Can complex surgical interventions be standardized? Reaching international consensus on posterior sagittal anorectoplasty using a modified-Delphi method

Background/Purpose: In an effort to standardize educational experience, address future physician short-ages, and improve quality of care to patients, many surgical specialties are discussing how to maximize exposure to index cases. One solution being explored is telementoring, which requires a well-developed educational curriculum with intraoperative objectives. The American College of Surgery Telementoring Task Force selected anorectal malformation and posterior sagittal anorectoplasty (PSARP) for the repair of imperforate anus as the initial educational focus for this pilot. The purpose of this study was to obtain international consensus on intraoperative learning objectives for a complex surgical procedure. Methods: A multidisciplinary team of medical educators and pediatric surgery experts created an outline of essential curricular content and intraoperative learning objectives for PSARP in three clinical scenarios. Twelve international subject matter experts were identified meeting strict inclusion criteria. Intraopera-tive checklists were revised using the modified-Delphi process. Results: After five rounds of modifications to the intraoperative checklists, international consensus was achieved for three different clinical scenarios requiring a PSARP: perineal or vestibular fistula, low pro-static fistula, and bladder neck fistula. Conclusions: A modified-Delphi approach was successful in generating guidelines for surgical techniques that can be used to standardize intraoperative teaching and expectations for trainees. Type of study: Diagnostic study Level of evidence: Level V (expert opinion) (c) 2021 Elsevier Inc. All rights reserved.

Automated summary

This study aimed to obtain international consensus on intraoperative learning objectives for the complex surgical procedure PSARP. Through collaboration with a multidisciplinary team and international experts, successful guidelines for intraoperative teaching in different clinical scenarios were established.