Search

Objectives: 1) Evaluate the value and strength of a competency framework for identifying and measuring performance requirements for expeditionary surgeons; 2) Verify psychometric integrity of assessment instrumentation for measuring domain knowledge and skills; 3) Identify gaps in knowledge and skills capabilities using assessment strategies; 4) Examine shared variance between knowledge and skills outcomes, and the volume and diversity of routine surgical practice. Background: Expeditionary military surgeons provide care for patients with injuries that extend beyond the care requirements of their routine surgical practice. The readiness of these surgeons to independently provide accurate care in expeditionary contexts is important for casualty care in military and civilian situations. Identifying and closing performance gap areas are essential for assuring readiness. Methods: We implemented evidence-based processes for identifying and measuring the essential performance competencies for expeditionary surgeons. All assessment instrumentation was rigorously examined for psychometric integrity. Performance outcomes were directly measured for expeditionary surgical knowledge and skills and gap areas were identified. Knowledge and skills assessment outcomes were compared, and also compared to the volume and diversity of routine surgical practice to determine shared variance. Results: Outcomes confirmed the integrity of assessment instrumentation and identified significant performance gaps for knowledge and skills in the domain. Conclusions: Identification of domain competencies and performance benchmarks, combined with best-practices in assessment instrumentation, provided a rigorous and defensible framework for quantifying domain competencies. By identifying and implementing strategies for closing performance gap areas, we provide a positive process for assuring surgical competency and clinical readiness. [ABSTRACT FROM AUTHOR]

The article discusses the competency-based medical education (CBME) program for physicians in the U.S. It states that it is an attractive option for the residency program and the resident. It notes that the program requires demonstration of mastery in targeted domain supported by criterion-reference and objective performance-based analysis. It mentions that transitioning to the CBME program will take a number of years.

The article discusses the advantages of simulation-based training on medical procedures at the task, clinical and environmental levels. It is asserted that simulation enables mastery prior to actual application and enables team members to practice together using various clinical scenarios. Tools may be inanimate or computer-driven and tasks that may be simulated include minimally invasive surgery, intravenous insertion and laparoscopic camera navigation. The need to adapt the leadership style and training approach to the type of team is also cited.

Introduction: Low-cost, high-fidelity models for training in advanced laparoscopic surgery techniques are not currently available. The objective of this study was to evaluate a model and assessment protocol for developing associated fine, precise laparoscopic dissection skills with accompanying surgical decision making., Methods: Novice to expert laparoscopists (n = 41) were asked to remove the peel of a clementine in as few pieces as possible, separate and remove all albedo from and between all fruit segments, and return the clementine to as close to its natural state as possible with completely closed skin (sutured). Clinical decision making included deciding when unacceptable segment damage would result by removing difficult-to-extract albedo, analogous to treating lesions or metastases through other methods, rather than risking damage to vital anatomic structures. Faculty assessed deidentified video-recorded performances. Data analyses included analysis of variance with Bonferroni post hoc., Results: A single-performance construct (operative ability) with 2 scoring dimensions (surgical skills and clinical judgment) was confirmed through factor analysis. There were significant performance differences between all experience levels (F2,41 = 59.175, P < 0.000). There were no statistical time differences between the groups., Conclusions: Validation of this low-cost, easily facilitated model for developing advanced laparoscopic surgical skills may support the preparation of residents and fellows and provide a platform for skill acquisition, assessment, and basic critical thinking for performing laparoscopic tasks.

Background: Effective interdisciplinary health care teamwork improves clinical and financial outcomes, and training and assessment of team competencies are central to establishing high-functioning health care teams. The roles that team members assume in the provision of patient care are important contributors to effective health care team performance; however, variability among health care practitioners can lead to philosophical, political, social, and clinical differences in perceptions and recommendations for patient care as well as expected communication patterns and protocols., Purpose: The purpose of this study was to describe the roles and behaviors within variable health care teams in the provision of patient care across multiple clinical practice areas to inform a model for team development strategies., Methodology: Interdisciplinary health care teams were observed in vivo during the routine course of their work in multiple patient care contexts. Data were collected and analyzed using qualitative methods of observation and categorization, with supplemental interviews to substantiate, to clarify, and to verify observations. The constant comparative method of data analyses was used to derive a compositional typology for health care teams., Findings: A compositional typology for health care teams emerged from the data specifying four types of health care teams: stable role, stable personnel (Type SRSP); stable role, variable personnel (Type SRVP); variable role, stable personnel (Type VRSP); and variable role, variable personnel (Type VRVP)., Implications: Results suggest that health care teams may be more complicated than non-health care teams, and team models with associated derived competencies from other professions may not wholly transfer to health care. A singular model to inform best practices for health care team development may not adequately address the specific performance challenges of each team type. Adaptable development strategies for each type of team and its associated role membership may be required to optimize team performance. The health care team typology derived from this study may help inform the selection of appropriate team development strategies and define associated team competencies.

Objective: To determine if prior training on the LapMentor laparoscopic simulator leads to improved performance of basic laparoscopic skills in the animate operating room environment., Summary Background Data: Numerous influences have led to the development of computer-aided laparoscopic simulators: a need for greater efficiency in training, the unique and complex nature of laparoscopic surgery, and the increasing demand that surgeons demonstrate competence before proceeding to the operating room. The LapMentor simulator is expensive, however, and its use must be validated and justified prior to implementation into surgical training programs., Methods: Nineteen surgical interns were randomized to training on the LapMentor laparoscopic simulator (n = 10) or to a control group (no simulator training, n = 9). Subjects randomized to the LapMentor trained to expert criterion levels 2 consecutive times on 6 designated basic skills modules. All subjects then completed a series of laparoscopic exercises in a live porcine model, and performance was assessed independently by 2 blinded reviewers. Time, accuracy rates, and global assessments of performance were recorded with an interrater reliability between reviewers of 0.99., Results: LapMentor trained interns completed the 30 degrees camera navigation exercise in significantly less time than control interns (166 +/- 52 vs. 220 +/- 39 seconds, P < 0.05); they also achieved higher accuracy rates in identifying the required objects with the laparoscope (96% +/- 8% vs. 82% +/- 15%, P < 0.05). Similarly, on the two-handed object transfer exercise, task completion time for LapMentor trained versus control interns was 130 +/- 23 versus 184 +/- 43 seconds (P < 0.01) with an accuracy rate of 98% +/- 5% versus 80% +/- 13% (P < 0.001). Additionally, LapMentor trained interns outperformed control subjects with regard to camera navigation skills, efficiency of motion, optimal instrument handling, perceptual ability, and performance of safe electrocautery., Conclusions: This study demonstrates that prior training on the LapMentor laparoscopic simulator leads to improved resident performance of basic skills in the animate operating room environment. This work marks the first prospective, randomized evaluation of the LapMentor simulator, and provides evidence that LapMentor training may lead to improved operating room performance.