Assessment of technical competency in pediatric cardiac surgery

Outcomes in pediatric cardiac surgery have improved dramatically since its infancy 40 years ago. Mortality has been reduced from as high as 90–100% in the initial years to around 4% for high complexity cases and virtually no mortality for simple cardiac defects. While part of this improvement can be attributed to advances in pediatric cardiac anesthesia, pediatric cardiopulmonary bypass and development of highly specialized pediatric cardiac intensive care units, outcomes continue to depend on the technical quality of the surgical repair. In this article we address the importance of the surgical technical performance on the outcomes and discuss the currently available tools for measurement of surgical competency. Our studies showed that the final technical (anatomical) result score had the strongest association with patient outcomes. We offer suggestions for a competency model that continues to evolve as we explore the use of immersive learning, deliberate practice, reflection in action, mentorship by senior surgeons and lifelong learning.