Thursday, July 2, 2015

Needs Analysis for a Performance Improvement Program in Intraoperative Imaging of the Proximal Femur

Claude Martin, MD, FRCSC, MBA, MEd
AO Foundation

Background: Medical education experts and surgeon faculty have agreed that moving beyond the traditional measuring of participation and satisfaction to higher outcomes of performance and patient care would enhance the quality and impact of medical education. Performance improvement programs have been shown to be an effective method of delivering continuing professional development education.

Objective: Clinical experts in one of the Arbeitsgemeinschaft für Osteosynthesefragen (AO) Foundation’s Educational working groups hypothesized that there was a suboptimal performance in lateral intraoperative imaging of the proximal femur in fracture fixation and many surgeons did not receive formal education or apply structured criteria to assess quality.
Methods: A four-step process consisting of an initial online questionnaire (n=13), focus group face-to-face interviews (n=8), full online needs analysis questionnaire (n=98) and a paper-based user acceptability survey (n=19) was employed in a needs analysis. This process identified several educational needs and potential performance gaps in intraoperative imaging of the proximal femur in trauma surgery.
Results: There was wide variation in understanding and application of proximal femur imaging reference points by surgeons of various experiences, especially with the lateral (axial) views, with no single criteria being utilized. The data from each of the four steps of the needs analysis questionnaire guided the design and delivery of focused educational interventions embedded within a protocol for a locally delivered performance improvement program. The initial questionnaire data confirmed and quantified the gaps envisioned by the expert surgical panel and identified topics to discuss with the participants of the focus group; the focus group interviews clarified terminology and criteria, particularly around the definition of quality imaging, resulting in adjustments to the full needs analysis questionnaire.
Conclusion: Data from the full needs analysis questionnaire informed the final imaging criteria defined by the expert panel and guided the selection of specific knowledge, skills and attitudes to address in the educational intervention. The user acceptability survey confirmed perceived needs by the surgical community to apply formal criteria that would improve reduction and fixation of proximal femur fractures, leading to better patient outcomes in a common fracture in the population.