amp Relevance of the Clinical Curriculum to Future Practice Jonathan Fryer MD Jeff Fronza MD Jeff Wayne MD Debra DaRosa PhD and Jay Prystowsky MD MHPE Northwestern University Feinberg School of Medicine ID: 557496
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Slide1
Surgical Residents’ Perception of Competence & Relevance of the Clinical Curriculum to Future Practice
Jonathan Fryer, MD, Jeff
Fronza
, MD,
Jeff Wayne, MD,
Debra DaRosa, PhD, and Jay Prystowsky, MD, MHPE
Northwestern University Feinberg School of MedicineSlide2
Graduation Requirements?*
A = “essential”
B = “should be”
C = “not necessary”121 operations = “essential” components of GS resident training by majority of PD’s (n=114/254)
*R.H
. Bell, Surgical council on resident education: a new organization devoted to graduate surgical education,
J Am
Coll
Surg
204
(2007), pp. 341–346. Slide3
But……
For 52% (63/121) of the “essential”
cases,
the mode no. of cases/resident = 0!These included cases such as:
CBDE
Transanal
tumor excisionAnal fistulotomySlide4
Research Questions
To what extent do our graduates feel competent with selected operations?
How relevant are these operations to their current practices?
Is there a relationship between the number of cases logged and post residency perceived competence?Slide5
Subjects Slide6
Survey Instrument = 67 OperationsSlide7
Survey Instrument Each operation= two 4-point scales
SA A D SD
“I was well-prepared to work-up, independently perform this operation, and effectively care for the patient post-operatively
” (i.e. COMPETENCE) “This operation is relevant to my current practice profile” (i.e. RELEVANCE)Slide8
Data Collection Annual electronic survey
sent out in January to
all general surgery residents graduating the previous year.
Case logs were reviewed for each resident compiling total case volume by operations listed on the survey.Slide9
Statistical analysisFrequency counts and means were calculated for both survey scales for each operation.
Linear regression analysis - correlation between perceptions of competence and total major procedural case volumes.
Unpaired Student-T-tests - compared mean case #s for each
procedure performed by residents’ who felt competent (SA+A) vs. those performed by those who did not feel competent (D+SD). Slide10
Results
Post
graduate Track
# (n= 22)Surgical Oncology 5Minimally Invasive Surgery4Cardiothoracic3Colorectal2Plastic Surgery
2
Pediatric Surgery
2Breast 1Endocrine1Non fellowship track2Slide11
Least Relevant OperationsProcedure for NEC
Orchiopexy
CEA
Creation of dialysis access fistulaMajor amputationEndovascular repair of AAAInfrainguinal arterial bypassDebridement of escharSlide12
Most Relevant OperationsExploratory laparotomy with LOA
Open
chole
Lap choleVentral hernia repairPartial gastrectomy Enterectomy w/ anastomosisColectomy, partial w/ anastomosisColectomy, partial w/ coloproctostomyG-tube or J-tube insertsSlide13
Highest CompetenceInguinal hernia >5
yrs
Exploratory lap w/ LOAOpen
choleLap choleEnterectomy w/ anastomosisColectomy, partial w/ anastomosisG-tube/J-tube insertionPartial gastrectomyWedge resection of liverNeedle breast bxSimple mastectomySLNBTotal thyroidectomyParathyroidectomySlide14
Least CompetenceSurgical treatment of NEC
Orchiopexy
Transhiatal
esophagectomyAdrenalectomyOpen AAA repairEndovascular AAA repairSlide15
100% Respondents Perceived Competence
24%
Operations (16 of 67)Slide16
90% Respondents Perceived Competence
Operations (34 of 67)Slide17
50% Respondents Perceived CompetenceSlide18
Procedural Volume vs. Competence For total major procedural volumeNo correlation (r = 0.343; p=0.12)
For individual procedural volume
+ve correlation with four procedures
Esophagectomy (p=0.014)Orchiopexy (p=0.03)EGD (p=0.018)Adrenalectomy (p=0.001)Slide19
SummaryThe majority of graduating general surgery residents feel they are competent to perform a very limited # of surgical procedures.There is little consistency among general surgery residency graduates regarding which procedures are relevant to their practice. Slide20
1. Is the current clinical curriculum on target with general surgery graduates’ learning needs? 2. Should the clinical curriculum be better tailored to graduates’ future practice?Slide21
-Slide22
LiteratureBlumenthal et al, JAMA, 2001“Overall (survey) data suggest that in 1998 residents…felt well...prepared for clinical practice. However, …the gaps still exist in the preparedness of physicians to manage the full range of patients, problems, and procedures they may confront at practitioners.”Slide23
Operative Experience Decreasing*
Kairys
JC et al. JACS, 2008Slide24
IntroductionRecent changes in general surgery and general surgery training have engendered questions about which procedures residents should become competent with by the end of their general surgery training.While procedural numbers are used as a proxy for competence with specific procedures, a program’s final declaration of competence is largely based on a cumulative faculty assessment of the resident’s overall competence. Slide25
Total Major Operations Decreasing*
Kairys
JC et al. JACS, 2008