A Novel Thyroid Ultrasound Proficiency Metric Designed Through a Multidisciplinary Delphi Approach

• Published in: The American surgeon 2023-02, Vol.89 (2), p.261-266
• Main Authors: Hu, Yinin, Michaels, Alex D., Khot, Rachita, Schenk, Worthington G., Hanks, John B., Smith, Philip W.
• Format: Article
• Language: English
• Subjects: Biopsy; Confidence intervals; Consensus; Delphi method; Delphi Technique; Endoscopy; Feedback; Humans; Inflection points; Learning curves; Patient positioning; Retention; Surgeons; Surgery; Thyroid; Thyroid gland; Thyroid Gland - diagnostic imaging; Tumors; Ultrasonic imaging; Ultrasound
• ISSN: 0003-1348; 1555-9823
• DOI: 10.1177/00031348211011151

Background Thyroid ultrasounds extend surgeons’ outpatient capabilities and are essential for operative planning. However, most residents are not formally trained in thyroid ultrasound. The purpose of this study was to create a novel thyroid ultrasound proficiency metric through a collaborative Delphi approach. Methods Clinical faculty experienced in thyroid ultrasound participated on a Delphi panel to design the thyroid Ultrasound Proficiency Scale (UPS-Thyroid). Participants proposed items under the categories of Positioning, Technique, Image Capture, Measurement, and Interpretation. In subsequent rounds, participants voted to retain, revise, or exclude each item. The process continued until all items had greater than 70% consensus for retention. The UPS-Thyroid was pilot tested across 5 surgery residents with moderate ultrasound experience. Learning curves were assessed with cumulative sum. Results Three surgeons and 4 radiologists participated on the Delphi panel. Following 3 iterative Delphi rounds, the panel arrived at >70% consensus to retain 14 items without further revisions or additions. The metric included the following items on a 3-point scale for a maximum of 42 points: Positioning (1 item), Technique (4 items), Image Capture (2 items), Measurement (2 items), and Interpretation (5 items). A pilot group of 5 residents was scored against a proficiency threshold of 36 points. Learning curve inflection points were noted at between 4 to 7 repetitions. Conclusions A multidisciplinary Delphi approach generated consensus for a thyroid ultrasound proficiency metric (UPS-Thyroid). Among surgery residents with moderate ultrasound experience, basic proficiency at thyroid ultrasound is feasible within 10 repetitions.