Development of omentectomy assessment tool score (OATS) and its validation

Background: Non communicable diseases (NCD) including cancer is rising worldwide and currently thirty percent of deaths due to NCDs are attributable to cancer. Omentum, which is a protective layer in peritoneal cavity is frequently involved in Gynecological malignancies like tubal, ovarian and uterine carcinomatosis. Omentectomy i.e., removal of omentum is therefore a common procedure performed in the surgeries for gynecological malignancies. Patients who underwent complete surgical procedures, with omentectomy, live longer, i.e. their survival outcome is better than those who have incomplete surgery. Despite the imperative role of omentectomy in the surgical management of various gynecological cancers, there is no standardized tool for effective assessment of this essential competence of gynecologists. Objective: To develop and validate a tool with reliable scores for Omentectomy to assess the OBGYN trainees at Aga Khan University Hospital (AKUH) and Jinnah Postgraduate Medical Center (JPMC) in acquiring the skills of performing omentectomy. Methodology: This was a pilot study done at OBGYN department of Aga Khan University. After the development of Omentectomy Assessment Tool Score (OATS), simulation-based hands-on workshops were conducted at AKUH and JPMC for performing Omentectomy. Forty-three OBGYN trainees participated, and they were assessed by two raters simultaneously but independently, on the developed OATS. Seven-point adjectival scale was used from 0 to 6. Unitary concept of validity, Messick’s validity framework was used to establish the validity evidence. Statistical analysis was performed using SPSS 19 Inter rater reliability was computed by intraclass correlation (ICC) while Cronbach’s alpha (α) was computed for internal consistency. Discriminate power of the instrument between different levels of trainees were assessed with mean score of raters by Kruskal Wallis’s test. The value of < 0.05 was taken as statistically significant. Results: Cronbach’s alpha of the 18 items of OATS tool was 0.94. ICC of 13 out of 18 items range from 0.75 to 0.84, while 5 of 18 items range of 0.64 to 0.74. However, none of the ICC value was below 0.5. There is no significant difference in the mean scores of different levels of trainees. Conclusion: The newly developed OATS for Omentectomy is a valid and reliable tool to assess the technical skills of OBGYN trainees.