Faculty and Resident Perspectives on the Implementation of Entrustable Professional Activities in General Surgery Residency.

OBJECTIVE: This study aimed to identify what best practices facilitate implementation of Entrustable Professional Activities (EPAs) into surgical training programs. DESIGN: This is a mixed methods study utilizing both survey data as well as semi-structured interviews of faculty and residents involved in the American Board of Surgery (ABS) EPA pilot study. SETTING: From 2018 to 2020, the ABS conducted a pilot that introduced five EPAs across 28 general surgery training programs. PARTICIPANTS: All faculty members and residents at the 28 pilot programs were invited to participate in the study. RESULTS: About 117 faculty members and 79 residents responded to the survey. The majority of faculty (81%) and residents (66%) felt that EPAs were useful and were a valuable addition to training. While neither group felt that EPAs were overly time consuming to complete, residents did report difficulty incorporating them into their daily workflow (44%). Semi-structured interviews found that programs that focused on faculty and resident -development and utilized frequent reminders about the importance and necessity of EPAs tended to perform better. CONCLUSIONS: EPA implementation is feasible in general surgery training programs but requires significant effort and engagement from all levels of program personnel. As EPAs are implemented by the ABS nationally a focus on resident and faculty development will be critical to success.

A Competency-based Laparoscopic Cholecystectomy Curriculum Significantly Improves General Surgery Residents' Operative Performance and Decreases Skill Variability: Cohort Study.

OBJECTIVE: To demonstrate the feasibility of implementing a CBE curriculum within a general surgery residency program and to evaluate its effectiveness in improving resident skill. SUMMARY OF BACKGROUND DATA: Operative skill variability affects residents and practicing surgeons and directly impacts patient outcomes. CBE can decrease this variability by ensuring uniform skill acquisition. We implemented a CBE LC curriculum to improve resident performance and decrease skill variability. METHODS: PGY-2 residents completed the curriculum during monthly rotations starting in July 2017. Once simulator proficiency was reached, residents performed elective LCs with a select group of faculty at 3 hospitals. Performance at curriculum completion was assessed using LC simulation metrics and intraoperative operative performance rating system scores and compared to both baseline and historical controls, comprised of rising PGY-3s, using a 2-sample Wilcoxon rank-sum test. PGY-2 group's performance variability was compared with PGY-3s using Levene robust test of equality of variances; P < 0.05 was considered significant. RESULTS: Twenty-one residents each performed 17.52 ± 4.15 consecutive LCs during the monthly rotation. Resident simulated and operative performance increased significantly with dedicated training and reached that of more experienced rising PGY-3s (n = 7) but with significantly decreased variability in performance ( P = 0.04). CONCLUSIONS: Completion of a CBE rotation led to significant improvements in PGY-2 residents' LC performance that reached that of PGY-3s and decreased performance variability. These results support wider implementation of CBE in resident training.

Identifying Managerial Roles of General Surgery Coordinators: Making the Case for Utilization of a Standardized Job Description Framework.

OBJECTIVE: Residency coordinators are valuable members of the education leadership administration. In General Surgery, program directors must devote time to both their clinical practice and as the leader of the education program for surgical residents. With the introduction of competencies and the Next Accreditation System, the responsibilities of training programs have increased, with much of the necessary day to day management being driven by the residency coordinator. The purpose of this study was to identify the current roles of a residency coordinator in surgery to determine appropriate language for a standardized job description that accurately describes the responsibilities of a program coordinator. DESIGN AND PARTICIPANTS: A survey was created and distributed via email to 317 general surgery program coordinators in programs with continued, initial, or pre-accreditation status by the ACGME in October-December 2017. Questions were asked about coordinator demographics, ADS involvement, and communication with program director, recruitment, and professional development. 223 coordinators (70%) completed the survey. RESULTS: Thirty-five percent of coordinators reported that their program director expects them to complete the annual ADS update in its entirety with a final review by the program director before submission, whereas 15% stated that the program director expects the program coordinator to input, update, and submit the annual ADS update without oversite from the program director. Fifty percent of program coordinators speak with their program director 2 to 4 days a week, whereas 38% speak with their program director daily. Eighty-nine percent of coordinators reported that their program directors trust them to make appropriate administrative decisions during scheduled or emergent absences. Sixty-nine percent of coordinators strongly agreed that they assist their program directors with collating and analyzing recruitment data post-recruitment season. Eighty-six percent of coordinators regularly participate in one or more professional development activities. Forty-six percent of coordinators stated that they oversee administrative staff in their office, division, or department. CONCLUSION: Given the current makeup of today's residency coordinator in general surgery programs, the need for baseline qualifications and a standardized job description allowing for recruitment and retention of a coordinator capable of managing a residency along with a program director. The data from our survey indicate that most coordinators currently perform tasks and take on responsibilities of a manager, but they hold current job descriptions that do not adequately reflect the role. The current proposed ACGME revisions state that there must be a program coordinator for a residency program, citing the coordinator as an integral member of the residency leadership team. Therefore, human resource departments need a job description that identifies level of responsibility, contribution, leadership, and management required of a program coordinator.

Impact of integrated programs on general surgery operative volume.

BACKGROUND: Integrated residencies are now commonplace, co-existing with categorical general surgery residencies. The purpose of this study was to define the impact of integrated programs on categorical general surgery operative volume. METHODS: Case logs from categorical general, integrated plastics, vascular, and thoracic surgery residents from a single institution from 2008 to 2016 were collected and analyzed. RESULTS: Integrated residents have increased the number of cases they perform that would have previously been general surgery resident cases from 11 in 2009-2010 to 1392 in 2015-2016. Despite this, there was no detrimental effect on total major cases of graduating chief residents. CONCLUSIONS: Multiple integrated programs can co-exist with a general surgery program through careful collaboration and thoughtful consideration to longitudinal needs of individual trainees. As additional programs continue to be created, both integrated and categorical program directors must continue to collaborate to insure the integrity of training for all residents.