Capturing the essence of developing endovascular expertise for the construction of a global assessment instrument.

OBJECTIVES: To explore what characterises the development of endovascular expertise and to construct a novel global assessment instrument. DESIGN: Literature review and an experimental study. MATERIALS AND METHODS: The literature was searched for information regarding available global rating scales (GRSs); scientific societies' official statements on endovascular competence; and task analyses of endovascular procedures. In the experimental study, clinicians performed a video-recorded simulated iliac-artery stenting procedure. Subsequently, by using the method of retrospective verbalisation, the clinicians were interviewed while watching their performance on video commenting on key issues of the construct. Data from all sources were analysed, categorised and synthesised into a novel rating scale. RESULTS: Available GRSs primarily included technical aspects of performance, whereas the competence statements, task analyses and clinicians' perceptions added a range of non-technical aspects. The novel rating scale SAVE (Structured Assessment of endoVascular Expertise) differs from prior scales by including issues of pre-planning; prediction of challenges; preparation of tools; management of imaging presentation; distinction of technical skills into external and internal control according to operator focus of visual attention; adaptation of strategy; clinical decision making; use of assistant; complications; inter-personal skills; and post-procedural planning. CONCLUSIONS: The essence of developing endovascular expertise goes far beyond mere technical aspects.