B. K. Bednarski1, T. A. Aloia1, J. E. Lee1, E. G. Grubbs1 1University Of Texas MD Anderson Cancer Center,Surgical Oncology,Houston, TX, USA
Introduction: As a board-certified, ACGME-approved specialty, 24-month Complex General Surgical Oncology (CGSO) fellowships are required to evaluate trainees using new CGSO Milestones. The evaluation includes ten disease site-specific patient care milestones (PCMs) scored every 6 months to assess fellow progression. The purpose of this study is to report a novel metric to assess the feasibility of implementation of these new milestones in a large CGSO fellowship.
Methods: Disease site-specific rotation schedules for all fellows completing fellowship in June 2016 and June 2017 were reviewed. Clinical rotations were categorized into PCM groups [PCM1/2 Hepatobiliary (HPB); PCM3/4 Endocrine/Head and Neck (Endo/HN); PCM5/6 Gastrointestinal/Gynecology/Thoracic (GI/Gyn/Thor); PCM7/8 Breast; PCM9/10 Melanoma/Sarcoma (Mel/Sarc)]. The number of rotations per fellow in each PCM category per 6-month evaluation period was determined. The Opportunity for Milestone Progress (OMP) score was defined as the percentage of fellows having subsequent 6–month PCM evaluations in the same category to allow assessment of progression. OMP-0, OMP-1, OMP-2 and OMP-3 were calculated for each PCM pair with 0, ≥ 1, ≥ 2 and 3 subsequent PCM evaluations.
Results: Over the study period, the rotation schedules of 13 fellows were reviewed. The total number of clinical rotations was 224 with an average of 17.2 rotations/fellow. The rotations contributed to 255 evaluable rotations in the 5 PCM categories as some rotations map to two disease sites. During the study period, 52 theoretical PCM assessments could be performed. The median number of PCM categories evaluated per 6-month period was 3 (Range 2-4). The OMP scores were highest for PCM5/6 (GI/Gyn/Thor) and PCM9/10 (Mel/Sarc) where the OMP-2 scores were 100%, and OMP-3 scores were 76.9% and 38.5%, respectively. On the other hand, PCM7/8 (Breast) and PCM3/4 (Endo/HN) faired much worse whereby 30.8% and 77.8% of fellows never had subsequent milestone assessments (Table 1).
Conclusion: In a large CGSO fellowship program, the implementation of disease site-specific PCMs results in assessment of only 60% of eligible milestones in a 6-month period. Moreover, the subsequent assessment of fellows’ progress in achieving the PCMs is limited as measured by the novel OMP scores. Challenges with the current disease site-specific PCMs are related to the content, frequency, and timing of clinical rotations during the 24-month fellowship. Future studies examining the outcome of disease site-specific PCM assessment as it correlates to OMP scores and new CGSO case requirements is warranted to determine the optimal number of assessments per milestone and the adequacy of this approach to fellow evaluation.
