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Deer TR, Russo MA, Sayed D, Pope JE, Grider JS, Hagedorn JM, Falowski SM, Al-Kaisy A, Slavin KV, Li S, Poree LR, Eldabe S, Meier K, Lamer TJ, Pilitsis JG, De Andrés J, Perruchoud C, Carayannopoulos AG, Moeschler SM, Hadanny A, Lee E, Varshney VP, Desai MJ, Pahapill P, Osborn J, Bojanic S, Antony A, Piedimonte F, Hayek SM, Levy RM. The Neurostimulation Appropriateness Consensus Committee (NACC)®: Recommendations for the Mitigation of Complications of Neurostimulation. Neuromodulation 2024; 27:977-1007. [PMID: 38878054 DOI: 10.1016/j.neurom.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/27/2024] [Accepted: 04/08/2024] [Indexed: 08/09/2024]
Abstract
INTRODUCTION The International Neuromodulation Society convened a multispecialty group of physicians based on expertise and international representation to establish evidence-based guidance on the mitigation of neuromodulation complications. This Neurostimulation Appropriateness Consensus Committee (NACC)® project intends to update evidence-based guidance and offer expert opinion that will improve efficacy and safety. MATERIALS AND METHODS Authors were chosen on the basis of their clinical expertise, familiarity with the peer-reviewed literature, research productivity, and contributions to the neuromodulation literature. Section leaders supervised literature searches of MEDLINE, BioMed Central, Current Contents Connect, Embase, International Pharmaceutical Abstracts, Web of Science, Google Scholar, and PubMed from 2017 (when NACC last published guidelines) to October 2023. Identified studies were graded using the United States Preventive Services Task Force criteria for evidence and certainty of net benefit. Recommendations are based on the strength of evidence or consensus when evidence was scant. RESULTS The NACC examined the published literature and established evidence- and consensus-based recommendations to guide best practices. Additional guidance will occur as new evidence is developed in future iterations of this process. CONCLUSIONS The NACC recommends best practices regarding the mitigation of complications associated with neurostimulation to improve safety and efficacy. The evidence- and consensus-based recommendations should be used as a guide to assist decision-making when clinically appropriate.
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Affiliation(s)
- Timothy R Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA.
| | | | - Dawood Sayed
- The University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Jay S Grider
- UKHealthCare Pain Services, Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Jonathan M Hagedorn
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Adnan Al-Kaisy
- Guy's and St. Thomas National Health Service (NHS) Foundation Trust, The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - Konstantin V Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA; Neurology Section, Jesse Brown Veterans Administration Medical Center, Chicago, IL, USA
| | - Sean Li
- National Spine & Pain Centers, Shrewsbury, NJ, USA
| | - Lawrence R Poree
- Department of Anesthesia and Perioperative Care, University of California at San Francisco, San Francisco, CA, USA
| | - Sam Eldabe
- The James Cook University Hospital, Middlesbrough, UK
| | - Kaare Meier
- Department of Anesthesiology (OPINord), Aarhus University Hospital, Aarhus, Arhus, Denmark; Department of Neurosurgery (Afd. NK), Aarhus University Hospital, Aarhus, Arhus, Denmark
| | | | | | - Jose De Andrés
- Valencia School of Medicine, Anesthesia Critical Care and Pain Management Department, General University Hospital, Valencia, Spain
| | | | - Alexios G Carayannopoulos
- Department of Physical Medicine and Rehabilitation and Comprehensive Spine Center, Rhode Island Hospital, Providence, RI, USA; Brown University Warren Alpert Medical School (Neurosurgery), Providence, RI, USA
| | - Susan M Moeschler
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Amir Hadanny
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Eric Lee
- Mililani Pain Center, Mililani, HI, USA
| | - Vishal P Varshney
- Anesthesiology and Pain Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Mehul J Desai
- International Spine, Pain & Performance Center, Virginia Hospital Center, Monument Research Institute, George Washington University School of Medicine, Arlington, VA, USA
| | - Peter Pahapill
- Functional Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - J Osborn
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Stana Bojanic
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ajay Antony
- The Orthopaedic Institute, Gainesville, FL, USA
| | - Fabian Piedimonte
- School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Salim M Hayek
- Case Western Reserve University, University Hospitals of Cleveland, Cleveland, OH, USA
| | - Robert M Levy
- Neurosurgical Services, Clinical Research, Anesthesia Pain Care Consultants, Tamarac, FL, USA
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Ly N, Ocoko F, Minter RM, Jung S. Assessing general surgery residents outside of the operating room: Our experience with entrustable professional activities in the pre-operative and post-operative settings. Am J Surg 2024:115849. [PMID: 39060189 DOI: 10.1016/j.amjsurg.2024.115849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/08/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024]
Affiliation(s)
- Nancy Ly
- Department of Surgery, Southern Illinois University, Springfield, IL, USA
| | - Faith Ocoko
- University of Wisconsin-Madison, Madison, WI, USA
| | - Rebecca M Minter
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sarah Jung
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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Kitto S, Fantaye AW, Zevin B, Fowler A, Sachdeva AK, Raiche I. A Scoping Review of the Literature on Entrustable Professional Activities in Surgery Residency Programs. JOURNAL OF SURGICAL EDUCATION 2024; 81:823-840. [PMID: 38679495 DOI: 10.1016/j.jsurg.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/20/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVE Entrustable professional activities (EPAs) are a crucial component of contemporary postgraduate medical education with many surgery residency programs having implemented EPAs as a competency assessment framework to assess and provide feedback on the performance of their residents. Despite broad implementation of EPAs, there is a paucity of evidence regarding the impact of EPAs on the learners and learning environments. A first step in improving understanding of the use and impact of EPAs is by mapping the rising number of EPA-related publications from the field of surgery. The primary objective of this scoping review is to examine the nature, extent, and range of articles on the development, implementation, and assessment of EPAs. The second objective is to identify the experiences and factors that influence EPA implementation and use in practice in surgical specialties. DESIGN Scoping review. Four electronic databases (Medline, Embase, Education Source, and ERIC) were searched on January 20, 2022, and then again on July 19, 2023. A quasi-statistical content analysis was employed to quantify and draw meaning from the information related to the development, implementation, assessment, validity, reliability, and experiences with EPAs in the workplace. PARTICIPANTS A total of 42 empirical and nonempirical articles were included. RESULTS Four thematic categories describe the topic areas in included articles related to: 1) the development and refinement of EPAs, including the multiple steps taken to develop and refine unique EPAs for surgery residency programs; 2) the methods for implementing EPAs; 3) outcomes of EPA use in practice; 4) barriers, facilitators, and areas for improvement for the implementation and use of EPAs in surgical education. CONCLUSIONS This scoping review highlights the key trends and gaps from the rapidly increasing number of publications on EPAs in surgery residency, from development to their use in the workplace. Existing EPA studies lack a theoretical and/or conceptual basis; future development and implementation studies should adopt implementation science frameworks to better structure and operationalize EPAs within surgery residency programs.
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Affiliation(s)
- Simon Kitto
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Arone W Fantaye
- Office of Continuing Professional Development, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Boris Zevin
- Department of Surgery, Queen's University, Kingston, Canada
| | - Amanda Fowler
- Department of Surgery, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Ajit K Sachdeva
- Division of Education, American College of Surgeons, Chicago, Illinios
| | - Isabelle Raiche
- Department of Surgery, University of Ottawa, Ottawa, Canada.
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Montgomery KB, Mellinger JD, Lindeman B. Entrustable Professional Activities in Surgery: A Review. JAMA Surg 2024; 159:571-577. [PMID: 38477902 PMCID: PMC11260519 DOI: 10.1001/jamasurg.2023.8107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
Importance Entrustable professional activities (EPAs) compose a competency-based education (CBE) assessment framework that has been increasingly adopted across medical specialties as a workplace-based assessment tool. EPAs focus on directly observed behaviors to determine the level of entrustment a trainee has for a given activity of that specialty. In this narrative review, we highlight the rationale for EPAs in general surgery, describe current evidence supporting their use, and outline some of the practical considerations for EPAs among residency programs, faculty, and trainees. Observations An expanding evidence base for EPAs in general surgery has provided moderate validity evidence for their use as well as practical recommendations for implementation across residency programs. Challenges to EPA use include garnering buy-in from individual faculty and residents to complete EPA microassessments and engage in timely, specific feedback after a case or clinical encounter. When successfully integrated into a program's workflow, EPAs can provide a more accurate picture of residents' competence for a fundamental surgical task or activity compared with other assessment methods. Conclusions and Relevance EPAs represent the next significant shift in the evaluation of general surgery residents as part of the overarching progression toward CBE among all US residency programs. While pragmatic challenges to the implementation of EPAs remain, the best practices from EPA and other CBE assessment literature summarized in this review may assist individuals and programs in implementing EPAs. As EPAs become more widely used in general surgery resident training, further analysis of barriers and facilitators to successful and sustainable EPA implementation will be needed to continue to optimize and advance this new assessment framework.
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Farmer DL, O'Connell PR, Pugh CM, Lang H, Greenberg CC, Borel-Rinkes IH, Mellinger JD, Pinto-Marques H. Surgical Education. Ann Surg 2023; 278:642-646. [PMID: 37796749 DOI: 10.1097/sla.0000000000006078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
This paper summarizes the proceedings of the joint European Surgical Association ESA/American Surgical Association symposium on Surgical Education that took place in Bordeaux, France, as part of the celebrations for 30 years of ESA scientific meetings. Three presentations on the use of quantitative metrics to understand technical decisions, coaching during training and beyond, and entrustable professional activities were presented by American Surgical Association members and discussed by ESA members in a symposium attended by members of both associations.
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Affiliation(s)
- Diana L Farmer
- Department of Surgery, University of California Davis Health, Davis, CA
| | | | - Carla M Pugh
- Department of Surgery, Stanford Medicine, Stanford, CA
| | - Hauke Lang
- University Medical Centre of the Johannes Gutenberg University Mainz, Germany
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Krecko LK, Jung S, Martin S, Krebsbach C, Rosser AA, Stahl C, Varley P, Greenberg J, Minter RM. Enhancing the Value of Surgical Entrustable Professional Activities through Integrative Learning Analytics. JOURNAL OF SURGICAL EDUCATION 2023; 80:1370-1377. [PMID: 37596105 DOI: 10.1016/j.jsurg.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/16/2023] [Accepted: 07/23/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVE To demonstrate the value of integrating surgical resident Entrustable Professional Activity (EPA) data into a learning analytics platform that provides meaningful feedback for formative and summative decision-making. DESIGN Description of the Surgical Entrustable Professional Activities (SEPA) analytics dashboard, and examples of summary analytics and intuitive display features. SETTING Department of Surgery, University of Wisconsin Hospital and Clinics. PARTICIPANTS Surgery residents, faculty, and residency program administrators. RESULTS We outline the major functionalities of the SEPA dashboard and offer concrete examples of how these features are utilized by various stakeholders to support progressive entrustment decisions for surgical residents. CONCLUSIONS Our intuitive analytics platform allows for seamless integration of SEPA microassessment data to support Clinical Competency Committee (CCC) decisions for resident evaluation and provides point of training feedback to faculty and trainees in support of progressive autonomy.
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Affiliation(s)
- Laura K Krecko
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Sarah Jung
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Shaun Martin
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Craig Krebsbach
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Christopher Stahl
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Patrick Varley
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jacob Greenberg
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Rebecca M Minter
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
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Stefan P, Pfandler M, Kullmann A, Eck U, Koch A, Mehren C, von der Heide A, Weidert S, Fürmetz J, Euler E, Lazarovici M, Navab N, Weigl M. Computer-assisted simulated workplace-based assessment in surgery: application of the universal framework of intraoperative performance within a mixed-reality simulation. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2023; 5:e000135. [PMID: 36687799 PMCID: PMC9853221 DOI: 10.1136/bmjsit-2022-000135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 08/24/2022] [Indexed: 01/20/2023] Open
Abstract
Objectives Workplace-based assessment (WBA) is a key requirement of competency-based medical education in postgraduate surgical education. Although simulated workplace-based assessment (SWBA) has been proposed to complement WBA, it is insufficiently adopted in surgical education. In particular, approaches to criterion-referenced and automated assessment of intraoperative surgical competency in contextualized SWBA settings are missing.Main objectives were (1) application of the universal framework of intraoperative performance and exemplary adaptation to spine surgery (vertebroplasty); (2) development of computer-assisted assessment based on criterion-referenced metrics; and (3) implementation in contextualized, team-based operating room (OR) simulation, and evaluation of validity. Design Multistage development and assessment study: (1) expert-based definition of performance indicators based on framework's performance domains; (2) development of respective assessment metrics based on preoperative planning and intraoperative performance data; (3) implementation in mixed-reality OR simulation and assessment of surgeons operating in a confederate team. Statistical analyses included internal consistency and interdomain associations, correlations with experience, and technical and non-technical performances. Setting Surgical simulation center. Full surgical team set-up within mixed-reality OR simulation. Participants Eleven surgeons were recruited from two teaching hospitals. Eligibility criteria included surgical specialists in orthopedic, trauma, or neurosurgery with prior VP or kyphoplasty experience. Main outcome measures Computer-assisted assessment of surgeons' intraoperative performance. Results Performance scores were associated with surgeons' experience, observational assessment (Objective Structured Assessment of Technical Skill) scores and overall pass/fail ratings. Results provide strong evidence for validity of our computer-assisted SWBA approach. Diverse indicators of surgeons' technical and non-technical performances could be quantified and captured. Conclusions This study is the first to investigate computer-assisted assessment based on a competency framework in authentic, contextualized team-based OR simulation. Our approach discriminates surgical competency across the domains of intraoperative performance. It advances previous automated assessment based on the use of current surgical simulators in decontextualized settings. Our findings inform future use of computer-assisted multidomain competency assessments of surgeons using SWBA approaches.
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Affiliation(s)
- Philipp Stefan
- Chair for Computer Aided Medical Procedures and Augmented Reality, Department of Informatics, Technical University of Munich, München, Germany
| | - Michael Pfandler
- Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, University Hospital, Ludwig Maximilians University Munich, München, Germany
| | - Aljoscha Kullmann
- Chair for Computer Aided Medical Procedures and Augmented Reality, Department of Informatics, Technical University of Munich, München, Germany
| | - Ulrich Eck
- Chair for Computer Aided Medical Procedures and Augmented Reality, Department of Informatics, Technical University of Munich, München, Germany
| | - Amelie Koch
- Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, University Hospital, Ludwig Maximilians University Munich, München, Germany
| | - Christoph Mehren
- Spine Center, Schön Klinik München Harlaching, München, Germany,Academic Teaching Hospital and Spine Research Institute, Paracelsus Medical University, Salzburg, Austria
| | - Anna von der Heide
- Department of General, Trauma and Reconstructive Surgery, University Hospital, Campus Grosshadern, Ludwig Maximilians University Munich, München, Germany
| | - Simon Weidert
- Department of General, Trauma and Reconstructive Surgery, University Hospital, Campus Grosshadern, Ludwig Maximilians University Munich, München, Germany
| | - Julian Fürmetz
- Department of General, Trauma and Reconstructive Surgery, University Hospital, Campus Innenstadt, Ludwig Maximilians University Munich, München, Germany
| | - Ekkehard Euler
- Department of General, Trauma and Reconstructive Surgery, University Hospital, Campus Innenstadt, Ludwig Maximilians University Munich, München, Germany
| | - Marc Lazarovici
- Institute for Emergency Medicine and Management in Medicine (INM), University Hospital, Ludwig Maximilians University Munich, München, Germany
| | - Nassir Navab
- Chair for Computer Aided Medical Procedures and Augmented Reality, Department of Informatics, Technical University of Munich, München, Germany
| | - Matthias Weigl
- Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, University Hospital, Ludwig Maximilians University Munich, München, Germany,Institute for Patient Safety, University of Bonn, Bonn, Germany
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Hanson MN, Pryor AD, Jeyarajah DR, Minter RM, Mattar SG, Scott DJ, Brunt LM, Cummings M, Vassiliou M, Feldman LS. Implementation of entrustable professional activities into fellowship council accredited programs: a pilot project. Surg Endosc 2022; 37:3191-3200. [PMID: 35974253 PMCID: PMC9381155 DOI: 10.1007/s00464-022-09502-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/23/2022] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The Fellowship Council (FC) is transitioning to a competency-based medical education (CBME) model, including the introduction of Entrustable Professional Activities (EPAs) for training and assessment of Fellows. This study describes the implementation process employed by the FC during a ten-month pilot project and presents data regarding feasibility and perceived value. METHODS The FC coordinated the development of EPAs in collaboration with the sponsoring societies for Advanced GI/MIS, Bariatrics, Foregut, Endoscopy and Hepatopancreaticobiliary (HPB) fellowships encompassing the preoperative, intraoperative, and postoperative phases of care for key competencies. Fifteen accredited fellowship programs participated in this project. The assessments were collected through a unique platform on the FC website. Programs were asked to convene a Clinical Competency Committee (CCC) on a quarterly basis. The pilot group met monthly to support and improve the process. An exit survey evaluated the perceived value of EPAs. RESULTS The 15 participating programs included 18 fellows and 106 faculty. A total of 655 assessments were initiated with 429 (65%) completed. The average (SD) number of EPAs completed for each fellow was 24(18); range 0-72. Intraoperative EPAs were preferentially completed (71%). The average(SD) time for both the fellow and faculty to complete an EPA was 27(78) hours. Engagement increased from 39% of fellows completing at least one EPA in September to 72% in December and declining to 50% in May. Entrustment level increased from 6% of EPAs evaluated as "Practice Ready" in September to 75% in June. The exit survey was returned by 63% of faculty and 72% of fellows. Overall, 46% of fellows and 74% of program directors recommended full-scale implementation of the EPA framework. CONCLUSION A competency-based assessment framework was developed by the FC and piloted in several programs. Participation was variable and required ongoing strategies to address barriers. The pilot project has prepared the FC to introduce CBME across all FC training programs.
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Affiliation(s)
- Melissa N Hanson
- Department of Surgery, McGill University, 1650 Cedar Ave, D6-136, Montreal, QC, H3G 1A4, Canada.,Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, H3A 0G4, Canada
| | - Aurora D Pryor
- Department of Surgery, Stony Brook Medicine, Stony Brook, NY, 11794, USA
| | - D Rohan Jeyarajah
- Department of Surgery, TCU School of Medicine and Methodist Richardson Medical Center, Richardson, TX, 75082, USA
| | - Rebecca M Minter
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53792, USA
| | - Samer G Mattar
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Daniel J Scott
- Department of Surgery, UT Southwestern Medical Center, Dallas, TX, 75390, USA
| | - L Michael Brunt
- Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | | | - Melina Vassiliou
- Department of Surgery, McGill University, 1650 Cedar Ave, D6-136, Montreal, QC, H3G 1A4, Canada.,Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, H3A 0G4, Canada
| | - Liane S Feldman
- Department of Surgery, McGill University, 1650 Cedar Ave, D6-136, Montreal, QC, H3G 1A4, Canada. .,Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, H3A 0G4, Canada.
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Thomson B, O'Halloran H, Wu L, Gauthier S, Taylor D. Transition to practice curriculum for general internal medicine physicians: scoping review and Canadian national survey. BMC MEDICAL EDUCATION 2022; 22:609. [PMID: 35945567 PMCID: PMC9361703 DOI: 10.1186/s12909-022-03673-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 07/29/2022] [Indexed: 05/16/2023]
Abstract
BACKGROUND There remains a paucity of evidence for curricula for the transition to practice (TTP) stage of Competence by Design internal medicine (IM) training programs. Current entrustable professional activities are based on expert consensus rather than robust subspecialty-specific needs assessment. METHODS A scoping review was completed to identify studies with TTP focus. A national survey was conducted to identify transition experiences for general internal medicine physicians. Results were assessed by grounded theory analysis to identify core topics for TTP curricula. RESULTS Neither scoping review nor national survey identified TTP topics related to the CanMEDS Medical Expert role. Scoping Review: 41 relevant studies were identified. Most (97.6%) were from North America. The most common study types were observational (survey) or curriculum (13/41 31.7% for each). Only two studies were exclusively in IM, and the most common subspecialty studied was surgical (13/41, 31.7%). The most common TTP topics were mentorship, billing and coding, practice management, negotiating contract and job, and financial aspects of practice. National Survey: There were 44 respondents, with the majority (25/44, 56.8%) having completed an IM subspecialty fellowship. Most (38/44) completed medical school in Canada, and most were from academic practice settings (33/44, 75.0%). The most common TTP topics were billing and coding, personal financial planning, practice management, work-life balance and mentorship. Grounded Theory Analysis: There were six themes that encompassed all TTP topics from the scoping review and national survey, being (i) building a career, (ii) continuing professional development, (iii) expectations of the profession, (iv) practice management, (v) Life, health and well-being and (vi) clinical skills. Curriculum competencies and resources for curriculum development were provided. CONCLUSIONS This study identifies topics critical for curricula development for IM transition to practice. Further research is required to evaluate effectiveness of curricula including topics and themes developed from this scoping review and national survey.
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Affiliation(s)
- Benjamin Thomson
- Department of Medicine, Division of General Internal Medicine, Queen's University, 76 Stuart Street, Kingston, ON, K7L-2V7, Canada.
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA.
| | - Heather O'Halloran
- Department of Medicine, Division of General Internal Medicine, Queen's University, 76 Stuart Street, Kingston, ON, K7L-2V7, Canada
| | - Luke Wu
- Department of Medicine, Division of General Internal Medicine, Queen's University, 76 Stuart Street, Kingston, ON, K7L-2V7, Canada
| | - Stephen Gauthier
- Department of Medicine, Division of General Internal Medicine, Queen's University, 76 Stuart Street, Kingston, ON, K7L-2V7, Canada
| | - David Taylor
- Department of Medicine, Division of General Internal Medicine, Queen's University, 76 Stuart Street, Kingston, ON, K7L-2V7, Canada
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Resident self-assessment of common endocrine procedures. Am J Surg 2021; 223:1094-1099. [PMID: 34689978 DOI: 10.1016/j.amjsurg.2021.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/10/2021] [Accepted: 10/15/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND General surgery residency graduates are expected to be proficient in straightforward endocrine operations. This study aimed to elucidate residents' self-assessment of their ability to perform common endocrine procedures. METHODS A fourteen-question survey was emailed to general surgery residents from seven U.S. residency programs regarding their self-assessed ability to perform each step of a straightforward thyroidectomy and parathyroidectomy. Demographics and perceived ability to perform the various procedures were collected. RESULTS A minority of respondents (17, 27.9%) agreed they could complete a straightforward thyroidectomy for benign disease, with only 11.7% (n = 7) agreeing they could complete a straightforward thyroidectomy for malignant disease. 26.2% (n = 16) of respondents agreed they could complete a straightforward parathyroidectomy. Completed number of cases was significantly associated with greater self-assessed ability to perform the endocrine operations (p = 0.02). CONCLUSIONS Most general surgery residents surveyed did not feel capable of performing common, straightforward endocrine procedures. Although confidence in operative ability increased with PGY-level and number of cases completed, the majority of PGY-5 residents still did not feel able to perform a thyroidectomy for malignant disease unassisted.
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Entrustable Professional Activities, a tool for addressing gender bias and the Imposter Syndrome? Ann Surg 2021; 275:230-231. [PMID: 34433185 DOI: 10.1097/sla.0000000000005189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kearse LE, Zeineddin A, Schmiederer IS, Korndorffer JR, Lau JN. A 20-year review of surgical training case logs: Is general surgery still general? Surgery 2021; 170:1347-1352. [PMID: 33975730 DOI: 10.1016/j.surg.2021.03.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/12/2021] [Accepted: 03/31/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Surgical training has undergone many facets of restructuring over the most recent decades, with critiques of the quality and variability of training as well as the competency of recent graduates. This study examines the changes in surgical training in operative volume and breadth in the past 2 decades. METHODS The Accreditation Council for Graduate Medical Education Case Log Statistics Reports from 1999 to 2019 were reviewed. Case logs were grouped into defined case categories and group levels of postgraduate training. Descriptive analyses and multiple linear regressions were performed. RESULTS General surgery residents are graduating with 10.7% more cases, owing to increases in mostly junior year cases (P < .001). The breadth of specialty cases has decreased, while there was an increase in alimentary and abdominal cases to 58.4% from 47.2% 20 years ago. A decrease in vascular surgery cases from 19.9% to 10.7% of all cases was noted. Analysis of the distribution of defined categories showed right skewness in many categories with mode being much lower than reported mean. CONCLUSION Evaluation of trends, despite residents graduating with higher case volume than the minimum required, shows that the breadth and variety of cases has narrowed significantly in the past 20 years, providing a case for general surgery training restructuring.
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Affiliation(s)
- LaDonna E Kearse
- Department of Surgery, Stanford University School of Medicine, Stanford, CA.
| | - Ahmad Zeineddin
- Department of Surgery, Howard University Hospital, Washington, DC
| | | | | | - James N Lau
- Department of Surgery, Loyola University Medical Center, Maywood, IL
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13
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Cruz AP, Skolarus TA, Ambani SN, Hafez K, Kraft KH. Aligning Urology Residency Training With Real-World Workforce Needs. JOURNAL OF SURGICAL EDUCATION 2021; 78:820-827. [PMID: 33046414 PMCID: PMC7546236 DOI: 10.1016/j.jsurg.2020.09.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/25/2020] [Accepted: 09/26/2020] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Research suggests recently graduated urology residents do not feel ready for independent practice. We conducted a study to determine if Accreditation Council for Graduate Medical Education (ACGME) minimum case requirements, resident case logs, and graduating resident perceived readiness for practice are aligned with the procedural demand and needs of the current urology workforce. DESIGN Correlative study comparing the association between (1) workforce demand and ACGME case requirements, and (2) workforce demand and perceived resident competency. Three distinct datasets were used; (1) the 2017 Medicare Part B National Summary Data File; (2) the 2017 National Data Report published by the ACGME; and (3) a graduating resident survey from Okhunov et al. SETTING: N/A. PARTICIPANTS N/A. RESULTS In 2017, there were a total of 6,784,696 urologic cases performed through Medicare. We found nonsignificant positive associations between resident case logs (rho = 0.16, p = 0.5784), ACGME minimum procedure requirements (rho = 0.42, p = 0.1255), and Medicare procedural demand. Our 15 index procedures accounted for 21.1% (n = 1,431,775) of all Medicare cases, with a median number of 7706 procedures. Endopyelotomy was the least common procedure (n = 98), while cystoscopy was the most common (n = 980,623). Medicare case volume was positively correlated with graduating residents' procedural confidence (r = 0.86, p < 0.0001). We identified four categories with varied alignment of training and demand: (1) high volume and high confidence, (2) high volume and low confidence, (3) low volume and high confidence, and (4) low volume and low confidence. CONCLUSIONS Optimizing urology residency training is time-sensitive and important. Using national Medicare data coupled with recently graduated urology resident survey results, we provide a guiding framework for improving the alignment of training with workforce demand. Informed by these results, we recommend altering training requirements to reflect these needs.
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Affiliation(s)
| | - Ted A Skolarus
- Department of Urology, University of Michigan, Ann Arbor, Michigan; VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan; Dow Division of Health Services Research, University of Michigan, Ann Arbor, Michigan
| | - Sapan N Ambani
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Khaled Hafez
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Kate H Kraft
- Department of Urology, University of Michigan, Ann Arbor, Michigan.
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14
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LaFemina J, Ahuja V, Alseidi A, Balters M, Brasel K, Clark C, Delman KA, Farley D, Lindeman B, Relles D, Shabahang M, Sohn V, Harrington D. APDS Consensus Statement: Ideal Senior Medical Student Experiences for Preparedness for General Surgery Internship. JOURNAL OF SURGICAL EDUCATION 2021; 78:69-75. [PMID: 32737002 DOI: 10.1016/j.jsurg.2020.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/11/2020] [Accepted: 07/13/2020] [Indexed: 06/11/2023]
Abstract
Guide optimal standards on ideal senior medical student experiences for preparedness for general surgery internship DESIGN: Work product of task force, approved by the Association of Program Directors in Surgery CONCLUSION: General surgery rotations should mirror the learning and working environment of a surgical intern. Opportunities should mimic the next phase of learning to help guide informed decisions regarding entrustability for entry into residency training. These opportunities will also help identify students who may have an aptitude for pursuing a general surgery internship. Students should achieve entrustability in Association of American Medical Colleges Core Entrustable Professional Activities (EPAs); curricula should align Core EPAs and modified American Board of Surgery EPAs to guide essential general surgery components. Experiences should include required night, holiday, and/or weekend shifts, a dedicated critical care experience, and a resident preparatory curriculum focusing on nontechnical and essential technical skills. We encourage the opportunity for additional surgical mentorship and subspecialty experience through Surgical Interest Groups or Surgical Honors or Specialty Tracks.
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Affiliation(s)
- Jennifer LaFemina
- Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts.
| | - Vanita Ahuja
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Adnan Alseidi
- Department of Surgery, University of California, San Francisco, California
| | - Marcus Balters
- Department of Surgery, Creighton University School of Medicine, Omaha, Nebraska
| | - Karen Brasel
- Department of Surgery, Oregon Health & Science University School of Medicine, Portland, Oregon
| | - Clarence Clark
- Department of Surgery, Morehouse University, Atlanta, Georgia
| | - Keith A Delman
- Department of Surgery, Emory University, Atlanta, Georgia
| | - David Farley
- Department of Surgery, Mayo Clinic-Rochester, Rochester, Minnesota
| | | | - Daniel Relles
- Department of Surgery, Lehigh Valley Health Network, Allentown, Pennsylvania
| | - Mohsen Shabahang
- Department of Surgery, Geisinger Commonwealth School of Medicine, Danville, Pennsylvania
| | - Vance Sohn
- Department of Surgery, Madigan Army Medical Center, Tacoma, Washington; Department of Surgery, Uniformed Services University, Tacoma, Washington
| | - David Harrington
- Department of Surgery, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
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15
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Lu J, Cuff RF, Mansour MA. Simulation in surgical education. Am J Surg 2020; 221:509-514. [PMID: 33358139 DOI: 10.1016/j.amjsurg.2020.12.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/07/2020] [Indexed: 01/23/2023]
Abstract
Simulation is becoming an important tool in surgical education. Surgical faculty have been forced to modify how they teach technical skills. Instead of a complete reliance on teaching in the operating room, a structured curriculum and dedicated time in the simulation center are being used in many centers. Some of the advantages of this approach include the ability to learn and practice new procedures in a safe and nurturing environment. The disadvantages include the significant cost of virtual reality simulators and the competition, between various training programs, to gain access to simulation.
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Affiliation(s)
- Joyce Lu
- Spectrum Health Medical Group, Department of Surgery, Michigan State University College of Human Medicine, United States
| | - Robert F Cuff
- Spectrum Health Medical Group, Department of Surgery, Michigan State University College of Human Medicine, United States
| | - M Ashraf Mansour
- Spectrum Health Medical Group, Department of Surgery, Michigan State University College of Human Medicine, United States.
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Lovasik BP, Kim SC, Wang VL, Fay KT, Santore MT, Delman KA, Srinivasan JK. A longitudinal cadaver-based simulation curriculum creates sustainable increases in resident confidence and exposure to fundamental techniques: Results of a 5-year program evaluation. Am J Surg 2020; 222:104-110. [PMID: 33187627 DOI: 10.1016/j.amjsurg.2020.10.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/28/2020] [Accepted: 10/28/2020] [Indexed: 01/22/2023]
Abstract
INTRODUCTION For the past five years, our surgical residency program has led a cadaver-based simulation course focused on fundamental surgical maneuvers. This study aimed to quantify the impact of this course on resident exposure to surgical skills and longitudinal impact on resident education. METHODS General surgery residents participated in an annual cadaver-based simulation curriculum. Participants completed surveys regarding improvements in knowledge and confidence; these results were stratified between course iterations (P1: 2 years, 2014-15; P2: 3 years, 2016-2018). RESULTS Residents reported a sustained increase in knowledge of anatomy and technical dissection, confidence in performing operative skills independently, and exposure to operative skills that were otherwise not encountered in clinical rotations. Junior residents demonstrated an increase in gaining skills they would otherwise not achieve (87% vs. 98%, p = 0.028) and confidence to safely perform these procedures in the clinical setting (94% vs. 100%, p = 0.077). CONCLUSION This annual, longitudinal cadaver-based skills course focused on fundamental maneuvers demonstrates a sustained impact in resident and faculty surgical confidence in resident's operative skills as a component of a longitudinal simulation curriculum to enhance competency-based promotion.
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Affiliation(s)
| | - Steven C Kim
- Department of Surgery, Emory University, Atlanta, GA, USA
| | - Vivian L Wang
- Department of Surgery, The Ohio State University, Columbus, OH, USA
| | | | | | - Keith A Delman
- Department of Surgery, Emory University, Atlanta, GA, USA
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17
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Turner SR, Huang J, Lai H, Bédard EL. Competency Assessment for Mediastinal Mass Resection and Thymectomy: Design and Delphi Review Process. JOURNAL OF SURGICAL EDUCATION 2020; 77:1583-1591. [PMID: 32571689 PMCID: PMC9465842 DOI: 10.1016/j.jsurg.2020.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/02/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Mediastinal mass resection and thymectomy are complex and related operations that are core components of competency for a general thoracic surgeon and an important learning objective for thoracic surgery trainees. This study aimed to design a combined competency assessment instrument for mediastinal mass resection and thymectomy. DESIGN A comprehensive competency assessment instrument was designed by a process of logical analysis by 3 expert thoracic surgeons with an interest in mediastinal surgery. The instrument was then assessed and refined using a modified Delphi process. SETTING The Delphi questionnaire was distributed to all members of the Canadian Association of Thoracic Surgeons in 2018 to 2019. PARTICIPANTS The first round of the Delphi review was completed by 58 respondents (response rate 43.9%). Respondents represented all Canadian provinces with a wide range of clinical experience and a high rate of involvement in resident education. RESULTS A first draft of the competency assessment instrument included 42 steps in 6 categories. A total of 3 rounds of Delphi review were performed. Cronbach's alpha for the final round was 0.83. Ultimately, 29 items were retained from the original instrument and two modified and three new items were added. The final instrument has 34 steps in 5 categories. CONCLUSIONS A nationwide consensus was established on the key components of assessing competence to perform mediastinal mass resection and thymectomy. The resulting instrument could be used to guide competency based assessments of thoracic surgeons and trainees.
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Affiliation(s)
- Simon R Turner
- Division of Thoracic Surgery, University of Alberta, Edmonton, Canada.
| | - James Huang
- Thoracic Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Hollis Lai
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Eric Lr Bédard
- Division of Thoracic Surgery, University of Alberta, Edmonton, Canada
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