Surgeons' attitude toward a competency-based training and assessment program: results of a multicenter survey

BACKGROUND

Currently, most surgical training programs are focused on the development and evaluation of professional competencies. Also in the Netherlands, competency-based training and assessment programs were introduced to restructure postgraduate medical training. The current surgical residency program is based on the Canadian Medical Education Directives for Specialists (CanMEDS) competencies and uses assessment tools to evaluate residents' competence progression. In this study, we examined the attitude of surgical residents and attending surgeons toward a competency-based training and assessment program used to restructure general surgical training in the Netherlands in 2009.

METHODS

In 2011, all residents (n = 51) and attending surgeons (n = 108) in 1 training region, consisting of 7 hospitals, were surveyed. Participants were asked to rate the importance of the CanMEDS competencies and the suitability of the adopted assessment tools. Items were rated on a 5-point Likert scale and considered relevant when at least 80% of the respondents rated an item with a score of 4 or 5 (indicating a positive attitude). Reliability was evaluated by calculating the Cronbach's α, and the Mann-Whitney test was applied to assess differences between groups.

RESULTS

The response rate was 88% (n = 140). The CanMEDS framework demonstrated good reliability (Cronbach's α = 0.87). However, the importance of the competencies 'Manager' (78%) and 'Health Advocate' (70%) was undervalued. The assessment tools failed to achieve an acceptable reliability (Cronbach's α = 0.55), and individual tools were predominantly considered unsuitable for assessment. Exceptions were the tools 'in-training evaluation report' (91%) and 'objective structured assessment of technical skill' (82%). No significant differences were found between the residents and the attending surgeons.

CONCLUSION

This study has demonstrated that, 2 years after the reform of the general surgical residency program, residents and attending surgeons in a large training region in the Netherlands do not acknowledge the importance of all CanMEDS competencies and consider the assessment tools generally unsuitable for competence evaluation.

Physician, healthy system: the challenge of training doctor-citizens

The need for committed "doctor-citizens" engaged in health system improvement has led to a variety of medical curricular overhauls in North America and elsewhere. In a research paper published in this edition, we evaluated one such curriculum and found it to be modestly successful. But, what are the limits of residency curriculum in producing such doctors? Much of the culture of medical practice runs against the grain of our efforts. In this piece we reflect on broader lessons learned in the process of trying to teach health policy and advocacy to family medicine residents.

Dermatoethics: a curriculum in bioethics and professionalism for dermatology residents at Brown Medical School

Both American and Canadian residency accreditation bodies have formal requirements in core competencies that include training in ethics and professionalism without prescribing content. A structured seminar series in medical ethics and professionalism relating to dermatology practice was started at Brown Medical School's dermatology residency in 2001. Methods of instruction include discussion groups, review of medical and lay literature, book review, didactic teaching, case presentation, and informal e-mail exchange. Some of the topics that have been covered include basic medical ethics, research ethics, physician-industry relationships, truth telling, privacy and confidentiality, duty to treat, and ethical and legal issues in cosmetic dermatology, dermatologic surgery, dermatologic genetics, occupational dermatology, and pediatric dermatology. The main goals of the curriculum are to fulfill the core competency requirement in professionalism of the specialty certifying boards, introduce trainees to the cross-disciplinary literature of biomedical ethics and current ethical controversies, and encourage dialogue on ethics and professionalism among faculty, colleagues in other specialties, and dermatology trainees.