Verification of proficiency in basic skills for postgraduate year 1 residents

Abstract

The American College of Surgeons and Association of Program Directors in Surgery Phase 1 curriculum involves basic surgical skills instructional modules and Verification of Proficiency. This article is a study and revision of beta versions of the Verification of Proficiency instruments. Postgraduate year 1 residents were tested on 11 skills after undergoing lab instruction and practice. Deidentified videotaped performances were scored and data were analyzed to identify correlations between individual checklist items and failure. In all, 23 residents underwent Verification of Proficiency over 2 years; 8 (35%) passed all Verification of Proficiency examinations at the first attempt, 15 (65%) failed at least 1 module, and 11 (48%) failed at least 2 modules. Residents who failed to demonstrate proficiency underwent mandatory remediation and retested until their scores were considered proficient. Scrutiny of the results revealed checklist items that were predictive independently of overall failure. The pass rate was significantly greater in 2009 compared with 2008 after the introduction of rater training and consequences for failure. Verification of Proficiency provides a framework to evaluate learner progress toward skills proficiency. That we achieved 100% faculty compliance with more than 250 performances speaks to the feasibility of Verification of Proficiency. This approach should facilitate a more widespread Verification of Proficiency acceptance as a step closer to developing a final proficiency examination for basic surgical skills in postgraduate year 1 residents.