Vaporciyan Ara A, Fikfak Vid, Lineberry Matthew C, Park Yoon Soo, Tekian Ara
Department of Thoracic and Cardiovascular Surgery, Division of Surgery, MD Anderson Cancer Center, University of Texas, Houston, Texas.
Department of General Surgery, Houston Methodist Hospital, Houston, Texas.
Ann Thorac Surg. 2017 Dec;104(6):2087-2092. doi: 10.1016/j.athoracsur.2017.07.029. Epub 2017 Nov 1.
Surgical skill assessment tools frequently reflect the opinions of small groups of surgeons. That raises concerns over their generalizability as well as their utilization when applied broadly. A Delphi approach could engage a broad group of experts to identify key elements for a checklist assessing coronary anastomotic skill, improving generalizability.
Expert surgeons in North America (10 or more years in practice, actively teaching coronary artery surgery) were contacted randomly to participate. Consenting surgeons first provided items they believed were mandatory when performing a coronary artery bypass. These were then entered into a three-round Delphi. Positive consensus was reached when 75% or more of participants ranked an item mandatory.
Sixteen faculty consented to participate. Each participant provided 25 ± 10 items. The 407 items provided were condensed, resulting in 146 items in the final list, divided into six sections based on the conduct of the operation. Twenty-three items reached consensus in the first round, 14 in the second, and 3 in the third. These 40 items represented only 27% of the initial 146 items. Agreement within sections varied widely, from 0% for "management of assistants" to 47% for "testing and final steps."
A randomly selected group of experts using a Delphi approach can generate a checklist to assess construction of a coronary artery bypass. Considerable disagreement among experts regarding what steps are mandatory calls into question the generalizability of any locally developed checklist.
手术技能评估工具常常反映的是一小部分外科医生的意见。这引发了人们对其普遍适用性以及广泛应用时的实用性的担忧。德尔菲法可以让广大专家群体参与进来，以确定评估冠状动脉吻合技能的检查表的关键要素，从而提高普遍适用性。
随机联系了北美地区的专家外科医生（从业10年或更长时间，积极教授冠状动脉手术）参与。同意参与的外科医生首先提供他们认为在进行冠状动脉搭桥手术时必不可少的项目。然后将这些项目纳入三轮德尔菲法。当75%或更多的参与者将某一项目列为必选时，就达成了积极共识。
16名教员同意参与。每位参与者提供了25±10个项目。所提供的407个项目经过浓缩，最终清单中有146个项目，根据手术操作流程分为六个部分。第一轮有23个项目达成共识，第二轮有14个，第三轮有3个。这40个项目仅占最初146个项目的27%。各部分的一致性差异很大，从“助手管理”的0%到“测试和最后步骤”的47%。
采用德尔菲法随机挑选的一组专家可以生成一份评估冠状动脉搭桥手术构建的检查表。专家们对于哪些步骤是必不可少的存在相当大的分歧，这让人质疑任何本地制定的检查表的普遍适用性。
