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      Defining competencies in robotic thyroidectomy: development of a model assessing an expert operator’s intraoperative performance skills and cognitive strategies


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          The changing medical education environment emphasizes the need for time efficiency, increasing the demand for competency-based medical education to improve trainees’ learning strategies. This study was performed to determine the competencies required for successful performance of robotic thyroidectomy (RT) and to determine the consensus of experts for performance of RT.


          Data were collected through 12 semi-structured interviews with RT experts and 11 field observations. Cognitive task analysis was performed to determine the competencies required for experts to perform RT. A modified Delphi methodology was used to determine how 20 experts rated the importance of each item of RT performance on a Likert 7-point scale. The criteria for the Delphi consensus were set at a Cronbach’s α≥0.80 with two survey rounds.


          After 11 field observations and 12 semi-structured interviews, 89 items were identified within six modules. These items were grouped into sub-modules according to their theme. The modified Delphi survey, involving 21 experts, reached the consensus standard during the second round (Cronbach’s α=0.954), enabling the identification of the 64 most important items within six modules related to RT performance: midline incision to isthmectomy (MID module; n=8), lateral dissection (LAT module; n=7), preservation of inferior parathyroid glands (INF module; n=16), preservation of recurrent laryngeal nerve and dissection of the ligament of Berry (BER module; n=21), dissection of the thyroid upper pole (SUP module; n=10), and specimen removal and closure (END module; n=2).


          This mixed-method study combining qualitative and quantitative methodology identified modules of core competencies required to perform RT. These modules can be used as a standard and objective guide to train surgeons to perform RT and evaluate outcomes.

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          Delphi methodology in healthcare research: How to decide its appropriateness

          The Delphi technique is a systematic process of forecasting using the collective opinion of panel members. The structured method of developing consensus among panel members using Delphi methodology has gained acceptance in diverse fields of medicine. The Delphi methods assumed a pivotal role in the last few decades to develop best practice guidance using collective intelligence where research is limited, ethically/logistically difficult or evidence is conflicting. However, the attempts to assess the quality standard of Delphi studies have reported significant variance, and details of the process followed are usually unclear. We recommend systematic quality tools for evaluation of Delphi methodology; identification of problem area of research, selection of panel, anonymity of panelists, controlled feedback, iterative Delphi rounds, consensus criteria, analysis of consensus, closing criteria, and stability of the results. Based on these nine qualitative evaluation points, we assessed the quality of Delphi studies in the medical field related to coronavirus disease 2019. There was inconsistency in reporting vital elements of Delphi methods such as identification of panel members, defining consensus, closing criteria for rounds, and presenting the results. We propose our evaluation points for researchers, medical journal editorial boards, and reviewers to evaluate the quality of the Delphi methods in healthcare research.
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            Outcomes That Define Successful Advance Care Planning: A Delphi Panel Consensus

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              What Are the Principles That Guide Behaviors in the Operating Room?

              To identify the core principles that guide expert intraoperative behaviors and to use these principles to develop a universal framework that defines intraoperative performance.

                Author and article information

                Gland Surg
                Gland Surg
                Gland Surgery
                AME Publishing Company
                22 March 2024
                27 March 2024
                : 13
                : 3
                : 340-350
                [1 ]deptDepartment of Public Health, Graduate School , Yonsei University , Seoul, Republic of Korea;
                [2 ]Department of Surgery, Seoul National University Bundang Hospital, Seongnam , Republic of Korea;
                [3 ]deptDepartment of Surgery , Seoul National University Hospital , Seoul, Korea;
                [4 ]deptDepartment of Neurosurgery , Severance Hospital & Yonsei University College of Medicine , Seoul, Republic of Korea;
                [5 ]deptCenter for Medical Education, Graduate School of Medicine , Nagoya University , Nagoya, Japan;
                [6 ]deptDepartment of Surgery , Seoul National University Hospital and College of Medicine , Seoul, Republic of Korea
                Author notes

                Contributions: (I) Conception and design: TS Lee, KE Lee; (II) Administrative support: HW Yu, KE Lee; (III) Provision of study materials or patients: HW Yu, JH Ahn, KE Lee; (IV) Collection and assembly of data: H Kim; (V) Data analysis and interpretation: H Kim, HW Yu, TS Lee; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.


                These authors contributed equally to this work.

                Correspondence to: Kyu Eun Lee, MD, PhD. Department of Surgery, Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea. Email: kyueunlee@ 123456snu.ac.kr ; Tae Seon Lee, PhD. Department of Neurosurgery, Severance Hospital & Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea; Center for Medical Education, Graduate School of Medicine, Nagoya University, Nagoya, Japan. Email: tseonlee@ 123456yonsei.ac.kr .
                Author information
                2024 Gland Surgery. All rights reserved.

                Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0.

                : 16 November 2023
                : 25 February 2024
                Funded by: the Basic Science Research Program through the National Research Foundation of Korea (NRF)
                Funded by: the Ministry of Science, ICT & Future Planning, Republic of Korea
                Award ID: No. 2018R1A1A1A05077361
                Funded by: the Korea Medical Device Development Fund grant funded by the Korea Government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety)
                Award ID: No. RS-2020-KD000146
                Funded by: the MSIT (Ministry of Science and ICT), Korea, under the ITRC (Information Technology Research Center) support program
                Award ID: No. IITP-2021-2018-0-01833
                Original Article

                thyroidectomy,clinical competence,robotics,surgical procedures,reference standards


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