The New ACS/APDS skills curriculum: Moving the learning curve out of the operating room

Department of Surgery, Southwestern Center for Minimally Invasive Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390-9156, USA.
Journal of Gastrointestinal Surgery (Impact Factor: 2.8). 03/2008; 12(2):213-21. DOI: 10.1007/s11605-007-0357-y
Source: PubMed


Surgical education has dramatically changed in response to numerous constraints placed on residency programs, but a substantial gap in uniform practices exist, especially in the area of skills laboratory availability and usage. Simulation-based training has gained significant momentum and will be a requirement for residencies in the near future. In response, the American College of Surgeons and the Association of Program Directors in Surgery have formed a Surgical Skills Curriculum Task Force with the aim of establishing a National Skills Curriculum. The first of three phases will undergo implementation in 2007, with subsequent phases scheduled for launch in 2008. The curriculum has been carefully structured and designed by content experts to enhance resident training through reproducible simulations, with verification of proficiency before operative experience. Free-of-charge distribution is planned through a web-based platform, and widespread adoption is encouraged. In the future, these simulation-based strategies may be useful in assuring the competency of practicing surgeons and for credentialing purposes.

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    • "Surgical educators should therefore incorporate didactics aimed toward multidisciplinary, team-based patient care training to provide residents with skills traditionally not incorporated into surgical curriculum. The American College of Surgeons and the Association of Program Directors in Surgery recognized the importance of improving team-based training in 2008 with phase III of the National Curriculum, which aims to provide team-based training modules for surgical patient care [22]. The importance of team training is highlighted by emerging studies suggesting that poorly functioning surgical teams commit more errors and deliver diminished care Fig. 3 e Resident learning styles differ based on gender. "
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    ABSTRACT: The Accreditation Council for Graduate Medical Education instituted the 80-h workweek for residency programs in 2003. This presented a unique challenge for surgery residents who must acquire a medical and technical knowledge base during training. Therefore, learning should be delivered in an environment congruent with an individual's learning style. In this study, we evaluated the learning styles of general surgery residents to determine how learning styles changed after the implementation to the 80-h workweek. Kolb learning style inventory was taken by general surgery residents at the University of Cincinnati's Department of Surgery, and results from 1999-2012 were analyzed. Statistical analysis was performed using the chi-squared, logistic regression and Wilcoxon rank-sum test. Significance was defined as a P value of <0.05. A total of 411 responses were obtained from 115 residents. Surgical residents were primarily converging (59.0%) and assimilating (19.1%) learners before 2003. However, there was a shift in predominate learning styles after the institution of the 80-h workweek to converging (43.9%) and accommodating (40.4%, P < 0.001). Surgical residents were also more likely to be team-based learners after the start of the 80-h workweek (odds ratio = 2.13, P = 0.0016). After the institution of the 80-h workweek, most general surgery residents remained action-based learners. However, there was a shift within this majority toward a preference for team-based learning. This change paralleled the transition to a more team-based approach to patient care with the implementation of the 80-h workweek. These findings are important for surgical educators to consider in the development of surgical resident curriculum. Copyright © 2015 Elsevier Inc. All rights reserved.
    Journal of Surgical Research 06/2015; DOI:10.1016/j.jss.2015.06.046 · 1.94 Impact Factor
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    • "5 procedures must be completed in the first year of training (Frederiksen 2010). For simulation-based training to have an impact on future surgeons’ education, it has to be integrated in the national curriculum and the learning outcome would have to be assessed (Scott and Dunnington 2007, Downing and Yudkowsky 2009). In future studies, it would be interesting to explore the effects of incorporating a simulation-based training program for residents (Karam et al. 2013). "
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    ABSTRACT: Background and purpose Internal fixation of hip fractures is a common and important procedure that orthopedic surgeons must master early in their career. Virtual-reality training could improve initial skills, and a simulation-based test would make it possible to ensure basic competency of junior surgeons before they proceed to supervised practice on patients. The aim of this study was to develop a reliable and valid test with credible pass/fail standards. Methods 20 physicians (10 untrained novices and 10 experienced orthopedic surgeons) each performed 3 internal fixation procedures of an undisplaced femoral neck fracture: 2 hook-pins, 2 screws, and a sliding hip screw. All procedures were preformed on a trauma simulator. Performance scores for each procedure were obtained from the predefined metrics of the simulator. The inter-case reliability of the simulator metrics was explored by calculation of intra-class correlation coefficient. Validity was explored by comparison between novices’ and experts’ scores using independent-samples t-test. A pass/fail standard was set by the contrasting-groups method and the consequences were explored. Results The percentage of maximum combined score (PM score) showed an inter-case reliability of 0.83 (95% CI: 0.65–0.93) between the 3 procedures. The mean PM score was 30% (CI: 7–53) for the novices and 76% (CI: 68–83) for the experienced surgeons. The pass/fail standard was set at 58%, resulting in none of the novices passing the test and a single experienced surgeon failing the test. Interpretation The simulation-based test was reliable and valid in our setting, and the pass/fail standard could discriminate between novices and experienced surgeons. Potentially, training and testing of future junior surgeons on a virtual-reality simulator could ensure basic competency before proceeding to supervised practice on patients.
    Acta Orthopaedica 04/2014; 85(4). DOI:10.3109/17453674.2014.917502 · 2.77 Impact Factor
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    • "This results in many patients receiving a valve replacement , not because the valves are irreparable, but because they are operated on by surgeons who do not have the specific expertise required to complete a successful repair [5]. In surgical education, a desire to move basic skills-acquisition out of the operating theatre still exists [6]. Therefore, to increase the experience in heart surgery, performing on porcine or bovine heart models is essential. "
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    ABSTRACT: The importance of surgical simulation has grown in the quickly changing climate of modern surgical training. Prior to operating on human hearts, practice in appropriate experimental models is necessary to attain adequate experience. Nowadays, training of surgery residents has shifted to simulation workshops and residency programmes outside the operating theatre. We have experience in training our residents to perform mitral valve repair techniques in bovine hearts. Previously, the heart would be fixed on the tablecloth with simple stitches, which proved to be a complex and difficult technique while performing surgery. Moving forwards, we have built a successful 'surgical table' to achieve better stabilization and to simplify the surgery. This paper describes our model, which could be a helpful tool for any cardiac surgeon performing surgical techniques successfully at home.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 12/2011; 41(4):940-1. DOI:10.1093/ejcts/ezr087 · 3.30 Impact Factor
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