Surgical Education
A major focus of new models in post-graduate medical education is a shift away from time and objective-based training to a competency-based framework. Surgical educators uniformly agree that technical skills exercises designed to allow the resident to opt
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Key Concepts • The dramatic changes in healthcare and surgical training have forced educators to adopt a new approach with an emphasis on outcomes and competence. • A major impediment to surgical education is the lack of hospital or administrative support. The fiscal solvency of most academic institutions is more dependent on a high volume, cost-effective, and efficient department of surgery than ever before. • Work hour restrictions are another major impediment to training. Residents must now make the most of all learning opportunities, as learners no longer have the “luxury” of unlimited clinical immersion. • Simulation and surgical skills laboratories will, over time, have an increasing role in training for general technical skills, such as knot tying and procedure-specific skills. The successful application for procedure-specific training with virtual reality systems has recently been demonstrated in several trials. • Competency-based medical education (CBME) is “an approach to preparing physicians for practice that is fundamentally oriented to graduated outcome abilities and organized around competencies derived from an analysis of societal and patient needs.” • To meet ACGME requirements, multiple assessments will be required to ensure milestone progression along all of the competencies. Assessments that are commonly used include the In-Training Evaluation Report (ITER), 360-Degree evaluations (including patient surveys), chart stimulated recall, oral examinations, multiple choice examinations, portfolios, and simulations and models. • Post-graduate medical education now demands an increase in support at a time of waning resource allocation and protected time. In this climate, education often takes a backseat.
Introduction Major changes in the way we train surgeons are occurring in several areas. One of the developments in medical education over the past decade which will have the largest impact on graduate education has been a shift in the focus from the processes of education to the outcomes of education, or development of competencies and attainment of milestones [1, 2]. This focus on outcome assessment and milestone achievement will require that training programs make better use of other advances in surgical education, such as simulation. Simulation-based training has also been used to help accelerate learners’ growth in knowledge, skills, and attitudes, prior to entering the clinical arena, and the literature evaluating the use of simulation-based learning will be examined. As well, a competency-based framework requires that multiple formative and summative assessments be used to ensure that the required outcomes are achieved. To help in assessing the outcomes of training, practical methods that are available to assess learners in the six broad competencies of the Accreditation Council for Graduate Medical Education (ACGME) outcome project will be discussed. Finally, we will use examples from the Colorectal Surgery Milestones from the American Board of Colorectal Surgery and ACGME milestones project to demo
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