title: Clinical validity of consultant technical skills assessment in the English National Training Programme for Laparoscopic Colorectal Surgery.
abstract: BACKGROUND
  The English National Training Programme for Laparoscopic Colorectal Surgery introduced a validated objective competency assessment tool to accredit surgeons before independent practice. The aim of this study was to determine whether this technical skills assessment predicted clinical outcomes.
  
  
  METHODS
  Established consultants, training in laparoscopic colorectal surgery, were asked to submit two operative videos for evaluation by two blinded assessors using the competency assessment tool. A mark of 2·7 or above was considered a pass. Clinical and oncological outcomes were compared above and below this mark, including regression analysis.
  
  
  RESULTS
  Eighty-five consultant surgeons submitted 171 videos. Of these, 44 (25·7 per cent) were in the fail group (score less than 2·7). This low scoring group had more postoperative morbidity (25 versus 8·7 per cent; P = 0·005), including surgical complications (18 versus 6·3 per cent; P = 0·020) and fewer lymph nodes harvested (median 13 versus 18; P = 0·004). A score of less than 2·7 was an independent predictor of surgical complication, lymph node yield and distal resection margin clearance. Consultants with higher scores had performed similar numbers of laparoscopic colorectal operations (median 37 versus 40; P = 0·373) but more structured training operations (18 versus 9; P < 0·001).
  
  
  CONCLUSIONS
  An objective technical skills assessment provided a discriminatory tool with which to accredit laparoscopic colorectal surgeons.
authors.affiliation: Department of Surgery and Cancer, Imperial College, London, UK.
authors.forename: H
authors.initials: H
authors.lastname: Mackenzie
authors.affiliation: Department of Surgery and Cancer, Imperial College, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Ni
authors.affiliation: John Goligher Colorectal Unit, Leeds Teaching Hospitals, Leeds, UK.
authors.forename: D
authors.initials: D
authors.lastname: Miskovic
authors.affiliation: ICENI Centre, Colchester Hospital, Colchester, UK.
authors.forename: R W
authors.initials: RW
authors.lastname: Motson
authors.affiliation: Colorectal Unit, Frimley Park Hospital, Frimley, UK.
authors.forename: M
authors.initials: M
authors.lastname: Gudgeon
authors.affiliation: Colorectal Unit, Queen Elizabeth Hospital, King's Lynn, Bristol, UK.
authors.forename: Z
authors.initials: Z
authors.lastname: Khan
authors.affiliation: Colorectal Unit, Bristol Royal Infirmary, Bristol, UK.
authors.forename: R
authors.initials: R
authors.lastname: Longman
authors.affiliation: Colorectal Unit, Derriford Hospital, Plymouth, UK.
authors.forename: M G
authors.initials: MG
authors.lastname: Coleman
authors.affiliation: Department of Surgery and Cancer, Imperial College, London, UK.
authors.forename: G B
authors.initials: GB
authors.lastname: Hanna
mesh_terms: D000368:Aged; D002983:Clinical Competence; D003108:Colonic Diseases / Q000601:surgery; D015179:Colorectal Neoplasms / Q000601:surgery; D003107:Colorectal Surgery / Q000193:education*; D004521:Educational Measurement; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D016014:Linear Models; D008197:Lymph Node Excision; D008297:Male; D011183:Postoperative Complications; D015203:Reproducibility of Results