independence scale in the overall assessment in the OSATS used in the Dutch surgical curriculum “Structuur Curriculum Heelkunde voor Reflectieve Professionals” (SCHERP). Schmidt et al. took one step further creating the A-OSATS for a part of the procedure: the anastomosis.44 This is a valuable addition: training particular steps as part of an advanced skills acquisition program requires specific assessments as well. Figure 3: Assessments Scales: Independence and Safety SCHERP = “Structuur Curriculum Heelkunde voor Reflectieve Professionals” (Dutch surgical curriculum) Computer algorithms and artificial intelligence (AI) provide multiple opportunities to enhance surgical assessment. Neural networks and machine learning, a form of AI that uses algorithms that autonomously learn to perform cognitive tasks, are already used to process surgical motion data.46,47 Surgical motion efficiency is arguably a result of adequate skill. Datta et al. have shown improved surgical efficiency score (SES) in relation to OSATS scores.48 Other SCHERP Independence scale A - Knowledge and skills to assist B - Knowledge and skills to perform under strict supervision C - Knowledge and skills to perform under limited supervision D - Knowledge and skills to perform unsupervised E - Knowledge and skills to supervise and teach Glarner et al.45 Independence scale 0 - Did not perform 1 - Unable to perform any of the task even with direct guidance & instructions 2 - Performs some of the task with direct guidance and instructions, needs assistance to complete task 3- Performs the task with direct guidance & instruction 4 - Performs the task with minimal guidance & instruction 5 - Performs the task with no guidance or instruction Nau et al.42 Safety scale Poor - unsafe Adequate - safe Good - safe 158 8
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