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OBJECTIVES:
There is clearly a need for accurate and robust endovascular
skills assessment for efficient training and accreditation. Current assessment
tools largely rely on expert judged procedural scoring systems. These evaluate
skill from a particular perspective, are time consuming and require the input of multiple, suitably trained, experts. The objective of this study was to seek expert opinion regarding key components of safe and efficient performance, in order to determine if the development of a reliable, objective and automated assessment tool is feasible.

METHODS: 11 international experts (in endovascular procedures and teaching/training) were recruited (until two consecutive interviews revealed no new themes) and interviewed in a semi-structured manner using a standardised pro-forma (7-24min interview length). Interviews were recorded, transcribed by hand and analysed using NVIVO 10 (QSR International, USA) qualitative data analysis software, which facilitates coding of responses into distinct sub-headings. It then counts the number of times a reference is made to a particular sub-heading and allows grouping into themes.

RESULTS: 123 sub-headings each corresponding to a statement of differing content were identified and grouped into 13 themes. 920 references were made in total to the different statements. Themes, in general, related to catheter/guide-wire handling ability; peri-operative safety; peri-operative cognitive ability including situational awareness, decision-making and 3D conceptualisation; and understanding of endovascular technology including tool selection. Highest-ranking themes (and sub-headings) were: Observable catheter movement-ergonomic movement (30 references per statement ), controlled movement (23), reduced path-length (20)]; general ability-generic catheter-handling skills (19), generic wire skills (16), appropriate/timely progression (11) and catheter manipulation-generally careful (22), accuracy of target vessel cannulation (20), appropriate pressure on catheter and wire (13).

CONCLUSIONS: This study has deconstructed endovascular skill into constituent components. A primary emphasis is placed on catheter manipulation, observable catheter movements and general skill, which may represent potential targets for the development of automated skills metrics.