Department of Orthopaedic Surgery, San Antonio Military Health System, Ft Sam Houston, Texas.
Brooke Army Medical Center, Ft Sam Houston, Texas.
J Surg Res. 2021 Mar;259:399-406. doi: 10.1016/j.jss.2020.09.016. Epub 2020 Oct 24.
Competency-based education (CBE) seeks to determine resident proficiency in the knowledge, skills, and behaviors required for independent patient care. Multiple assessment instruments evaluate technical skills or direct patient care in the clinic setting, but there are few reports incorporating both within an orthopedic specialty rotation. This study reports a residency program's comprehensive CBE initiative using formative assessments in the clinic and operating room during a sports medicine rotation.
The sports medicine rotation used validated formative assessments to evaluate resident performance during clinic encounters and program-defined surgical entrustable professional activities (EPAs). Junior resident (postgraduate year [PGY] 1-2) EPAs included basic knee/shoulder arthroscopic procedures. Senior resident (PYG 5) EPAs comprised anterior cruciate ligament reconstruction, biceps tenodesis, shoulder stabilization, and rotator cuff repair. Assessment scores were compared between individuals and PGY groups.
Sixty-six clinical skills (CS) and 106 surgical skills assessments were conducted for 22 residents in one academic year. Surgical skills assessments demonstrated significant differences between each PGY group (P < 0.01). All PGY2 and PGY5 residents achieved independence on the evaluated EPAs. PGY5s earned higher scores in CS assessments than the other classes (P < 0.01). PGY2 residents scored higher than PGY1s in 7 of 9 CS domains. CS independence was achieved by 21 of 22 residents by the end of the rotation.
The CBE program effectively quantified expected differences in resident performance by PGY for clinic and surgical assessments on a sports medicine rotation. Assessments built an environment where feedback was more structured and standardized, creating a culture to improve resident education.
以能力为基础的教育（CBE）旨在确定住院医师在独立患者护理所需的知识、技能和行为方面的熟练程度。多种评估工具可评估技术技能或临床环境中的直接患者护理，但在骨科专业轮转中结合这两者的报告很少。本研究报告了一个住院医师培训计划在运动医学轮转中使用形成性评估在临床和手术室进行的综合 CBE 计划。
运动医学轮转使用经过验证的形成性评估来评估住院医师在临床就诊和计划定义的手术可委托专业活动（EPA）中的表现。初级住院医师（住院医师 1-2 年）EPA 包括基本的膝关节/肩部关节镜手术。高级住院医师（住院医师 5 年）EPA 包括前交叉韧带重建、肱二头肌肌腱固定术、肩关节稳定术和肩袖修复术。评估分数在个体和住院医师组之间进行比较。
在一个学术年中，对 22 名住院医师进行了 66 项临床技能（CS）和 106 项手术技能评估。手术技能评估显示每个住院医师组之间存在显著差异（P<0.01）。所有 PGY2 和 PGY5 住院医师都在评估的 EPA 上实现了独立性。PGY5 在 CS 评估中的得分高于其他班级（P<0.01）。PGY2 住院医师在 9 个 CS 领域中的 7 个领域的得分高于 PGY1。到轮转结束时，22 名住院医师中有 21 名达到了 CS 的独立性。
CBE 计划在运动医学轮转中，通过住院医师在临床和手术评估方面的 PGY，有效地量化了住院医师表现的预期差异。评估建立了一个更具结构性和标准化的反馈环境，营造了一种改善住院医师教育的文化。
