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Is Competency Assessment at the Specialist Level Achievable? A Study for the National Training Programme in Laparoscopic Colorectal Surgery in England

Miskovic, Danilo MD, PhD, FRCS*; Ni, Melody PhD*; Wyles, Susannah M. MBBS, MSc, MRCS(Eng)*; Kennedy, Robin H. MD, FRCS; Francis, Nader K. PhD, FRCS; Parvaiz, Amjad FRCS, FRCS(Gen)§; Cunningham, Chris MD, FRCS; Rockall, Timothy A. MD, FRCS; Gudgeon, Andrew M. MBBS, FRCS**; Coleman, Mark G. MD, FRCS††; Hanna, George B. PhD, FRCS*

doi: 10.1097/SLA.0b013e318275b72a
Original Articles

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.

This article describes the design, validation, and implementation of a novel tool to objectively assess the quality of the technical performance of specialist laparoscopic colorectal surgeons.

*Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London

St Mark's Hospital, Harrow

Department of Surgery, Yeovil District Hospital Foundation Trust Higher Kensington, Yeovil

§Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth Hospitals NHS, Portsmouth

Department of Colorectal Surgery, Oxford Radcliffe Hospitals, Oxford

Minimal Access Therapy Training Unit (MATTU), Post-Graduate Medical School, University of Surrey, Guildford

**Department of Surgery, Frimley Park Hospital NHS Trust, Frimley

††National Coordination Office, Derriford Hospital, Plymouth, United Kingdom.

Reprints: George B. Hanna, PhD, FRCS, Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, 10th Floor, QEQM, Praed St, London W2 1NY, United Kingdom. E-mail: g.hanna@imperial.ac.uk.

Disclosure: This study was supported by the National Cancer Action Team, Department of Health, England. There are no competing interests on behalf of the authors. Full ethical approval was obtained for the use of de-identified patient video material and patients consented accordingly to the operating surgeon (NREC 04/Q0403/54).

© 2013 Lippincott Williams & Wilkins, Inc.