Consensus-Derived Coronary Anastomotic Checklist Reveals Significant Variability Among Experts

Area of Science:

• Cardiovascular Surgery
• Surgical Education
• Medical Informatics

Background:

• Surgical skill assessment tools often lack generalizability due to reliance on small expert groups.
• A Delphi approach can enhance the generalizability of assessment tools by engaging a wider expert consensus.
• This study aimed to develop a checklist for coronary anastomotic skill assessment.

Purpose of the Study:

• To identify key elements for a coronary anastomotic skill assessment checklist.
• To improve the generalizability of surgical skill assessment tools.
• To utilize a Delphi approach for expert consensus building.

Main Methods:

• Expert surgeons (≥10 years experience, teaching coronary artery surgery) were randomly selected.
• Participants submitted items considered mandatory for coronary artery bypass.
• A three-round Delphi process was used to achieve 75% consensus on items.

Main Results:

• Sixteen surgeons participated, contributing 407 initial items, condensed to 146.
• Only 40 items (27%) reached consensus, with 23 in round 1, 14 in round 2, and 3 in round 3.
• Agreement varied significantly across sections, from 0% for 'management of assistants' to 47% for 'testing and final steps.'

Conclusions:

• A Delphi approach with randomly selected experts can generate a coronary artery bypass checklist.
• Significant expert disagreement on mandatory steps questions the generalizability of locally developed checklists.
• Further research is needed to address inter-expert variability in surgical skill assessment.