Department of Surgery, 1371Emory University, Atlanta, GA, USA.
Am Surg. 2022 Aug;88(8):1766-1772. doi: 10.1177/00031348221083942. Epub 2022 Mar 25.
Validated assessment of procedural knowledge and skills with formative remediation is a foundational part of achieving surgical competency. High-fidelity simulation programs provide a unique area to assess resident proficiency and independence, as well as to assist in identifying residents in need of further practice. While several studies have validated the use of simulation to attain proficiency of specific technical skills, few have validated remediation pathways for their trainees objectively. In this descriptive analysis, we review 2 remediation pathways within our simulation training curricula and how these are used in assessments of resident proficiency.
Two methods of remediation were formulated for use in high-fidelity simulation labs. One remediation pathway was a summative process, where ultimate judgment of resident competency was assessed through intra-operative assessments of a holistic skill set. The second remediation pathway was a formative "coaching" process, where feedback is given at several intervals along the pathway towards a specific technical skills competence. All general surgery residents are enrolled in the longitudinal, simulation curricula.
Approximately one-third of surgical residents entered into a remediation pathway for either of the high-fidelity simulation curricula. Both residents and faculty expressed support for the summative and formative remediation pathways as constructed. Residents who entered remediation pathways believed it was a beneficial exercise, and the most common feedback was that remediation principles should be expanded to all residents. Interestingly, faculty demonstrated stronger support for the formative coaching feedback model than the summative assessment model.
Through the complementary use of both formative and summative remediation pathways, resident competence can be enriched in a constructive, nonpunitive method for self-directed performance improvement. Both trainees and faculty express high satisfaction with programs explicitly organized to ensure that skills are rated through a standardized process.
通过形成性补救措施对程序性知识和技能进行验证评估，是实现手术能力的基础部分。高保真模拟计划为评估住院医师的熟练程度和独立性提供了独特的领域，同时也有助于确定需要进一步实践的住院医师。虽然有几项研究已经验证了使用模拟来实现特定技术技能的熟练程度，但很少有研究客观地验证其学员的补救途径。在这项描述性分析中，我们回顾了我们模拟培训课程中的两种补救途径，以及如何在评估住院医师的熟练程度中使用这些途径。
为高保真模拟实验室制定了两种补救方法。一种补救途径是总结性的过程，通过对整体技能集的手术评估来最终判断住院医师的能力。第二种补救途径是形成性的“辅导”过程，在该过程中，会在几个时间点提供反馈，以达到特定技术技能的熟练程度。所有普通外科住院医师都参加了纵向模拟课程。
大约三分之一的外科住院医师进入了高保真模拟课程的任何一种补救途径。住院医师和教师都对构建的总结性和形成性补救途径表示支持。进入补救途径的住院医师认为这是一项有益的练习，最常见的反馈是应将补救原则扩展到所有住院医师。有趣的是，教师对形成性辅导反馈模型的支持强于总结性评估模型。
通过同时使用形成性和总结性补救途径，可以以建设性的、非惩罚性的方式丰富住院医师的能力，从而进行自我导向的绩效改进。接受明确组织以确保通过标准化流程对技能进行评分的培训计划的住院医师和教师都表示非常满意。
