The Feasibility of Real-Time Intraoperative Performance Assessment With SIMPL (System for Improving and Measuring Procedural Learning): Early Experience From a Multi-institutional Trial

Jordan D. Bohnen, Brian C. George, Reed G. Williams, Mary C. Schuller, Debra A. DaRosa, Laura Torbeck, John T. Mullen, Shari L. Meyerson, Edward D. Auyang, Jeffrey G. Chipman, Jennifer N. Choi, Michael A. Choti, Eric D. Endean, Eugene F. Foley, Samuel P. Mandell, Andreas H. Meier, Douglas S. Smink, Kyla P. Terhune, Paul E. Wise, Nathaniel J. SoperJoseph B. Zwischenberger, Keith D. Lillemoe, Gary L. Dunnington, Jonathan P. Fryer

Research output: Contribution to journalReview articlepeer-review

147 Scopus citations


Purpose Intraoperative performance assessment of residents is of growing interest to trainees, faculty, and accreditors. Current approaches to collect such assessments are limited by low participation rates and long delays between procedure and evaluation. We deployed an innovative, smartphone-based tool, SIMPL (System for Improving and Measuring Procedural Learning), to make real-time intraoperative performance assessment feasible for every case in which surgical trainees participate, and hypothesized that SIMPL could be feasibly integrated into surgical training programs. Methods Between September 1, 2015 and February 29, 2016, 15 U.S. general surgery residency programs were enrolled in an institutional review board-approved trial. SIMPL was made available after 70% of faculty and residents completed a 1-hour training session. Descriptive and univariate statistics analyzed multiple dimensions of feasibility, including training rates, volume of assessments, response rates/times, and dictation rates. The 20 most active residents and attendings were evaluated in greater detail. Results A total of 90% of eligible users (1267/1412) completed training. Further, 13/15 programs began using SIMPL. Totally, 6024 assessments were completed by 254 categorical general surgery residents (n = 3555 assessments) and 259 attendings (n = 2469 assessments), and 3762 unique operations were assessed. There was significant heterogeneity in participation within and between programs. Mean percentage (range) of users who completed ≥1, 5, and 20 assessments were 62% (21%-96%), 34% (5%-75%), and 10% (0%-32%) across all programs, and 96%, 75%, and 32% in the most active program. Overall, response rate was 70%, dictation rate was 24%, and mean response time was 12 hours. Assessments increased from 357 (September 2015) to 1146 (February 2016). The 20 most active residents each received mean 46 assessments by 10 attendings for 20 different procedures. Conclusions SIMPL can be feasibly integrated into surgical training programs to enhance the frequency and timeliness of intraoperative performance assessment. We believe SIMPL could help facilitate a national competency-based surgical training system, although local and systemic challenges still need to be addressed.

Original languageEnglish
Pages (from-to)e118-e130
JournalJournal of Surgical Education
Issue number6
StatePublished - Nov 1 2016

Bibliographical note

Publisher Copyright:
© 2016


  • Interpersonal and Communication Skills
  • Medical Knowledge
  • Patient Care
  • Practice-Based Learning and Improvement
  • Professionalism
  • autonomy and Zwisch scale
  • intraoperative feedback
  • mobile technology
  • operative performance assessment
  • smartphone

ASJC Scopus subject areas

  • Surgery
  • Education


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