An Evaluation of the Feasibility, Validity, and Reliability of Laparoscopic Skills Assessment in the Operating Room

To assess the use of a synchronized video-based motion tracking device for objective, instant, and automated assessment of laparoscopic skill in the operating room. The assessment of technical skills is fundamental to recognition of proficient surgical practice. It is necessary to demonstrate the va...

Full description

Saved in:
Bibliographic Details
Published inAnnals of surgery Vol. 245; no. 6; pp. 992 - 999
Main Authors Aggarwal, Rajesh, Grantcharov, Teodor, Moorthy, Krishna, Milland, Thor, Papasavas, Pavlos, Dosis, Aristotelis, Bello, Fernando, Darzi, Ara
Format Journal Article
LanguageEnglish
Published Hagerstown, MD Lippincott 01.06.2007
Subjects
Online AccessGet full text
ISSN0003-4932
1528-1140
1528-1140
DOI10.1097/01.sla.0000262780.17950.e5

Cover

Abstract To assess the use of a synchronized video-based motion tracking device for objective, instant, and automated assessment of laparoscopic skill in the operating room. The assessment of technical skills is fundamental to recognition of proficient surgical practice. It is necessary to demonstrate the validity, reliability, and feasibility of any tool to be applied for objective measurement of performance. Nineteen subjects, divided into 13 experienced (performed >100 laparoscopic cholecystectomies) and 6 inexperienced (performed <10 LCs) surgeons completed LCs on 53 patients who all had a diagnosis of biliary colic. Each procedure was recorded with the ROVIMAS video-based motion tracking device to provide an objective measure of the surgeon's dexterity. Each video was also rated by 2 experienced observers on a previously validated operative assessment scale. There were significant differences for motion tracking parameters between the 2 groups of surgeons for the Calot triangle dissection part of procedure for time taken (P = 0.002), total path length (P = 0.026), and number of movements (P = 0.005). Both motion tracking and video-based assessment displayed intertest reliability, and there were good correlations between the 2 modes of assessment (r = 0.4 to 0.7, P < 0.01). An instant, objective, valid, and reliable mode of assessment of laparoscopic performance in the operating room has been defined. This may serve to reduce the time taken for technical skills assessment, and subsequently lead to accurate and efficient audit and credentialing of surgeons for independent practice.
AbstractList The assessment of technical skills in the operating room is fundamental to the credentialing of surgeons for independent practice. This paper investigates the use of motion-tracking of a surgeon's hands for assessment of laparoscopic skill, in synchrony with video-based assessment of performance on a structured rating scale.
To assess the use of a synchronized video-based motion tracking device for objective, instant, and automated assessment of laparoscopic skill in the operating room.OBJECTIVETo assess the use of a synchronized video-based motion tracking device for objective, instant, and automated assessment of laparoscopic skill in the operating room.The assessment of technical skills is fundamental to recognition of proficient surgical practice. It is necessary to demonstrate the validity, reliability, and feasibility of any tool to be applied for objective measurement of performance.SUMMARY BACKGROUND DATAThe assessment of technical skills is fundamental to recognition of proficient surgical practice. It is necessary to demonstrate the validity, reliability, and feasibility of any tool to be applied for objective measurement of performance.Nineteen subjects, divided into 13 experienced (performed >100 laparoscopic cholecystectomies) and 6 inexperienced (performed <10 LCs) surgeons completed LCs on 53 patients who all had a diagnosis of biliary colic. Each procedure was recorded with the ROVIMAS video-based motion tracking device to provide an objective measure of the surgeon's dexterity. Each video was also rated by 2 experienced observers on a previously validated operative assessment scale.METHODSNineteen subjects, divided into 13 experienced (performed >100 laparoscopic cholecystectomies) and 6 inexperienced (performed <10 LCs) surgeons completed LCs on 53 patients who all had a diagnosis of biliary colic. Each procedure was recorded with the ROVIMAS video-based motion tracking device to provide an objective measure of the surgeon's dexterity. Each video was also rated by 2 experienced observers on a previously validated operative assessment scale.There were significant differences for motion tracking parameters between the 2 groups of surgeons for the Calot triangle dissection part of procedure for time taken (P = 0.002), total path length (P = 0.026), and number of movements (P = 0.005). Both motion tracking and video-based assessment displayed intertest reliability, and there were good correlations between the 2 modes of assessment (r = 0.4 to 0.7, P < 0.01).RESULTSThere were significant differences for motion tracking parameters between the 2 groups of surgeons for the Calot triangle dissection part of procedure for time taken (P = 0.002), total path length (P = 0.026), and number of movements (P = 0.005). Both motion tracking and video-based assessment displayed intertest reliability, and there were good correlations between the 2 modes of assessment (r = 0.4 to 0.7, P < 0.01).An instant, objective, valid, and reliable mode of assessment of laparoscopic performance in the operating room has been defined. This may serve to reduce the time taken for technical skills assessment, and subsequently lead to accurate and efficient audit and credentialing of surgeons for independent practice.CONCLUSIONSAn instant, objective, valid, and reliable mode of assessment of laparoscopic performance in the operating room has been defined. This may serve to reduce the time taken for technical skills assessment, and subsequently lead to accurate and efficient audit and credentialing of surgeons for independent practice.
To assess the use of a synchronized video-based motion tracking device for objective, instant, and automated assessment of laparoscopic skill in the operating room. The assessment of technical skills is fundamental to recognition of proficient surgical practice. It is necessary to demonstrate the validity, reliability, and feasibility of any tool to be applied for objective measurement of performance. Nineteen subjects, divided into 13 experienced (performed >100 laparoscopic cholecystectomies) and 6 inexperienced (performed <10 LCs) surgeons completed LCs on 53 patients who all had a diagnosis of biliary colic. Each procedure was recorded with the ROVIMAS video-based motion tracking device to provide an objective measure of the surgeon's dexterity. Each video was also rated by 2 experienced observers on a previously validated operative assessment scale. There were significant differences for motion tracking parameters between the 2 groups of surgeons for the Calot triangle dissection part of procedure for time taken (P = 0.002), total path length (P = 0.026), and number of movements (P = 0.005). Both motion tracking and video-based assessment displayed intertest reliability, and there were good correlations between the 2 modes of assessment (r = 0.4 to 0.7, P < 0.01). An instant, objective, valid, and reliable mode of assessment of laparoscopic performance in the operating room has been defined. This may serve to reduce the time taken for technical skills assessment, and subsequently lead to accurate and efficient audit and credentialing of surgeons for independent practice.
Author Moorthy, Krishna
Papasavas, Pavlos
Aggarwal, Rajesh
Grantcharov, Teodor
Dosis, Aristotelis
Milland, Thor
Bello, Fernando
Darzi, Ara
AuthorAffiliation From the Department of Biosurgery & Surgical Technology, Imperial College London, UK; †Department of Surgical Gastroenterology, Glostrup University Hospital, Glostrup, Denmark; and ‡Department of Surgery, Western Pennsylvania Hospital, Pittsburgh, PA
AuthorAffiliation_xml – name: From the Department of Biosurgery & Surgical Technology, Imperial College London, UK; †Department of Surgical Gastroenterology, Glostrup University Hospital, Glostrup, Denmark; and ‡Department of Surgery, Western Pennsylvania Hospital, Pittsburgh, PA
Author_xml – sequence: 1
  givenname: Rajesh
  surname: Aggarwal
  fullname: Aggarwal, Rajesh
– sequence: 2
  givenname: Teodor
  surname: Grantcharov
  fullname: Grantcharov, Teodor
– sequence: 3
  givenname: Krishna
  surname: Moorthy
  fullname: Moorthy, Krishna
– sequence: 4
  givenname: Thor
  surname: Milland
  fullname: Milland, Thor
– sequence: 5
  givenname: Pavlos
  surname: Papasavas
  fullname: Papasavas, Pavlos
– sequence: 6
  givenname: Aristotelis
  surname: Dosis
  fullname: Dosis, Aristotelis
– sequence: 7
  givenname: Fernando
  surname: Bello
  fullname: Bello, Fernando
– sequence: 8
  givenname: Ara
  surname: Darzi
  fullname: Darzi, Ara
BackLink http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18797061$$DView record in Pascal Francis
https://www.ncbi.nlm.nih.gov/pubmed/17522527$$D View this record in MEDLINE/PubMed
BookMark eNqVkd1u1DAQhS1URLeFV0AWElyRxXbiOAEJsapaQFqpUvm5tSbOpDV47RAnrfbt62ZXWuAKfGPL882ZmTMn5MgHj4S84GzJWa3eML6MDpYsHVEKVaVvVUu2RPmILLgUVcZ5wY7IIgF5VtS5OCYnMf5gjBcVU0_IMVdSCCnUgsSVp-e34CYYbfA0dHS8QXqBEG1jnR23r-l3cLadX-BbeoXOwi70QK-hhyFEE3pr6Jef1rlIVzFijBv0I7V-1rvscUgF_DW9CmHzlDzuwEV8tr9PybeL869nn7L15cfPZ6t1ZqRgY9Yp02DDO1mLVjFAoUpZqQK7vDSNEEXbIuSsrNuuVLJCU6YEwWTZmopLrFR-St7tdCffw_YOnNP9YDcwbDVn-sFKzbhOVuqDlXq2UqNM2e932f3UbLA1aZwBDgoBrP4z4u2Nvg63mleqrGWZBF7tBYbwa8I46o2NBp0Dj2GKWjEppJzB579XOjS531ICXu4BiAZcN4A3Nh64StWKlTxxH3acSSuJA3ba2HFebGrQun-b-u1fEv9h2T2-DswE
CODEN ANSUA5
CitedBy_id crossref_primary_10_1016_j_jchirv_2020_04_006
crossref_primary_10_1177_1457496913496494
crossref_primary_10_2106_JBJS_K_01438
crossref_primary_10_3390_jcm11144145
crossref_primary_10_1016_j_jsurg_2016_03_018
crossref_primary_10_1089_end_2016_0554
crossref_primary_10_1007_s11548_015_1194_1
crossref_primary_10_1007_s00464_022_09466_6
crossref_primary_10_1177_0363546513483535
crossref_primary_10_1097_MAO_0b013e3181e3d385
crossref_primary_10_4300_JGME_D_09_00103_1
crossref_primary_10_1002_aet2_10064
crossref_primary_10_1016_j_apergo_2020_103136
crossref_primary_10_1177_000313481107700625
crossref_primary_10_1016_j_jsurg_2011_08_008
crossref_primary_10_1155_2013_686494
crossref_primary_10_1007_s00464_023_10006_z
crossref_primary_10_1016_j_cmpb_2017_09_007
crossref_primary_10_1007_s00464_012_2284_6
crossref_primary_10_2106_JBJS_17_01512
crossref_primary_10_1007_s00464_013_3226_7
crossref_primary_10_1007_s00464_022_09108_x
crossref_primary_10_1007_s11548_021_02339_8
crossref_primary_10_1515_bmt_2015_0008
crossref_primary_10_1016_j_jsurg_2019_11_012
crossref_primary_10_1109_THMS_2020_3035763
crossref_primary_10_1016_j_jsurg_2019_06_011
crossref_primary_10_1177_1129729818804997
crossref_primary_10_1016_j_gie_2017_08_020
crossref_primary_10_1016_j_amjsurg_2015_04_024
crossref_primary_10_1016_j_gie_2011_09_028
crossref_primary_10_1177_1541931218621133
crossref_primary_10_1016_j_apergo_2018_12_010
crossref_primary_10_1007_s11548_013_0909_4
crossref_primary_10_1016_j_gie_2011_01_069
crossref_primary_10_12998_wjcc_v3_i3_265
crossref_primary_10_1016_j_amjsurg_2011_08_008
crossref_primary_10_2196_22536
crossref_primary_10_1007_s10459_011_9281_8
crossref_primary_10_1002_rcs_1702
crossref_primary_10_1016_j_jmig_2013_07_016
crossref_primary_10_1016_j_eururo_2008_09_045
crossref_primary_10_2500_ajra_2010_24_3434
crossref_primary_10_1016_j_jss_2011_06_034
crossref_primary_10_1007_s00464_012_2631_7
crossref_primary_10_1007_s00464_017_5641_7
crossref_primary_10_3109_13645700903492977
crossref_primary_10_1097_SLA_0000000000003385
crossref_primary_10_1067_j_cpsurg_2011_08_003
crossref_primary_10_1016_j_jsurg_2019_02_010
crossref_primary_10_1016_j_surg_2012_08_009
crossref_primary_10_2106_JBJS_H_01762
crossref_primary_10_1016_j_ergon_2017_12_002
crossref_primary_10_2106_JBJS_I_00024
crossref_primary_10_1016_j_surg_2016_05_004
crossref_primary_10_1016_j_bjoms_2009_11_010
crossref_primary_10_1007_s00464_013_2859_x
crossref_primary_10_1097_SIH_0b013e31828fdedc
crossref_primary_10_1016_j_gie_2010_09_005
crossref_primary_10_1159_000369471
crossref_primary_10_1016_j_jsurg_2011_10_014
crossref_primary_10_1590_0102_672020200004e1559
crossref_primary_10_1007_s00464_017_5574_1
crossref_primary_10_1016_j_arthro_2013_01_026
crossref_primary_10_3109_0142159X_2013_801548
crossref_primary_10_1097_SLA_0b013e318160b371
crossref_primary_10_1097_SLA_0b013e3182197016
crossref_primary_10_1007_s00464_009_0792_9
crossref_primary_10_1111_medu_12220
crossref_primary_10_1002_lary_20678
crossref_primary_10_1016_j_ijnurstu_2009_03_002
crossref_primary_10_1007_s00464_023_10076_z
crossref_primary_10_1016_j_ijsu_2020_05_015
crossref_primary_10_1016_j_surg_2014_04_044
crossref_primary_10_1007_s00464_009_0721_y
crossref_primary_10_1016_j_amjsurg_2014_08_031
crossref_primary_10_1007_s11255_015_1023_z
crossref_primary_10_1016_j_media_2017_11_011
crossref_primary_10_1051_fopen_2022001
crossref_primary_10_1109_TBME_2020_3011867
crossref_primary_10_1016_j_suc_2010_02_008
crossref_primary_10_1016_j_suc_2010_02_009
crossref_primary_10_1016_j_arthro_2015_07_023
crossref_primary_10_1007_s00464_016_5213_2
crossref_primary_10_1007_s00464_012_2513_z
crossref_primary_10_1080_13645706_2017_1284131
crossref_primary_10_1016_j_amjsurg_2009_05_016
crossref_primary_10_1016_j_jsurg_2016_05_012
crossref_primary_10_1016_j_jbi_2015_11_002
crossref_primary_10_1007_s00464_012_2220_9
crossref_primary_10_1016_j_jsurg_2019_05_010
crossref_primary_10_1016_j_jviscsurg_2020_04_006
crossref_primary_10_1002_aet2_10560
crossref_primary_10_1016_j_amjsurg_2007_10_024
crossref_primary_10_1016_j_amjsurg_2010_10_020
crossref_primary_10_1007_s11548_020_02259_z
crossref_primary_10_1136_bmjqs_2016_005816
crossref_primary_10_1177_0018720819838901
crossref_primary_10_1007_s00464_017_5802_8
crossref_primary_10_1007_s00464_008_0246_9
crossref_primary_10_1007_s11548_016_1459_3
crossref_primary_10_1007_s11548_024_03248_2
crossref_primary_10_1097_SIH_0000000000000544
crossref_primary_10_1007_s00464_019_07024_1
crossref_primary_10_1016_j_jsurg_2014_08_006
crossref_primary_10_1007_s00464_018_6535_z
crossref_primary_10_1097_TA_0000000000000813
crossref_primary_10_1186_s12893_015_0058_5
crossref_primary_10_1007_s00464_015_4285_8
crossref_primary_10_1016_j_jsurg_2009_09_005
Cites_doi 10.1016/S0003-6870(98)00016-7
10.1016/0002-9610(91)90607-F
10.1097/01.sla.0000118753.22830.41
10.1016/0002-9610(91)90588-5
10.1007/s00464-004-8100-1
10.1001/archsurg.139.11.1215
10.1016/S1072-7515(00)00339-2
10.1016/j.surg.2005.02.014
10.1007/s00268-005-0157-z
10.1016/S0002-9610(01)00667-5
10.1097/01.sla.0000150066.83563.52
10.1136/bmj.327.7422.1032
10.1007/s00464-003-8157-2
10.1016/S0002-9610(05)80843-8
10.1007/s00464-001-9132-4
10.1016/j.jamcollsurg.2004.08.029
10.1136/bmj.38030.642963.AE
10.1136/bmj.318.7188.887
10.1016/j.amjsurg.2005.03.020
10.1136/bmj.38562.690104.43
10.1089/109264200421559
10.1067/msy.2002.120664
10.1001/jama.1981.03310270040022
10.1080/13645700310007698
10.1007/s004640080081
10.1002/bjs.4020
10.1007/s002689910070
10.1016/j.surg.2005.07.017
10.1007/s00464-004-9174-5
10.1001/archsurg.140.3.293
10.1056/NEJM199104183241601
10.1002/bjs.4816
10.1136/bmj.316.7149.1917
10.1097/00001888-199809000-00020
10.1002/bjs.4407
10.1046/j.1365-2923.37.s1.2.x
10.1016/j.surg.2004.09.001
ContentType Journal Article
Copyright 2007 INIST-CNRS
2007 Lippincott Williams & Wilkins, Inc.
Copyright_xml – notice: 2007 INIST-CNRS
– notice: 2007 Lippincott Williams & Wilkins, Inc.
DBID AAYXX
CITATION
IQODW
CGR
CUY
CVF
ECM
EIF
NPM
7X8
5PM
ADTOC
UNPAY
DOI 10.1097/01.sla.0000262780.17950.e5
DatabaseName CrossRef
Pascal-Francis
Medline
MEDLINE
MEDLINE (Ovid)
MEDLINE
MEDLINE
PubMed
MEDLINE - Academic
PubMed Central (Full Participant titles)
Unpaywall for CDI: Periodical Content
Unpaywall
DatabaseTitle CrossRef
MEDLINE
Medline Complete
MEDLINE with Full Text
PubMed
MEDLINE (Ovid)
MEDLINE - Academic
DatabaseTitleList
MEDLINE - Academic
MEDLINE
Database_xml – sequence: 1
  dbid: NPM
  name: PubMed
  url: https://proxy.k.utb.cz/login?url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
  sourceTypes: Index Database
– sequence: 2
  dbid: EIF
  name: MEDLINE
  url: https://proxy.k.utb.cz/login?url=https://www.webofscience.com/wos/medline/basic-search
  sourceTypes: Index Database
– sequence: 3
  dbid: UNPAY
  name: Unpaywall
  url: https://proxy.k.utb.cz/login?url=https://unpaywall.org/
  sourceTypes: Open Access Repository
DeliveryMethod fulltext_linktorsrc
EISSN 1528-1140
EndPage 999
ExternalDocumentID oai:pubmedcentral.nih.gov:1876956
PMC1876956
17522527
18797061
10_1097_01_sla_0000262780_17950_e5
Genre Validation Studies
Journal Article
GroupedDBID ---
.-D
.3C
.55
.GJ
.XZ
.Z2
01R
0R~
1J1
23M
2WC
354
3O-
40H
4Q1
4Q2
4Q3
53G
5GY
5VS
6J9
71W
77Y
7O~
AAAAV
AAAXR
AAEJM
AAFWJ
AAGIX
AAHPQ
AAIQE
AAJCS
AAMOA
AAMTA
AAQKA
AARTV
AASCR
AASOK
AASXQ
AAUEB
AAXQO
AAYXX
ABASU
ABBUW
ABDIG
ABJNI
ABOCM
ABPMR
ABPPZ
ABPXF
ABVCZ
ABXVJ
ABXYN
ABZAD
ABZZY
ACCJW
ACDDN
ACDOF
ACEWG
ACGFO
ACGFS
ACILI
ACLDA
ACOAL
ACWDW
ACWRI
ACXJB
ACXNZ
ACZKN
ADBBV
ADFPA
ADGGA
ADHPY
ADKSD
ADNKB
ADSXY
AE3
AE6
AEBDS
AEETU
AENEX
AFBFQ
AFCHL
AFDTB
AFEXH
AFMBP
AFNMH
AFSOK
AFUWQ
AGINI
AHJKT
AHOMT
AHQNM
AHQVU
AHRYX
AHVBC
AI.
AIJEX
AINUH
AJCLO
AJIOK
AJJEV
AJNWD
AJNYG
AJZMW
AKCTQ
AKULP
ALKUP
ALMA_UNASSIGNED_HOLDINGS
ALMTX
AMJPA
AMKUR
AMNEI
AOHHW
AOQMC
ASPBG
AVWKF
AZFZN
BAWUL
BOYCO
BQLVK
BS7
BYPQX
C45
CITATION
CS3
DIK
DIWNM
DUNZO
E.X
E3Z
EBS
EEVPB
EJD
ERAAH
EX3
F2K
F2L
F2M
F2N
F5P
FCALG
FEDTE
FL-
FW0
GNXGY
GQDEL
H0~
HLJTE
HVGLF
HZ~
IH2
IKREB
IKYAY
IN~
IPNFZ
J5H
JF7
JF9
JG8
JK3
JK8
K-A
K-F
K8S
KD2
KMI
L-C
L7B
M18
N4W
N9A
N~7
N~B
N~M
O9-
OAG
OAH
OBH
OCB
OCUKA
ODA
ODMTH
OGEVE
OHH
OHYEH
OK1
OL1
OLB
OLG
OLH
OLU
OLV
OLY
OLZ
OPUJH
ORVUJ
OUVQU
OVD
OVDNE
OVIDH
OVLEI
OVOZU
OWBYB
OWU
OWV
OWW
OWX
OWY
OWZ
OXXIT
P-K
P2P
R58
RIG
RLZ
RPM
RXW
S4R
S4S
T8P
TAF
TEORI
TR2
TSPGW
UQX
V2I
VH1
VVN
W3M
WH7
WOQ
WOW
X3V
X3W
X7M
XXN
XYM
YFH
YOC
ZFV
ZGI
ZXP
ZY1
ZZMQN
~H1
IQODW
CGR
CUY
CVF
ECM
EIF
NPM
7X8
5PM
ADTOC
UNPAY
ID FETCH-LOGICAL-c520t-f7cbeb1f592d70ae2765874ef36cb224ddea3069df6758ec6f7c2056dc815e873
IEDL.DBID UNPAY
ISSN 0003-4932
1528-1140
IngestDate Wed Aug 20 00:08:33 EDT 2025
Tue Sep 30 16:50:00 EDT 2025
Mon Sep 08 02:39:09 EDT 2025
Mon Jul 21 05:33:55 EDT 2025
Mon Jul 21 09:13:23 EDT 2025
Wed Oct 01 02:20:45 EDT 2025
Thu Apr 24 22:55:15 EDT 2025
IsDoiOpenAccess true
IsOpenAccess true
IsPeerReviewed true
IsScholarly true
Issue 6
Keywords Medicine
Evaluation
Validity
Treatment
Operating room
Surgery
Vocational aptitude
Feasibility
Laparoscopy
Endoscopy
Reliability
Language English
License CC BY 4.0
LinkModel DirectLink
MergedId FETCHMERGED-LOGICAL-c520t-f7cbeb1f592d70ae2765874ef36cb224ddea3069df6758ec6f7c2056dc815e873
Notes ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ObjectType-Undefined-3
OpenAccessLink https://proxy.k.utb.cz/login?url=http://doi.org/10.1097/01.sla.0000262780.17950.e5
PMID 17522527
PQID 70525556
PQPubID 23479
PageCount 8
ParticipantIDs unpaywall_primary_10_1097_01_sla_0000262780_17950_e5
pubmedcentral_primary_oai_pubmedcentral_nih_gov_1876956
proquest_miscellaneous_70525556
pubmed_primary_17522527
pascalfrancis_primary_18797061
crossref_citationtrail_10_1097_01_sla_0000262780_17950_e5
crossref_primary_10_1097_01_sla_0000262780_17950_e5
ProviderPackageCode CITATION
AAYXX
PublicationCentury 2000
PublicationDate 2007-06-01
PublicationDateYYYYMMDD 2007-06-01
PublicationDate_xml – month: 06
  year: 2007
  text: 2007-06-01
  day: 01
PublicationDecade 2000
PublicationPlace Hagerstown, MD
PublicationPlace_xml – name: Hagerstown, MD
– name: United States
PublicationTitle Annals of surgery
PublicationTitleAlternate Ann Surg
PublicationYear 2007
Publisher Lippincott
Publisher_xml – name: Lippincott
References (R6-22-20210203) 1994; 8
(R22-22-20210203) 1991; 324
Pellegrini (R43-22-20210203) 2004; 136
Kneebone (R15-22-20210203) 2003; 37
Elwyn (R4-22-20210203) 2005; 331
Hall (R23-22-20210203) 2003; 90
Cao (R28-22-20210203) 1999; 62
Mackay (R26-22-20210203) 2002; 16
Sarker (R34-22-20210203) 2005; 19
Tang (R35-22-20210203) 2004; 139
Moorthy (R10-22-20210203) 2003; 327
Tang (R37-22-20210203) 2005; 138
Cuschieri (R11-22-20210203) 2001; 182
Dath (R21-22-20210203) 2004; 18
Joice (R27-22-20210203) 1998; 29
Jackson (R7-22-20210203) 1999
Darzi (R16-22-20210203) 1999; 318
Grantcharov (R29-22-20210203) 2004; 91
Reznick (R13-22-20210203) 1993; 165
Larson (R33-22-20210203) 2005; 138
Darosa (R41-22-20210203) 2002; 131
Hanna (R18-22-20210203) 2000; 24
Scott (R31-22-20210203) 2000; 10
Ribble (R8-22-20210203) 1981; 245
Scott (R32-22-20210203) 2000; 191
Bann (R39-22-20210203) 2005; 189
Guerlain (R40-22-20210203) 2005; 200
Smith (R3-22-20210203) 1998; 316
Aggarwal (R14-22-20210203) 2004; 91
Reason (R2-22-20210203) 1994
(R9-22-20210203) 1991; 161
Tang (R38-22-20210203) 2006; 30
Smith (R19-22-20210203) 2002; 16
Tang (R36-22-20210203) 2004; 18
Dosis (R17-22-20210203) 2005; 140
Martin (R20-22-20210203) 1997; 84
Dent (R5-22-20210203) 1991; 161
Regehr (R30-22-20210203) 1998; 73
Urbach (R25-22-20210203) 2004; 328
Vincent (R12-22-20210203) 2004; 239
Cuschieri (R1-22-20210203) 2003; 12
Debas (R42-22-20210203) 2005; 241
Spencer (R24-22-20210203) 1978; 63
11574079 - Am J Surg. 2001 Aug;182(2):110-6
9796785 - Appl Ergon. 1998 Dec;29(6):409-14
10706917 - World J Surg. 2000 Apr;24(4):444-8; discussion 448-9
1825767 - Am J Surg. 1991 Mar;161(3):399-403
15781796 - Arch Surg. 2005 Mar;140(3):293-9
9759104 - Acad Med. 1998 Sep;73(9):993-7
15024308 - Ann Surg. 2004 Apr;239(4):475-82
15523386 - Surgery. 2004 Nov;136(5):953-65
15547882 - Br J Surg. 2004 Dec;91(12):1549-58
16269292 - Surgery. 2005 Oct;138(4):640-7; discussion 647-9
15868251 - Surg Endosc. 2005 Jun;19(6):832-5
11972205 - Surg Endosc. 2002 Apr;16(4):640-5
14641639 - Med Educ. 2003 Nov;37 Suppl 1:50-8
9052454 - Br J Surg. 1997 Feb;84(2):273-8
12163963 - Surg Endosc. 2002 Jun;16(6):957-61
11854700 - Surgery. 2002 Feb;131(2):205-9
8059317 - Surg Endosc. 1994 Jun;8(6):721-2
15910731 - Am J Surg. 2005 Jun;189(6):747-52
1826143 - N Engl J Med. 1991 Apr 18;324(16):1073-8
16003310 - Surgery. 2005 Jul;138(1):14-20
12520568 - Br J Surg. 2003 Jan;90(1):10-6
16754088 - Minim Invasive Ther Allied Technol. 2003 Jul;12(3):111-20
15545569 - Arch Surg. 2004 Nov;139(11):1215-20
9641922 - BMJ. 1998 Jun 27;316(7149):1917-8
14760660 - Br J Surg. 2004 Feb;91(2):146-50
7452832 - JAMA. 1981 Jan 9;245(2):160-3
15631917 - J Am Coll Surg. 2005 Jan;200(1):29-37
15621984 - Ann Surg. 2005 Jan;241(1):1-8
15809778 - Surg Endosc. 2004 Dec;18(12):1716-20
10102830 - BMJ. 1999 Apr 3;318(7188):887-8
15020356 - BMJ. 2004 Mar 27;328(7442):737-40
15809794 - Surg Endosc. 2004 Dec;18(12):1800-4
16061500 - BMJ. 2005 Aug 6;331(7512):302-4
10989902 - J Am Coll Surg. 2000 Sep;191(3):272-83
16547622 - World J Surg. 2006 Apr;30(4):527-34
8447543 - Am J Surg. 1993 Mar;165(3):358-61
10538405 - Stud Health Technol Inform. 1999;62:83-9
14593041 - BMJ. 2003 Nov 1;327(7422):1032-7
10997840 - J Laparoendosc Adv Surg Tech A. 2000 Aug;10(4):183-90
References_xml – volume: 29
  start-page: 409
  year: 1998
  ident: R27-22-20210203
  article-title: Errors enacted during endoscopic surgery: a human reliability analysis.
  publication-title: Appl Ergon
  doi: 10.1016/S0003-6870(98)00016-7
– volume: 161
  start-page: 399
  year: 1991
  ident: R5-22-20210203
  article-title: Training, credentialling, and granting of clinical privileges for laparoscopic general surgery.
  publication-title: Am J Surg
  doi: 10.1016/0002-9610(91)90607-F
– volume: 239
  start-page: 475
  year: 2004
  ident: R12-22-20210203
  article-title: Systems approaches to surgical quality and safety: from concept to measurement.
  publication-title: Ann Surg
  doi: 10.1097/01.sla.0000118753.22830.41
– volume: 63
  start-page: 9
  year: 1978
  ident: R24-22-20210203
  article-title: Teaching and measuring surgical techniques: the technical evaluation of competence.
  publication-title: Bull Am Coll Surg
– volume: 161
  start-page: 324
  year: 1991
  ident: R9-22-20210203
  article-title: Granting of privileges for laparoscopic general surgery.
  publication-title: Am J Surg
  doi: 10.1016/0002-9610(91)90588-5
– volume: 18
  start-page: 1716
  year: 2004
  ident: R36-22-20210203
  article-title: Analysis of technical surgical errors during initial experience of laparoscopic pyloromyotomy by a group of Dutch pediatric surgeons.
  publication-title: Surg Endosc
  doi: 10.1007/s00464-004-8100-1
– volume: 139
  start-page: 1215
  year: 2004
  ident: R35-22-20210203
  article-title: Identification and categorization of technical errors by Observational Clinical Human Reliability Assessment (OCHRA) during laparoscopic cholecystectomy.
  publication-title: Arch Surg
  doi: 10.1001/archsurg.139.11.1215
– volume: 191
  start-page: 272
  year: 2000
  ident: R32-22-20210203
  article-title: Laparoscopic training on bench models: better and more cost effective than operating room experience?
  publication-title: J Am Coll Surg
  doi: 10.1016/S1072-7515(00)00339-2
– volume: 138
  start-page: 14
  year: 2005
  ident: R37-22-20210203
  article-title: Analysis of errors enacted by surgical trainees during skills training courses.
  publication-title: Surgery
  doi: 10.1016/j.surg.2005.02.014
– volume: 30
  start-page: 527
  year: 2006
  ident: R38-22-20210203
  article-title: Competence assessment of laparoscopic operative and cognitive skills: Objective Structured Clinical Examination (OSCE) or Observational Clinical Human Reliability Assessment (OCHRA).
  publication-title: World J Surg
  doi: 10.1007/s00268-005-0157-z
– volume: 182
  start-page: 110
  year: 2001
  ident: R11-22-20210203
  article-title: What do master surgeons think of surgical competence and revalidation?
  publication-title: Am J Surg
  doi: 10.1016/S0002-9610(01)00667-5
– volume: 241
  start-page: 1
  year: 2005
  ident: R42-22-20210203
  article-title: American Surgical Association Blue Ribbon Committee Report on Surgical Education: 2004.
  publication-title: Ann Surg
  doi: 10.1097/01.sla.0000150066.83563.52
– volume: 327
  start-page: 1032
  year: 2003
  ident: R10-22-20210203
  article-title: Objective assessment of technical skills in surgery.
  publication-title: BMJ
  doi: 10.1136/bmj.327.7422.1032
– volume: 18
  start-page: 1800
  year: 2004
  ident: R21-22-20210203
  article-title: Toward reliable operative assessment: the reliability and feasibility of videotaped assessment of laparoscopic technical skills.
  publication-title: Surg Endosc
  doi: 10.1007/s00464-003-8157-2
– volume: 165
  start-page: 358
  year: 1993
  ident: R13-22-20210203
  article-title: Teaching and testing technical skills.
  publication-title: Am J Surg
  doi: 10.1016/S0002-9610(05)80843-8
– volume: 16
  start-page: 957
  year: 2002
  ident: R26-22-20210203
  article-title: Practice distribution in procedural skills training: a randomized controlled trial.
  publication-title: Surg Endosc
  doi: 10.1007/s00464-001-9132-4
– volume: 200
  start-page: 29
  year: 2005
  ident: R40-22-20210203
  article-title: Assessing team performance in the operating room: development and use of a ‘black-box’ recorder and other tools for the intraoperative environment.
  publication-title: J Am Coll Surg
  doi: 10.1016/j.jamcollsurg.2004.08.029
– volume: 328
  start-page: 737
  year: 2004
  ident: R25-22-20210203
  article-title: Does it matter what a hospital is ‘high volume’ for? Specificity of hospital volume-outcome associations for surgical procedures: analysis of administrative data.
  publication-title: BMJ
  doi: 10.1136/bmj.38030.642963.AE
– volume: 8
  start-page: 721
  year: 1994
  ident: R6-22-20210203
  article-title: Training and assessment of competence.
  publication-title: Surg Endosc
– volume: 318
  start-page: 887
  year: 1999
  ident: R16-22-20210203
  article-title: Assessing operative skill: needs to become more objective.
  publication-title: BMJ
  doi: 10.1136/bmj.318.7188.887
– volume: 189
  start-page: 747
  year: 2005
  ident: R39-22-20210203
  article-title: The reliability of multiple objective measures of surgery and the role of human performance.
  publication-title: Am J Surg
  doi: 10.1016/j.amjsurg.2005.03.020
– volume: 331
  start-page: 302
  year: 2005
  ident: R4-22-20210203
  article-title: The patient safety story.
  publication-title: BMJ
  doi: 10.1136/bmj.38562.690104.43
– volume: 10
  start-page: 183
  year: 2000
  ident: R31-22-20210203
  article-title: Measuring operative performance after laparoscopic skills training: edited videotape versus direct observation.
  publication-title: J Laparoendosc Adv Surg Tech A
  doi: 10.1089/109264200421559
– year: 1994
  ident: R2-22-20210203
  article-title: Human Error.
– volume: 131
  start-page: 205
  year: 2002
  ident: R41-22-20210203
  article-title: It takes a faculty.
  publication-title: Surgery
  doi: 10.1067/msy.2002.120664
– volume: 245
  start-page: 160
  year: 1981
  ident: R8-22-20210203
  article-title: Priorities and practices of continuing medical education program directors.
  publication-title: JAMA
  doi: 10.1001/jama.1981.03310270040022
– volume: 12
  start-page: 111
  year: 2003
  ident: R1-22-20210203
  article-title: Medical error, incidents, accidents and violations.
  publication-title: Min Inv Ther Allied Technol
  doi: 10.1080/13645700310007698
– volume: 62
  start-page: 83
  year: 1999
  ident: R28-22-20210203
  article-title: Hierarchical decomposition of laparoscopic procedures.
  publication-title: Stud Health Technol Inform
– volume: 16
  start-page: 640
  year: 2002
  ident: R19-22-20210203
  article-title: Motion analysis.
  publication-title: Surg Endosc
  doi: 10.1007/s004640080081
– volume: 90
  start-page: 10
  year: 2003
  ident: R23-22-20210203
  article-title: Surgeons and cognitive processes.
  publication-title: Br J Surg
  doi: 10.1002/bjs.4020
– volume: 24
  start-page: 444
  year: 2000
  ident: R18-22-20210203
  article-title: Influence of two-dimensional and three-dimensional imaging on endoscopic bowel suturing.
  publication-title: World J Surg
  doi: 10.1007/s002689910070
– volume: 138
  start-page: 640
  year: 2005
  ident: R33-22-20210203
  article-title: Feasibility, reliability and validity of an operative performance rating system for evaluating surgery residents.
  publication-title: Surgery
  doi: 10.1016/j.surg.2005.07.017
– volume: 19
  start-page: 832
  year: 2005
  ident: R34-22-20210203
  article-title: Technical skills errors in laparoscopic cholecystectomy by expert surgeons.
  publication-title: Surg Endosc
  doi: 10.1007/s00464-004-9174-5
– volume: 140
  start-page: 293
  year: 2005
  ident: R17-22-20210203
  article-title: Synchronized video and motion analysis for the assessment of procedures in the operating theater.
  publication-title: Arch Surg
  doi: 10.1001/archsurg.140.3.293
– volume: 324
  start-page: 1073
  year: 1991
  ident: R22-22-20210203
  article-title: A prospective analysis of 1518 laparoscopic cholecystectomies.
  publication-title: N Engl J Med
  doi: 10.1056/NEJM199104183241601
– volume: 91
  start-page: 1549
  year: 2004
  ident: R14-22-20210203
  article-title: Laparoscopic skills training and assessment.
  publication-title: Br J Surg
  doi: 10.1002/bjs.4816
– volume: 316
  start-page: 1917
  year: 1998
  ident: R3-22-20210203
  article-title: All changed, changed utterly: British medicine will be transformed by the Bristol case.
  publication-title: BMJ
  doi: 10.1136/bmj.316.7149.1917
– volume: 73
  start-page: 993
  year: 1998
  ident: R30-22-20210203
  article-title: Comparing the psychometric properties of checklists and global rating scales for assessing performance on an OSCE-format examination.
  publication-title: Acad Med
  doi: 10.1097/00001888-199809000-00020
– volume: 91
  start-page: 146
  year: 2004
  ident: R29-22-20210203
  article-title: Randomized clinical trial of virtual reality simulation for laparoscopic skills training.
  publication-title: Br J Surg
  doi: 10.1002/bjs.4407
– year: 1999
  ident: R7-22-20210203
  article-title: Surgical Competence: Challenges of Assessment in Training and Practice, 5th ed.
– volume: 84
  start-page: 273
  year: 1997
  ident: R20-22-20210203
  article-title: Objective structured assessment of technical skill (OSATS) for surgical residents.
  publication-title: Br J Surg
– volume: 37
  start-page: 50
  issue: suppl 1
  year: 2003
  ident: R15-22-20210203
  article-title: Learning the skills of flexible sigmoidoscopy: the wider perspective.
  publication-title: Med Educ
  doi: 10.1046/j.1365-2923.37.s1.2.x
– volume: 136
  start-page: 953
  year: 2004
  ident: R43-22-20210203
  article-title: Residency training in surgery in the 21st century: a new paradigm.
  publication-title: Surgery
  doi: 10.1016/j.surg.2004.09.001
– reference: 7452832 - JAMA. 1981 Jan 9;245(2):160-3
– reference: 14593041 - BMJ. 2003 Nov 1;327(7422):1032-7
– reference: 15868251 - Surg Endosc. 2005 Jun;19(6):832-5
– reference: 15547882 - Br J Surg. 2004 Dec;91(12):1549-58
– reference: 12163963 - Surg Endosc. 2002 Jun;16(6):957-61
– reference: 8447543 - Am J Surg. 1993 Mar;165(3):358-61
– reference: 15781796 - Arch Surg. 2005 Mar;140(3):293-9
– reference: 1825767 - Am J Surg. 1991 Mar;161(3):399-403
– reference: 12520568 - Br J Surg. 2003 Jan;90(1):10-6
– reference: 16003310 - Surgery. 2005 Jul;138(1):14-20
– reference: 9759104 - Acad Med. 1998 Sep;73(9):993-7
– reference: 15809778 - Surg Endosc. 2004 Dec;18(12):1716-20
– reference: 11574079 - Am J Surg. 2001 Aug;182(2):110-6
– reference: 10706917 - World J Surg. 2000 Apr;24(4):444-8; discussion 448-9
– reference: 15523386 - Surgery. 2004 Nov;136(5):953-65
– reference: 10102830 - BMJ. 1999 Apr 3;318(7188):887-8
– reference: 15631917 - J Am Coll Surg. 2005 Jan;200(1):29-37
– reference: 1826143 - N Engl J Med. 1991 Apr 18;324(16):1073-8
– reference: 15809794 - Surg Endosc. 2004 Dec;18(12):1800-4
– reference: 16061500 - BMJ. 2005 Aug 6;331(7512):302-4
– reference: 10997840 - J Laparoendosc Adv Surg Tech A. 2000 Aug;10(4):183-90
– reference: 8059317 - Surg Endosc. 1994 Jun;8(6):721-2
– reference: 9052454 - Br J Surg. 1997 Feb;84(2):273-8
– reference: 11972205 - Surg Endosc. 2002 Apr;16(4):640-5
– reference: 15024308 - Ann Surg. 2004 Apr;239(4):475-82
– reference: 15621984 - Ann Surg. 2005 Jan;241(1):1-8
– reference: 9641922 - BMJ. 1998 Jun 27;316(7149):1917-8
– reference: 14641639 - Med Educ. 2003 Nov;37 Suppl 1:50-8
– reference: 14760660 - Br J Surg. 2004 Feb;91(2):146-50
– reference: 15910731 - Am J Surg. 2005 Jun;189(6):747-52
– reference: 16269292 - Surgery. 2005 Oct;138(4):640-7; discussion 647-9
– reference: 10989902 - J Am Coll Surg. 2000 Sep;191(3):272-83
– reference: 16547622 - World J Surg. 2006 Apr;30(4):527-34
– reference: 15020356 - BMJ. 2004 Mar 27;328(7442):737-40
– reference: 10538405 - Stud Health Technol Inform. 1999;62:83-9
– reference: 11854700 - Surgery. 2002 Feb;131(2):205-9
– reference: 9796785 - Appl Ergon. 1998 Dec;29(6):409-14
– reference: 16754088 - Minim Invasive Ther Allied Technol. 2003 Jul;12(3):111-20
– reference: 15545569 - Arch Surg. 2004 Nov;139(11):1215-20
SSID ssj0014807
Score 2.2880201
Snippet To assess the use of a synchronized video-based motion tracking device for objective, instant, and automated assessment of laparoscopic skill in the operating...
The assessment of technical skills in the operating room is fundamental to the credentialing of surgeons for independent practice. This paper investigates the...
SourceID unpaywall
pubmedcentral
proquest
pubmed
pascalfrancis
crossref
SourceType Open Access Repository
Aggregation Database
Index Database
Enrichment Source
StartPage 992
SubjectTerms Biological and medical sciences
Cholecystectomy, Laparoscopic - standards
Clinical Competence
Digestive system. Abdomen
Endoscopy
Feasibility Studies
General aspects
Humans
Investigative techniques, diagnostic techniques (general aspects)
Medical sciences
Operating Rooms
Original
Reproducibility of Results
Statistics, Nonparametric
Time and Motion Studies
Title An Evaluation of the Feasibility, Validity, and Reliability of Laparoscopic Skills Assessment in the Operating Room
URI https://www.ncbi.nlm.nih.gov/pubmed/17522527
https://www.proquest.com/docview/70525556
https://pubmed.ncbi.nlm.nih.gov/PMC1876956
http://doi.org/10.1097/01.sla.0000262780.17950.e5
UnpaywallVersion submittedVersion
Volume 245
hasFullText 1
inHoldings 1
isFullTextHit
isPrint
journalDatabaseRights – providerCode: PRVBFR
  databaseName: Free Medical Journals
  customDbUrl:
  eissn: 1528-1140
  dateEnd: 20071231
  omitProxy: true
  ssIdentifier: ssj0014807
  issn: 0003-4932
  databaseCode: DIK
  dateStart: 18850101
  isFulltext: true
  titleUrlDefault: http://www.freemedicaljournals.com
  providerName: Flying Publisher
– providerCode: PRVAQN
  databaseName: PubMed Central
  customDbUrl:
  eissn: 1528-1140
  dateEnd: 20071231
  omitProxy: true
  ssIdentifier: ssj0014807
  issn: 0003-4932
  databaseCode: RPM
  dateStart: 18850101
  isFulltext: true
  titleUrlDefault: https://www.ncbi.nlm.nih.gov/pmc/
  providerName: National Library of Medicine
link http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1Lb9QwEB6V7QEkREG8Au3iA0eySryxHR9XqFXLo6DConKKEj_EqpE3YneFll_POK8lKkKFW5R4HHk8yXyjGX8D8FLKXIpIyVDpWIVJbFQorTRhlJu4SK0SWviDwu_P-ek8eXPJLvega1w4SN97bsV4gpqpSQYppyLF20KyaGLYLdjnPqc0gv35-cfZ164zXiLrpmToljA6wuihIxr962QDp3S3yleoH9s0tvgT8rxeQHl746p8-yMvy9-808kBXHRnfJqilKvJZl1M1M_rlI83X_h9uNdiVTJrjOsB7Bn3EFYzR457inCytAQhJEEk2dbZbl-RL4jtdX2VO0180XNDBr71o9-hd_YMmstqocinq0VZrsispwclC1fP96HyZM_oVskFIvtHMD85_vz6NGw7N4SK0WgdWqEKdAKWSaoFbjsVCHREYuyUqwJBA_5Tc4xVpLY-XjGKowBFKKZVGjOTiuljGLmlM0-BSGtVqlAHOrFJQmleSG2mngVOGI7BUwCy27pMtbTmvrtGmfXp9ThDVWY7VWa1KjPDApj2slVD7nEjqfHAQnaiqUC753EALzqTyfBj9RmY3JnlZpUJ3zWQMR7Ak8aAdrICgTCjIgAxMK1-gKcBHz5xi281HTi-lks_Z9Ib4T-s5tn_iT2HO13lZBQfwmj9fWOOEJ6tizEGJmdvx-1n-QvS8C71
linkProvider Unpaywall
linkToUnpaywall http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1Lj9MwEB4t3QNIiId4hcfiA0dSJW5sx8cK7WqFYEELRcspcvwQ1UZuRFuh8usZ51WiRWjhFiUeRx5PMt9oxt8AvJJSSZFoGWuT6jhLrY6lkzZOlE3L3GlhRDgo_P6Mny6ytxfs4gD6xoWj9H3gVkynqJmGZJByKnK8LSRLppbdgEMeckoTOFycfZx_7TvjZbJpSoZuCaMjjB56otG_TjZySrdrtUb9uLaxxZ-Q59UCyptbX6vdD1VVv3mnk7tw3p_xaYtSLqfbTTnVP69SPl5_4ffgTodVybw1rvtwYP0DWM89OR4owsnKEYSQBJFkV2e7e02-ILY3zZXyhoSi55YMfBdGv0PvHBg0V_VSk0-Xy6pak_lAD0qWvpnvQx3IntGtknNE9g9hcXL8-c1p3HVuiDWjySZ2QpfoBByT1AjcdioQ6IjMuhnXJYIG_KcqjFWkcSFesZqjAEUoZnSeMpuL2SOY-JW3T4BI53SuUQcmc1lGqSqlsbPAAicsx-ApAtlvXaE7WvPQXaMqhvR6WqAqi70qi0aVhWURzAbZuiX3uJbU0chC9qK5QLvnaQQve5Mp8GMNGRjl7Wq7LkToGsgYj-Bxa0B7WYFAmFERgRiZ1jAg0ICPn_jlt4YOHF_LZZgzG4zwH1bz9P_EnsGtvnIySZ_DZPN9a18gPNuUR90H-Qu-6C38
openUrl ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=An+evaluation+of+the+feasibility%2C+validity%2C+and+reliability+of+laparoscopic+skills+assessment+in+the+operating+room&rft.jtitle=Annals+of+surgery&rft.au=AGGARWAL%2C+Rajesh&rft.au=GRANTCHAROV%2C+Teodor&rft.au=MOORTHY%2C+Krishna&rft.au=MILLAND%2C+Thor&rft.date=2007-06-01&rft.pub=Lippincott&rft.issn=0003-4932&rft.volume=245&rft.issue=6&rft.spage=992&rft.epage=999&rft_id=info:doi/10.1097%2F01.sla.0000262780.17950.e5&rft.externalDBID=n%2Fa&rft.externalDocID=18797061
thumbnail_l http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=0003-4932&client=summon
thumbnail_m http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=0003-4932&client=summon
thumbnail_s http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=0003-4932&client=summon