A novel approach to assess clinical competence of postgraduate year 1 surgery residents

Xin Qi,Lian Ding,Wei Zhai,Qiang Li,Yan Li,Haichao Li,Bing Wen

doi:10.1080/10872981.2017.1342523

Xin Qi, Lian Ding + Show 5 more

Open Access

https://doi.org/10.1080/10872981.2017.1342523

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Abstract

ABSTRACTBackground: An increased demand for accountability and transparency in medicine have initiated a shift toward a more objective and standardized approach for postgraduate medical training.Objective: To develop and evaluate an objective method to assess clinical competence of postgraduate year 1 surgery residents.Design: Thirty-one postgraduate year 1 surgery residents, who had been trained in the Surgical School of Peking University First Hospital for one year, participated in an objective structured clinical examination as a final assessment of their clinical competence. A test station of irregular wound repair (debridement and suture) was specially designed to test the residents’ surgical integrative competence in a complex-trauma treatment procedure. A modified global rating scale, in combination with wound area measurement, was applied to evaluate residents’ surgical performance. The validity of the subjective global rating scale was evaluated by the objective measurement results from the software.Results: The global rating scale score had no obvious correlation with the area of the removed tissue and the residual wound area after the suture. There was significant difference in the debridement time and the residual wound area between 0–3 and >3 total stitches. There were significant differences in the area of the removed tissue between 0 and 1–2 grey stitches and 0 and 3–4 grey stitches, and in the residual wound area after suture between 0 and 3–4 grey stitches and 1–2 and 3–4 grey stitches.Conclusions: An irregular wound repair procedure could be an effective method to assess the integrative competence of surgery residents. The training for surgical thinking in the early stage of junior residents needs to be strengthened. The entire measurement process was more complex and time-consuming than expected. The possibility of measurement by simply counting the numbers of the key spots might be explored in the future.Abbreviations: ACS/APDS American College of Surgeons/Association of Program Directors in Surgery; GRS Global rating scale; LSD-T Least significant difference-test; OSATS Objective structured assessment of technical skills; OSCE Objective structured clinical examination; PBT Proficiency based training; PGY1 Postgraduate Year 1

Highlights

An increased demand for accountability and transparency in medicine have initiated a shift toward a more objective and standardized approach for postgraduate medical training
Since the cadaveric pork belly skin had no elastic retraction, we considered the area of the removed tissue to represent the area of the wound after debridement
30 residents succeeded in excising the necrotic parts of the irregular wound, whereas only 1 resident was not able to complete the debridement

Summary

Introduction

An increased demand for accountability and transparency in medicine have initiated a shift toward a more objective and standardized approach for postgraduate medical training. It has been considered that clinical competence of surgery residents can be enhanced by (1) increased exposure to surgical procedures (2), bedside care of patients (3), copying from role models, and (4) receiving verbal instructions from expert surgeons [2,3] This surgical training model continues to have a strong impact on surgical education, it has been criticized for its high investment in training time and teaching staff resources [4]. Disparity in training time and opportunities may affect residents’ clinical competence and, in turn, patient safety These trends, in combination with an increased demand for accountability and transparency in medicine, have initiated a shift toward a more objective and standardized approach for postgraduate medical training. As part of a national initiative to reform postgraduate medical training, Peking University First Hospital started in 2014 the first surgical school in China, aimed at formalizing and standardizing training for CONTACT Bing Wen Republic of China

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