title: A global Delphi consensus study on defining and measuring quality in surgical training.
abstract: BACKGROUND
  Evidence suggests that patient outcomes can be associated with the quality of surgical training. To raise the standards of surgical training, a tool to measure training quality is needed. The objective of this study was to define the elements of high-quality surgical training and methods to measure them.
  
  
  METHODS
  Modified Delphi methodology was used to achieve international expert consensus. Seventy statements about indicators and measures of training quality were developed based on themes from semi-structured interviews of surgeons. Eighty-three experts in surgical education from 13 countries were invited to complete an online survey ranking each statement on a 5-point Likert scale. Consensus was predefined as Cronbach's α ≥0.80. Once consensus was achieved, statements ranked ≥4 by ≥80% of experts were used as themes to develop the Surgical Training Quality Assessment Tool (S-QAT).
  
  
  RESULTS
  Fifty-three (64%) experts from 11 countries responded. Consensus was achieved after 2 rounds of voting (Cronbach's α = 0.930). Thirty-five statements were selected as themes for the Surgical Training Quality Assessment Tool. Statements defining training quality covered the following subjects: relationship between the trainer and trainee, operative exposure, supervision, feedback, structure and organization, and structured teaching programs. Consensus statements on measuring training quality included trainee feedback, trainer feedback, timetable structure, and trainee improvement. There was agreement that measuring training quality would have a positive effect on training.
  
  
  CONCLUSIONS
  International expert consensus was achieved on defining and measuring high-quality surgical training. This has been translated into the (S-QAT) to evaluate surgical training programs. Competition created by comparing training quality might raise the standards of surgical education.
authors.affiliation: Division of Surgery, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK. Electronic address: pritam.singh@imperial.ac.uk.
authors.forename: Pritam
authors.initials: P
authors.lastname: Singh
authors.affiliation: Division of Surgery, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Aggarwal
authors.affiliation: Division of General Surgery, Department of Surgery, University of Toronto, Ontario, Canada.
authors.forename: Boris
authors.initials: B
authors.lastname: Zevin
authors.affiliation: Division of General Surgery, Department of Surgery, University of Toronto, Ontario, Canada.
authors.forename: Teodor
authors.initials: T
authors.lastname: Grantcharov
authors.affiliation: Division of Surgery, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK.
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
mesh_terms: D003697:Delphi Technique; D004501:Education, Medical / Q000592:standards*; D038622:Internationality; D013043:Specialties, Surgical / Q000193:education*