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Competency-Based Education: Will This be the New Training Paradigm in Plastic Surgery? J Craniofac Surg 2023; 34:181-186. [PMID: 36104832 DOI: 10.1097/scs.0000000000009005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/14/2022] [Indexed: 01/11/2023] Open
Abstract
The Accreditation Council for Graduate Medical Education created the "Next Accreditation System" in 2013 requiring residents to meet educational milestones based on core competencies over the course of their training. The 6 core competencies include patient care and technical skills, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice. Since the traditional time-based model requires a predetermined length of training irrespective of learning style, pace, or activity, a competency-based model is appealing because it refocuses education on deliberate and relevant skills acquisition and retention. Plastic surgery has been slowly transitioning to competency-based education (CBE), thereby permitting residents to learn at their own pace to master each competency. We performed a nonsystematic literature review of the efficacy of CBE and implementation efforts, particularly within plastic surgery. The literature revealed perceived barriers to implementation, as well as the nuts and bolts of implementation. We highlighted possible solutions and training tools with practical applications in plastic surgery. Success of CBE in plastic surgery requires instituting a transparent process that involves continuously piloting multiple assessment tools and a discussion of related costs. CBE may be particularly appealing for trainees focused on further training in craniofacial or pediatric plastic surgery after completion of an integrated or independent training program in plastic surgery to allow them to focus on their career interests once competence is achieved in the core skills required of a plastic surgeon.
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Sarıoğlu Büke A, Karabilgin Öztürkçü ÖS, Yılmaz Y, Sayek İ. Core Professionalism Education in Surgery: A Systematic Review. Balkan Med J 2018; 35:167-173. [PMID: 29553464 PMCID: PMC5863255 DOI: 10.4274/balkanmedj.2017.0534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Professionalism education is one of the major elements of surgical residency education. AIMS To evaluate the studies on core professionalism education programs in surgical professionalism education. STUDY DESIGN Systematic review. METHODS This systematic literature review was performed to analyze core professionalism programs for surgical residency education published in English with at least three of the following features: program developmental model/instructional design method, aims and competencies, methods of teaching, methods of assessment, and program evaluation model or method. A total of 27083 articles were retrieved using EBSCOHOST, PubMed, Science Direct, Web of Science, and manual search. RESULTS Eight articles met the selection criteria. The instructional design method was presented in only one article, which described the Analysis, Design, Development, Implementation, and Evaluation model. Six articles were based on the Accreditation Council for Graduate Medical Education criterion, although there was significant variability in content. The most common teaching method was role modeling with scenario- and case-based learning. A wide range of assessment methods for evaluating professionalism education were reported. The Kirkpatrick model was reported in one article as a method for program evaluation. CONCLUSION It is suggested that for a core surgical professionalism education program, developmental/instructional design model, aims and competencies, content, teaching methods, assessment methods, and program evaluation methods/models should be well defined, and the content should be comparable.
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Affiliation(s)
- Akile Sarıoğlu Büke
- Emeritus Professor of Paediatric Surgery, Pamukkale University School of Medicine, Denizli, Turkey
| | | | - Yusuf Yılmaz
- Department of Medical Education, Ege University School of Medicine, İzmir, Turkey
| | - İskender Sayek
- Emeritus Professor of Surgery, Hacettepe University School of Medicine, Ankara, Turkey
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McKendy KM, Watanabe Y, Lee L, Bilgic E, Enani G, Feldman LS, Fried GM, Vassiliou MC. Perioperative feedback in surgical training: A systematic review. Am J Surg 2016; 214:117-126. [PMID: 28082010 DOI: 10.1016/j.amjsurg.2016.12.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 12/09/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Changes in surgical training have raised concerns about residents' operative exposure and preparedness for independent practice. One way of addressing this concern is by optimizing teaching and feedback in the operating room (OR). The objective of this study was to perform a systematic review on perioperative teaching and feedback. METHODS A systematic literature search identified articles from 1994 to 2014 that addressed teaching, feedback, guidance, or debriefing in the perioperative period. Data was extracted according to ENTREQ guidelines, and a qualitative analysis was performed. RESULTS Thematic analysis of the 26 included studies identified four major topics. Observation of teaching behaviors in the OR described current teaching practices. Identification of effective teaching strategies analyzed teaching behaviors, differentiating positive and negative teaching strategies. Perceptions of teaching behaviors described resident and attending satisfaction with teaching in the OR. Finally models for delivering structured feedback cited examples of feedback strategies and measured their effectiveness. CONCLUSIONS This study provides an overview of perioperative teaching and feedback for surgical trainees and identifies a need for improved quality and quantity of structured feedback.
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Affiliation(s)
- Katherine M McKendy
- Henry K.M. de Kuyper Education Center, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.
| | - Yusuke Watanabe
- Henry K.M. de Kuyper Education Center, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.
| | - Lawrence Lee
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.
| | - Elif Bilgic
- Henry K.M. de Kuyper Education Center, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.
| | - Ghada Enani
- Henry K.M. de Kuyper Education Center, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.
| | - Liane S Feldman
- Henry K.M. de Kuyper Education Center, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.
| | - Gerald M Fried
- Henry K.M. de Kuyper Education Center, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.
| | - Melina C Vassiliou
- Henry K.M. de Kuyper Education Center, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.
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Resident training in a teaching hospital: How do attendings teach in the real operative environment? Am J Surg 2016; 214:141-146. [PMID: 28476201 DOI: 10.1016/j.amjsurg.2015.12.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 12/15/2015] [Accepted: 12/21/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND The study aim was to explore the nature of intraoperative education and its interaction with the environment where surgical education occurs. METHODS Video and audio recording captured teaching interactions between colorectal surgeons and general surgery residents during laparoscopic segmental colectomies. Cases and collected data were analyzed for teaching behaviors and workflow disruptions. Flow disruptions (FDs) are considered deviations from natural case progression. RESULTS Across 10 cases (20.4 operative hours), attendings spent 11.2 hours (54.7%) teaching, using directing (M = 250.1), and confirming (M = 236.1) most. FDs occurred 410 times, accounting for 4.4 hours of case time (21.57%). Teaching occurred with FD events for 2.4 hours (22.2%), whereas 77.8% of teaching happened outside FD occurrence. Teaching methods shifted from active to passive during FD events to compensate for patient safety. CONCLUSIONS Understanding how FDs impact operative learning will inform faculty development in managing interruptions and improve its integration into resident education.
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Pernar LIM, Peyre SE, Hasson RM, Lipsitz S, Corso K, Ashley SW, Breen EM. Exploring the Content of Intraoperative Teaching. JOURNAL OF SURGICAL EDUCATION 2016; 73:79-84. [PMID: 26489601 DOI: 10.1016/j.jsurg.2015.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 09/12/2015] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Much teaching to surgical residents takes place in the operating room (OR). The explicit content of what is taught in the OR, however, has not previously been described. This study investigated the content of what is taught in the OR, specifically during laparoscopic cholecystectomies (LCs), for which a cognitive task analysis (CTA), explicitly delineating individual steps, was available in the literature. METHODS A checklist of necessary technical and decision-making steps to be executed during performance of LCs, anchored in the previously published CTA, was developed. A convenience sample of LCs was identified over a 12-month period from February 2011 to February 2012. Using the checklist, a trained observer recorded explicit teaching that occurred regarding these steps during each observed case. All observations were tallied and analyzed. RESULTS In all, 51 LCs were observed; 14 surgery attendings and 33 residents participated in the observed cases. Of 1042 observable teaching points, only 560 (53.7%) were observed during the study period. As a proportion of all observable steps, technical steps were observed more frequently, 377 (67.3%), than decision-making steps, 183 (32.7%). Also when focusing on technical and decision-making steps alone, technical steps were taught more frequently (60.9% vs 43.3%). CONCLUSIONS Only approximately half of all possible observable teaching steps were explicitly taught during LCs in this study. Technical steps were more frequently taught than decision-making steps. These findings may have important implications: a better understanding of the content of intraoperative teaching would allow educators to steer residents' preoperative preparation, modulate intraoperative instruction by members of the surgical faculty, and guide residents to the most appropriate teaching venues.
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Affiliation(s)
- Luise I M Pernar
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Sarah E Peyre
- Center for Experiential Learning, University of Rochester Medical Center, Rochester, New York
| | - Rian M Hasson
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stuart Lipsitz
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Katherine Corso
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stanley W Ashley
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Elizabeth M Breen
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
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Kwakye G, Chen XP, Havens JM, Irani JL, Yule S, Smink DS. An Apprenticeship Rotation Teaches Chief Residents Nontechnical Skills and ACGME Core Competencies. JOURNAL OF SURGICAL EDUCATION 2015; 72:1095-1101. [PMID: 26250596 DOI: 10.1016/j.jsurg.2015.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 06/28/2015] [Accepted: 07/06/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Traditionally, surgical training has used an apprenticeship model but has more recently moved to a service-based model, with groups of residents working with groups of attending surgeons. We developed an apprenticeship rotation to enhance one-on-one interaction between chief residents and selected faculty. We hypothesized that the apprenticeship rotation would be effective for teaching nontechnical skills (NTS) and core competencies. MATERIALS AND METHODS An apprenticeship rotation was created at a university-based surgery residency in which each chief resident selected a single attending surgeon with whom to work exclusively with for a 4-week period. Emphasis was placed on teaching intraoperative NTS as well as the 4 difficult-to-teach Accreditation Council for Graduate Medical Education core competencies (DCC): Interpersonal and Communication Skills, Practice-Based Learning and Improvement, Professionalism, and Systems-Based Practice. Participants were surveyed afterwards about their rotation using a 5-point Likert scale. A Wilcoxon signed rank test was used to compare differences depending on data distribution. RESULTS All (13/13) the chief residents and 67% (8/12) faculty completed the survey. Overall, 85% of residents and 87.5% of faculty would recommend the rotation to other residents/faculty members. Both residents and faculty reported improvement in trainees' technical skills and NTS. Residents reported improvement in all 4 DCC, particularly, Practice-Based Learning and Improvement, Professionalism, and Interpersonal and Communication Skills. CONCLUSION The apprenticeship rotation is an effective means of teaching residents both NTS and DCC essential for independent practice. Consideration should be given to introducing this program into surgical curricula nationally.
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Affiliation(s)
- Gifty Kwakye
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Joaquim M Havens
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jennifer L Irani
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Steven Yule
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Douglas S Smink
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
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Nguyen N, Elliott JO, Watson WD, Dominguez E. Simulation Improves Nontechnical Skills Performance of Residents During the Perioperative and Intraoperative Phases of Surgery. JOURNAL OF SURGICAL EDUCATION 2015; 72:957-963. [PMID: 25911460 DOI: 10.1016/j.jsurg.2015.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 03/10/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Failures in nontechnical skills (NTS) rather than technical expertise are frequently at the root of medical errors in the operating room (OR). NTS are the cognitive (decision making and situation awareness) and interpersonal (communication and teamwork) skills that are recognized but are not formally addressed in surgical training. The purpose of the study was to examine the effect of simulation-based training (SBT) on NTS performance of surgical residents during simulated laparoscopic cholecystectomy (LC). SETTING The study was performed in a simulated OR at the Center for Medical Education and Innovation at Riverside Methodist Hospital, Columbus, OH. The simulated OR was arranged with standard equipment for LC, a high-fidelity patient simulator, and a real OR team. DESIGN General surgical residents completed 2 identical SBT sessions. For each session, residents were briefed on the LC case, completed the case in the simulated OR, and debriefed their videotaped simulation performance with a content expert. The video recordings were reviewed and the residents' NTS were scored using a perioperative time-out checklist and an intraoperative checklist for LC by 4 raters who were blinded to both the residents' postgraduate year level and the order of the videotaped simulation sessions. RESULTS Residents showed a significant improvement in completeness of the perioperative time-out checklist from session 1 (mean score = 1.27 ± 1.00) to session 2 (mean score = 5.00 ± 1.28), p < 0.001. Residents' scores on the intraoperative checklist also improved from session 1 to session 2, p < 0.05. Overall, residents felt that the simulation was a valuable teaching and training tool and recommend that it be incorporated into residency training. CONCLUSION SBT appears to be an effective technique for improving NTS of surgical residents during the perioperative and intraoperative phases of surgery. As surgical proficiency is 75% nontechnical and 25% technical, it could be reasonably argued that improved NTS of surgeons could improve surgical outcomes.
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Affiliation(s)
- Ngan Nguyen
- OhioHealth Learning, Riverside Methodist Hospital, Columbus, Ohio
| | - John O Elliott
- Department of Medical Education, Riverside Methodist Hospital, Columbus, Ohio
| | - William D Watson
- OhioHealth Learning, Riverside Methodist Hospital, Columbus, Ohio
| | - Edward Dominguez
- Department of Medical Education, Riverside Methodist Hospital, Columbus, Ohio.
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Putnam MD, Kinnucan E, Adams JE, Van Heest AE, Nuckley DJ, Shanedling J. On orthopedic surgical skill prediction--the limited value of traditional testing. JOURNAL OF SURGICAL EDUCATION 2015; 72:458-470. [PMID: 25547465 DOI: 10.1016/j.jsurg.2014.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 09/30/2014] [Accepted: 11/03/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Primary: to assess the utility of our distal radius fracture repair model as a tool for examining residents' surgical skills. Secondary: to compare the residents' ability to achieve specific biomechanically measured fracture stability with traditional test scores. DESIGN Our laboratory pioneered a model that measures biomechanical qualities of a repaired distal radius fracture. Before participation, all residents to be tested completed specified knowledge examinations. During the laboratory exercise, proctors observed each resident and completed Objective Structured Assessment of Technical Skills forms. At the completion of the laboratory, each specimen was tested biomechanically. Written examinations were completed in a proctored setting and computer examinations at home following the honor system. The laboratory exercise had adequate space and materials and allowed 60 minutes to complete the procedure. Residents had equal access to x-ray imaging. SETTING The examination environment of the study resembled an operating room. PARTICIPANTS Postgraduate years 3 and 4 orthopedic residents in our program were asked to participate. The institutional review board reviewed and approved the study as exempt. RESULTS Fracture repair constructs capable of resisting loads expected during rehabilitation were created by approximately half the residents tested. However, traditional written and computer-based testing methods failed to predict which resident's fracture construct would pass the biomechanical testing. Prior in vivo similar case experience was not predictive. CONCLUSIONS The idea that "book smart does not equal street smart" applies to the tested model. To measure surgical skill acquisition and increase public safety related to surgery, it will be necessary to employ new and specific examination methods that identify the skill to be acquired and test the acquisition of this skill as precisely as possible.
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Affiliation(s)
- Matthew D Putnam
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota.
| | | | - Julie E Adams
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Ann E Van Heest
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | | | - Janet Shanedling
- Academic Health Center, University of Minnesota, Minneapolis, Minnesota
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Team interaction during surgery: a systematic review of communication coding schemes. J Surg Res 2015; 195:422-32. [DOI: 10.1016/j.jss.2015.02.034] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 01/22/2015] [Accepted: 02/13/2015] [Indexed: 11/17/2022]
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Abstract
Medical literature has demonstrated the effectiveness of narrative writing in enhancing self-reflection and empathy, which opens the door for deeper understanding of patients' experiences of illness. Similarly, it promotes practitioner well-being. Therefore, it is no surprise that narrative writing finds a new home in medical education. The Accreditation Council of Graduate Medical Education (ACGME), through its Outcome Project, established six core competencies that every residency program must teach. However, no specific pedagogies were suggested. We explored the role that narrative writing can play in reconciling the ACGME core competencies with daily encounters in medical education. Our study suggests a hidden wealth in reflective writing through narratives with a promising potential for application in medical education. Reflective writing may turn out to be an innovative tool for teaching and evaluating ACGME core competencies.
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Affiliation(s)
- Samir Johna
- Residency Program Director at Arrowhead Regional Medical Center and the Fontana Medical Center in CA.
| | - Brandon Woodward
- General Surgery Resident at the Arrowhead Regional/Kaiser Fontana General Surgery Residency Program in CA.
| | - Sunal Patel
- General Surgery Resident at the Arrowhead Regional/Kaiser Fontana General Surgery Residency Program in CA.
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Chaudhry SI, Lien C, Ehrlich J, Lane S, Cordasco K, McDonald FS, Arora VM, Steinmann A. Curricular content of internal medicine residency programs: a nationwide report. Am J Med 2014; 127:1247-54. [PMID: 25168079 DOI: 10.1016/j.amjmed.2014.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 04/11/2014] [Accepted: 08/21/2014] [Indexed: 10/24/2022]
Affiliation(s)
| | - Cynthia Lien
- Hofstra North Shore LIJ School of Medicine, Hempstead, NY
| | - Jason Ehrlich
- Hofstra North Shore LIJ School of Medicine, Hempstead, NY
| | - Susan Lane
- Stony Brook University Medical Center, Stony Brook, NY
| | - Kristina Cordasco
- VA Greater Los Angeles Healthcare System, Los Angeles, Calif; UCLA School of Medicine, Los Angeles, Calif; RAND Corporation, Santa Monica, Calif
| | | | - Vineet M Arora
- University of Chicago Pritzker School of Medicine, Chicago, Ill
| | - Alwin Steinmann
- Exempla Saint Joseph Hospital, Denver, Colo; University of Colorado School of Medicine, Denver
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Guided outcomes in learned efficiency model in clinical medical education: a randomized controlled trial of self-regulated learning. Am J Obstet Gynecol 2014; 211:544.e1-7. [PMID: 24907703 DOI: 10.1016/j.ajog.2014.05.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 05/14/2014] [Accepted: 05/31/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The guided outcomes in learned efficiency (GOLE) model emphasizes the use of evidence-based resources to understand the diagnosis, treatment, follow-up, and prevention of disease. We seek to determine whether presentations created using the GOLE model are superior to an unstructured approach in achieving Accreditation Council for Graduate Medical Education (ACGME) Core Competencies. STUDY DESIGN Consenting medical students were randomized to GOLE or control groups to individually research a self-selected clinical topic. A validated survey instrument was used prepresentation and postpresentation to assess perceived improvement in knowledge. Subjects completed self-evaluations at enrollment and after presentation of their chosen clinical topic. Other students, residents, and a faculty member also completed evaluations after each student presentation. Standard statistical methods (analysis of variance, 2-tailed t test) were used to determine if a statistically significant difference existed between intervention and control groups. RESULTS Self-assessments were similar in the GOLE and control groups. Externally perceived presentation scores were greater in the GOLE group (ACGME global P < .0001, presentation global P = .07), which demonstrated a significant improvement in 5 core competencies. Time spent preparing the presentation and resources utilized did not differ between groups. CONCLUSION The presentations prepared using the GOLE model were rated higher by observers than those prepared using traditional techniques.
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Hu YY, Peyre SE, Arriaga AF, Roth EM, Corso KA, Greenberg CC. War stories: a qualitative analysis of narrative teaching strategies in the operating room. Am J Surg 2011; 203:63-8. [PMID: 22088266 DOI: 10.1016/j.amjsurg.2011.08.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 08/12/2011] [Accepted: 08/12/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND "War stories" are commonplace in surgical education, yet little is known about their purpose, construct, or use in the education of trainees. METHODS Ten complex operations were videotaped and audiotaped. Narrative stories were analyzed using grounded theory to identify emergent themes in both the types of stories being told and the teaching objectives they illustrated. RESULTS Twenty-four stories were identified in 9 of the 10 cases (mean, 2.4/case). They were brief (mean, 58 seconds), illustrative of multiple teaching points (mean, 1.5/story), and appeared throughout the operations. Anchored in personal experience, these stories taught both clinical (eg, operative technique, decision making, error identification) and programmatic (eg, resource management, professionalism) topics. CONCLUSIONS Narrative stories are used frequently and intuitively by physicians to emphasize a variety of intraoperative teaching points. They socialize trainees in the culture of surgery and may represent an underrecognized approach to teaching the core competencies. More understanding is needed to maximize their potential.
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Affiliation(s)
- Yue-Yung Hu
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
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Ahmed K, Miskovic D, Darzi A, Athanasiou T, Hanna GB. Observational tools for assessment of procedural skills: a systematic review. Am J Surg 2011; 202:469-480.e6. [PMID: 21798511 DOI: 10.1016/j.amjsurg.2010.10.020] [Citation(s) in RCA: 171] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 10/11/2010] [Accepted: 10/11/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Assessment by direct observation of procedural skills is an important source of constructive feedback. The aim of this study was to identify observational tools for technical skill assessment, to assess characteristics of these tools, and to assess their usefulness for assessment. METHODS Included studies reported tools for observational assessment of technical skills. A total of 106 articles were included. RESULTS Three main categories included global assessment scales evaluating generic skills (n = 29), task-specific methods assessing procedure-specific skills (n = 30), and combinations of tools evaluating both generic and task-specific skills (n = 47). In most studies, content validity was not evaluated using an accepted scientific method. All tools were assessed for inter-rater reliability and construct validity. Data on feasibility, acceptability, and educational impact were sparse. CONCLUSIONS There is evidence of validity and reliability for observational assessment tools at the trainee level. In most studies a comprehensive analysis of the tools was not achieved. Evaluation of technical skill using current observational assessment tools is not reliable and valid at the specialist level. Future research needs to focus on further systematic tool development and analysis, especially at the specialist level.
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Affiliation(s)
- Kamran Ahmed
- Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital Campus, UK
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Gómez Fleitas M, Manuel Palazuelos JC. La simulación clínica en la formación quirúrgica en el siglo xxi. Cir Esp 2011; 89:133-5. [DOI: 10.1016/j.ciresp.2011.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Accepted: 12/23/2010] [Indexed: 11/28/2022]
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Educational value of the operating room experience during a core surgical clerkship. Am J Surg 2010; 200:167-72. [DOI: 10.1016/j.amjsurg.2009.06.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Revised: 05/30/2009] [Accepted: 06/15/2009] [Indexed: 11/23/2022]
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Toward Outcomes-Based Plastic Surgery Training: A Needs Assessment of Recent Graduates. Plast Reconstr Surg 2009; 124:1703-1710. [DOI: 10.1097/prs.0b013e3181b98c49] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lurie SJ, Mooney CJ, Lyness JM. Measurement of the general competencies of the accreditation council for graduate medical education: a systematic review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2009; 84:301-9. [PMID: 19240434 DOI: 10.1097/acm.0b013e3181971f08] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
PURPOSE To evaluate published evidence that the Accreditation Council for Graduate Medical Education's six general competencies can each be measured in a valid and reliable way. METHOD In March 2008, the authors conducted searches of Medline and ERIC using combinations of search terms "ACGME," "Accreditation Council for Graduate Medical Education," "core competencies," "general competencies," and the specific competencies "systems-based practice" (SBP) and "practice based learning and improvement (PBLI)." Included were all publications presenting new qualitative or quantitative data about specific assessment modalities related to the general competencies since 1999; opinion pieces, review articles, and reports of consensus conferences were excluded. The search yielded 127 articles, of which 56 met inclusion criteria. Articles were subdivided into four categories: (1) quantitative/psychometric evaluations, (2) preliminary studies, (3) studies of SBP and PBLI, and (4) surveys. RESULTS Quantitative/psychometric studies of evaluation tools failed to develop measures reflecting the six competencies in a reliable or valid way. Few preliminary studies led to published quantitative data regarding reliability or validity. Only two published surveys met quality criteria. Studies of SBP and PBLI generally operationalized these competencies as properties of systems, not of individual trainees. CONCLUSIONS The peer-reviewed literature provides no evidence that current measurement tools can assess the competencies independently of one another. Because further efforts are unlikely to be successful, the authors recommend using the competencies to guide and coordinate specific evaluation efforts, rather than attempting to develop instruments to measure the competencies directly.
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Affiliation(s)
- Stephen J Lurie
- Office of Curriculum and Assessment, University of Rochester School of Medicine and Dentistry, Rochester, New York 14642, USA.
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Jamshidi R, Ozgediz D. Medical student teaching: a peer-to-peer toolbox for time-constrained resident educators. JOURNAL OF SURGICAL EDUCATION 2008; 65:95-98. [PMID: 18439527 DOI: 10.1016/j.jsurg.2007.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2007] [Accepted: 11/06/2007] [Indexed: 05/26/2023]
Affiliation(s)
- Ramin Jamshidi
- Department of Surgery, University of California San Francisco, San Francisco, CA 94143-0470, USA.
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