Re: Hamdorf JM. Critical evaluation. What makes a competent surgeon? (ANZ J. Surg. 2010; 80: 656)
We read with interest the paper by Hamdorf1 commenting on our study of UK surgeons' perceptions of the CanMEDS-specified competencies.2 We found two distinct ‘families’ of competencies: the first relates to clinical practice (roles of Collaborator, Professional, Manager, Health advocate, Communicator). The second reflects academic expertise (roles of Scholar, Medical expert). Hamdorf finds this of interest, but criticizes some of our analyses. Small sample size is part of the critique, followed by the view that our multivariate analyses (internal consistency, principal components analysis (PCA)) do not add to the findings.
Regarding sample, we explicitly acknowledged sample size as a limitation in our paper. Regarding analyses, we feel they do add to the demonstration of the effects of interest. First, the ratio of questions : participants for these analyses meets the criterion of 1 : 10 often recommended (7 roles : 92 participants),3 whereas the total n is very near a suggested minimum of 1004– with few questions analysed. Second, we took care not to report subgroup analyses by specialty, as we did not have adequate specialty representation. Third, our analyses of variance demonstrated differences in perceptions of the seven roles at each grade (from Foundation Trainees to Consultants). The finding that the roles of Scholar/Medical expert are perceived differently from the other five roles, considered the research highlight by Hamdorf, did in fact emerge from the internal consistency and PCA – which, therefore, are not redundant. In addition to these analyses corroborating each other, the graphical depiction of this statistical pattern in participants' perceptions is only available through PCA – therefore, this analysis also adds to the clarity of a key finding.
Further investigations should focus on replication with a larger sample in the UK, coupled with similar studies elsewhere to gauge similarities/differences in perceptions of professional roles by surgeons. Clearer understanding of the facets of competence valued by the profession will hopefully contribute to refinement of curricula and assessment tools.
Sonal Arora, BSc, MBBS, MRCS, PhD
Nick Sevdalis, BSc, MSc, PhD
Department of Surgery and Cancer, Imperial College, London, UK
References
1. Hamdorf JM. Critical evaluation. What makes a competent surgeon? ANZ J. Surg. 2010; 80: 656.
2. Arora S, Sevdalis N, Suliman I, Athanasiou T, Kneebone R, Darzi A. What makes a competent surgeon? Experts’ and trainees’ perceptions of the roles of a surgeon. Am. J. Surg. 2009; 198: 726–32.
3. Abell N, Springer DW, Kamata A. Developing and Validating Rapid Assessment Instruments. New York: Oxford University Press, 2009.
4. Gorsuch RL. Factor Analysis, 2nd edn. Hillsdale, NJ: Erlbaum, 1983.
