1. Intersection of Surgical Outcomes and Medical Education The RRC Perspective APDS Panel Session IV Surgical Education Week March 21,2012 San Diego, CA James C Hebert, MD, FACS Chair – RRC-Surgery

2. Disclosures No financial disclosures The views presented are my own

3. PD CMO Resident RRC ACS ABS What are we trying to describe?

4. RRC Perspective – Accreditation Specific Questions 1.Can you satisfy the requirement for a patient safety curriculum and nail the core competencies with the use of outcomes data in surgical education? 2.Does providing 30 day continuous data to your residents reduce the reality of training itinerant surgeons?

5. Specific Questions – Short Answers 1.Can you satisfy the requirement for a patient safety curriculum and nail the core competencies with the use of outcomes data in surgical education? Depends on how data are generated and reported; core processes that involve residents 2.Does providing 30 day continuous data to your residents reduce the reality of training “itinerant” surgeons? The process of just providing data will not, but integrating residents into a culture of measuring outcomes may. Let’s analyze it further.

6. “…Quality isn’t method. It’s the goal toward which the method is aimed.” Robert Pirsig, Zen and the Art of Motorcycle Maintenance

7. Education Goal - Safe & Competent Surgeon Demonstrated by Clinical Outcomes Knowledge Patient Care Professionalism Communication Practice-based learning and improvement Systems based practice

8. Current Training Model Limited patient interactions along the continuum of care for a specific patient - outpatient management - limited duty hours - changing culture of surgical care - more specialization More hand-offs – “itinerant “surgery

9. What Currently Drives the Structure and Content of our Residency Programs? “Curriculum” ACGME Standards In the context of local service needs, Choose Educational Experiences within Institution, Faculty Identify/Develop Evaluation Idiosyncratic Tools - Formative and Summative - Experience Tracking “Educate” Residents “Circumstantial Practice” Guarantees that education is institutionally idiosyncratic, and lags rather than anticipates change in the delivery system Guarantees that education is institutionally idiosyncratic, and lags rather than anticipates change in the delivery system

10. Clinical Outcomes – Resident Role Patient outcomes are primarily systems-based Depend on balance of supervision and independence Defined role of resident within system - Data gatherer Leader

11. The Continuum of Clinical Professional Development Authority and Decision Making versus Supervision Authority and Decision Making LowHigh Supervision Low High Physical Diagnosis Internship Residency Fellowship Sub-Internship Attending Clerkship “Graded or Progressive Responsibility”

12. Expert Proficient Competent Advanced Beginner Novice Increase the Accreditation Emphasis on Educational Outcomes Tracking Milestones along the Continuum of Resident Training

13. What Will Drive the Structure and Content of our Residency Programs in the Near Future? Design Educational Experiences Select Faculty Expert Physicians who aspire to Mastery (Outcomes) The Required Outcomes in Each Clinical Competency (Milestones) “Intentional Practice” Guarantees that education has the opportunity to anticipate change in the delivery system Guarantees that education has the opportunity to anticipate change in the delivery system National Evaluation Tools to Track Outcomes - Formative and Summative - Clinical Outcomes Tracking (not just counting) National Evaluation Tools to Track Outcomes - Formative and Summative - Clinical Outcomes Tracking (not just counting)

14. Program Accreditation Structure Resources Core Processes – (Clinical outcome measurement) Detailed Processes- (Program specifics) Educational Outcomes – “Milestones”

15. Clinical Outcomes and Accreditation Residents should want to train where there are excellent clinical outcomes which implies good systems of care which implies a strong educational foundation (structure, resources, core &detailed processes) Residents must be integrated into processes that measure outcomes and demonstrate competent and proficient levels of achievement AND the program must demonstrate good clinical outcomes

16. Thank You ???????