Current problems in surgery 12/2011; 48(12):854-968. · 1.42 Impact Factor
ABSTRACT: This study explored the amount of guidance provided to residents in the operating room (OR) and the relationship of OR guidance with postgraduate year (PGY) and operative performance rating (OPR).
We used OPR instruments to collect data from supervising surgeons after each performance. External expert raters blindly rated the amount of guidance for 5 videotaped performances.
Three hundred sixty-eight performances were analyzed for 5 procedures performed by 26 residents with 16 supervising surgeons over 6 months. Guidance ratings varied with procedure, individual supervising surgeons varied in the amount of guidance reported, the amount of guidance decreased as residents' PGY level increased, and the correlation between guidance rating and overall performance was .62. In comparison cases, most supervising surgeons underestimated the amount of guidance provided.
Controlling for the amount of supervising surgeon guidance has important implications for training and evaluation as we strive to prepare residents to practice independently.
American journal of surgery 11/2011; 203(1):44-8. · 2.36 Impact Factor
ABSTRACT: The American College of Surgeons/Association of Program Directors in Surgery Phase 1 Curriculum (ACS/APDS) includes evaluation of basic surgical skills for junior residents. It is unclear if basic surgical skills evaluation is incorporated into residency curricula or used for resident advancement decisions. Our aim was to identify the perceptions of general surgery program directors (PDs) on the importance of basic surgical skills training and evaluation.
Thirty PDS were invited to participate in a telephone interview. PDs were chosen for diversity of program location and size and asked to comment on their use and perceptions of basic surgical skills curricula, and evaluation.
Twenty-two interviews were conducted with 23 of the total 30 invited PDs who agreed to participate. The mean number of residents graduating annually was 6 (range 2 to 12) per program. Ten of 22 (45%) PDs used the ACS/APDS curriculum, and 5 (23%) PDs were unaware of its existence. Only 4 programs (18%) perform formal basic surgical skills evaluation with mandatory remediation. No PD would either prevent residents with demonstrable poor basic surgical skills from going to the operating room or use poor basic surgical skills as a reason to deny promotion. One institution required evidence of satisfactory central line placement skills for credentialing. Obstacles to implementation of basic surgical skills included a lack of time, resources, and validated tests. Sixteen (73%) PDs saw some value in skills evaluation generally, but only 41% saw basic surgical skills evaluation as important for junior residents.
Implementation of a summative evaluation of skills will require considerable resources for PDs. This study suggests that scarce resources might be more usefully directed toward evaluation of operative skills of senior residents.
Journal of the American College of Surgeons 03/2011; 212(3):406-12. · 4.55 Impact Factor