Consensus on Key Attributes of Cardiac Surgeons' Intraoperative Performance

Abstract

Objective: To generate a comprehensive model of cardiac surgeons' intraoperative performance, encompassing a wide range of attributes most related to patient safety and surgical outcomes.

Methods: A 3-phase mixed methods study was conducted: (1) an online survey of cardiac surgeons from the National Cardiac Surgery Quality IMPROVEment Network to identify key performance attributes; (2) an expert panel meeting during The Society of Thoracic Surgeons Annual Meeting using video-based recall protocol to extract additional performance attributes; and (3) three rounds of Delphi consensus method to rate attributes' importance. Attributes rated as "very important" or "essential" by ≥80% of participants were included in the final consensus statement. Performance attributes were mapped to the Accreditation Council for Graduate Medical Education (ACGME) Core Competencies and Thoracic Surgery Integrated Milestones.

Results: Twenty-five surgeons from the United States participated in Phases 1 and 2, generating 54 unique performance attributes. In Phase 3, 27 cardiac surgeons from 5 countries participated in the Delphi process, yielding consensus on 46 attributes classified into 5 operative performance domains: cognitive skills (14 attributes, 30.4%), technical skills (12 attributes, 26.1%), social skills (9 attributes, 19.6%), medical knowledge (6 attributes, 13.0%), and emotional intelligence (5 attributes, 10.9%).

Conclusions: This study establishes a comprehensive model demonstrating that a cardiac surgeon's intraoperative performance encompasses multiple domains beyond medical knowledge and technical skills. The resulting performance model aligns with educational frameworks and facilitates practical implementation in surgical training programs for holistic performance assessment and quality improvement.

Keywords: cardiac surgery; intraoperative performance; nontechnical skills; patient safety; surgical education.