Is competency assessment at the specialist level achievable? A study for the national training programme in laparoscopic colorectal surgery in England.

Abstract:

OBJECTIVES:To develop, validate, and implement a competency assessment tool (CAT) for technical surgical performance in the context of a summative assessment process for the National Training Programme in Laparoscopic Colorectal Surgery (NTP). BACKGROUND:The NTP is an educational initiative by the National Cancer Action Team in England to safely increase the uptake of laparoscopic colorectal surgery. It is the first competency-based national educational initiative for specialist surgeons (consultants), and performance assessment is an integral part of the program. METHODS:Content validity was sought using expert opinion by semistructured interviews and the Delphi method. For validity and reliability studies, NTP apprentices and experts were asked to submit video-recorded cases. Construct validity was established between delegates who passed the assessment and those who failed. Concurrent validity was tested by comparing scores with error counts as identified by observational clinical human reliability analysis. A fully crossed design, using generalizability theory methods and D-studies, was used for reliability. FINDINGS:Interviews and the Delphi method revealed a list of characteristics for assessment. A hybrid structure combining task-specific and generic items was used to include important characteristics into the assessment format. Fifty-four cases were submitted. Overall reliability reached G(ACI) = 0.803 when using 2 cases and 2 assessors. Experts scored significantly better than apprentices (3.19 vs 2.60; P = 0.004), and apprentices who passed had better scores than those who failed (2.95 vs 2.28; P < 0.001). There was an inverse correlation between CAT scores and observational clinical human reliability analysis error counts (ρ = -0.520, P < 0.001). The combination of both methods reached overall sensitivity of 100%, specificity of 83.3%, a positive predictive value of 93.8%, and a negative predictive value of 100%. CONCLUSIONS:The CAT can reliably assess technical performance in laparoscopic colorectal surgery. The use of CATs to judge specialist technical performance before embarking on independent practice of new procedures is achievable on a national scale and can be adapted by other specialties.

journal_name

Ann Surg

journal_title

Annals of surgery

authors

Miskovic D,Ni M,Wyles SM,Kennedy RH,Francis NK,Parvaiz A,Cunningham C,Rockall TA,Gudgeon AM,Coleman MG,Hanna GB,National Training Programme in Laparoscopic Colorectal Surgery in England.

doi

10.1097/SLA.0b013e318275b72a

subject

Has Abstract

pub_date

2013-03-01 00:00:00

pages

476-82

issue

3

eissn

0003-4932

issn

1528-1140

pii

00000658-201303000-00016

journal_volume

257

pub_type

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