title: Defining competencies for safe thyroidectomy: An international Delphi consensus.
abstract: BACKGROUND
  Current methods for teaching and assessing competencies that characterize expert intraoperative performance are inconsistent, subjective, and lack standardization. This mixed-methods study was designed to define and establish expert consensus on the most important competencies required to perform a thyroidectomy safely.
  
  
  METHODS
  Cognitive task analyses for thyroidectomy were performed with semistructured interviews of experts in thyroid surgery. Verbal data were transcribed verbatim, coded, and categorized according to themes that were synthesized into a list of items. Once qualitative data reached saturation, 26 experts were invited to complete 2-round online Delphi surveys to rank each item on a Likert scale of importance (1-7). Consensus was predefined as a Cronbach's α ≥ 0.80.
  
  
  RESULTS
  Sixty items were synthesized from 5 interviews and categorized into 8 sections: preparation (n = 8), incision/exposure (n = 11), general considerations (n = 4), middle thyroid vein (n = 1), superior pole (n = 5), inferior pole (n = 5), posterolateral dissection (n = 19), and closure (n = 7). Eighteen (69%) experts from 3 countries participated in the Delphi survey. Consensus was achieved after 2 voting rounds (Cronbach's α = 0.95). Greatest weighted sections included "Superior Pole Dissection" and "Posterolateral Dissection."
  
  
  CONCLUSIONS
  Consensus was achieved on defining the most important competencies for safe thyroidectomy. This blueprint serves as the basis for instructional design and objective assessment tools to evaluate performance.
authors.affiliation: Department of Surgery, McGill University, Montreal, Quebec, Canada; Centre for Minimally Invasive Surgery and Innovation, McGill University, Montreal, Quebec, Canada.
authors.forename: Amin
authors.initials: A
authors.lastname: Madani
authors.affiliation: Centre for Minimally Invasive Surgery and Innovation, McGill University, Montreal, Quebec, Canada.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Watanabe
authors.affiliation: Department of Surgery, McGill University, Montreal, Quebec, Canada; Centre for Minimally Invasive Surgery and Innovation, McGill University, Montreal, Quebec, Canada.
authors.forename: Melina
authors.initials: M
authors.lastname: Vassiliou
authors.affiliation: Department of Surgery, McGill University, Montreal, Quebec, Canada; Centre for Minimally Invasive Surgery and Innovation, McGill University, Montreal, Quebec, Canada.
authors.forename: Liane S
authors.initials: LS
authors.lastname: Feldman
authors.affiliation: Department of Surgery, University of California, San Francisco, San Francisco, CA.
authors.forename: Quan-Yang
authors.initials: QY
authors.lastname: Duh
authors.affiliation: Department of Otolaryngology, Henry Ford Hospital, Detroit, MI.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Singer
authors.affiliation: Department of Surgery, Brigham and Women's Hospital, Boston, MA.
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Ruan
authors.affiliation: Department of Surgery, McGill University, Montreal, Quebec, Canada.
authors.forename: Roger
authors.initials: R
authors.lastname: Tabah
authors.affiliation: Department of Surgery, McGill University, Montreal, Quebec, Canada. Electronic address: elliot.mitmaker@mcgill.ca.
authors.forename: Elliot
authors.initials: E
authors.lastname: Mitmaker
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D003697:Delphi Technique; D004503:Education, Medical, Graduate / Q000592:standards*; D006801:Humans; D013961:Thyroid Gland / Q000601:surgery*; D013965:Thyroidectomy / Q000193:education / Q000592:standards*