Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.
Faculty of Medicine, Department of Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
PLoS One. 2024 Oct 4;19(10):e0311444. doi: 10.1371/journal.pone.0311444. eCollection 2024.
Surgery for spinal disorders represents some of the commonest surgical procedures performed in many countries worldwide, carried out by neurosurgeons and orthopedic surgeons. Residency training is shifting to competency-based medical education, which requires setting standards for graduating residents and their assessments. However, gaps exist in the literature regarding the parameters used for assessment and the mastery levels expected of graduating residents in the performance of common spinal procedures as defined in Entrustable Professional Activities (EPAs). The objectives of the study were to describe the assessment parameters used for residents, identify the standard of performance expected of graduating residents of EPAs of spinal procedures, and identify factors predicting the expected standard of competent performance of graduating residents.
The survey was sent to neurosurgery and orthopedic surgery Faculty requesting their recommendations on parameters of assessment and the expected standard competence performance for EPAs related to spinal procedures using our entrustment scale (A-E).
Based on total responses, the recommended number of assessments and assessors for each EPA was 5 and 2, respectively. Regarding each specialty, there was no significant difference in the recommended number of assessments for each EPA. However, neurosurgery Faculty recommended higher number of assessors(n = 3) than orthopedic surgery Faculty(n = 2) for both posterior spinal decompression EPA(PSD) (p = 0.01) and spinal instrumentation EPA(SI) (p = 0.04). Based on total responses, 83% felt PSD was appropriate to the general practice, 86.8% considered it not too broad, and 62.3% expected entrustment level E as a graduation target. The proportions of these ratings were slightly lower for SI at 58.5%, 71.7% and 56.6%, respectively. Both specialties indicated that the EPAs were not too broad. In contrast, neurosurgery Faculty were more likely to consider these EPAs appropriate for general practice than orthopedic surgery Faculty for both PSD (94.7% vs 53.3%, p = 0.0003) and SI (68.4% vs 33.3%, p = 0.02). Moreover, neurosurgery Faculty had a higher expected standard of performance as a graduation target for both PSD (Level E 76.3% vs 26.7%, p = 0.001) and SI (Level E 65.8% vs 33.3%, p = 0.03) than orthopedic surgery Faculty. Expectations of entrustment level E for PSD was associated with the belief that the current EPA was appropriate for the general practice of their specialty with an odds ratio of 8.35 (p = 0.01, 95%CI 1.53-45.67).
A difference exists in parameters of assessment and expected standard competence performance of spine procedures among spinal surgery specialties. In our opinion, there should be efforts to develop consensus between specialties for the sake of uniform delivery of high-quality care for patients regardless of the specialty of their surgeon. Our results will be particularly valuable to certification bodies in the assessment of spinal milestones. This study has important implications for the design of residency and fellowship education in spinal surgery internationally.
脊柱疾病手术是全球许多国家最常见的手术之一，由神经外科医生和骨科医生进行。住院医师培训正在转向以能力为基础的医学教育，这需要为毕业住院医师及其评估设定标准。然而，关于评估参数以及在委托专业活动 (EPA) 定义的常见脊柱手术中毕业住院医师应达到的熟练水平标准，文献中存在差距。本研究的目的是描述住院医师的评估参数，确定与脊柱手术相关的 EPA 毕业住院医师的预期熟练水平标准，并确定预测毕业住院医师预期胜任表现的因素。
向神经外科和骨科教师发送了一份调查，要求他们使用我们的委托量表 (A-E) 就与脊柱手术相关的 EPA 的评估参数和预期的熟练水平标准提出建议。
基于总回复，每个 EPA 的推荐评估次数和评估者分别为 5 次和 2 次。关于每个专业，每个 EPA 的推荐评估次数没有显著差异。然而，神经外科教师建议为后路脊柱减压 EPA (PSD) (p = 0.01) 和脊柱器械化 EPA (SI) (p = 0.04) 选择更多的评估者(n = 3)，而骨科教师建议为 2 名(n = 2)。基于总回复，83%的人认为 PSD 适合一般实践，86.8%的人认为它不太广泛，62.3%的人期望将委托级别 E 作为毕业目标。这些评级的比例对于 SI 略低，分别为 58.5%、71.7%和 56.6%。两个专业都表示这些 EPA 不太广泛。相比之下，神经外科教师比骨科教师更有可能认为这些 EPA 适合一般实践，PSD (94.7%比 53.3%，p = 0.0003) 和 SI (68.4%比 33.3%，p = 0.02)。此外，神经外科教师对 PSD (E 级 76.3%比 26.7%，p = 0.001) 和 SI (E 级 65.8%比 33.3%，p = 0.03) 的毕业目标设定了更高的预期绩效标准。对 PSD 的 E 级委托水平的期望与他们认为当前 EPA 适合其专业一般实践的信念有关，优势比为 8.35(p = 0.01，95%CI 1.53-45.67)。
脊柱外科专业之间在脊柱手术的评估参数和预期熟练水平标准方面存在差异。我们认为，应该努力在专业之间达成共识，以便为患者提供无论其外科医生的专业如何都能达到高质量的护理。我们的结果对于脊柱里程碑评估的认证机构尤其有价值。本研究对国际脊柱外科住院医师和研究员教育的设计具有重要意义。
