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Identification Of Essential Procedural Steps For The Objective Assessment Of Competence In Facial Botulinum Toxin Injections Using The Delphi Methodology
Roy Kazan, MD, PhD, Jad Abi-Rafeh, MSc, Alex Viezel-Mathieu, MD, MSc, Mirko Gilardino, MD, MSc, FACS, FRCSC.
McGill University, Montreal, QC, Canada.

PURPOSE:
Facial botulinum toxin injections (FBTI) represent the most commonly performed aesthetic non-surgical procedures by plastic surgeons. However, post-graduate programs remain devoid of objective tools to adequately assess competence in trainees.
METHODS:
The Delphi methodology was used to establish a list of essential procedural steps in FBTI. A list of 10 suggested skills was generated through a literature search and in consultation with an expert plastic surgeon. An expert panel was selected to which an online survey was administered; suggested skills were ranked for their relevance using a 1-10 Likert Scale. Recommendations for additional skills were solicited and survey rounds were repeated until consensus was achieved. The latter was a measure of panelist reliability and assessed using Cronbach's alpha (≥ 0.8); skills with a rating of 7 or above were taken to be essential.
RESULTS:
The survey process was successful at achieving consensus following two rounds of survey administration. Twenty-one participants completed the first round, representing a response rate of 38%. Percent agreement among the panel was 83% and Cronbach alpha computed as 0.78 necessitating further rounds. The response rate in the second round was 90%; one additional skill was added on the suggestion of multiple experts. Percent agreement improved to 88% and Cronbach's alpha was computed as 0.87. This indicated that consensus was reached and that no further rounds were required.
CONCLUSION:
A total of 9 procedural steps were identified as essential for FBTI. These findings will guide the development of objective assessment tools for the more appropriate training of aesthetic procedures in plastic surgery.


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