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Title: Proficiency gain and competency assessment in laparoscopic colorectal surgery
Author: Miskovic, Danilo
ISNI:       0000 0004 2728 8198
Awarding Body: Imperial College London
Current Institution: Imperial College London
Date of Award: 2012
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Aims and objectives: The aim of this thesis was to investigate the proficiency gain curve and competency in laparoscopic colorectal surgery (LCS) for specialist colorectal surgeons. The objectives were (1) to analyse the shortfalls of proficiency gain curve analysis in LCS, (2) to develop methods to describe proficiency gain and competency in LCS and (3) to analyse proficiency gain and competency within the National Training Programme (NTP). Methods: Objective 1: Two systematic reviews and a meta-analysis of current evidence were performed. Objective 2: Semi-structured interviews and a Delphi method were applied to develop proficiency and competency assessment tools and clinical cases were used for validation. A novel observational clinical human reliability analysis (OCHRA) of clinical cases was developed and evaluated. Objective 3: clinical and educational data from the National Training Programme were used for the analysis of proficiency gain and competency using advanced statistical methods. Results: Using clinical data alone is insufficient for the description of proficiency gain and competency. A generic assessment scale (GAS form) and a competency assessment tool (CAT) were developed and validated. A combination of CAT and OCHRA has been shown to be highly sensitive and specific to determine competency. Analysis of clinical and educational data revealed a shortening of the proficiency gain curve using the approach of the NTP without the risk of increased rates adverse outcomes. Conclusion: Tools for proficiency gain and competency assessment of specialist surgeons have been shown to be valid and feasible and are fully implemented in the NTP. Data suggest that a novel technique can be introduced to specialists on a National level using a structured educational approach with safe clinical outcomes.
Supervisor: Hanna, George ; Darzi, Ara Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral