Competency Based Residency Training: the Next Advance in Graduate Medical Education

Long, Donlin M.

doi:10.1007/978-3-7091-6237-8_28

Cited by 118 publications

(150 citation statements)

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“…In contrast, the European neurosurgical programs consist of six years with a minimum of 48 months dedicated to clinical neurosurgery 7,13 . However, greater importance is being placed on 'competency-based' training compared to a traditional 'years-in-training' program 3,4 . There is no objective evidence that the chosen number of years in training is appropriate for neurosurgical training 3,4 .…”

Section: Discussionmentioning

confidence: 99%

“…However, greater importance is being placed on 'competency-based' training compared to a traditional 'years-in-training' program 3,4 . There is no objective evidence that the chosen number of years in training is appropriate for neurosurgical training 3,4 .…”

Section: Discussionmentioning

confidence: 99%

“…There is no literature that guides residents or program directors to the minimum or average number of surgical cases required to graduate a competent neurosurgical trainee in Canada 3-5 . Currently, the program director must judge that the trainee can practice independently for successful graduation 3,4 . One aspect of this decision is based on evaluating the surgical competency of that trainee.…”

mentioning

confidence: 99%

“…Surgical activity in isolation is not an accurate reflection of the quality of a training program 8 . The most important aspect of a high quality surgical training program is a continuous escalation of a resident's surgical responsibility until competency is achieved 3,4,7,9,10 . This must be monitored through early recognition of deficits and frequent feedback from mentors.…”

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confidence: 99%

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Surgical Activity of First-Year Canadian Neurosurgical Residents

Fallah

Ebrahim

Haji

et al. 2010

Can. j. neurol. sci.

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Surgical activity is perhaps the most important aspect of neurosurgical training 1 . The Royal College of Physicians and Surgeons of Canada mandate that training programs provide an "adequate number of cases" in different categories for residents 2 . The adequate number of cases is not numerically defined 2 . There is no literature that guides residents or program directors to the minimum or average number of surgical cases required to graduate a competent neurosurgical trainee in Canada 3-5 . Currently, the program director must judge that the trainee can practice independently for successful graduation 3,4 . One aspect of this decision is based on evaluating the surgical competency of that trainee. There is no data available to verify a reliable prediction model of competency 3 . Although it is likely that most ABSTRACT: Introduction: Surgical activity is probably the most important component of surgical training. During the first year of surgical residency, there is an early opportunity for the development of surgical skills, before disparities between the skill sets of residents increase in future years. It is likely that surgical skill is related to operative volumes. There are no published guidelines that quantify the number of surgical cases required to achieve surgical competency. The aim of this study was to describe the current trends in surgical activity in a recent cohort of first-year Canadian neurosurgical trainees. Methods: This study utilized retrospective database review and survey methodology to describe the current state of surgical training for first-year neurosurgical trainees. A committee of five residents designed this survey in an effort to capture factors that may influence the operative activity of trainees. Results: Nine out of a cohort of 20 first-year Canadian neurosurgical trainees that began training in July of 2008 participated in the study. The median number of cases completed by a resident during the initial three month neurosurgical rotation was 66, within which the trainee was identified as the primary surgeon in 12 cases. Intracranial hemorrhage and cerebrospinal fluid diversion procedures were the most common operations to have the trainee as primary surgeon. Conclusion: Based on this pilot study, it appears that the operative activity of Canadian first-year residents is at least equivalent to the residents of other studied training systems with respect to volume and diversity of surgical activity.RÉSUMÉ: Activité chirurgicale des résidents canadiens en neurochirurgie au cours de leur première année de formation. Contexte : L'activité chirurgicale est probablement la composante la plus importante de la formation en chirurgie. La première année de résidence en chirurgie constitue une occasion de développer des habiletés chirurgicales tôt au cours de la formation, avant que les disparités entre les habiletés des résidents n'augmentent avec les années. Il est vraisemblable que les habiletés chirurgicales sont liées au volume chirurgical. Il n'existe pas de lignes directrices pu...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Surgical Activity of First-Year Canadian Neurosurgical Residents

Fallah

Ebrahim

Haji

et al. 2010

Can. j. neurol. sci.

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“…78,79 Slightly different models have been used to implement the competencies in the United States and Canada, with the United States using the competencies and Canada using the CanMEDS roles, yet the basic aims are comparable. [78][79][80][81][82] In the United States, nearly ten years into the initial implementation of the competencies, research has yet to produce evidence for the benefits of the current approach. Innovation in the field currently comes through collaborative work among stakeholders in the clinical specialties to develop the educational milestones.…”

Section: Embedding the Competencies In Resident Teaching And Evaluationmentioning

confidence: 99%

Review article: Closing the research gap at the interface of learning and clinical practice

Philibert

2011

Can J Anesth/J Can Anesth

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Purpose The dialogue at the interface of education and clinical practice highlights areas of critical importance to the development of new approaches for educating anesthesiologists. The purpose of this article is to examine the literature on education and acquisition of competence in three areas relevant to the interface of learning and clinical practice, with the aim to suggest a research agenda that adds to the evidence on preparing physicians for independent practice. The three areas are: 1) transitions across the continuum of education; 2) the effect of reductions in hours of clinical training on competence; and 3) efforts to incorporate the competencies and CanMEDS roles into teaching and evaluation. Principal findings Fifty-six articles relevant to one or more of the themes were identified in the review, including 21 studies of transitions (in, during, and after residency education), 19 studies on the effects of duty hour limits on residents' acquisition of competence, and 16 articles that assessed competency-based teaching and assessment in anesthesiology. Overall, the findings suggested a relative paucity of scientific evidence and a need for research and the development of new scientific theory. Studies generally treated one of the themes in isolation, while in actuality they interact to produce optimal as well as suboptimal learning situations, while medical education research often is limited by small samples, brief follow-up, and threats to validity. This suggests a ''research gap'' where editorials and commentaries have moved ahead of an evidence base for education. Promising areas for research include preparation for care deemed important by society, work to apply knowledge about the development of expertise in other disciplines to medicine, and ways to embed the competencies in teaching and evaluation more effectively. Conclusion Closing the research gap in medical education will require clear direction for future work. The starting point, at an institution or nationally, is dialogue within the specialty to achieve consensus on some of the most pressing questions.

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