• Amin Madani, Yusuke Watanabe, Melina Vassiliou, Liane S Feldman, Quan-Yang Duh, Michael C Singer, Daniel T Ruan, Roger Tabah, and Elliot Mitmaker.
• Department of Surgery, McGill University, Montreal, Quebec, Canada; Centre for Minimally Invasive Surgery and Innovation, McGill University, Montreal, Quebec, Canada.
• Surgery. 2016 Jan 1; 159 (1): 86-94, 96-101.

BackgroundCurrent methods for teaching and assessing competencies that characterize expert intraoperative performance are inconsistent, subjective, and lack standardization. This mixed-methods study was designed to define and establish expert consensus on the most important competencies required to perform a thyroidectomy safely.MethodsCognitive task analyses for thyroidectomy were performed with semistructured interviews of experts in thyroid surgery. Verbal data were transcribed verbatim, coded, and categorized according to themes that were synthesized into a list of items. Once qualitative data reached saturation, 26 experts were invited to complete 2-round online Delphi surveys to rank each item on a Likert scale of importance (1-7). Consensus was predefined as a Cronbach's α ≥ 0.80.ResultsSixty items were synthesized from 5 interviews and categorized into 8 sections: preparation (n = 8), incision/exposure (n = 11), general considerations (n = 4), middle thyroid vein (n = 1), superior pole (n = 5), inferior pole (n = 5), posterolateral dissection (n = 19), and closure (n = 7). Eighteen (69%) experts from 3 countries participated in the Delphi survey. Consensus was achieved after 2 voting rounds (Cronbach's α = 0.95). Greatest weighted sections included "Superior Pole Dissection" and "Posterolateral Dissection."ConclusionConsensus was achieved on defining the most important competencies for safe thyroidectomy. This blueprint serves as the basis for instructional design and objective assessment tools to evaluate performance.Copyright © 2016 Elsevier Inc. All rights reserved.

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