Accreditation Council on Graduate Medical Education Technical Skills Competency Compliance: Urologic Surgical Skills

doi:10.1016/j.jamcollsurg.2005.05.002

Journal of the American College of Surgeons

Volume 201, Issue 3, September 2005, Pages 454-457

https://doi.org/10.1016/j.jamcollsurg.2005.05.002 Get rights and content

Background

In accordance with new mandates implemented by the Accreditation Council on Graduate Medical Education, reliance on operative case logs as demonstration of residents’ surgical competence will no longer be adequate. We describe the implementation of a comprehensive, year-round, mandatory skills laboratory curriculum as an integral component of our urology residency training program.

Study design

We developed eight laboratory practicums using primarily nonhuman models: basic endoscopy, advanced endoscopy, ureteroscopy, percutaneous renal surgery, basic laparoscopy, advanced laparoscopy, urologic use of the gastrointestinal tract, and cadaveric pelvic dissection.

Results

Anonymous evaluations submitted by all training session participants indicate that acquisition of surgical skills is facilitated through participation in laboratory practicums. An incremental progression in proficiency was observed by all of the instructors and students who participated. There was a high degree of satisfaction with model fidelity and the value of technical experience gained.

Conclusions

Our urologic surgery skills laboratory curriculum is an effective means of skills acquisition and maintenance for a wide variety of urologic techniques, including complex endourologic procedures. Patient care can safely be of secondary importance with respect to trainee experience in a low-stress environment that provides an opportunity for supervised repetitive performance of essential technical skills. We describe effective models, with high fidelity-to-cost ratio, that incorporate laboratory-based surgical skills training and evaluation into urology residency programs, with the aim of Accreditation Council on Graduate Medical Education competency guideline compliance.

Section snippets

Methods

Our program consists of eight laboratory practicums using primarily nonhuman models. Six of the sessions require only low-cost retail items and readily available hospital equipment, supplemented with equipment loaned by professional instrument company representatives who, in our experience, are very accommodating toward educational endeavors. The curriculum offers gradated progression throughout the year and within individual sessions, to encompass the needs of residents of all training levels,

Results

This surgical skills laboratory training curriculum was quite effective at simulating a wide variety of urologic procedures. The majority of these practicums were simple to set up, extremely low cost, and surprisingly high in fidelity, considering the use of “homemade” models constructed from readily available retail items. The sessions provided a rare chance for educators to concentrate on observation, instruction, evaluation, and documentation of trainee technique. Forms documenting

Discussion

We have now entered phase 2 of the ACGME’s timeline for implementation of their new Competencies in Resident’s Education. This 4-year phase spans July 2002 to June 2006, during which residency training programs are charged with devising systems to provide evidence of learning in the core competencies as defined by the ACGME’s Outcomes Assessment Project Advisory Group and a similar task force from the American Board of Surgery.¹ Development of our structured urologic surgical skills training

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Effects of a laboratory-based skills curriculum on laparoscopic proficiencya randomized trial
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Virtual reality (VR), augmented reality (AR), mixed reality (MR), and extended reality (XR) are examples of immersive technologies that have the potential to improve medical practice and education. As a result, they have recently sparked much research interest. However, there are few reviews related to the use of immersive technologies (including VR, AR, MR, and XR) in medical practice and education. Remarkably, six research questions related to the trends, application areas, recipients, teaching contents, evaluation methods, and performance remain unanswered. To this end, this study conducts a systematic review to analyse 128 articles from 2012 source papers, all of which are indexed in the Web of Science. The review results indicate that immersive technology is currently used primarily on surgery and anatomy-related subjects for doctors, medical students and interns. Furthermore, group experiments are the most commonly used data collection method. The results provide insights into the current research trends related to immersive technology applications for medical practice and education. They also serve as an essential reference for scholars in the medical practice and education contexts.
Surgical skills curricula in American College of Surgeons Accredited Education Institutes: An international survey
2017, American Journal of Surgery
A clear understanding of simulation-based curricula in use at American College of Surgeons Accredited Education Institutes (ACS-AEIs) is lacking.
A 25-question online survey was sent to ACS-AEIs.
The response rate approached 60%. The most frequent specialties to use the ACS-AEIs are general surgery and obstetrics/gynecology (94%). Residents are the main target population for programming/training (96%). Elements of the ACS/Association of Program Directors in Surgery Surgical Skills Curriculum are used by 77% of responding ACS-AEIs. Only 49% of ACS-AEIs implement the entire curriculum and 96% have independently developed their own surgical skills curricula. “Home-grown” simulators have been designed at 71% of ACS-AEIs. Feasibility (80%), evidence of effectiveness (67%), and cost (60%) were reasons for curriculum adoption. All programs use operative assessment tools for resident performance, and 53% use Messick's unitary framework of validity. Most programs (88%) have financial support from their academic institute. Majority of ACS-AEIs had trainees evaluate their faculty instructors (90%), and the main form of such faculty evaluation was postcourse surveys (97%).
This study provides specific information regarding simulation-based curricula at ACS-AEIs.
Training in ureteroscopy for urolithiasis
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Their effect on the outcome was assessed by a global rating scale (GRS), the task completion time (TCT) and the learning curve. Validation studies were found in 14 articles (Table 2) [7–32]. Randomised controlled trials (RCTs) were reported in four articles [10,14,21,33].
To provide an insight into the current status of semi-rigid and flexible ureteroscopy, following new curricula for training methods, including training with models, virtual reality and active mentoring.
We systematically reviewed previous reports, including articles in English identified using the following strategy: (‘ureteroscopy’[Mesh]) or (‘urolithiasis’[Mesh]) AND (‘education’[Mesh]), or (‘teaching’[Mesh]). Abstracts submitted at congresses were not included. Relevant articles that were identified as references in the retrieved articles were also included.
The terms (‘urolithiasis’[Mesh] AND ‘education’[Mesh]) retrieved 106 articles, of which five were included. The terms (‘urolithiasis’[Mesh] AND ‘teaching’[Mesh]) retrieved six articles, of which three were included. The terms (‘ureteroscopy’[Mesh] AND ‘education’[Mesh]) retrieved 29 articles, of which 21 were included. The terms (‘ureteroscopy’[Mesh] AND ‘teaching’[Mesh]) retrieved eight articles, of which seven were included. Remaining articles were found in the reference section of retrieved articles. Finally, 43 articles were included. Four randomised controlled trials with level 1b evidence were included. Currently there is no standard teaching method for ureteroscopy and the number of cases to reach competence has not yet been defined. However, simulation-based training has been shown to be effective, cost-effective, and to increase patient safety.
Simulators lead to a more rapid acquisition of skills in ureteroscopy than do conventional training methods, and improve the performance of future surgeons. Flexible ureteroscopy simulators are a promising tool for training, and have the advantage of minimising the need for learning the procedures on patients. A didactic and clinical curriculum, including surgical videotape reviews as well as operative mentoring, enables a rapid progression in already experienced endourologists. However, there are few reports specifically addressing the skills necessary for training.
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This significant funding shortfall does not take into account the lack of GME support for resident research, and, most importantly, the funding necessary for simulation and surgical skills laboratories. These proficiency laboratories provide effective skills acquisition and maintenance training in preparation for the sophisticated technology used in urology including robotic, endoscopic, microscopic, and laparoscopic diagnostic and treatment modalities.11-14 These laboratories are very much in need and mandatory for the training of urologists; however, these methods are expensive, time consuming, and are not covered by GME funding.
To determine the most pressing issues facing academic urology training centers. The supply of urologists per capita in the United States continues to decrease. Stricter resident requirements, restriction of resident duty hours, and a Graduate Medical Education (GME) funding cap on resident education has led to significant challenges for academic centers.
A 32-question survey was sent to Society of University Urologists members. Respondents defined themselves as academic faculty tenure track, program director, academic chair, program director and academic chair, clinical faculty nontenure track, and community faculty member.
A total of 143 of 446 members(32%) responded. A lack of funding was indicated as an obstacle to adding new residency positions (65% respondents) and recruiting new faculty (60% respondents). Residency positions not funded by GME (40% respondents) required either clinical or hospital dollars to support these slots. Most respondents (51%) indicated resident research rotations are funded with clinical dollars. Surgical skills laboratories are commonly used (85% respondents) and are supported mostly with hospital or clinical dollars. The majority of respondents (84%) indicated they would expand simulation laboratories if they had better funding. Other than urodynamics and ultrasound, urology residency training programs reported little income from ancillary dollars.
There is a significant workforce shortage within urology training programs. Clinical revenue and hospital funding seem to be the main financial support engines to supplement the GME funding shortage, proficiency training, and faculty salary support for teaching. The current system of GME funding for urology residency programs is not sustainable.
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Simulators are an objective and reproducible medium that can allow technology to ease the transition from beginner to expert, while standardizing education, decreasing costs, reducing patient risk and improving outcomes [4]. The efficacy of simulators has been reported in the literature [9], and their widespread application is seen in general surgery [10], urology [11], gynecology [12] and endoscopy [13]. Increasing prevalence of simulation in medical training has prompted the Accreditation Council for Graduate Medical Education (ACGME) and the American College of Surgeons (ACS), to implement a phased approach to formally require their use in surgical education.
Education in burn care can be divided into three main components: surgical education, inter-professional education, e.g. critical care education and mentorship. To date these components have been used in varying degrees in most health institutions and to even lesser extent in burn care. The aim of this paper is to highlight each component and how these have been utilized in other fields to develop teams and foster education, and how they can be translated for burn teams. These ideas are not novel; however, this paper aims to shed light on how these concepts can be implemented in burn care, thus not only improving education, but also enabling recruitment and retention of health care providers in this field.
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EducationAccreditation Council on Graduate Medical Education Technical Skills Competency Compliance: Urologic Surgical Skills

Background

Study design

Results

Conclusions

Section snippets

Methods

Results

Discussion

J Urol

Am J Surg

Am J Surg

J Urol

Am J Obstet Gynecol

Education
Accreditation Council on Graduate Medical Education Technical Skills Competency Compliance: Urologic Surgical Skills