Can complex surgical interventions be standardized? Reaching international consensus on posterior sagittal...

Area of Science:

• Surgical Education
• Pediatric Surgery
• Medical Simulation

Background:

• Standardizing surgical education is crucial for addressing physician shortages and enhancing patient care.
• Telementoring is being explored as a method to maximize exposure to index cases, requiring defined intraoperative objectives.
• Anorectal malformation repair using posterior sagittal anorectoplasty (PSARP) was chosen as the pilot procedure.

Purpose of the Study:

• To achieve international consensus on intraoperative learning objectives for PSARP.
• To develop a standardized curriculum for telementoring in pediatric surgery.
• To establish clear expectations for surgical trainees performing complex procedures.

Main Methods:

• A multidisciplinary team developed initial curricular content and learning objectives for PSARP.
• Twelve international pediatric surgery experts were selected based on strict criteria.
• The modified-Delphi process was employed to revise intraoperative checklists through multiple rounds.

Main Results:

• International consensus was achieved on intraoperative learning objectives for PSARP.
• Guidelines were established for three distinct clinical scenarios: perineal/vestibular fistula, low prostatic fistula, and bladder neck fistula.
• The modified-Delphi process facilitated agreement among international experts.

Conclusions:

• The modified-Delphi approach effectively generated guidelines for surgical techniques.
• These guidelines can standardize intraoperative teaching and trainee expectations in PSARP.
• This methodology provides a framework for developing consensus on learning objectives in other complex surgical procedures.