Safer Surgery part 7. There have been few research investigations into how highly trained doctors and nurses work together to achieve safe and efficient anaesthesia and surgery. While there have been major advances in surgical and anaesthetic procedures, there are still significant risks for patients during operations and adverse events are not unknown. Due to rising concern about patient safety, surgeons and anaesthetists have looked for ways of minimising adverse events. | 34 Safer Surgery Which Procedure In order to guarantee a sufficiently wide range of assessment each surgical specialty has selected a number of index procedures. These procedures are selected on the basis of their broad accessibility to trainees observability and in most cases an aspect of the procedure which contributes something unique to the assessment range. In orthopaedics there is presently a collection of 14 index procedures . carpal tunnel decompression total knee replacement compression hip screw for intertrochanteric fracture neck of femur . A trainee may submit PBA assessments on any number of procedures but a successful example of all 14 must be included before the completion of training. By the end of training all the index procedures must be scored at the defined competence level of four. Naturally in the early years an intermediate score is inevitable for all or some domains. It is very important for both trainer and trainee to appreciate that it is progression towards competence which is being assessed primarily. Less than a score of four is to be expected early on in training culminating in straight fours towards the completion of training. PBA and the Curriculum It should be noted that PBAs are one element of a wider specialty curriculum. They are linked to the learning agreement and work in synergy with other tools that vary to some degree between specialties. Designing and Developing PBA Historically the roots of PBA go back in the authors experience to the early 1990s1 when a desire to evaluate the change in performance before and after a fracture fixation course lead to the development of a 20-item multisource feedback tool assessing performance in inserting a dynamic hip screw DHS into a fractured neck of femur. The potential of this approach went unrecognized until 2002 when the recommendations of the JCHST Competence Working Party Rowley et al. 2002 made it possible to proceed with PBA development in orthopaedics at which time it was .
