Was it all worth it? A graduating resident perspective on CBME.

BACKGROUND: Our institution simultaneously transitioned all postgraduate specialty training programs to competency-based medical education (CBME) curricula. We explored experiences of CBME-trained residents graduating from five-year programs to inform the continued evolution of CBME in Canada. METHODS: We utilized qualitative description to explore residents' experiences and inform continued CBME improvement. Data were collected from fifteen residents from various specialties through focus groups, interviews, and written responses. The data were analyzed inductively, using conventional content analysis. RESULTS: We identified five overarching themes. Three themes provided insight into residents' experiences with CBME, describing discrepancies between the intentions of CBME and how it was enacted, challenges with implementation, and variation in residents' experiences. Two themes - adaptations and recommendations - could inform meaningful refinements for CBME going forward. CONCLUSIONS: Residents graduating from CBME training programs offered a balanced perspective, including criticism and recognition of the potential value of CBME when implemented as intended. Their experiences provide a better understanding of residents' needs within CBME curricula, including greater balance and flexibility within programs of assessment and curricula. Many challenges that residents faced with CBME could be alleviated by greater accountability at program, institutional, and national levels. We conclude with actionable recommendations for addressing residents' needs in CBME.

Recent evidence on visual-spatial ability in surgical education: A scoping review.

BACKGROUND: Understanding the relationships between structures is critical for surgical trainees. However, the heterogeneity of the literature on visual-spatial ability (VSA) in surgery makes it challenging for educators to make informed decisions on incorporating VSA into their programs. We conducted a scoping review of the literature on VSA in surgery to provide a map of the literature and identify where gaps still exist for future research. METHODS: We searched databases until December 2019 using keywords related to VSA and surgery. The resulting articles were independently screened by two researchers for inclusion in our review. RESULTS: We included 117 articles in the final review. Fifty-nine articles reported significant correlations between VSA tests and surgical performance, and this association is supported by neuroimaging studies. However, it remains unclear whether VSA should be incorporated into trainee selection and whether there is a benefit of three-dimensional (3D) over two-dimensional (2D) training. CONCLUSIONS: It appears that VSA correlates with surgical performance in the simulated environment, particularly for novice learners. Based on our findings, we make suggestions for how surgical educators may use VSA to support novice learners. Further research should determine whether VSA remains correlated to surgical performance when trainees move into the operative environment.

CONTEXTE: Il est fondamental pour les chirurgiens en formation de comprendre les liens qui unissent les diverses structures corporelles. Étant donné l'hétérogénéité de la littérature portant sur les habiletés visuo-spatiales (HVS) nécessaires en chirurgie, les éducateurs ont de la difficulté à prendre des décisions éclairées quant à l'enseignement des HVS dans leurs programmes. On a effectué une étude exploratoire de la littérature sur les HVS en chirurgie afin de répertorier la littérature et de cerner des lacunes pouvant faire l'objet de recherches ultérieures. MÉTHODOLOGIE: On a interrogé des bases de données jusqu'à décembre 2019 à l'aide de mots-clés reliés aux HVS et à la chirurgie. Les articles trouvés ont été évalués de façon indépendante par deux chercheurs pour déterminer leur inclusion à la revue. RÉSULTATS: Au total, 117 articles ont été inclus dans la revue finale. Cinquante-neuf faisaient état d'importantes corrélations entre les tests d'évaluation des HVS et la performance chirurgicale. Cette association est étayée par les résultats d'études en neuro-imagerie. Il n'est pas clair cependant si les HVS devraient faire partie des critères de sélection des résidents et si une formation sur les techniques de visualisation en trois dimensions (3D) est préférable à une formation sur les techniques de visualisation en deux dimensions (2D). CONCLUSIONS: Il semble exister un lien entre les HVS et la performance chirurgicale en contexte de simulation, particulièrement chez les apprenants novices. À la lumière de nos résultats, nous présentons des recommandations sur la façon dont les formateurs en chirurgie pourraient se servir des HVS pour aider les apprenants novices. D'autres travaux de recherche devraient permettre de savoir si les HVS restent reliés à la performance chirurgicale lorsque les stagiaires passent à un environnement opératoire réel.

A Shift on the Horizon: A Systematic Review of Assessment Tools for Plastic Surgery Trainees.

BACKGROUND: As plastic surgery programs transition toward competency-based medical education curricula, it is important to critically assess current methods of evaluating trainee competence. The purpose of this systematic review was to identify and evaluate assessment tools for technical and nontechnical competencies in plastic surgery. METHODS: A systematic search using keywords related to competency-based medical education, assessment, and plastic surgery was conducted. Two independent reviewers extracted data pertaining to study characteristics, study design, and psychometric properties. Data pertaining to the establishment of competence and barriers to tool implementation were noted. RESULTS: Twenty-three studies were included in this review. Technical competencies were assessed in 16 studies. Nontechnical competencies were assessed in five studies. Two studies assessed both technical and nontechnical competence. Six tools were implemented in a simulated setting and 17 tools were implemented in a clinical setting. Thirteen studies (57 percent) did not report reliability scores and nine (39 percent) did not report validity scores. Two tools established clear definitions for competence. Common barriers to implementation included high demands on resources and time, uncertainty about simulation transferability, and assessor burnout. CONCLUSIONS: A number of tools exist to assess a range of plastic surgery skills, in both clinical and simulated settings. There is a need to determine the transferability of simulated assessments to clinical practice, as most available tools are simulation-based. Although additional psychometric testing of current assessment tools is required, particularly in the nontechnical domain, this review provides a base on which to build assessment frameworks that will support plastic surgery's transition to competency-based medical education.

Surgical simulation training in orthopedics: current insights.

BACKGROUND: While the knowledge required of residents training in orthopedic surgery continues to increase, various factors, including reductions in work hours, have resulted in decreased clinical learning opportunities. Recent work suggests residents graduate from their training programs without sufficient exposure to key procedures. In response, simulation is increasingly being incorporated into training programs to supplement clinical learning. This paper reviews the literature to explore whether skills learned in simulation-based settings results in improved clinical performance in orthopedic surgery trainees. MATERIALS AND METHODS: A scoping review of the literature was conducted to identify papers discussing simulation training in orthopedic surgery. We focused on exploring whether skills learned in simulation transferred effectively to a clinical setting. Experimental studies, systematic reviews, and narrative reviews were included. RESULTS: A total of 15 studies were included, with 11 review papers and four experimental studies. The review articles reported little evidence regarding the transfer of skills from simulation to the clinical setting, strong evidence that simulator models discriminate among different levels of experience, varied outcome measures among studies, and a need to define competent performance in both simulated and clinical settings. Furthermore, while three out of the four experimental studies demonstrated transfer between the simulated and clinical environments, methodological study design issues were identified. CONCLUSION: Our review identifies weak evidence as to whether skills learned in simulation transfer effectively to clinical practice for orthopedic surgery trainees. Given the increased reliance on simulation, there is an immediate need for comprehensive studies that focus on skill transfer, which will allow simulation to be incorporated effectively into orthopedic surgery training programs.