Kerwin Thomas, Wiet Gregory, Hittle Brad, Stredney Don, De Boeck Paul, Moberly Aaron, Andersen Steven Arild Wuyts
Office of Research, Ohio State University, Columbus, OH, USA.
Department of Otolaryngology, Ohio State University, Columbus, OH, USA.
Ann Otol Rhinol Laryngol. 2020 Apr;129(4):340-346. doi: 10.1177/0003489419889376. Epub 2019 Nov 15.
Competency-based surgical training involves progressive autonomy given to the trainee. This requires systematic and evidence-based assessment with well-defined standards of proficiency. The objective of this study is to develop standards for the cross-institutional mastoidectomy assessment tool to inform decisions regarding whether a resident demonstrates sufficient skill to perform a mastoidectomy with or without supervision.
A panel of fellowship-trained content experts in mastoidectomy was surveyed in relation to the 16 items of the assessment tool to determine the skills needed for supervised and unsupervised surgery. We examined the consensus score to investigate the degree of agreement among respondents for each survey item as well as additional analyses to determine whether the reported skill level required for each survey item was significantly different for the supervised versus unsupervised level.
Ten panelists representing different US training programs responded. There was considerable consensus on cut-off scores for each item and trainee level between panelists, with moderate (0.62) to very high (0.95) consensus scores depending on assessment item. Further analyses demonstrated that the difference between supervised and unsupervised skill levels was significantly meaningful for all items. Finally, minimum-passing scores for each item was established.
We defined performance standards for the cross-institutional mastoidectomy assessment tool using the Angoff method. These cut-off scores that can be used to determine when trainees can progress from performance under supervision to performance without supervision. This can be used to guide training in a competency-based training curriculum.
基于能力的外科培训涉及给予学员逐步增加的自主权。这需要进行系统的、基于证据的评估，并制定明确的熟练标准。本研究的目的是制定跨机构乳突切开术评估工具的标准，以便就住院医师在有或没有监督的情况下是否具备进行乳突切开术的足够技能做出决策。
对一组接受过乳突切开术专项培训的内容专家就评估工具的16项内容进行了调查，以确定监督手术和非监督手术所需的技能。我们检查了共识分数，以调查受访者对每个调查项目的一致程度，以及进行额外分析以确定每个调查项目报告的技能水平在监督与非监督水平之间是否存在显著差异。
代表美国不同培训项目的10名专家组成员做出了回应。专家组成员之间对于每个项目的截止分数和学员水平达成了相当程度的共识，根据评估项目的不同，共识分数从中等（0.62）到非常高（0.95）不等。进一步分析表明，所有项目的监督和非监督技能水平之间的差异都具有显著意义。最后，确定了每个项目的最低及格分数。
我们使用安戈夫方法定义了跨机构乳突切开术评估工具的表现标准。这些截止分数可用于确定学员何时能够从在监督下的表现过渡到无监督下的表现。这可用于指导基于能力的培训课程中的培训。
