Building validity evidence for the advanced laparoscopic suturing curriculum and assessment (ALS)

Introduction: There is broad agreement in surgical education that we need to move away from the current time-based model of training to a proficiency-based model. One of the challenges to this lies in the ability to have valid assessments of proficiency at various stages of training. To this end, there has been success in developing fundamental assessments and curricula in general surgery training which include the Fundamentals of Laparoscopic Surgery (FLS), Fundamentals of Endoscopic Surgery (FES) and the Fundamental Use of Surgical Energy (FUSE). However, there are no advanced skill assessments or curricula. We describe our experience developing and validating an advanced laparoscopic skills (ALS) assessment and curriculum with the goal that it will become adopted in the proficiency-based model of surgical training.Methods: We describe a series of projects which are used to build validity evidence for adoption of the ALS assessment and curriculum. We began with a nation-wide needs assessment of stakeholders. We then developed simulated tasks based on the survey, and began to build evidence of internal structure validity by assessing multiple levels of learners. Finally, we developed proficiency benchmarks for the curriculum.Results: The needs assessment targeted minimally invasive surgery (MIS) fellows, past fellows and program directors and included 186 respondents for a response rate of 64%. The majority (73%) identified the need for an ALS curriculum and 78% identified laparoscopic suturing as the most needed portion such a curriculum. Next, a series of laparoscopic suturing tasks was developed. Based on our novel metrics, expert MIS surgeons out-performed surgery residents on the following tasks: needle handling, (p = 0.04) off-angle suturing, (p< 0.01) back-hand suturing, (p = 0.01) confined space suturing, (p = 0.02) suturing under tension (p< 0.01) and continuous suturing. (p< 0.01). Next, proficiency benchmarks of time and error were set based on data from a national sample of 17 expert surgeons from 7 institutions.Conclusion: We have begun to build validity evidence for incorporating the advanced laparoscopic skills curricula and assessment into proficiency-based surgical training. Additional work is currently under way to improve several elements of validity including the internal structure, relationship to other variables and to determine how the curriculum and assessment can optimally be used. With that said, this project likely represents one of the most methodologically robust curriculum development processes in the literature.Introduction: Il existe un large consensus dans le domaine de la formation en chirurgie, selon lequel nous devons abandonner le modèle actuel de formation axé sur le temps pour adopter un modèle axé sur la compétence. L'un des défis à relever réside dans la capacité d'avoir des évaluations valides de la compétence à différentes étapes de la formation. À cette fin, on a réussi à développer des évaluations fondamentales et des programmes d'études en chirurgie générale, notamment les principes fondamentaux de la chirurgie laparoscopique, les fondements de la chirurgie endoscopique et l'utilisation fondamentale de l'énergie chirurgicale. Cependant, il n'y a pas d'évaluation avancée des compétences ni de programmes d'études. Nous décrivons notre expérience en matière de développement et de validation d'une évaluation et d'un programme d'études avancés en laparoscopie (ALS) dans le but de l'adopter dans le modèle de formation en chirurgie basé sur la compétence.Méthodes: Nous décrivons une série de projets qui sont utilisés pour construire des preuves de validité pour l'adoption de l'évaluation et du programme ALS. Nous avons commencé par une évaluation des besoins des parties prenantes à l'échelle nationale. Nous avons ensuite développé des tâches simulées basées sur l'enquête, et avons commencé à construire des preuves de la validité de la structure interne en évaluant plusieurs niveaux d'apprenants. Enfin, nous avons élaboré des repères de compétences pour le programme d'études.Résultats: L'évaluation des besoins ciblait les boursiers en chirurgie mini-invasive (SIM), les anciens boursiers et les directeurs de programme et comprenait 186 répondants pour un taux de réponse de 64%. La majorité (73%) a identifié le besoin d'un programme ALS et 78% ont identifié la suture laparoscopique comme la partie la plus nécessaire d'un tel programme. Ensuite, une série de tâches de suture laparoscopique a été développée. Sur la base de nos métriques novatrices, les chirurgiens experts MIS ont surpassé les chirurgiens résidents dans les tâches suivantes: manipulation des aiguilles, (p = 0,04) suture hors angle, (p <0,01) suture en arrière, (p = 0,01) suture en espace confiné , (p = 0,02) suture sous tension (p <0,01) et suture continue. (p <0,01). Ensuite, des repères de compétence en termes de temps et d'erreurs ont été établis à partir des données d'un échantillon national de 17 chirurgiens experts de 7 établissements.Conclusion: Nous avons commencé à accumuler des données probantes sur l'intégration des programmes de compétences avancées en laparoscopie et de l'évaluation à la formation en chirurgie axée sur la compétence. Des travaux supplémentaires sont actuellement en cours pour améliorer plusieurs éléments de validité, y compris la structure interne, la relation avec d'autres variables et pour déterminer comment le programme et l'évaluation peuvent être utilisés de manière optimale. Cela dit, ce projet représente probablement l'un des processus de développement du curriculum les plus solides sur le plan méthodologique dans la littérature

Needs Assessment for a Resuscitative Thoracotomy Curriculum for General Surgery Residents in the Northeast Region

INTRODUCTION: Resuscitative thoracotomy (RT) is a high-acuity low occurrence (HALO) procedure with which general surgical resident (GSR) experience and confidence are unknown. We sought to identify and describe this educational gap by conducting a targeted needs assessment for an RT curriculum for GSRs. METHODS: An online regional needs assessment survey was conducted for an RT curriculum for GSRs. The survey was developed by a group of trauma stakeholders and revised after being piloted on a small, representative group of GSRs. We surveyed GSRs in the Northeast region regarding their experience and confidence with RT; interest in an RT curriculum; and content, format, and scope for an RT curriculum. RESULTS: The survey response rate was 43%, reflecting the viewpoints of GSRs at 8 major training centers across the Northeast. Only 13% of respondents were interested in pursuing a career in Trauma and Critical Care despite 97% of them training at a Level I Trauma Center. Twenty-nine percent and 33% of GSRs had ever assisted with or performed RT, respectively. Twenty-one percent of GSRs reported feeling confident performing RT. Most respondents (98%) agreed or strongly agreed that an RT curriculum would add value to their general surgery education. The most positively rated content topics were resuscitative maneuvers (100% positive responses [PR]), when to cease resuscitative efforts (100% PR), and morbidity and mortality associated with RT (98% PR). The most highly rated learning methods were individual RT simulation time (97% PR) and a tour of the trauma bay equipment (97% PR). CONCLUSIONS: This needs assessment demonstrates a lack of experience and confidence with RT, a strong learner interest in an RT curriculum, and a desire for experiential learning methods. Learning objectives are defined herein, and the next steps involve developing educational materials for an RT curriculum for GSRs

The value proposition of simulation

BACKGROUND: Simulation has been shown to improve trainee performance at the bedside and in the operating room. As the use of simulation-based training is expanded to address a host of health care challenges, its added value needs to be clearly demonstrated. Demonstrable improvements will support the expansion of infrastructure, staff, and programs within existing simulation facilities as well as the establishment of new facilities to meet growing needs and demands. Thus, organizational and institutional leaders, faculty members, and other stakeholders can be assured of the best use of existing resources and can be persuaded to make greater investments in simulation-based training for the future. METHODS: A multidisciplinary panel was convened during the 8th Annual Meeting of the Consortium of the American College of Surgeons-Accredited Education Institutes (Simulation Centers) in March 2015 to discuss the added value of simulation-based training. Panelists shared the ways in which the value of simulation was demonstrated at their institutions. CONCLUSION: The value of simulation-based training was considered and described in terms of educational impact, patient care outcomes, and costs

Update on the Personal and Professional Well-Being of Surgical Residents in New England

BACKGROUND: Surgical culture has shifted to recognize the importance of resident wellbeing. This is the first study to longitudinally track regional surgical resident wellbeing over 5 years. STUDY DESIGN: An anonymous cross-sectional, multi-institutional survey of New England general surgery residents using novel and published instruments to create three domains: health maintenance, burnout, and work environment. RESULTS: Overall, 75% (15/20) of programs participated. The response rate was 44% (250/570) and 53% (133/250) were female, 94% (234/250) were 25-34 years old, and 71% (178/250) were in a relationship. For health maintenance, 57% (143/250) reported having a primary care provider, 26% (64/250) had not seen a primary care provider in 2 years, 59% (147/250) endorsed being up to date with age-appropriate health screening, however, only 44% (109/250) were found to actually be up to date. Only 14% (35/250) reported exercising greater than 150 minutes/week. The burnout rate was 19% (47/250), with 32% (81/250) and 25% (63/250) reporting high levels of emotional exhaustion and depersonalization, respectively. For both program directors and attendings, 90% of residents reported they cared about resident wellbeing. 87% of residents believe it was acceptable to take time off during the workday for a personal appointment, while only 49% reported they would personally take the time. CONCLUSIONS: The personal health maintenance of general surgery residents has changed little over the past five years, despite an overwhelming majority of residents reporting attendings and program directors care about their wellbeing. Further study is needed to understand the barriers to improvement of resident wellbeing