten videos of diagnostic shoulder arthroscopy showing different levels of proficiency. All were blinded to the level of experience of each surgeon performing the arthroscopy and the assessments were performed remotely using an online system developed for the study. Construct validity was assessed via Cronbach’s alpha, and inter-rater reliability was assessed via two-way ANOVA. 

Results
Results suggest good construct validity (high internal consistency of GRS categories – Cronbach’s alpha = 0.89 - 0.96).  Two way ANOVA demonstrated a good discriminatory ability of the GRSSA, but variability between raters (P=0.0002 – 0.01), suggesting a current lack of inter-rater reliability.

Conclusions
The GRSSA seems to be a useful tool for the assessment of diagnostic arthroscopic skills and using our online system the assessor can be remote to the surgeon performing the procedure. 



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