title: Safety of training and assessment in operating theatres--a systematic review and meta-analysis.
abstract: OBJECTIVE
  Procedural outcomes can be used to assess the performance of specialists and trainees. This article establishes a systematic evidence base for the safety of training in the operating theatre. It also explores the possibility of using early, intermediate and late procedural outcomes of cardiac surgical operations to evaluate the performance of the clinicians and the healthcare system.
  
  
  METHODS
  Medline, EMBASE and PsycINFO databases were searched. Comparative studies evaluating quality indicators of cardiac surgical procedures (coronary artery bypass grafting (CABG) and valve surgery) were included. guidelines from the preferred reporting items for systematic reviews and meta-analyses (PRISMA) were used.
  
  
  RESULTS
  Fourteen studies met the inclusion criteria. For CABG, meta-analysis of outcomes did not show any significant differences between the technical and non-technical skills of trainees versus specialists apart from bypass time (less for specialists) and intensive care unit (ICU) length of stay (less for trainees). Studies reporting outcomes on valve surgery also did not report any statistically significant differences amongst the outcomes.
  
  
  CONCLUSIONS
  This systematic review did not discern any significant differences between the procedural outcomes of trainees and specialists, which indicates that trainees are safe to operate under senior supervision. In addition, this article recommends that various procedural outcomes can be used to evaluate the performance of clinicians and healthcare systems. Prospective studies need to be performed, taking into account the specific contribution of trainees and specialists during the procedure. This will give a clearer indication of safety and performance of trainees and specialists in the operating theatre.
authors.affiliation: Department of Surgery and Cancer, Imperial College London, St Mary's Hospital Campus, London, UK.
authors.forename: K
authors.initials: K
authors.lastname: Ahmed
authors.forename: H
authors.initials: H
authors.lastname: Ashrafian
authors.forename: L
authors.initials: L
authors.lastname: Harling
authors.forename: V M
authors.initials: VM
authors.lastname: Patel
authors.forename: C
authors.initials: C
authors.lastname: Rao
authors.forename: A
authors.initials: A
authors.lastname: Darzi
authors.forename: G B
authors.initials: GB
authors.lastname: Hanna
authors.forename: P
authors.initials: P
authors.lastname: Punjabi
authors.forename: T
authors.initials: T
authors.lastname: Athanasiou
mesh_terms: D058385:Cardiac Valve Annuloplasty / Q000193:education*; D001026:Coronary Artery Bypass / Q000193:education* / Q000379:methods; D004502:Education, Medical, Continuing / Q000379:methods / Q000458:organization & administration / Q000592:standards; D005260:Female; D006801:Humans; D016239:MEDLINE; D008297:Male; D013647:Task Performance and Analysis