Trauma and Orthopedic Surgery Curriculum Concordance: An Operative Learning Curve Trajectory Perspective

Hopkins, Luke; Robinson, Denise; Brown, Christopher; Egan, Richard; Iorwerth, Awen; Holt, M. Shaun; Lewis, Wyn G.

doi:10.1016/j.jsurg.2019.05.009

Cited by 12 publications

(19 citation statements)

References 14 publications

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“…Nineteen studies assessed or surveyed surgical residents in either basic or specialist training. [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] Seven studies recorded perceptions and experiences of workplacebased assessments from both trainers and residents. 4,[46][47][48][49][50][51] Phillips et al (2015) surveyed surgical trainers only, 52 while Basu et al (2013) surveyed surgical residents, residents from medicine, paediatrics, general practice and emergency medicine, and trainers from both surgery and medicine.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…49,53 Eight studies were designed as retrospective cohort studies. 27,[36][37][38][39][40]43,44 Seven studies reported quantitative data from online questionnaires, 4,29,33,47,50,51,53 while seven further mixed-methodology studies included qualitative data either from focus groups 42 or online questionnaires. 4,22,29,39,40,43 Shalhoub et al (2017) conducted a series of indepth and semi-structured interviews with surgical residents.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…10 in operative competency (level 2b). 27,31,34,[35][36][37][38][39][40]44 Ten further studies documented the transfer of learning to the workplace, or willingness of learners to apply new knowledge and skills as a result of workplacebased assessments or operative number targets, or a change in behaviour as a result of the introduction of these assessment measures. 4,28,29,32,33,42,43,45,46,49…”

Section: Response Processmentioning

confidence: 99%

“…36 For these procedures, the operative numbers required to achieve competence for CCT level was double the set target. 36 These studies suggest that the current indicative numbers in General and Orthopaedic surgery are therefore not reliable proxy measures of operative competence.…”

Section: Contentmentioning

confidence: 99%

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Assessing Operative Skill in the Competency-based Education Era

2021

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Introduction:Decisions regarding the operative competence of surgical residents in the United Kingdom and Ireland are informed by operative workplace-based assessments (WBAs) and operative number targets for index procedures. This review seeks to outline the validity evidence of these assessment methods.Methods:A review of the MEDLINE (Pubmed), EMBASE and Cochrane Library databases was undertaken in accordance with the Joanna Briggs Institute Protocol for Scoping Reviews (2020). Articles were included if they provided evidence of the validity of procedure-based assessments, direct observation of procedural skills, or indicative operative number targets. The educational impact of each article was evaluated using a modified Kirkpatrick model.Results:Twenty-eight articles outlining validity evidence of WBAs and operative number targets were synthesised by narrative review. Five studies documented users’ views on current assessment methods (Kirkpatrick level 1). Two articles recorded changes in attitudes towards current operative assessments (level 2a). Ten studies documented the ability of current assessments to record improvements in operative competence (level 2b). Ten studies measured a change in behaviour as a result of the introduction of these assessments (level 3). One article studied the ability of operative assessments to predict clinical outcomes (level 4b).Conclusions:Operative WBAs are reliable. Scores achieved correlate with both time spent in training and recorded operative experience. Trainers and residents have concerns regarding the subjectivity of these assessments and the opportunistic nature in which they are used. Operative number targets are not criterion-referenced, lack validity evidence, and may be set too low to ensure operative competence.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Response Processmentioning

confidence: 99%

Section: Contentmentioning

confidence: 99%

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Assessing Operative Skill in the Competency-based Education Era

2021

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“…Apesar de esse modelo de ensino-aprendizagem ser amplamente predominante no Brasil e na maior parte do mundo, a relação entre proficiência e experiência é controversa, reforçada por estudos que questionaram a utilidade do número de cirurgias executadas como um marcador de competência 4 . Algumas pessoas demandam uma exposição menor a uma série de desafios para que sejam capazes de assimilar as habilidades necessárias para uma boa desenvoltura cirúrgica, enquanto outras requerem maior tempo de treinamento 5 .…”

Section: Introductionunclassified

Avaliação baseada em procedimentos (PBA) em uma residência de urologia: experiência inicial

Medeiros

Diniz

2021

Rev. bras. educ. med.

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Introduction: Changes in society and in medical practice have demanded improvements in the surgical teaching process in Medical Residency, leading to the emergence of new teaching-learning and assessment models based on competencies. In this process, the Procedure Based Assessment (PBA) stands out as an assessment tool in the workplace, supported by the assessment of competencies and structured feedback. Objective: This study aims to present the development and implementation of PBA protocols in an Urology Medical Residency Program. Method: This is a prospective, action-research study, carried out from July/2019 to July/2020, involving 10 preceptors and six urology residents. The group consensus methodology was used to create the protocols, in addition to training participants for competency assessment. Six PBA protocols were created, corresponding to the prevalent procedures in the training of the resident/year, followed by their implementation. In addition to the descriptive data analysis, Spearman’s coefficient (rR) was used for inferential analysis of the correlation between training time and the resident’s performance assessed by the PBA. Result: The development of two PBA instruments for each of the three years of training allowed the assessment of all residents. Thirty-one evaluation meetings were held, with an average of five evaluations per resident. There was a positive correlation between longer training time and better resident performance in laparoscopic radical prostatectomy, percutaneous nephrolithotomy, laparoscopic nephrectomy and in the set of the six procedures (rR = 0.97, 0.55, 0.42 and 0.31, respectively). We report the first use of PBA in Urology Residency in Brazil. The methodology of group consensus associated with a training process proved to be an option for developing this type of instrument. The positive correlation between improved performance in the PBA and training time corroborates studies that resulted in the consolidation of the tool’s validity and reliability. Conclusion: The creation of PBA protocols by group consensus is feasible and resulted in the first use of this tool in Urology Residency in Brazil. The PBA may represent a more modern surgical teaching assessment strategy, suitable for training in real scenarios.

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The number of arthroscopies performed by trainees does not deduce the level of their arthroscopic proficiency

Anetzberger

Kugler²,

John³

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose It is reasonable to question whether the case volume is a suitable proxy for the manual competence of an arthroscopic surgeon. The aim of this study was to evaluate the correlation between the number of arthroscopies previously performed and the arthroscopic skills acquired using a standardized simulator test. Methods A total of 97 resident and early orthopaedic surgeons who participated in arthroscopic simulator training courses were divided into ive groups based on their self-reported number of arthroscopic surgeries: (1) none, (2) < 10, (3) 10 to 19, (4) 20 to 39 and (5) 40 to 100. Arthroscopic manual skills were evaluated with a simulator by means of the diagnostic arthroscopy skill score (DASS) before and after training. Seventy-ive points out of 100 must be achieved to pass the test. Results In the pretest, only three trainees in group 5 passed the arthroscopic skill test, and all other participants failed. Group 5 (57 ± 17 points; n = 17) scored signiicantly higher than the other groups (group 1: 30 ± 14, n = 20; group 2: 35 ± 14, n = 24; group 3: 35 ± 18, n = 23; and group 4: 33 ± 17, n = 13). After a two-day simulator training, trainees showed a signiicant increase in performance. In group 5, participants scored 81 ± 17 points, which was signiicantly higher than the other groups (group 1: 75 ± 16; group 2: 75 ± 14; group 3: 69 ± 15; and group 4: 73 ± 13). While self-reported arthroscopic procedures were n.s. associated with higher log odds of passing the test (p = 0.423), the points scored in the pretest were found to be a good predictor of whether a trainee would pass the test (p < 0.05). A positive correlation was observed between the points scored in the pretest and the posttest (p < 0.05, r = 0.59, r 2 = 0.34). Conclusions The number of previously performed arthroscopies is not a reliable indicator of the skills level of orthopaedic residents. A reasonable alternative in the future would be to verify arthroscopic proiciency on the simulator by means of a score as a pass-fail examination. Level of evidence III.

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Trauma and Orthopedic Surgery Curriculum Concordance: An Operative Learning Curve Trajectory Perspective

Cited by 12 publications

References 14 publications

Assessing Operative Skill in the Competency-based Education Era

Assessing Operative Skill in the Competency-based Education Era

Avaliação baseada em procedimentos (PBA) em uma residência de urologia: experiência inicial

The number of arthroscopies performed by trainees does not deduce the level of their arthroscopic proficiency

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