Surgical expertise and its application to gastric and oesophageal cancer surgery
File(s)
Author(s)
Harris, Alexander
Type
Thesis
Abstract
Aim
To investigate surgical expertise and examine its application to gastric and oesophageal cancer surgery.
Rationale
Popular and scientific publications have used expertise to address the wider themes of service provision and professional development. However, the nature and characteristics of surgical expertise remain subject to debate, and there is currently no clear framework for combining elements of surgical expertise with surgical practice (e.g. training/ assessment).
Method
A mixed methods approach was applied in the collection, analysis, and interpretation of quantitative and qualitative data in order to capture and analyse the subtleties and complexities of surgical expertise. Key stakeholders in the UK and abroad were involved throughout, with research techniques including: literature review; questionnaires; semi-structured interviews; direct structured observations; and a Delphi consensus process.
Results and Discussion
Results demonstrated that: (a) there is no consensus definition for surgical expertise; (b) directly relevant, high impact, original research to guide the design and application of interventions is lacking; (c) stakeholders place operative skill at the heart of surgical expertise; (d) although simulation holds potential for exploring surgical expertise, current modalities are inadequate for supporting its nuances; (e) surgical expertise comprises a complex interplay of individual and organisation-specific factors; (f) consensus agreement on procedure-specific performance standards was reached amongst experts in gastric and oesophageal cancer surgery; (g) consultant-level surgical assessment tools have been developed with potential for use in (inter)national randomised controlled trials.
Conclusion
This PhD thesis systematically identifies and maps the fundamental concepts of surgical expertise, developing methods for its investigation, and incorporating findings into practical interventions within the chosen domain of gastric and oesophageal cancer surgery, where expertise is critical (as surgery is only performed at tertiary centres).
Original contributions to the field include: an evidence-based framework for defining surgical expertise; exploratory research into surgical simulation performed at the specialist level; and the development of evidence-based consultant-level surgical assessment tools specific to the technical performance and oncological quality of gastrectomy and oesophagectomy.
To investigate surgical expertise and examine its application to gastric and oesophageal cancer surgery.
Rationale
Popular and scientific publications have used expertise to address the wider themes of service provision and professional development. However, the nature and characteristics of surgical expertise remain subject to debate, and there is currently no clear framework for combining elements of surgical expertise with surgical practice (e.g. training/ assessment).
Method
A mixed methods approach was applied in the collection, analysis, and interpretation of quantitative and qualitative data in order to capture and analyse the subtleties and complexities of surgical expertise. Key stakeholders in the UK and abroad were involved throughout, with research techniques including: literature review; questionnaires; semi-structured interviews; direct structured observations; and a Delphi consensus process.
Results and Discussion
Results demonstrated that: (a) there is no consensus definition for surgical expertise; (b) directly relevant, high impact, original research to guide the design and application of interventions is lacking; (c) stakeholders place operative skill at the heart of surgical expertise; (d) although simulation holds potential for exploring surgical expertise, current modalities are inadequate for supporting its nuances; (e) surgical expertise comprises a complex interplay of individual and organisation-specific factors; (f) consensus agreement on procedure-specific performance standards was reached amongst experts in gastric and oesophageal cancer surgery; (g) consultant-level surgical assessment tools have been developed with potential for use in (inter)national randomised controlled trials.
Conclusion
This PhD thesis systematically identifies and maps the fundamental concepts of surgical expertise, developing methods for its investigation, and incorporating findings into practical interventions within the chosen domain of gastric and oesophageal cancer surgery, where expertise is critical (as surgery is only performed at tertiary centres).
Original contributions to the field include: an evidence-based framework for defining surgical expertise; exploratory research into surgical simulation performed at the specialist level; and the development of evidence-based consultant-level surgical assessment tools specific to the technical performance and oncological quality of gastrectomy and oesophagectomy.
Version
Open Access
Date Issued
2017-01
Date Awarded
2017-09
Copyright Statement
Attribution NoDerivatives 4.0 International Licence (CC BY-ND)
Advisor
Kneebone, Roger
Bello, Fernando
Hanna, George
Publisher Department
Department of Surgery & Cancer
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)