Planning for Surgical Competency: The University of Iowa Experience
2009, Volume 2, Number 1 23 Introduction Multiple public and private health care organizations, including insurers, patient advocacy groups, and hos-pitals, have convinced the Accreditation Council for Graduate Medical Education (ACGME) that resident education must change [1]. These stakeholders pointed to evidence that physicians had a variable and unreliably measured skill set that was not aligned with the evolving demands of today's healthcare market. The ACGME recognized that there were significant short-comings in how the process assessed resident physician competence. For instance, the measurement of resident surgical skill was based on minimum numbers and not actual surgical outcomes. The em-phasis in the old model was on medical knowledge and not real world performance. Resident education in this apprenticeship model often did not employ the evolving and increasingly accepted models of pro-fessional skill acquisition, adult learning, and compe-tency based assessment. In order to assess physician competency the ACGME outlined 6 competencies for programs to emphasize: Patient Care, Medical Knowledge, Practice Based Learning and Improve-Planning for Surgical Competency: The University of Iowa Experience Thomas A. Oetting, MS, MD 1,2* , Hilary A. Beaver, MD 3 , A. Tim Johnson, MD, PhD 1 , Emily Greenlee, MD 1,2 , Bonnie An Henderson, MD 4 , Andrew Doan, MD, PhD 5 , and Andrew G. Lee, MD 3 1 Department of Ophthalmology, The University of Iowa Hospital and Clinics, Iowa City, IA 2 Department of Ophthalmology, Veterans Affairs Medical Center Iowa City, Iowa City, IA 3 Department of Ophthalmology, The Methodist Hospital, Weill Cornell Medical College, Houston, TX 4 Ophthalmic Consultants, Boston, MA 5 Department of Ophthalmology, Naval Medical Center San Diego, San Diego, CA * Corresponding Author & e-mail: thomas-oetting@uiowa.edu Abstract Medical educators feel increasing pressure from external public and private organizations, including insurers, patient advo-cacy groups, and hospitals to improve resident education and to provide proof of quality [1]. The current training of resi-dent physicians is believed by some to be producing physicians with an unreliable skill set that may not be aligned with the demands of today's healthcare market. The measurement of resident surgical skill for accreditation and certification pur-poses in the past was based on minimum numbers and not actual outcomes. The emphasis was on medical knowledge and not performance in other domains. Here we present a detailed strategy to plan for teaching and assessing competency in cataract surgical skills for residents. We propose the use of distinct stages of professional development similar to those of Dreyfus [2] with each stage of resident training defined by clear expectations that can be used to measure progress. We rec-ommend sustained and frequent short formative encounters rather than a single end of rotation summative feedback alone. We hope this will serve as a starting point as other programs prepare their competency based educational programs. This article is our perspective on the lessons learned, the barriers encountered, and our institutional and programmatic experience with overcoming the cultural, organizational, resource, time, and financial barriers to local implementation of the assess-ment of resident competency in cataract surgery. Accepted for publication January 24, 2009 Revision received February 3, 2009 2009; 2: 23-32. Available via open-access on the web at http://www.academic-ophthalmology.com The author(s) have no personal financial interest in any of the products or technologies cited herein. The views expressed in this paper are those of the authors and do not necessarily reflect the official policy of the Department of the Navy, Department of Defense, or the United States Gov-ernment. Â 2009 Although Dr. Andrew G. Lee is a member of the RRC for oph-thalmology, the content and opinions represented in this paper do not reflect those of the RRC and represent the opinions of the authors alone.