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 4 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 4 categories. The first round of the Delphi review was completed by 14 respondents (response rate 66.7%). A total of 3 rounds of Delphi review were performed. Ultimately, 25 items were retained from the original instrument and 1 modified and 4 new items were added. The final instrument has 30 steps in 4 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.