Division of Vascular Surgery, Department of Surgery, University of Utah, School of Medicine, Salt Lake City, UT.
Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
J Vasc Surg. 2022 Nov;76(5):1388-1397. doi: 10.1016/j.jvs.2022.06.091. Epub 2022 Jul 4.
The quality and effectiveness of vascular surgery education should be evaluated based on patient care outcomes. To investigate predictive associations between trainee performance and subsequent patient outcomes, a critical first step is to determine the conceptual alignment of educational competencies with clinical outcomes in practice. We sought to generate expert consensus on the conceptual alignment of the Accreditation Council for Graduate Medical Education (ACGME) Vascular Surgery subcompetencies with patient care outcomes across different Vascular Quality Initiative (VQI) registries.
A national panel of vascular surgeons with expertise in both clinical care and education were recruited to participate in a modified Delphi expert consensus building process to map ACGME Vascular Surgery subcompetencies (educational markers of resident performance) to VQI clinical modules (patient outcomes). A master list of items for rating was created, including the 31 ACGME Vascular Surgery subcompetencies and 8 VQI clinical registries (endovascular abdominal aortic aneurysm repair, open abdominal aortic aneurysm, thoracic endovascular aortic repair, carotid endarterectomy, carotid artery stent, infrainguinal, suprainguinal, and peripheral vascular intervention). These items were entered into an iterative Delphi process. Positive consensus was reached when 75% or more of the participants ranked an item as mandatory. Intraclass correlations (ICCs) were used to evaluate consistency between experts for each Delphi round.
A total of 13 experts who contributed to the development of the Vascular Surgery Milestones participated; 12 experts (92%) participated in both rounds of the Delphi process. Two rounds of Delphi were conducted, as suggested by excellent expert agreement (round 1, ICC = 0.79 [95% confidence interval, 0.74-0.84]; round 2, ICC = 0.97 [95% confidence interval, 0.960-.98]). Using the predetermined consensus cutoff threshold, the Delphi process reduced the number of subcompetencies mapped to patient care outcomes from 31 to a range of 9 to 15 across the 8 VQI clinical registries. Practice-based learning and improvement, and professionalism subcompetencies were identified as less relevant to patient outcome variables captured by the VQI registries after the final round, and the only the systems-based practice subcompetency that was identified as relevant was radiation safety in two of the endovascular registries.
A national panel of vascular surgeon experts reported a high degree of agreement on the relevance of ACGME subcompetencies to patient care outcomes as captured in the VQI clinical registry. Systems-based practice, practice-based learning and improvement, and professionalism competencies were identified as less relevant to patient outcomes after specific surgical procedures.
血管外科学教育的质量和效果应基于患者护理结果进行评估。为了研究学员表现与后续患者结果之间的预测关联，关键的第一步是确定教育能力与实践中临床结果的概念一致性。我们试图就研究生医学教育认证委员会（ACGME）血管外科学子能力与不同血管质量倡议（VQI）登记册中患者护理结果的概念一致性达成专家共识。
我们招募了具有临床护理和教育专业知识的全国性血管外科专家小组，以参与修改后的 Delphi 专家共识制定过程，将 ACGME 血管外科学子能力（学员表现的教育标志）映射到 VQI 临床模块（患者结果）。创建了一份评级项目的主列表，其中包括 31 项 ACGME 血管外科学子能力和 8 项 VQI 临床登记册（血管内腹主动脉瘤修复、开放腹主动脉瘤、胸主动脉腔内修复、颈动脉内膜切除术、颈动脉支架、下肢、上肢和外周血管介入）。这些项目被输入到迭代 Delphi 过程中。当 75%或更多的参与者将一项列为强制性时，即达成积极共识。使用组内相关系数（ICC）评估每位 Delphi 回合专家之间的一致性。
共有 13 位为血管外科学里程碑的制定做出贡献的专家参与其中；12 位专家（92%）参与了 Delphi 流程的两轮。正如优秀专家意见所建议的那样，进行了两轮 Delphi（第 1 轮，ICC=0.79[95%置信区间，0.74-0.84]；第 2 轮，ICC=0.97[95%置信区间，0.960-0.98]）。使用预定的共识截止阈值，将子能力映射到患者护理结果的数量从 31 项减少到 8 项 VQI 临床登记册的 9 至 15 项。在最后一轮之后，实践基础学习和改进以及专业精神子能力被确定为与 VQI 登记册中捕获的患者结果变量相关性较低，而仅在两个血管内登记册中与辐射安全相关的系统基础实践子能力被确定为相关。
血管外科专家小组的全国性专家报告称，ACGME 子能力与 VQI 临床登记册中患者护理结果的相关性具有高度共识。在特定手术程序后，系统基础实践、实践基础学习和改进以及专业精神能力被确定为与患者结果相关性较低。
