Competency-Based Assessment Tool for Pediatric Tracheotomy: International Modified Delphi Consensus

Evan J Propst; Nikolaus E Wolter; Stacey L Ishman; Karthik Balakrishnan; Ashley R Deonarain; Deepak Mehta; George Zalzal; Seth M Pransky; Soham Roy; Charles M Myer 3rd; Michele Torre; Romaine F Johnson; Jeffrey P Ludemann; Craig S Derkay; Robert H Chun; Paul Hong; David W Molter; Jeremy D Prager; Lily H P Nguyen; Michael J Rutter; Charles M Myer 4th; Karen B Zur; Douglas R Sidell; Liane B Johnson; Robin T Cotton; Catherine K Hart; J Paul Willging; Carlton J Zdanski; John J Manoukian; Derek J Lam; Nancy M Bauman; Eric A Gantwerker; Murad Husein; Andrew F Inglis; Glenn E Green; Luv Ram Javia; Scott Schraff; Marlene A Soma; Ellen S Deutsch; Steven E Sobol; Jonathan B Ida; Sukgi Choi; Trina C Uwiera; Udayan K Shah; David R White; Christopher T Wootten; Hamdy El-Hakim; Matthew A Bromwich; Gresham T Richter; Shyan Vijayasekaran; Marshall E Smith; Jean-Philippe Vaccani; Christopher J Hartnick; Erynne A Faucett

doi:10.1002/lary.28461

Competency-Based Assessment Tool for Pediatric Tracheotomy: International Modified Delphi Consensus

Laryngoscope. 2020 Nov;130(11):2700-2707. doi: 10.1002/lary.28461. Epub 2019 Dec 10.

Authors

Evan J Propst¹, Nikolaus E Wolter¹, Stacey L Ishman², Karthik Balakrishnan³, Ashley R Deonarain¹, Deepak Mehta⁴, George Zalzal⁵, Seth M Pransky⁶, Soham Roy⁷, Charles M Myer 3rd², Michele Torre⁸, Romaine F Johnson⁹, Jeffrey P Ludemann¹⁰, Craig S Derkay¹¹, Robert H Chun¹², Paul Hong¹³, David W Molter¹⁴, Jeremy D Prager¹⁵, Lily H P Nguyen¹⁶, Michael J Rutter², Charles M Myer 4th², Karen B Zur¹⁷, Douglas R Sidell¹⁸, Liane B Johnson¹³, Robin T Cotton², Catherine K Hart², J Paul Willging², Carlton J Zdanski¹⁹, John J Manoukian¹⁶, Derek J Lam²⁰, Nancy M Bauman⁵, Eric A Gantwerker²¹, Murad Husein²², Andrew F Inglis²³, Glenn E Green²⁴, Luv Ram Javia¹⁷, Scott Schraff²⁵, Marlene A Soma²⁶, Ellen S Deutsch^{27

28}, Steven E Sobol¹⁷, Jonathan B Ida²⁹, Sukgi Choi³⁰, Trina C Uwiera³¹, Udayan K Shah³², David R White³³, Christopher T Wootten³⁴, Hamdy El-Hakim³¹, Matthew A Bromwich³⁵, Gresham T Richter³⁶, Shyan Vijayasekaran³⁷, Marshall E Smith³⁸, Jean-Philippe Vaccani³⁵, Christopher J Hartnick³⁹, Erynne A Faucett⁴⁰

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
² Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
³ Department of Otolaryngology and Mayo Children's Center, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, U.S.A.
⁴ Department of Pediatric Otolaryngology, Texas Children's Hospital, Houston, Texas, U.S.A.
⁵ Department of Otolaryngology, Children's National Health System, Division of Otolaryngology, George Washington University Washington, DC, U.S.A.
⁶ Division of Pediatric Otolaryngology, Rady Children's Hospital San Diego, San Diego, California, U.S.A.
⁷ Department of Otorhinolaryngology, University of Texas at Houston McGovern Medical School, Houston, Texas, U.S.A.
⁸ Airway Unit, Scientific Institute for Research and Healthcare, Giannina Gaslini Institute, Genoa, Italy.
⁹ Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.
¹⁰ Pediatric Otolaryngology, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
¹¹ Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of the King's Daughters, Eastern Virginia Medical School, Norfolk, Virginia, U.S.A.
¹² Department of Otolaryngology, Children's Hospital of Wisconsin-Milwaukee Campus, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A.
¹³ Division of Otolaryngology, Dalhousie University, Izaak Walton Killam Health Centre, Halifax, Nova Scotia, Canada.
¹⁴ Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A.
¹⁵ Department of Pediatric Otolaryngology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, U.S.A.
¹⁶ Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
¹⁷ Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A.
¹⁸ Department of Otolaryngology-Head and Neck Surgery, Stanford University, Lucile Salter Packard Children's Hospital, Palo Alto, California, U.S.A.
¹⁹ Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A.
²⁰ Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Pediatric Otolaryngology, Doernbecher Children's Hospital, Portland, Oregon, U.S.A.
²¹ Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, U.S.A.
²² Department of Otolaryngology-Head and Neck Surgery, Victoria Hospital, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
²³ Division of Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A.
²⁴ Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Mott Children's Hospital, Ann Arbor, Michigan, U.S.A.
²⁵ Arizona Otolaryngology Consultants, Phoenix, Arizona, U.S.A.
²⁶ Department of Pediatric Otolaryngology, Sydney Children's Hospital, Randwick, New South Wales, Australia.
²⁷ Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
²⁸ Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A.
²⁹ Division of Pediatric Otolaryngology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A.
³⁰ Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.
³¹ Divisions of Pediatric Surgery and Otolaryngology-Head and Neck Surgery, Departments of Surgery and Pediatrics, The Stollery Children's Hospital, University of Alberta Hospital, Edmonton, Alberta, Canada.
³² Division of Pediatric Otolaryngology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, U.S.A.
³³ Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A.
³⁴ Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.
³⁵ Division of Otolaryngology, Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.
³⁶ Division of Pediatric Otolaryngology, Arkansas Children's Hospital, Little Rock, Arkansas, U.S.A.
³⁷ Department of Otolaryngology-Head and Neck Surgery, Perth Children's Hospital, University of Western Australia, Nedlands, Western Australia, Australia.
³⁸ Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A.
³⁹ Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A.
⁴⁰ Department of Pediatric Otolaryngology, Phoenix Children's Hospital, Phoenix, Arizona, U.S.A.

PMID: 31821571
DOI: 10.1002/lary.28461

Abstract

Objectives/hypothesis: Create a competency-based assessment tool for pediatric tracheotomy.

Study design: Blinded, modified, Delphi consensus process.

Methods: Using the REDCap database, a list of 31 potential items was circulated to 65 expert surgeons who perform pediatric tracheotomy. In the first round, items were rated as "keep" or "remove," and comments were incorporated. In the second round, experts were asked to rate the importance of each item on a seven-point Likert scale. Consensus criteria were determined a priori with a goal of 7 to 25 final items.

Results: The first round achieved a response rate of 39/65 (60.0%), and returned questionnaires were 99.5% complete. All items were rated as "keep," and 137 comments were incorporated. In the second round, 30 task-specific and seven previously validated global rating items were distributed, and the response rate was 44/65 (67.7%), with returned questionnaires being 99.3% complete. Of the Task-Specific Items, 13 reached consensus, 10 were near consensus, and 7 did not achieve consensus. For the 7 previously validated global rating items, 5 reached consensus and two were near consensus.

Conclusions: It is feasible to reach consensus on the important steps involved in pediatric tracheotomy using a modified Delphi consensus process. These items can now be considered to create a competency-based assessment tool for pediatric tracheotomy. Such a tool will hopefully allow trainees to focus on the important aspects of this procedure and help teaching programs standardize how they evaluate trainees during this procedure.

Level of evidence: 5 Laryngoscope, 130:2700-2707, 2020.

Keywords: Delphi; Objective Structured Assessment of Technical Skill, OSAT, OSATS; Tracheostomy; assessment; education; objective structured assessment of technical skills; tracheotomy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Child
Clinical Competence / standards*
Consensus
Delphi Technique
Humans
Pediatrics / education
Pediatrics / methods
Pediatrics / standards*
Single-Blind Method
Surgeons / education
Surgeons / standards*
Tracheotomy / education
Tracheotomy / standards*