Evaluating the Impact of Surgeon Self-Awareness by Comparing Self Versus Peer Ratings of Surgical Skill and Outcomes for Bariatric Surgery

Objective: To evaluate variation in self vs. peer-assessments of surgical skill using surgical videos and compare surgeon-specific outcomes with bariatric surgery. Summary background data: Prior studies have demonstrated that surgeons with lower peer-reviewed ratings of surgical skill had higher complication rates after bariatric surgery. Methods: This is a retrospective cohort study of 25 surgeons who voluntarily submitted a video of a typical laparoscopic sleeve gastrectomy (SG) between 2015-2016. Videos were self and peer-rated using a validated instrument based on a 5-point Likert scale (5="master surgeon" and 1="surgeon-in-training"). Risk adjusted 30-day complication rates were compared between surgeons who over-rated and under-rated their skill based on data from 24,186 SG cases as well as 12,888 gastric bypass (GBP) cases. Results: Individual overall self-rating of surgical skill varied between 2.5 to 5. Surgeons in the top quartile for self:peer ratings (n=6, ratio 1.58) had lower overall mean peer-scores (2.98 vs 3.79, p = 0.0150) than surgeons in the lowest quartile (n = 6, ratio 0.94). Complication rates between top and bottom quartiles were similar after SG, however leak rates were higher with GBP among surgeons who over-rated their skill with sleeve gastrectomy (0.65 vs 0.27, p = 0.0181). Surgeon experience was similar between comparison groups. Conclusions and relevance: Self-perceptions of surgical skill varied widely. Surgeons who over-rated their skill had higher leak rates for more complex procedures. Video assessments can help identify surgeons with poor self-awareness who may benefit from a surgical coaching program.