Working models of Society’s own case log system for MOC reviewed in Vancouver
By Dr. Conor P. Delaney
After reviewing working models of its own case log system for Maintenance of Certification (MOC) at the Vancouver Annual Meeting, the project is ready for the next step. The ASCRS case log system needs to be sufficiently complex to be a valid tool for certification, without being overly burdensome for the membership.
The current American College of Surgeons (ACS) case log is a very complete system that enables ASCRS members to track their own cases, but it is generic and probably not ideally suited for certification with the American Board of Colon and Rectal Surgery (ABCRS).
We started by using a modified Delphi method to identify key operations to include in the case log. The Delphi method uses “rounds” of anonymous, open-ended, self-administered questionnaires. Our panels identified six key operations for the case log: colectomy (laparoscopic and open), rectal cancer resection, hemorrhoidectomy, anal fistula and abscess, colonoscopy, and rectal prolapse.
Recognizing that endpoints for quality assessment of colorectal surgical care are poorly defined, we continued with the modified Delphi to rank the endpoints for each of these procedures/diagnoses. Standardized, consensus-derived parameters are needed for case reporting and quality improvement. We also wanted to be sure the case log endpoints would integrate closely with the CREST Committee’s plans for online education.
After initial development of endpoints by a core group of eight surgeons, the endpoints were expanded and scored in three successive rounds of 8, 18, and 28 members from the ABCRS, Executive Council, and the Society’s Quality and CREST (online education) Committees. We have now developed a consensus-derived listing of 90 endpoints for these six key operations in colorectal surgery. These data provide a framework for development of case reporting and quality-based initiatives for colon and rectal surgery, and should be suitable endpoints for use in prospective studies.
Common endpoints are complications, mortality (30-day), reoperation (30-day), comorbidities, readmission (30-day), ASA, BMI, hospital stay, and demographics. Specific endpoints have been ranked for each procedure.
We have worked closely with Dr. Clifford Ko, an ASCRS Fellow who developed the ACS case log system to be sure our system will integrate well with the ACS system.