Universal framework of intraoperative performance five-domain model,14 our SP adjunct and VP-specific operationalization with corresponding expert-defined performance indicators
| Intraoperative performance domain | VP-specific framework operationalization | Related expert-based observational rating |
| Psychomotor skills (PMS) Visuospatial skills, depth perception, dexterity, bimanual coordination, hand-to-eye coordination | PMS score Path length soft tissue Path length vertebra Needle positioning attempts Accuracy with respect to plan Pedicle entry Vertebra target | OSATS GRS Time and motion Instrument handling |
| Declarative knowledge (DK) Knowledge of anatomy, physiology, and pathology Knowledge of surgical techniques, procedural steps, and instruments Knowledge of scientific literature | DK score (preoperative planning) Pedicle entry Expert-defined entry area agreement Expert-defined optimal entry point Vertebra target Expert-defined optimal target point Safety margins Distance from pedicle wall Danger zones Pedicle perforation Vertebra perforation Injury of critical structures | OSATS GRS Knowledge of instruments Knowledge of specific procedure |
| Interpersonal skills (IPS) Teamwork, communication, and cooperation Leadership and management | Not operationalized | OTAS Communication Cooperation/backup behavior Leadership Coordination |
| Personal resourcefulness (PR) Self-awareness and metacognition Managing modulators of attention, stress, and goals | PR score Time Total X-ray amount | OTAS Monitoring/situational awareness |
| Advanced cognitive skills (ACS) Surgical planning and error prevention Error recognition, rescue, and recovery | ACS score Intraoperative planning and error prevention X-ray visualization Pedicle entry Expert-defined entry area agreement Expert-defined optimal entry point Vertebra target Expert-defined optimal target point Error recognition, rescue, and recovery Safety margins Distance from pedicle wall Danger zones Pedicle perforation Vertebra perforation | OSATS GRS Respect for tissue Flow of operation OSATS CL Locate entry points Team time-out Skin incisions Guide needle to pedicles Insert needle through pedicles Locate final positions in vertebrae Cement injections Needle removal Skin sutures Final C-arm image control |
| Surgical product (SP) General aims Understanding, removing, or fixing pathology Restoring physiology and function Restoring or altering anatomy | SP score Cement amount Cement leakage Injury of critical structures | OSATS PF PF rating |
Table expanded on Madani et al (p258).14
CL, checklist; GRS, Global Rating Scale; OSATS, Objective Structured Assessment of Technical Skill; OTAS, Observational Teamwork Assessment for Surgery; PF, pass/fail; VP, vertebroplasty.