Association Of Program Directors In Surgery Research Articles

Barriers to adoption of the surgical resident skills curriculum of the American College of Surgeons/Association of Program Directors in Surgery

The American College of Surgeons (ACS) and the Association of Program Directors in Surgery (APDS) jointly developed a standardized skills curriculum for surgical residents. This program was intended to be affordable, reproducible, reliable, and proficiency-based. Some experts have proposed mandating that all residency programs implement the curriculum. Although general surgery program directors have supported uniformly the use of simulation in training, one third of general surgery residencies have no simulation curricula. Our goal was to identify barriers to the implementation of the ACS/APDS curriculum. The ACS/APDS skills curriculum was analyzed on the basis of the ACS website. All materials listed in each module in all 3 phases were tabulated. Supply costs per resident were calculated along with the time requirements for each. The approximate cost per resident for supplies to complete the entire ACS/APDS skills curriculum exceeds $30,000. The initial cost for the development of our surgery learning center was $4.5 million. Capital equipment and instruments were an additional cost. Time to complete the program was 90 h for each resident, with additional time commitments by surgery faculty, simulation center staff, educational development staff, and veterinary staff. Simulation staffing costs were $22,107. The ACS/APDS skills curriculum has a substantial resource commitment associated with its implementation. These capital, instrument, and personnel costs present a major challenge to residency programs that want to adopt this program. Faculty participation in the program poses an additional logistic challenge. Last, resident involvement must be scheduled within the 80-h work-week limit, impacting resident availability for their obligations of patient care. Re-examination of the scope and complexity appears warranted, along with development of low-fidelity substitutions for the proposed modules as well as opportunities for resource-sharing.

Global Surgery Rotations for Residents

I read with interest the results of the Association of Program Directors in Surgery (APDS) survey on international electives authored by Mitchell and coworkers in a recent issue of the journal [1]. It is indeed laudable that they have attempted to address the need for surgical trainees in the United States to gain exposure to the ‘‘bigger picture’’ of surgery in less-resourced environments. As someone working in the developing world as an academic surgeon and who supervises trainees, I would like to make a few practical comments that may further assist the authors and the APDS with the design of such educational opportunities for the residents. First, from having hosted a number of international elective trainees over the years (US, UK, German citizens, among others), I would like to recommend to the researchers that the minimum length of time for these elective periods should be 2–3 months. It takes time to settle into a routine, normally about 2 weeks. This should be sufficient time for residents to adjust to the cultural (and potential language) differences and still enable them to effectively benefit from a clinical perspective. This also avoids the ‘‘drop-and-go’’ effect of doing something and not having time to see the final results—something important to surgical trainees. I also found it interesting that the recommendation was for these electives to be done in the third or fourth year of training, as I have previously recommended, preferably after some training in intensive care [2]. As far as curriculum, supervision, and evaluation are concerned, it is important to identify suitable local surgeons, either with FACS or local academic standing (widely published or internationally respected in their field), to provide surrogate supervision rather than relying on direct American supervision, as the nuances of local practice and the adaptation to local resource constraints may otherwise be sacrificed. While no program required research as part of the elective, this is a potential goldmine for the resident, since many developing countries have a wealth of research opportunity but a dearth of local capability to perform it. For the evaluation process, standardized forms could be developed by the Residency Review Committee (RRC) or the American College of Surgeons and used by the local supervisor, thus making the process fair and equitable. Finally, most surgical colleges (American College of Surgeons, Royal College of Surgeons, College of Surgeons of SA, Royal Australasian College of Surgeons, and Pan African Association of Surgeons) hold intercollegiate meetings and combined conferences. There could be formal or informal agreements between the colleges that recognize training undertaken in one country as time served, thus satisfying the RRC that adequate supervision and training of the resident were performed. In conclusion, I wish to support the authors’ contention that a consortium model be adopted to address the requirements for these electives, but I also appeal to the authors and the RRC to include the international partner organizations in the consortium so as to set reasonable and achievable goals for the residents undertaking international electives. T. Hardcastle (&) Trauma Unit, Inkosi Albert Luthuli Central Hospital/ University of Kwa-Zulu Natal, Private Bag X05, PostNet 27, Malvern 4055, South Africa e-mail: timothyhar@ialch.co.za

Perceived Benefits of a Transplant Surgery Experience to General Surgery Residency Training

The benefit of a solid-organ transplant experience during general surgical training has been questioned recently. In 2008, in response to an American Board of Surgery (ABS) directive, a survey was conducted by the Association of Program Directors in Surgery (APDS) in coordination with the American Society of Transplant Surgeons (ASTS) to determine the perceived value of a transplant surgery rotation to program directors and residents. With the aim of providing additional insight, we conducted a separate study, independent of the ABS and ASTS, to ascertain resident perceptions regarding the specific skill sets that they acquire during their transplant surgery rotations and their applicability to other surgical subspecialties. A preliminary, 51-item, web-based questionnaire was completed by 69.6% of residents in nationally accredited general surgery programs who accessed the survey. The results were examined using appropriate statistical methods to determine associations between answers. Although only 16.6% of participants responded that they were considering a career in transplantation, 63.4% answered that the skill sets acquired during this rotation would assist them in their surgical careers regardless of their chosen specialty. Most (65.5%) respondents answered that the techniques learned were directly applicable to other specialties, such as vascular, urologic, trauma, and hepatobiliary surgery. Free response questions indicated that the most common criticisms of this rotation were the limited amount of operative participation, lack of teaching by attendings, and lifestyle limitations. The results of this study indicate that surgery residents are conflicted regarding their transplant surgery experience but regard it as a beneficial addition to their training. Most respondents indicated also that these skills were transferable directly to other surgical specialties.

Surgical Council on Resident Education: A New Organization Devoted to Graduate Surgical Education

The Surgical Council on Resident Education (SCORE) is a voluntary consortium of six organizations with responsibility for resident education in surgery and an interest in improving the training of surgeons. The founding organizations are the American Board of Surgery (ABS), the American College of Surgeons (ACS), the American Surgical Association (ASA), the Association of Program Directors in Surgery (APDS), the Association for Surgical Education (ASE), and the Residency Review Committee for Surgery of the Accreditation Council on Graduate Medical Education (RRC-S). SCORE emerged from a concerted desire to strengthen the graduate education of surgeons and to assure the competence of surgical trainees in the US. SCORE has a unique ability to foster change in resident education because it brings together the major regulatory organizations (ABS and RRC-S), the major professional organization in surgery (ACS), the senior academic organization in surgery (ASA), and the major surgical education organizations (APDS and ASE). SCORE envisions an ambitious agenda. At its meeting in Philadelphia on November 20, 2006, it began developing a standardized curriculum in general surgery to span the period from medical school to practice, and it defined the scope of the curriculum. It approved continued work of building a national Web site to deliver educational content to general surgery residents and to assist program directors. It endorsed continued development of a basic surgery curriculum for all first-year surgery residents and development of a comprehensive technical skills curriculum for all levels of general surgery training, both of which have been initiated by the ACS. In the future, SCORE plans to examine issues such as the assessment of technical competency, the role of simulation in surgical education, the teaching and assessment of professional behaviors, the practicing surgeon's view of the adequacy of residency training, faculty development, and the attrition of residents from surgery residencies. Members of SCORE intend to investigate best practices in surgical education in other countries. SCORE hopes to take a leadership position in improving the quality of surgical education and surgery in the US.

Surgical Education Research 1

There are a number of associations with a strong commitment to surgical education, the principal ones being the Association for Surgical Education (ASE), the American College of Surgeons (ACS) Committee on Education, and the Association of Program Directors in Surgery (APDS). The mission of the Association for Surgical Education is to promote, recognize, and reward excellence, innovation, and scholarship in surgical education. Membership is available to medical students, residents, and faculty [ 1 The Association for Surgical Education. Available online: http://www.surgicaleducation.com. Accessed December 23, 2004. Google Scholar ]. Information concerning this association is available on their Website (http://www.surgicaleducation.com). Among the many resources available through the ASE is the Surgical Educators’ Handbook that has a section specifically devoted to research in education. A second good resource is A Manual for Researchers in Surgical Education that covers topics such as surgical education publications, educational research design, and statistics. The ASE also has a research committee that assists individuals in the pursuit of surgical education. They offer a surgical education research fellowship (SERF) as well. This is an intense fellowship that provides instruction on surgical education techniques and includes workshops, home study, and an assigned research mentor. The fellow is required to develop, conduct, write, and present a structured research project in education.

Report of the American Board of Surgery (ABS) to the Association of Program Directors in Surgery (APDS)

Report of the American Board of Surgery (ABS) to the Association of Program Directors in Surgery (APDS)

A tale of two domains—opportunity in the face of despair

At the joint meeting of the Association for Surgical Education (ASE) and the Association of Program Directors in Surgery (APDS) in Nashville in March 2001, the (mis)match captured the creative energy and angst of most of the audience and many speakers and panel members. Electrified dialog from the floor followed on the heels of numerous podium presentations, but attention returned often to the nagging issue on everyone’s mind: our failure to attract adequate numbers of talented medical students into surgery’s residency applicant pool. Other topics discussed were the attrition of residents during their training, attrition of ATLS skills and knowledge over time, the key role of M&M conferences in resident education, issues associated with residents seeking informed consent, professionalism, the “surgical personality,” and the impact of tension among operating room personnel. Yet, the conundrum knotting the collective surgical brow was how to assure a steady stream of highly qualified and motivated students into careers in surgery. This overarching dilemma was revisited throughout the week, and a few paradigm shifts were suggested for American surgery’s “March madness.” When the American Association of Clinical Anatomists

Evaluation of endoscopic and laparoscopic training practices in surgical residency programs.

The ability to adequately train surgical residents in flexible and rigid endoscopy has become a difficult challenge for program directors. The American Board of Surgery requires residents to be familiar in these procedures but the methods for training have not been well defined nor formally outlined. The goals of this study were to evaluate resident experience in flexible endoscopy and laparoscopy and to investigate the specific methods used by surgical programs for the training of residents. A survey was created by the authors and the Resident Education Committee of the Society of American Gastrointestinal Endoscopic Surgeons and was mailed to all program directors in general surgery in the United States based on the data base of the Association of Program Directors in Surgery (APDS). Ninety-six of 283 surveys were returned (33.9%). The surgeon played a greater role in flexible endoscopic training in 1998 as compared to 1988 (p=0.002). When analyzed by type of institution, community programs showed a similar trend but this was not seen in academic programs. Formal endoscopy rotations existed in 60% of programs but flexible endoscopy (5.2%) and laparoscopy (10.4%) fellowships were uncommon. No significant differences in the number of advanced laparoscopic procedures performed were found between academic and community programs. The presence of a laparoscopic fellow did not significantly decrease the number of cases per resident. According to our survey, surgery departments have a greater impact on flexible endoscopic training in 1998 than in 1988. This is likely due to the creation of formal endoscopy rotations and the hiring of fellowship trained endoscopic instructors. In addition, community programs have been able to provide adequate experience in both basic and advanced laparoscopic techniques as compared to academic programs. As with flexible endoscopy, however, formal laparoscopic rotations may be necessary to allow more intensive experience for each resident.

Presidential address: Practice patterns in vascular surgery—Implications for the certification and training of vascular surgeons

It is a privilege for me to welcome you to the Eleventh Annual Meeting of the Eastern Vascular Society (EVS). Serving as President of your Society during this past year has been a great pleasure and distinct honor for me. As I contemplated the traditional obligation for this address, I was impressed with the emergence of our specialty of vascular surgery to a position of independence, as well as the gravity of decisions and crossroads we face movingtoward the next century. Today, I have chosen to review a body of data that impacts on the practice of vascular surgery and the training of vascular surgeons. In preparing for this presentation, I have used data previously collected for the Association of Program Directors in Vascular Surgery (APDVS; Manpower survey. Hobson RW, unpublished data; 199596.). I have been urged by many colleagues to publish this information, and I trust that it will interest you as well as constitute a useful review for those of you in the audience who attended recent meetings of the APDVS. In my opinion, these data reflect ongoing changes in the practice of vascular surgery and have important implications for the certification and future training of vascular surgeons.