Evaluating the role of expertise-based trial designs in trials of surgical interventions

随机对照试验（RCT）在推进医疗保健方面发挥了非常重要的作用，通过与标准治疗进行比较，可以准确评估新治疗。外科领域使用随机对照试验的速度比一般医学要慢。关于如何开展这类研究，存在不同的选择。传统参与的外科医生预计将进行评估下的两种治疗。另一种方法是要求参与手术的外科医生进行他们最熟悉的干预。这被称为基于专业知识的方法。从外科医生的角度来看，这是有吸引力的，尽管这种方法确实提出了一些科学（这种研究可能需要更大）和实际挑战（组织相应的专业外科医生）。本研究的目的是评估不同方法的相对优点，具体而言，在何种情况下，从实践和科学的角度来看，基于专业知识的方法更可取。

Randomised Controlled Trials (RCTs) have played a very important role in advancing health care by allowing accurate assessment of a new treatment by comparison with a standard treatment. The field of surgery has been slower to use RCTs than medicine in general. Different options for how to run such studies exist. Conventionally participating surgeons have been expected to perform both treatments under assessment. An alternative approach is to require a participating surgeon to perform the intervention they are most comfortable with. This has been called an expertise-based approach. This is attractive from a surgeon‘s perspective though such an approach does raise some scientific (such a study may need to be larger) and practical challenges (organising corresponding expertise surgeons to be available). The aim of this research is to evaluate the relative merit of the different approaches and specifically, in which circumstances is an expertise-based approach preferable from both a practical and scientific perspective.