Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA.
J Pediatr Orthop. 2021;41(5):322-326. doi: 10.1097/BPO.0000000000001795.
The average age of practicing surgeons is increasing, consistent with the overall population; one third of Americans are over 55 years of age. Aging is clearly associated with varying loss of skills, yet there are no age-based state or federal requirements for professional skill assessment; or age-specific criteria for board certification, recertification, or retirement. Capability based policies are preferred to age based criteria (3) but very few organizations have such policies in place.
A Delphi method study was utilized to answer: When should a surgeon's performance be assessed? If mandatory, then at what age? If adverse events triggered, then what events? What should be assessed? By whom? And, who determines the result-based actions? A systematic literature review indicated institutional stakeholders. On the basis of this a 20-member expert panel was created drawing from 13 US pediatric institutions: orthopaedic surgical department-division chiefs (14), children's hospital general counsel (3), surgical chief responsible for hospital bylaws-medical peer review (1), OR nursing managers (2). Three rounds of iterative questionnaires were utilized.
A 100% response rate was achieved. Consensus supported recommendations included: Mandatory assessments should start at the age of 65 years, after a medical disability, and or at the request of other health care professionals. Assessments should include criteria for behavioral health, mental capacity, physical health, surgical performance, 360 human resource reviews, and surgical adverse events. Assessments should be performed by an external group with validated tools and reviewed by the department and overall surgeon-in-chief. The final decisions for an action plan based on results should be made by departmental and overall surgeon-in-chief.
Our expert panel Delphi method study recognized aging is a risk factor in performance and recommended surgeon assessments should be automatically triggered by the age of 65 years, negative health events, or serious performance concerns. Assessments should be multifaceted, fair, reliable with minimal bias, and performed by an external professional group. Decisions should be managed by departmental and surgical chiefs.
Level V.
与整体人口趋势一致，执业外科医生的平均年龄也在增长，有三分之一的美国人年龄超过 55 岁。随着年龄的增长，技能确实会逐渐下降，但目前并没有针对专业技能评估的州级或联邦级年龄要求；也没有专门针对认证、再认证或退休的年龄标准。与基于年龄的标准相比，基于能力的政策更受青睐（3），但很少有组织制定此类政策。
本研究采用德尔菲法来回答以下问题：何时应评估外科医生的表现？如果是强制性的，那么在什么年龄？如果是触发了负面事件，那么是什么事件？应评估哪些内容？由谁评估？以及，谁来决定基于评估结果的行动？系统文献回顾确定了机构利益相关者。在此基础上，我们从 13 家美国儿科机构中选出了 20 名专家组成了一个小组：骨科外科部门负责人（14 人）、儿童医院总法律顾问（3 人）、负责医院章程-医疗同行评审的外科首席（1 人）、手术室护理经理（2 人）。我们使用了三轮迭代问卷。
我们实现了 100%的回复率。达成共识的建议包括：强制性评估应从 65 岁开始，当出现医疗残疾或其他医疗保健专业人员提出要求时。评估应包括行为健康、精神能力、身体健康、手术表现、360 人力资源审查和手术不良事件等方面的标准。评估应由具有经过验证工具的外部小组进行，并由部门和外科主任进行审查。基于结果的行动计划的最终决策应由部门和外科主任共同做出。
我们的专家小组德尔菲法研究认识到年龄是表现的一个风险因素，并建议自动触发外科医生的评估，年龄应在 65 岁、出现负面健康事件或出现严重的表现问题时触发。评估应该是多方面的、公平的、可靠的、最小偏见的，并且应由外部专业小组进行。决策应由部门和外科主任管理。
5 级。
