Proficiency gain and competency assessment in laparoscopic colorectal surgery
Author(s)
Miskovic, Danilo
Type
Thesis
Abstract
Aims and objectives:
The aim of this thesis was to investigate the proficiency gain curve and competency in
laparoscopic colorectal surgery (LCS) for specialist colorectal surgeons. The objectives were
(1) to analyse the shortfalls of proficiency gain curve analysis in LCS, (2) to develop methods
to describe proficiency gain and competency in LCS and (3) to analyse proficiency gain and
competency within the National Training Programme (NTP).
Methods:
Objective 1: Two systematic reviews and a meta-analysis of current evidence were performed.
Objective 2: Semi-structured interviews and a Delphi method were applied to develop
proficiency and competency assessment tools and clinical cases were used for validation. A
novel observational clinical human reliability analysis (OCHRA) of clinical cases was
developed and evaluated. Objective 3: clinical and educational data from the National Training
Programme were used for the analysis of proficiency gain and competency using advanced
statistical methods.
Results:
Using clinical data alone is insufficient for the description of proficiency gain and competency.
A generic assessment scale (GAS form) and a competency assessment tool (CAT) were
developed and validated. A combination of CAT and OCHRA has been shown to be highly
sensitive and specific to determine competency. Analysis of clinical and educational data
revealed a shortening of the proficiency gain curve using the approach of the NTP without the
risk of increased rates adverse outcomes. Conclusion:
Tools for proficiency gain and competency assessment of specialist surgeons have been shown
to be valid and feasible and are fully implemented in the NTP. Data suggest that a novel
technique can be introduced to specialists on a National level using a structured educational
approach with safe clinical outcomes.
The aim of this thesis was to investigate the proficiency gain curve and competency in
laparoscopic colorectal surgery (LCS) for specialist colorectal surgeons. The objectives were
(1) to analyse the shortfalls of proficiency gain curve analysis in LCS, (2) to develop methods
to describe proficiency gain and competency in LCS and (3) to analyse proficiency gain and
competency within the National Training Programme (NTP).
Methods:
Objective 1: Two systematic reviews and a meta-analysis of current evidence were performed.
Objective 2: Semi-structured interviews and a Delphi method were applied to develop
proficiency and competency assessment tools and clinical cases were used for validation. A
novel observational clinical human reliability analysis (OCHRA) of clinical cases was
developed and evaluated. Objective 3: clinical and educational data from the National Training
Programme were used for the analysis of proficiency gain and competency using advanced
statistical methods.
Results:
Using clinical data alone is insufficient for the description of proficiency gain and competency.
A generic assessment scale (GAS form) and a competency assessment tool (CAT) were
developed and validated. A combination of CAT and OCHRA has been shown to be highly
sensitive and specific to determine competency. Analysis of clinical and educational data
revealed a shortening of the proficiency gain curve using the approach of the NTP without the
risk of increased rates adverse outcomes. Conclusion:
Tools for proficiency gain and competency assessment of specialist surgeons have been shown
to be valid and feasible and are fully implemented in the NTP. Data suggest that a novel
technique can be introduced to specialists on a National level using a structured educational
approach with safe clinical outcomes.
Date Issued
2012
Date Awarded
2012-08
Copyright Statement
Attribution NoDerivatives 4.0 International Licence (CC BY-ND)
Advisor
Hanna, George
Darzi, Ara
Publisher Department
Surgery and Cancer
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)