Open Technical Skills Expert-administered Assessment Test
INSTRUMENT HANDLING
Forceps: Using the FLS Pegboard, transfer six triangles from left to right using two DeBakey forceps. Each triangle should be
picked up with one hand, transferred to the other, and placed back on the pegboard. Repeat Right -> Left and Left -> Right.
Area of Target Performance/Key Errors
Performs without Dropping Triangle
Holds Forceps Like a Pencil
Yes
No
Scalpels: After loading the blades, use the appropriate scalpel(s) to incise the three marked incision points.
Area of Target Performance/Key Errors
Loads scalpels without touching blade with fingers
Long Incision – Used #10 Blade
#10 Blade – Held like bowstring
#10 Blade - Stayed on Line (No Deviation)
#10 Blade - Keeps blade perpendicular to the skin (does not skive)
Short Curved Incision – Used #15 Blade
#15 Blade – Held Like Pencil
#15 Blade - Stayed on Line (No Deviation)
#15 Blade - Keeps blade perpendicular to the skin (does not bevel or skive)
Stab Incision – Used #11 Blade
#11 Blade – Held Like Pencil, Blade Up
#11 Blade - Stabbed on Mark (No Deviation)
Yes
No
Needle Drivers: Grasp the 5mm marked tubing by closing and opening the needle driver (perform 10 times, flip/spin driver in hand
after each grasp to simulate reloading needle for next throw).
Area of Target Performance/Key Errors
Uses Index Finger to Stabilize
Grasps Marked Point (no deviation)
Performs without Dropping Instrument
Flips instrument between attempts
Fully Opens and Closes Instrument Successfully
Yes
No
Scissors: Using the correct scissors, cut the suture tails to 2mm in length (10 suture tails). Note – video may be out of order (suture
cutting follows knot-tying)
Area of Target Performance/Key Errors
Uses suture scissors (not metzenbaum scissors)
Ring Finger and Thumb in Rungs
Uses Index Finger to Stabilize
Suture Tails Cut to 2mm (not short, not long)
Cuts with scissor tips (as opposed to mid portion of blade)
Tips Visualized Prior to Cutting
Yes
No
EXAMINER: PLEASE FILL OUT OSATS GLOBAL ASSESSMENT FOR INSTRUMENT HANDLING
Revised 11/4/2009
Page 1
Open Technical Skills Expert-administered Assessment Test
INSTRUMENT HANDLING OSATS
GLOBAL RATING SCALE OF OPERATIVE PERFORMANCE
Please circle the number corresponding to the candidate's performance in each category, irrespective of training level.
Respect for Tissue
1
Frequently used
unnecessary force on
tissue or caused damage
2
Time and Motion
1
Many unnecessary
moves
2
1
Repeatedly makes
tentative or awkward
moves with instruments
by inappropriate use of
instruments
1
2
Instrument Handling
Knowledge of
Instruments
Flow of Operation
Knowledge of
Procedure
Frequently asked for
wrong instruments or
used inappropriate
instrument
1
Frequently stopped
operating and seemed
unsure of next move
1
FINAL PRODUCT
1
Very poor
1
Clearly substandard
outcome
4
5
Consistently handled
tissues appropriately
with minimal damage
4
5
Clear economy of
movement and
maximum efficiency
5
Fluid moves with
instruments and no
awkwardness
3
4
2
5
Obviously familiar
with the instruments
and their names
2
3
Demonstrated some
forward planning with
reasonable progression
of procedure
4
2
3
4
5
Obviously planned
course of operation
with effortless flow
from one move to the
next
5
4
Demonstrated
familiarity with all
aspects of operation
5
Knew all important
steps of operation
2
3
2
Competent
3
Competent but
uninspired outcome
OVERALL ON THIS PROCEDURE, SHOULD THE CANDIDATE:
Revised 11/4/2009
4
Knew names of most
instruments and used
appropriate instrument
Deficient knowledge
OVERALL
PERFORMANCE
3
Careful handling of
tissue but occasionally
caused inadvertent
damage
3
Efficient time/motion
but some unnecessary
moves
3
Competent use of
instruments but
occasionally appeared
stiff or awkward
PASS
4
Clearly superior
5
Clearly superior
outcome
FAIL
Page 2
Open Technical Skills Expert-administered Assessment Test
KNOT TYING
1. Two-Handed Square Knot: Using a knotboard and 3-0 Silk ties, tie ten two-handed square knots under tension on the parallel
tubing.
Area of Target Performance/Key Errors
Yes
No
Knots Secure (No Air knots)
Alternates Throws
Knots Laid Down Square
Knots Pushed Down with Fingertips (not thumb)
Knots pushed down with 180-degrees of tension across knot
Optimal suture length used (not impeded by excessively short/long tail)
Performs without Dropping Suture Tail
Performs without Breaking Suture Tail
2. Surgeons’ Knot: Using a knotboard and 3-0 Silk ties, tie ten two-handed surgeon’s knots under tension on the parallel tubing.
Area of Target Performance/Key Errors
Yes
No
Uses Double Throw on First Hitch
Uses Single Throw on all Subsequent Hitches
Knots Secure (No Air knots)
Alternates Throws
Knots Laid Down Square
Knots Pushed Down with Fingertips (not thumb)
Knots pushed down with 180-degrees of tension across knot
Optimal suture length used (not impeded by excessively short/long tail)
Performs without Dropping Suture Tail
Performs without Breaking Suture Tail
3. One-Handed Knot (Right-Handed): Using a knotboard and 3-0 Silk ties, tie ten one-handed (using right hand to tie) square knots
under tension on the parallel tubing.
Area of Target Performance/Key Errors
Yes
No
Knots Secure (No Air knots)
Alternates Throws
Knots Pushed Down with Fingertips (not thumb)
Knots pushed down with 180-degrees of tension across knot
Optimal suture length used (not impeded by excessively short/long tail)
Performs without Dropping Suture Tail
Performs without Breaking Suture Tail
4. One-Handed Knot (Left-Handed): Using a knotboard and 3-0 Silk ties, tie ten one-handed (using left hand to tie) square knots
under tension on the parallel tubing.
Area of Target Performance/Key Errors
Yes
No
Knots Secure (No Air knots)
Alternates Throws
Knots Pushed Down with Fingertips (not thumb)
Knots pushed down with 180-degrees of tension across knot
Optimal suture length used (not impeded by excessively short/long tail)
Performs without Dropping Suture Tail
Performs without Breaking Suture Tail
EXAMINER: PLEASE FILL OUT OSATS GLOBAL ASSESSMENT FOR SURGICAL KNOT-TYING
Revised 11/4/2009
Page 3
Open Technical Skills Expert-administered Assessment Test
KNOT-TYING OSATS
GLOBAL RATING SCALE OF OPERATIVE PERFORMANCE
Please circle the number corresponding to the candidate's performance in each category, irrespective of training level.
Respect for Tissue
1
2
Frequently used unnecessary
force on tissue or caused
damage
Time and Motion
1
2
Many unnecessary moves
Instrument Handling
1
1
1
1
1
1
Clearly substandard outcome
4
3
2
5
Obviously familiar with the
instruments and their
names
5
Obviously planned course
of operation with effortless
flow from one move to the
next
4
Knew all important steps of
operation
3
5
Demonstrated familiarity
with all aspects of
operation
4
5
Competent
2
Clearly superior
3
4
Competent but uninspired
outcome
OVERALL ON THIS PROCEDURE, SHOULD THE CANDIDATE:
Revised 11/4/2009
4
3
2
5
Fluid moves with
instruments and no
awkwardness
Demonstrated some forward
planning with reasonable
progression of procedure
Very poor
FINAL PRODUCT
4
3
2
5
Clear economy of
movement and maximum
efficiency
Knew names of most
instruments and used
appropriate instrument
Deficient knowledge
OVERALL
PERFORMANCE
4
3
2
5
Consistently handled
tissues appropriately with
minimal damage
Competent use of instruments
but occasionally appeared stiff
or awkward
Frequently stopped operating
and seemed unsure of next
move
Knowledge of Procedure
3
2
Frequently asked for wrong
instruments or used
inappropriate instrument
Flow of Operation
4
Efficient time/motion but
some unnecessary moves
Repeatedly makes tentative or
awkward moves with
instruments by inappropriate
use of instruments
Knowledge of Instruments
3
Careful handling of tissue but
occasionally caused
inadvertent damage
PASS
5
Clearly superior outcome
FAIL
Page 4
Open Technical Skills Expert-administered Assessment Test
WOUND CLOSURE I
Simple Stitch with Instrument Tie: Using a marked skinpad and 3-0 Silk sutures, place 6 simple interrupted sutures and tie them
with an instrument-tied square knot.
Area of Target Performance/Key Errors
Yes
No
Follows Curve of Needle
Enters tissue at 90 degrees
Performs without Deviation From Marked Entry and Exit Sites
Knots Secure (No Air Knots)
Alternates Throws
Knots Laid Down Square
Knots laid down with 180-degrees of tension across knot
Works from center of “V”
Proper tail length (not impeded by excessively short/long tail)
Simple Stitch and Run (non-locked): Using a skin pad, close a 6cm incision with a continuous suture.
Area of Target Performance/Key Errors
Yes
No
Performs without using Finger to Reload Needle
Consistent Needle Reload
Stabilizes needle for reload (performs without reloading in the air)
Tissue Apposed
Bite Width Symmetric and Consistent
Performs without locking throws
Suture Limbs Parallel (Consistently Travels Above or Below Skin)
Simple Stitch and Run (locked): Using a skin pad, close a 6cm incision with a locked continuous suture.
Area of Target Performance/Key Errors
Yes
No
Performs without using Finger to Reload Needle
Consistent Needle Reload
Stabilizes needle for reload (performs without reloading in the air)
Tissue Apposed
Bite Width Symmetric and Consistent
Locks throws
Suture Limbs Parallel (Consistently Travels Above or Below Skin)
EXAMINER: PLEASE FILL OUT OSATS GLOBAL ASSESSMENT FOR WOUND CLOSURE I
Revised 11/4/2009
Page 5
Open Technical Skills Expert-administered Assessment Test
WOUND CLOSURE I OSATS
GLOBAL RATING SCALE OF OPERATIVE PERFORMANCE
Please circle the number corresponding to the candidate's performance in each category, irrespective of training level.
Respect for Tissue
1
2
Frequently used unnecessary
force on tissue or caused
damage
Time and Motion
1
2
Many unnecessary moves
Instrument Handling
1
1
1
1
1
1
Clearly substandard outcome
4
3
2
5
Obviously familiar with the
instruments and their
names
5
Obviously planned course
of operation with effortless
flow from one move to the
next
4
Knew all important steps of
operation
3
5
Demonstrated familiarity
with all aspects of
operation
4
5
Competent
2
Clearly superior
3
4
Competent but uninspired
outcome
OVERALL ON THIS PROCEDURE, SHOULD THE CANDIDATE:
Revised 11/4/2009
4
3
2
5
Fluid moves with
instruments and no
awkwardness
Demonstrated some forward
planning with reasonable
progression of procedure
Very poor
FINAL PRODUCT
4
3
2
5
Clear economy of
movement and maximum
efficiency
Knew names of most
instruments and used
appropriate instrument
Deficient knowledge
OVERALL
PERFORMANCE
4
3
2
5
Consistently handled
tissues appropriately with
minimal damage
Competent use of instruments
but occasionally appeared stiff
or awkward
Frequently stopped operating
and seemed unsure of next
move
Knowledge of Procedure
3
2
Frequently asked for wrong
instruments or used
inappropriate instrument
Flow of Operation
4
Efficient time/motion but
some unnecessary moves
Repeatedly makes tentative or
awkward moves with
instruments by inappropriate
use of instruments
Knowledge of Instruments
3
Careful handling of tissue but
occasionally caused
inadvertent damage
PASS
5
Clearly superior outcome
FAIL
Page 6
Open Technical Skills Expert-administered Assessment Test
WOUND CLOSURE II
Horizontal Mattress Stitch: Using a skin pad, place five interrupted horizontal mattress sutures.
Area of Target Performance/Key Errors
Yes
Performs without using Finger to Reload Needle
Consistent Needle Reload
Tissue Apposed
Consistency in back-stitch
Consistent technique for needle re-load (backhand throw)
Stabilizes needle for reload (performs without reloading in the air)
Sews toward self
Mattress Limbs Symmetric and Consistent
Proper Length for Tying (not impeded by excessively short/long tail)
Vertical Mattress Stitch: Using a skin pad, place five interrupted vertical mattress sutures.
Area of Target Performance/Key Errors
Yes
Performs without using Finger to Reload Needle
Consistent Needle Reload (In Skin)
Tissue Apposed
Consistency in back-stitch
Consistent technique for needle re-load (backhand throw)
Stabilizes needle for reload (performs without reloading in the air)
Sews toward self
Mattress Limbs Symmetric and Consistent
Proper Length for Tying (not impeded by excessively short/long tail)
No
No
Purse-String Suture: Using a foam stomach, place a purse-string suture around a 5mm “G-Tube” site.
Area of Target Performance/Key Errors
Yes
No
Pulls tail through
Consistent technique for needle re-load (Does not reload in tissue)
Does not cross hands/use awkward moves
Appropriately Loads Needle on Angles
Stabilizes needle for reload (performs without reloading in the air)
Mattress Bites are Symmetric (no focal tension)
Diameter of Purse-String is 3x that of Defect
Interrupted Subcuticular Stitch: Using a skin pad, close three 1cm incisions with interrupted subcuticular technique.
Area of Target Performance/Key Errors
Yes
No
Knot Inverted
Follows the curve of the needle
Stabilizes needle for reload (performs without reloading in the air)
In Correct Dermal Plane
Tissue Apposed
Sews towards self
Revised 11/4/2009
Page 7
Open Technical Skills Expert-administered Assessment Test
Running Subcuticular Stitch: Using a skin pad, close a 6cm incision with running subcuticular technique.
Area of Target Performance/Key Errors
Yes
No
Correct dermal plane
Follows the curve of the needle
Starts at Apex
First Knot Buried
Consistent technique for needle re-load (in skin)
Uses non-dominant hand to retract tissue
Sews towards self
Back-tracks 50%
Last Knot Buried
EXAMINER: PLEASE FILL OUT OSATS GLOBAL ASSESSMENT FOR WOUND CLOSURE II
WOUND CLOSURE II OSATS
GLOBAL RATING SCALE OF OPERATIVE PERFORMANCE
Please circle the number corresponding to the candidate's performance in each category, irrespective of training level.
Respect for Tissue
1
2
Frequently used unnecessary
force on tissue or caused
damage
Time and Motion
1
2
Many unnecessary moves
Instrument Handling
1
1
1
1
1
1
Clearly substandard outcome
4
3
2
5
Obviously familiar with the
instruments and their
names
5
Obviously planned course
of operation with effortless
flow from one move to the
next
4
Knew all important steps of
operation
3
5
Demonstrated familiarity
with all aspects of
operation
4
5
Competent
2
Clearly superior
3
4
Competent but uninspired
outcome
OVERALL ON THIS PROCEDURE, SHOULD THE CANDIDATE:
Revised 11/4/2009
4
3
2
5
Fluid moves with
instruments and no
awkwardness
Demonstrated some forward
planning with reasonable
progression of procedure
Very poor
FINAL PRODUCT
4
3
2
5
Clear economy of
movement and maximum
efficiency
Knew names of most
instruments and used
appropriate instrument
Deficient knowledge
OVERALL
PERFORMANCE
4
3
2
5
Consistently handled
tissues appropriately with
minimal damage
Competent use of instruments
but occasionally appeared stiff
or awkward
Frequently stopped operating
and seemed unsure of next
move
Knowledge of Procedure
3
2
Frequently asked for wrong
instruments or used
inappropriate instrument
Flow of Operation
4
Efficient time/motion but
some unnecessary moves
Repeatedly makes tentative or
awkward moves with
instruments by inappropriate
use of instruments
Knowledge of Instruments
3
Careful handling of tissue but
occasionally caused
inadvertent damage
PASS
5
Clearly superior outcome
FAIL
Page 8
Open Technical Skills Expert-administered Assessment Test
HEMOSTASIS
Figure-of-Eight Stitch-Blood Vessel: Using a foam stomach, place three figure of eight stitches over three short gastric sites.
Area of Target Performance/Key Errors
Yes
No
Consistency in needle reload
Parallel Throws (figure of eight above tissue, not in tissue)
Performs without using Finger to Reload Needle
Sews Toward Self
Tie in a Hole (with passer), Right: Using a model of a simulated clamped vessel in the bottom of the cup on the knotboard, place a
ligature around the vessel. The assistant’s clamp tips should point to the surgeon’s right.
Area of Target Performance/Key Errors
Yes
No
Loads tie off of tip of clamp (not perpendicular)
Suture passed around back clamp before around tip of clamp (may pass clamp or
suture)
Passer tip brought under clamp tip
Ties with right hand
Pushes knot down with right finger beyond tip of clamp
Asks assistant to release clamp after first hitch thrown
Knots tied with 180-degrees of tension
Knots square
Knot secure
Uses proper suture length (not impeded by excessively short/long tail)
2. Tie in a Hole (with passer), Left: Using a model of a simulated clamped vessel in the bottom of the cup on the knotboard, place a
ligature around the vessel. The assistant’s clamp tips should point to the surgeon’s left.
Area of Target Performance/Key Errors
Yes
No
Loads tie off of tip of clamp (not perpendicular)
Suture passed around back clamp before around tip of clamp (may pass clamp or
suture)
Passer tip brought under clamp tip
Ties with left hand
Pushes knot down with left finger beyond tip of clamp
Asks assistant to release clamp after first hitch thrown
Knots tied with 180-degrees of tension
Knots square
Knot secure
Uses proper suture length for (not impeded by excessively short/long tail)
3. Suture Ligature: Using a simulated clamped artery, place a suture ligature (“stick-tie”) on the artery. The tip of the clamp should
point to the surgeon’s right
Area of Target Performance/Key Errors
Yes
No
Places stitch through center of vessel (two-passes, mattress technique)
Exhibits universal precaution method of needle protection
Only one hitch on first knot
Final ligature placed around entire vessel
Pushes knot down with finger beyond tip of clamp
Asks assistant to release clamp after first hitch of final ligature thrown
Knots tied with 180-degrees of tension
Knots square
Knot secure
Uses proper suture length for (not impeded by excessively short/long tail)
Revised 11/4/2009
Page 9
Open Technical Skills Expert-administered Assessment Test
EXAMINER: PLEASE FILL OUT OSATS GLOBAL ASSESSMENT FOR HEMOSTASIS
Open Technical Skills Expert-administered Assessment Test
GLOBAL RATING SCALE OF OPERATIVE PERFORMANCE
Please circle the number corresponding to the candidate's performance in each category, irrespective of training level.
Respect for Tissue
1
Frequently used
unnecessary force on
tissue or caused damage
2
Time and Motion
1
Many unnecessary
moves
2
1
Repeatedly makes
tentative or awkward
moves with instruments
by inappropriate use of
instruments
1
2
Instrument Handling
Knowledge of
Instruments
Flow of Operation
Knowledge of
Procedure
Frequently asked for
wrong instruments or
used inappropriate
instrument
1
Frequently stopped
operating and seemed
unsure of next move
1
FINAL PRODUCT
4
5
Consistently handled
tissues appropriately
with minimal damage
4
5
Clear economy of
movement and
maximum efficiency
5
Fluid moves with
instruments and no
awkwardness
3
4
2
5
Obviously familiar
with the instruments
and their names
2
3
Demonstrated some
forward planning with
reasonable progression
of procedure
4
2
3
4
5
Obviously planned
course of operation
with effortless flow
from one move to the
next
5
Demonstrated
familiarity with all
aspects of operation
5
Knew all important
steps of operation
1
2
3
4
Very poor
1
Clearly substandard
outcome
2
Competent
3
Competent but
uninspired outcome
4
OVERALL ON THIS PROCEDURE, SHOULD THE CANDIDATE:
Revised 11/4/2009
4
Knew names of most
instruments and used
appropriate instrument
Deficient knowledge
OVERALL
PERFORMANCE
3
Careful handling of
tissue but occasionally
caused inadvertent
damage
3
Efficient time/motion
but some unnecessary
moves
3
Competent use of
instruments but
occasionally appeared
stiff or awkward
PASS
Clearly superior
5
Clearly superior
outcome
FAIL
Page 10