Brett R Anderson1, S Ram Kumar2, Danielle Gottlieb-Sen3, Matthew H Liava'a4, Kevin D Hill5, Jeffrey P Jacobs6, Francis X Moga7, David M Overman7, Jane W Newburger8, Sherry A Glied9, Emile A Bacha4. 1. 1 Division of Pediatric Cardiology, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY, USA. 2. 2 Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA. 3. 3 Section of Pediatric Surgery, Children's Hospital of New Orleans, New Orleans, LA, USA. 4. 4 Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA. 5. 5 Department of Pediatrics, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA. 6. 6 Division of Cardiac Surgery, Johns Hopkins All Children's Heart Institute, St. Petersburg, FL, USA. 7. 7 Division of Cardiac Surgery, The Children's Heart Clinic, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA. 8. 8 Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA. 9. 9 The Robert F. Wagner Graduate School of Public Service, New York University, New York, NY, USA.
Abstract
BACKGROUND: We report the rationale and design for a peer-evaluation protocol of attending congenital heart surgeon technical skill using direct video observation. METHODS: All surgeons contributing data to The Society of Thoracic Surgeons-Congenital Heart Surgery Database (STS-CHSD) are invited to submit videos of themselves operating, to rate peers, or both. Surgeons may submit Norwood procedures, complete atrioventricular canal repairs, and/or arterial switch operations. A HIPPA-compliant website allows secure transmission/evaluation. Videos are anonymously rated using a modified Objective Structured Assessment of Technical Skills score. Ratings are linked to five years of contemporaneous outcome data from the STS-CHSD and surgeon questionnaires. The primary outcome is a composite for major morbidity/mortality. RESULTS: Two hundred seventy-six surgeons from 113 centers are eligible for participation: 83 (30%) surgeons from 53 (45%) centers have agreed to participate, with recruitment ongoing. These surgeons vary considerably in years of experience and outcomes. Participants, both early and late in their careers, describe the process as "very rewarding" and "less time consuming than anticipated." An initial subset of 10 videos demonstrated excellent interrater reliability (interclass correlation = 0.85). CONCLUSIONS: This study proposes to evaluate the technical skills of attending pediatric cardiothoracic surgeons by video observation and peer-review. It is notable that over a quarter of congenital heart surgeons, across a range of experiences, from almost half of United States centers have already agreed to participate. This study also creates a mechanism for peer feedback; we hypothesize that feedback could yield broad and meaningful quality improvement.
BACKGROUND: We report the rationale and design for a peer-evaluation protocol of attending congenital heart surgeon technical skill using direct video observation. METHODS: All surgeons contributing data to The Society of Thoracic Surgeons-Congenital Heart Surgery Database (STS-CHSD) are invited to submit videos of themselves operating, to rate peers, or both. Surgeons may submit Norwood procedures, complete atrioventricular canal repairs, and/or arterial switch operations. A HIPPA-compliant website allows secure transmission/evaluation. Videos are anonymously rated using a modified Objective Structured Assessment of Technical Skills score. Ratings are linked to five years of contemporaneous outcome data from the STS-CHSD and surgeon questionnaires. The primary outcome is a composite for major morbidity/mortality. RESULTS: Two hundred seventy-six surgeons from 113 centers are eligible for participation: 83 (30%) surgeons from 53 (45%) centers have agreed to participate, with recruitment ongoing. These surgeons vary considerably in years of experience and outcomes. Participants, both early and late in their careers, describe the process as "very rewarding" and "less time consuming than anticipated." An initial subset of 10 videos demonstrated excellent interrater reliability (interclass correlation = 0.85). CONCLUSIONS: This study proposes to evaluate the technical skills of attending pediatric cardiothoracic surgeons by video observation and peer-review. It is notable that over a quarter of congenital heart surgeons, across a range of experiences, from almost half of United States centers have already agreed to participate. This study also creates a mechanism for peer feedback; we hypothesize that feedback could yield broad and meaningful quality improvement.
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