Competency Assessment for Laparoscopic Anti-Reflux Surgery: Design and Delphi Review, a Collaboration With the American Foregut Society.

Background: Laparoscopic anti-reflux surgery, including hiatus hernia repair, is a common operation performed by both general and thoracic surgeons and an important learning objective for surgical trainees. This study aimed to design a competency assessment instrument for laparoscopic anti-reflux surgery. Method: A comprehensive competency assessment instrument was designed by a process of logical analysis by four expert thoracic surgeons with an interest in foregut surgery, and then reviewed informally by a panel of experts. The instrument was then further assessed and refined using a modified Delphi process. The Delphi questionnaire was distributed to all members of the Fellowship Training Committee of the American Foregut Society (n=21). Results: A first draft of the competency assessment instrument included 32 steps in four categories. The first round of the Delphi review was completed by 14 respondents (response rate 66.7%). A total of three rounds of Delphi review were performed. Ultimately, 25 items were retained from the original instrument and one modified and four new items were added. The final instrument has 30 steps in four categories. Conclusions: An international and inter-specialty consensus was established on the key components of assessing competence to perform anti-reflux surgery. The resulting instrument could be used to guide competency based assessments of general and thoracic surgeons and trainees.