title: Is competency assessment at the specialist level achievable? A study for the national training programme in laparoscopic colorectal surgery in England.
abstract: OBJECTIVE
  To develop, validate, and implement a competency assessment tool (CAT) for technical surgical performance in the context of a summative assessment process for the National Training Programme in Laparoscopic Colorectal Surgery (NTP).
  
  
  BACKGROUND
  The NTP is an educational initiative by the National Cancer Action Team in England to safely increase the uptake of laparoscopic colorectal surgery. It is the first competency-based national educational initiative for specialist surgeons (consultants), and performance assessment is an integral part of the program.
  
  
  METHODS
  Content validity was sought using expert opinion by semistructured interviews and the Delphi method. For validity and reliability studies, NTP apprentices and experts were asked to submit video-recorded cases. Construct validity was established between delegates who passed the assessment and those who failed. Concurrent validity was tested by comparing scores with error counts as identified by observational clinical human reliability analysis. A fully crossed design, using generalizability theory methods and D-studies, was used for reliability.
  
  
  RESULTS
  Interviews and the Delphi method revealed a list of characteristics for assessment. A hybrid structure combining task-specific and generic items was used to include important characteristics into the assessment format. Fifty-four cases were submitted. Overall reliability reached G(ACI) = 0.803 when using 2 cases and 2 assessors. Experts scored significantly better than apprentices (3.19 vs 2.60; P = 0.004), and apprentices who passed had better scores than those who failed (2.95 vs 2.28; P < 0.001). There was an inverse correlation between CAT scores and observational clinical human reliability analysis error counts (ρ = -0.520, P < 0.001). The combination of both methods reached overall sensitivity of 100%, specificity of 83.3%, a positive predictive value of 93.8%, and a negative predictive value of 100%.
  
  
  CONCLUSIONS
  The CAT can reliably assess technical performance in laparoscopic colorectal surgery. The use of CATs to judge specialist technical performance before embarking on independent practice of new procedures is achievable on a national scale and can be adapted by other specialties.
authors: Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, United Kingdom.
authors: Danilo
authors: D
authors: Miskovic
authors: Melody
authors: M
authors: Ni
authors: Susannah M
authors: SM
authors: Wyles
authors: Robin H
authors: RH
authors: Kennedy
authors: Nader K
authors: NK
authors: Francis
authors: Amjad
authors: A
authors: Parvaiz
authors: Chris
authors: C
authors: Cunningham
authors: Timothy A
authors: TA
authors: Rockall
authors: Andrew M
authors: AM
authors: Gudgeon
authors: Mark G
authors: MG
authors: Coleman
authors: George B
authors: GB
authors: Hanna
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D003107:Colorectal Surgery / Q000193:education*; D003162:Competency-Based Education / Q000379:methods*; D004522:Educational Status; D004739:England; D006801:Humans; D007318:Inservice Training / Q000379:methods*; D010535:Laparoscopy / Q000193:education*; D015203:Reproducibility of Results; D013038:Specialization / Q000592:standards*