Value of the Crowd-Sourced Assessment of Technical Skills (C-SATS) Platform in Surgical Procedures: A Systematic Review of Evidence

Background: Crowd-Sourced Assessment of Technical Skills (C-SATS) is a surgical data management and learning platform that leverages the knowledge of large expert surgeon and lay groups to assess the technique and technical skills of surgeons in a highly efficient manner. The aim of this systematic review was to summarize published literature on the performance of C-SATS as compared to expert evaluations and assess its use as a training and validation tool in minimally invasive surgery (MIS). Methods: A comprehensive literature search was performed per PRISMA guidelines using the Medline, Embase, and Google Scholar databases on published studies that evaluated the use of C-SATS following MIS, such as laparoscopic or robotic-assisted surgery. Results: A total of 21 reports were included in the review. Twelve studies comparing crowd-sourcing evaluations against expert opinion indicated overall excellent or good correlation with Global Operative Assessment of Laparoscopic Skills (GOALS), Global Evaluative Assessment of Robotic Skills (GEARS), and Robotic Objective Structured Assessment of Technical Skills (R-OSATS) scores, with correlation coefficients (Pearson or Spearman) ranging from 0.69 to 0.95 and reliability index (Cronbach’s alpha) from 0.63 to 0.93 across different specialties and surgical approaches. When using C-SATS to assess performance and validation, assessments positively correlated with traditional methods of time and error-based scoring and global rating scale. Conclusions: Based on the current published literature, the C-SATS platform has been shown to efficiently provide crowd-sourced evaluations that correlate favorably with expert evaluation across a range of surgical specialties and approaches. Use of crowdsourcing has uniformly yielded accurate evaluations of surgeons’ technical skills in a markedly shorter time than expert reviews. C-SATS may be a cost-effective complement or alternative to traditional models of evaluating surgical proficiency. Future studies are needed to determine whether the use of C-SATS will lead to improved surgical performance and patient outcomes.