Learning Curves of Syllabus Head and Neck Procedures;Monitoring Trainees Performance and Progress

Abstract

Objectives:

Otolaryngology trainees undergo regular procedure-based assessments (PBAs) throughout training; however, these are rarely used to analyze performance and monitor progress. The aim of the study was to validate PBA in assessing otolaryngology trainees in head and neck surgery (HNS) and identify the pattern by which trainees progress in syllabus HNS procedures.

Methods:

We analyzed all PBAs from North-Thames otolaryngology trainees, during early years or core (CT) and more senior specialty training (ST) years from 2008 to 2013. We used mean scores and standard deviations to draw procedure-specific learning curves. The PBA tool is procedure-specific. It is produced by the Joint Committee of Surgical Training and is used in assessing UK surgical trainees performance in all specialties. The tool is composed of 6 main domains: consent, planning, preparation, exposure/closure, technique, and postoperative care.

Results:

A total of 3306 PBAs from 46 trainees were identified; 1806 were HNS. PBA reliability was shown by high internal consistency (Cronbach’s Alpha:0.921) and discriminated between grades (CT and ST, Mann-Whitney U: P < .001) and levels (CT1-2 and ST3-8, Kruskal Wallis: P < .001). All domains correlated with overall performance, but the best predictor was technical skills. A total of 7 HNS procedures achieved sufficient power to draw learning curves (n > 100, 90% confidence): tonsillectomy: 309, pan-endoscopy: 186, microlaryngoscopy: 174, thyroidectomy: 152, tracheostomy: 137, adenoidectomy: 129, and lymphadenectomy: 101.

Conclusions:

Procedure-specific learning curves can be drawn to set milestones and deliver targeted training. Curves of various HNS procedures plateau at different stages in training. This method is more robust and should replace arbitrary numbers as a measure of competence.