Abstract
Abstract: 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.
Highlights
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
This study aims to present the initial experience in the creation and implementation of the Procedure Based Assessment (PBA) in a Medical Residency Program in Urology in Brazil
We describe the first experience with the use of the PBA – a tool for assessing surgical skills in the workplace – in a Medical Residency Program in Urology in Brazil
Summary
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. The teaching of surgical techniques in medical residency programs has historically followed Halstead’s model of “see one, do one, teach one”[1] It is a model based on surgical experience, in which proficiency is determined by the number of surgeries performed in key procedures[2], with little emphasis on details or technical skills[3]. Some factors have been pressing for changes, such as greater concern about ethics and patient safety, the demand from society for greater efficiency and quality of health services and the limitation of the resident’s workload in some countries[3,5,6] In this scenario, the teaching of the surgical technique has been widely discussed, undergoing significant changes, especially in some developed countries. Students cannot progress and cannot complete their training if they do not demonstrate competency in predefined areas of the curriculum[7]
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