The Congenital Heart Technical Skill Study: Rationale and Design
The Congenital Heart Technical Skill Study: Rationale and Design
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DOI：
10.1177/2150135118822689
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发表时间：
2019-03-01
影响因子：
0.9
通讯作者：
Pincus, Harold
中科院分区：
文献类型：
--
作者：
Anderson, Brett R.;Kumar, S. Ram;Pincus, Harold
背景：我们报道了使用直接视频观察法对参加先天性心脏病外科医生技能的同行评估方案的原理和设计。方法：所有向胸外科学会先天性心脏手术数据库(STS-CHSD)贡献数据的外科医生都被邀请提交自己手术的视频，或对同行进行评分，或两者兼而有之。外科医生可以提交诺伍德手术、完整的房室管修复和/或动脉转换术。符合HIPPA的网站允许安全传输/评估。视频使用修改后的客观结构化技术技能评分进行匿名评分。评级与STS-CHSD和外科医生问卷的五年同期结果数据有关。主要结果是主要发病率/死亡率的综合结果。结果：113个中心的276名外科医生有资格参加：53个中心(45%)的83名外科医生(30%)已同意参加，招募工作仍在进行中。这些外科医生在多年的经验和结果上差异很大。无论是在职业生涯的早期还是后期，参与者都认为这一过程非常有益，耗时也比预期的要少。最初的10个视频子集显示出极好的评委间可靠性(类间相关性=0.85)。结论：本研究建议通过视频观察和同行评议来评估儿科心胸外科医生的技术技能。值得注意的是，来自美国近一半中心的超过四分之一的先天性心脏病外科医生，根据各种经验，已经同意参加。这项研究还为同伴反馈创造了一种机制；我们假设反馈可以产生广泛而有意义的质量改进。
Background: We report the rationale and design for a peer-evaluation protocol of attending congenital heart surgeon technical skill using direct video observation. Methods: All surgeons contributing data to The Society of Thoracic SurgeonsCongenital Heart Surgery Database (STS-CHSD) are invited to submit videos of themselves operating, to rate peers, or both. Surgeons may submit Norwood procedures, complete atrioventricular canal repairs, and/or arterial switch operations. A HIPPA-compliant website allows secure transmission/evaluation. Videos are anonymously rated using a modified Objective Structured Assessment of Technical Skills score. Ratings are linked to five years of contemporaneous outcome data from the STS-CHSD and surgeon questionnaires. The primary outcome is a composite for major morbidity/mortality. Results: Two hundred seventy-six surgeons from 113 centers are eligible for participation: 83 (30%) surgeons from 53 (45%) centers have agreed to participate, with recruitment ongoing. These surgeons vary considerably in years of experience and outcomes. Participants, both early and late in their careers, describe the process as very rewarding and less time consuming than anticipated. An initial subset of 10 videos demonstrated excellent interrater reliability (interclass correlation = 0.85). Conclusions: This study proposes to evaluate the technical skills of attending pediatric cardiothoracic surgeons by video observation and peer-review. It is notable that over a quarter of congenital heart surgeons, across a range of experiences, from almost half of United States centers have already agreed to participate. This study also creates a mechanism for peer feedback; we hypothesize that feedback could yield broad and meaningful quality improvement.