Intended for healthcare professionals

Letters Surgical performance

A narrow definition of performance perhaps?

BMJ 2012; 344 doi: (Published 28 February 2012) Cite this as: BMJ 2012;344:e1439
  1. Suparna Das, consultant anaesthetist1
  1. 1South London Healthcare NHS Trust, London SE18 4QH, UK
  1. suparnadas1{at}

In the 21st century, performance management and key performance indicators are something doctors will simply have to learn to live with. From that perspective, this research is timely and interesting.1 However, as the authors state, the study has serious limitations, such as sample size, definition of experience, cross sectional design, and inability to extrapolate findings to other surgical specialties. So are the findings valid? If not, what is the point of this exercise by 11 eminent healthcare professionals?

What intrigued me further is the narrow definition of performance as determined by specific postoperative complications after thyroidectomy—presumably to allow rigorous quantitative analysis and comparison. But surely performance is the sum of knowledge, skills, and attitudes, not just the first two, as this study suggests. And admittedly, attitudes, communication skills, interpersonal skills, leadership, and so on cannot be measured quantitatively but require qualitative research methods.

The trend these days is to look at high performing teams and not high performing individuals. Were higher complication rates related to poor system design or inadequate team working or behavioural attributes? We simply don’t know. And spending further resources on a longitudinal study, as the authors recommend, won’t answer these questions either.


Cite this as: BMJ 2012;344:e1439


  • Competing interests: None declared.


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