Expertise-Based Randomized Controlled Trials

The randomized controlled trial (RCT) is considered the gold standard for evaluating healthcare interventions. This design presents a challenge for certain treatment modalities, such as surgical interventions, due to the inherent learning curve that some participating surgeons may not be able to overcome. The expertise-based RCT has responded to this challenge by assigning surgeons with objectively determined expertise to that treatment arm exclusively. This chapter will provide a comprehensive approach to interpreting and critically appraising expertise-based RCTs in surgery.