Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA.
Surgery. 2013 Jul;154(1):13-20. doi: 10.1016/j.surg.2013.04.061.
The American College of Surgeons/Association of Program Directors in Surgery (ACS/APDS) National Skills Curriculum is a 3-phase program targeting technical and nontechnical skills development. Few data exist regarding the adoption of this curriculum by surgical residencies. This study attempted to determine the rate of uptake and identify implementation enablers/barriers.
A web-based survey was developed by an international expert panel of surgical educators (5 surgeons and 1 psychologist). After piloting, the survey was sent to all general surgery program directors via email link. Descriptive statistics were used to determine the residency program characteristics and perceptions of the curriculum. Implementation rates for each phase and module were calculated. Adoption barriers were identified quantitatively and qualitatively using free text responses. Standardized qualitative methodology of emergent theme analysis was used to identify strategies for success and details of support required for implementation.
Of the 238 program directors approached, 117 (49%) responded to the survey. Twenty-one percent (25/117) were unaware of the ACS/APDS curriculum. Implementation rates for were 36% for phase I, 19% for phase II, and 16% for phase III. The most common modules adopted were the suturing, knot-tying, and chest tube modules of phase I. Over 50% of respondents identified lack of faculty protected time, limited personnel, significant costs, and resident work-hour restrictions as major obstacles to implementation. Strategies for effective uptake included faculty incentives, adequate funding, administrative support, and dedicated time and resources.
Despite the availability of a comprehensive curriculum, its diffusion into general surgery residency programs remains low. Obstacles related to successful implementation include personnel, learner, and administrative issues. Addressing these issues may improve the adoption rate of the curriculum.
美国外科医师学院/外科住院医师培训计划主任协会（ACS/APDS）国家技能课程是一个针对技术和非技术技能发展的 3 阶段项目。关于该课程被外科住院医师培训项目采用的数据很少。本研究试图确定采用率，并确定实施的促进因素/障碍。
由 5 名外科医生和 1 名心理学家组成的国际外科教育专家小组开发了一个基于网络的调查。经过试点后，通过电子邮件链接将调查发送给所有普通外科项目主任。使用描述性统计来确定住院医师培训计划的特征和对课程的看法。计算每个阶段和模块的采用率。使用自由文本回复定量和定性地确定采用障碍。使用出现主题分析的标准化定性方法来确定成功的策略和实施所需的支持细节。
在联系的 238 名项目主任中，有 117 名（49%）对调查做出了回应。21%（25/117）不知道 ACS/APDS 课程。第 I 阶段的实施率为 36%，第 II 阶段为 19%，第 III 阶段为 16%。采用最多的模块是第 I 阶段的缝合、打结和胸腔引流模块。超过 50%的受访者认为缺乏受保护的教师时间、人员有限、成本高昂以及居民工作时间限制是实施的主要障碍。有效采用的策略包括教师激励、充足的资金、行政支持以及专用的时间和资源。
尽管有全面的课程，但它在普通外科住院医师培训项目中的传播仍然很低。与成功实施相关的障碍包括人员、学习者和行政问题。解决这些问题可能会提高课程的采用率。
