NEW DIRECTIONS IN SURGICAL EDUCATION AND TRAINING Ajit K. Sachdeva, MD, FRCSC, FACS Director, Division of Education American College of Surgeons Challenges of Transitions in Surgery Residency

Practice- based Learning & Improve- ment Proficiency- based Training FRAMEWORK OF THE CORE COMPETENCIES IN SURGERY RESIDENCY TRAINING Milestones Surgical Knowledge Inter- personal and Communi- cation Skills Patient Care and Procedural Skills Profession -alism System- based Practice Sachdeva 2013

FOCUS ON TRANSITIONS IN SURGERY RESIDENCY TRAINING Transition from medical school to surgery residency Transition from surgery residency to independent practice Sachdeva 2013

UNDERPINNINGS OF EFFORTS TO ADDRESS THE TRANSITION FROM MEDICAL SCHOOL TO SURGERY RESIDENCY Demonstration of significant variability in the clinical skills of entering surgery residents using long, integrated Objective Structured Clinical Examination (OSCE) stations; findings of high reliability with relatively short testing time Sachdeva, et al, Surgery, 1995 Demonstration of significant impact of a single structured SP intervention to teach critical clinical skills to third-year medical students Sachdeva, et al, Am J Surg, 1999

UNDERPINNINGS OF EFFORTS TO ADDRESS THE TRANSITION FROM MEDICAL SCHOOL TO SURGERY RESIDENCY Recommendations of the American Surgical Association Blue Ribbon Committee on Surgical Education Debas, et al, Ann Surg, 2005 Impact of the major AHRQ Grant: Educating Surgeons in Patient Safety Sachdeva (PI),

ACS DIVISION OF EDUCATION EFFORTS TO ADDRESS THE TRANSITION FROM MEDICAL SCHOOL TO SURGERY RESIDENCY Definition of essential areas of knowledge and skills for residents beginning and completing PGY-1 Year of surgery residency training Content defined within the framework of the 6 core competencies Developed with broad input from across surgical specialties Published 2005; Funded through AHRQ Grant Sachdeva 2013

ACS DIVISION OF EDUCATION EFFORTS TO ADDRESS THE TRANSITION FROM MEDICAL SCHOOL TO SURGERY RESIDENCY Simulation-based, interactive, on-line curriculum, for PGY-1 surgery residents: 11 modules; 94 case scenarios Innovative IT engine, patent pending 213 residency programs (1,820 residents) currently enrolled in the curriculum Launched 2005 after pilot testing Sachdeva 2013

ACS DIVISION OF EDUCATION EFFORTS TO ADDRESS THE TRANSITION FROM MEDICAL SCHOOL TO SURGERY RESIDENCY 10 integrated, long OSCE stations focusing on patient safety, for PGY-1 surgery residents Validated evaluation model, with standardized assessment tools Comprehensive package including illustrative videos and pictures, and detailed information to facilitate implementation Launched 2008; Funded through AHRQ Grant Sachdeva 2013

Proficiency-based surgical skills curriculum for residents Phase I – 20 modules; Phase II – 15 modules; Phase III – 10 modules Currently undergoing revision New videos and OSATS Stations being added Launched 2009 ACS DIVISION OF EDUCATION EFFORTS TO ADDRESS THE TRANSITION FROM MEDICAL SCHOOL TO SURGERY RESIDENCY Sachdeva 2013

ACS DIVISION OF EDUCATION EFFORTS TO ADDRESS THE TRANSITION FROM MEDICAL SCHOOL TO SURGERY RESIDENCY Designed for fourth-year medical students, to prepare them for surgery residency training Based on thorough gap analyses Modular curricula with sufficient flexibility Modules address clinical, procedural, and non-technical skills Pilot testing commenced in 2013 ACS/APDS/ ASE Resident Prep Curriculum Sachdeva 2013

ACS DIVISION OF EDUCATION EFFORTS TO ADDRESS THE TRANSITION FROM MEDICAL SCHOOL TO SURGERY RESIDENCY Modular, simulation-based curriculum for all medical students in Years 1-3, regardless of career goals 25 Modules address clinical, procedural, and non-technical skills Content anchored to training needs in each year of medical school Launched 2013 Sachdeva 2013

ACS DIVISION OF EDUCATION EFFORTS TO ADDRESS THE TRANSITION FROM MEDICAL SCHOOL TO SURGERY RESIDENCY Modular, proficiency-based, cognitive skills curriculum for all medical students in Third Year Surgery Clerkships Educational needs in Years 1-2 to be addressed later Use of simulations, animations, and new technologies Curriculum development commenced in 2012 ACS/ASE Medical Student Core Surgery Curriculum Sachdeva 2013

UNDERPINNINGS OF EFFORTS TO ADDRESS THE TRANSITION FROM SURGERY RESIDENCY TO INDEPENDENT PRACTICE ACS Board of Governors Survey Napolitano, et al, 2012 Recent changes in the training and experiences of surgery residents Lewis and Klingensmith, Ann Surg, 2012 Proficiency-based training of surgery residents, including use of simulation Sachdeva, et al, Acad Med, 2007

UNDERPINNINGS OF EFFORTS TO ADDRESS THE TRANSITION FROM SURGERY RESIDENCY TO INDEPENDENT PRACTICE Representatives from the respective Certifying Boards, RRCs, PDs Organizations; Professional Societies; other Key Stakeholders invited to a conference at ACS Headquarters Over 75 individuals participated in the conference Plenary Sessions and Small Groups addressed key topics Sachdeva 2013

ACS DIVISION OF EDUCATION EFFORTS TO ADDRESS THE TRANSITION FROM RESIDENCY TO INDEPENDENT SURGICAL PRACTICE ACS RATL Course ACS Program on Starting Surgical Practice: Essentials for Success Sachdeva 2013

Appointment of ACS TTP in General Surgery Steering Committee Definition of framework of ACS TTP Program Outline of education and training model Articulation of principles for accreditation Program development commenced in 2012 ACS DIVISION OF EDUCATION EFFORTS TO ADDRESS THE TRANSITION FROM RESIDENCY TO INDEPENDENT SURGICAL PRACTICE Sachdeva 2013

PILOT SITES FOR THE ACS TRANSITION TO PRACTICE PROGRAM IN GENERAL SURGERY Initial Group of Participating Institutions Alpert Medical School of Brown University, Providence, RI Eastern Virginia Medical School, Norfolk, VA Gundersen Lutheran Health System, LaCrosse, WI Mercer University School of Medicine/Medical Center of Central Georgia, Macon, GA Ohio State University Wexner Medical Center, Columbus, OH University of Louisville School of Medicine, KY University of Tennessee College of Medicine, Chattanooga, TN Sachdeva 2013

CLOSING COMMENTS… Innovative education and training needs to be an integral part of efforts to enhance quality and safety in surgery Special focus on transitions is key to achieving the best outcomes ACS Division of Education looks forward to opportunities for collaboration with other international organizations to address the myriad opportunities ahead Sachdeva 2013

American College of Surgeons Division of Education Blended Surgical Education and Training for Life