Khalid Syed I, Mehta Ankit I, Atwal Gursant, Hogan Sean O, Park Yoon Soo, Charbel Fady T
Department of Neurosurgery, University of Illinois Chicago, Chicago , Illinois , USA.
Accreditation Council for Graduate Medical Education, Chicago , Illinois , USA.
Neurosurgery. 2025 Jun 1;96(6):1419-1429. doi: 10.1227/neu.0000000000003301. Epub 2024 Dec 19.
The Accreditation Council for Graduate Medical Education Milestones assessment system provides a structured framework for evaluating the developmental progression of neurosurgery residents. Understanding the variability in learning trajectories and identifying critical intervention points are essential for refining educational strategies and enhancing training outcomes. In this article, we aim to identify learning trajectories of neurosurgery residents and pinpoint pivotal junctures for potential interventions to aid residents struggling to meet expected competency levels.
We analyzed Accreditation Council for Graduate Medical Education Milestones data from 3541 neurosurgery residents across 124 programs from 2013-2014 to 2022-2023. We examined the reliability of Milestone assessments across programs and addressed potential biases because of program-level differences. Through cluster analysis, we identified distinct learning trajectories, focusing on competency-specific developments and crucial intervention points based on divergences in trajectory.
Our analysis revealed 5 distinct learning trajectories among neurosurgery residents, highlighting diverse developmental pathways. Cluster 1 (n = 1,719, 48.5%) and Cluster 2 (n = 341, 9.6%) demonstrated initial foundational competencies but varied in progression, with Cluster 2 failing to meet the threshold for independent practice by postgraduate year 7 consistently. Cluster 3 (n = 459, 13%), starting with the lowest initial competency levels, surpassed independence thresholds, illustrating the potential for significant growth regardless of initial competency levels. Cluster 4 (n = 520, 14.7%) and Cluster 5 (n = 502, 14.2%) exhibited accelerated competency development, achieving early readiness for independent practice. We found no significant association between cluster membership and program characteristics, suggesting that the trajectories reflect individual variations rather than programmatic differences.
Our findings highlight the need for educational strategies tailored to residents' unique development paths to support the achievement of competency thresholds. While the data suggest potential benefits of adaptive learning, further exploration is required to confirm its impact on educational outcomes.
毕业后医学教育认证委员会（Accreditation Council for Graduate Medical Education，ACGME）的里程碑评估系统为评估神经外科住院医师的发展进程提供了一个结构化框架。了解学习轨迹的变异性并确定关键干预点对于完善教育策略和提高培训效果至关重要。在本文中，我们旨在确定神经外科住院医师的学习轨迹，并找出潜在干预的关键节点，以帮助难以达到预期能力水平的住院医师。
我们分析了2013 - 2014年至2022 - 2023年期间来自124个项目的3541名神经外科住院医师的毕业后医学教育认证委员会里程碑数据。我们检查了各项目间里程碑评估的可靠性，并解决了因项目层面差异导致的潜在偏差。通过聚类分析，我们确定了不同的学习轨迹，重点关注特定能力的发展以及基于轨迹差异的关键干预点。
我们的分析揭示了神经外科住院医师的5种不同学习轨迹，突出了多样的发展路径。第1组（n = 1719，48.5%）和第2组（n = 341，9.6%）展现出初始的基础能力，但进展有所不同，第2组在研究生第7年始终未达到独立执业的阈值。第3组（n = 459，13%）最初的能力水平最低，却超过了独立阈值，表明无论初始能力水平如何都有显著成长的潜力。第4组（n = 520，14.7%）和第5组（n = 502，14.2%）表现出能力的加速发展，提前具备了独立执业的准备。我们发现聚类成员与项目特征之间没有显著关联，这表明这些轨迹反映的是个体差异而非项目差异。
我们的研究结果强调了需要根据住院医师独特的发展路径制定教育策略，以支持达到能力阈值。虽然数据表明适应性学习可能有好处，但需要进一步探索以确认其对教育结果的影响。
