Outlier experienced surgeon’s performances impact on benchmark for technical surgical skills training
Prospective, randomised and blinded clinical trials in surgery and interventional cardiology demonstrate that proficiency based progression (PBP) training produces a superior intra-operative skill-set.1-5 The PBP approach to training relies on a robust, quantitative assessment of experienced operator performance to establish a benchmark. Atypical expert performances can lower the benchmark level that trainees must demonstrate in simulation before progressing to in vivo performance.
This study published in the ANZ Journal of Surgery (https://doi.org/10.1111/ans.14474) quantitatively addressed the issue of benchmarking based on the consistent performances of experienced surgeons. It indicates an approach to dealing with the performances of experienced surgeons that differ significantly from their peers. The methodology described in two studies quality assures proficiency benchmarks, which trainees must demonstrate in simulation, before progressing to in vivo performance, by ensuring that the competency benchmarks set are based on experienced surgeons who perform unvaryingly to this level of competency.
The statistical approach used in both studies demonstrates an objective, transparent and fair approach data falling > 1.96 standard deviations from the mean differs statistically significantly and as in this case should be excluded from quantitative benchmark definitions. The studies showed that objectively assessed atypical expert performances were few and Z‐score standardization identified them and produced a more robust quantitative definition of proficiency.
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