M. L. Cox1, S. R. Sprinkle1, U. Nag1, M. C. Turner1, R. Sudan1 1Duke University Medical Center,Durham, NC, USA
Introduction:
Surgical training has evolved tremendously since the first program was started by William Halstead in 1904. Arguably, the most impactful change occurred in July 2003 with implementation of the 80-hour work week after patient safety concerns were raised by the Libby Zion case. Since that time, there has been increased emphasis on patient outcomes in the academic environment and a new focus on competency-based training in surgical education. Many pilot studies and competency curriculums are evolving across the nation, but resident input on these changes has yet to be investigated. Our aim was to solicit opinions from residents at our institution prior to implementing a competency-based simulation curriculum.
Methods:
A survey was created using Qualtrics (Provo, UT, http://www.qualtrics.com) and distributed to 44 general surgery residents at a single institution. Anonymous responses were collected from January to February 2016 with a total of three email invitations to participate. Most questions utilized a corresponding five point Likert scale with space for free-text commentary. Categorical variables were analyzed by chi-squared tests using SAS (version, 9.4; SAS Institute Inc., Cary, NC).
Results:
Thirty residents (68.2%) participated with an 86.7% (26/30) survey completion rate. According to 63.0% (17/27) of residents, instituting modules to test competencies prior to performing a skill in the operating room should be a high priority compared to 22.2% (6/27) rating it as a low priority and 14.8% (4/27) categorizing it as not necessary (p=0.004). If a resident were to fail a particular competency, 73.1% (19/26) of residents felt a personalized remediation program would be somewhat to very useful (p<0.001). However, 61.5% (16/26) of residents did not believe a resident should be prevented from advancing to the next clinical year after failure to pass a competency (p=0.006). Subjective comments revealed concerns regarding the validity of the metrics utilized to determine competency as well as the quality and reproducibility of simulators used for testing. Residents requested that a well-defined curriculum with milestones be developed with the expectation of increased operating room autonomy once a competency is achieved.
Conclusion:
Competency-based training is important for patient safety and is the future of surgical education, but such curricular changes directly affect residents. Our institutional study reveals that residents are accepting of a competency-based curriculum and believe its implementation is a high priority. However, some reservations exist, and this type of curriculum requires thoughtful implementation to produce valid metrics, maintain objectivity, and set expectations for increased autonomy. Once a competency-based curriculum is instituted, further evaluation will consist of resident surveys, individual competency data, resident case-logs, and patient outcomes to maximize the utility of the new educational model.