Key result
Expertise-based randomized controlled trials, where patients are randomized to surgeons with specific expertise, can overcome differential expertise bias seen in conventional surgical RCTs.
Expertise-based randomized controlled trials may overcome differential expertise bias in surgical trials by randomizing patients to surgeons with specific expertise rather than randomizing patients to interventions performed by potentially less experienced surgeons.
Expertise-based RCTs merit pilot evaluation in orthopedics; leaves open empirical confirmation of bias reduction versus conventional designs.
In this article, we discuss the limitations of conventional randomized controlled trials (RCTs) in the surgical field. Surgeons are often believers in certain surgical techniques and therefore can be reluctant to learn new interventions. In expertise-based trials, the patients are randomized to surgeons with expertise in the intervention under investigation. In conventional RCTs, patients are randomized to an intervention, and surgeons will perform this intervention regardless of whether this is the surgery they typically undertake. Conventional randomization may lead to surgery performed by a less experienced or less motivated surgeon, resulting in differential expertise bias. Expertise-based trials can overcome these limitations if potential pitfalls are taken into account.
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Scholtes et al. (2012) conducted a review in Orthopaedic surgery. Expertise-based randomized controlled trials vs. Conventional randomized controlled trials was evaluated. Expertise-based randomized controlled trials, where patients are randomized to surgeons with specific expertise, can overcome differential expertise bias seen in conventional surgical RCTs.
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