Ahmad Syed Ameen, Armache Maria, Chen Jenny X
Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
J Surg Educ. 2025 Sep;82(9):103565. doi: 10.1016/j.jsurg.2025.103565. Epub 2025 Jun 26.
The landscape of surgical skills assessments in graduate medical education is broad and complex. To map the required assessments from the start of training to initial certification, we systematically catalogued the requirements for assessing surgical skills across the 9 surgical specialties mandated by the Accreditation Council for Graduate Medical Education (ACGME) and specialty certifying boards.
We performed a qualitative document analysis to examine specialty-specific ACGME documents. Surgical specialty board websites were also reviewed for information about assessment requirements prior to initial certification. Findings were iteratively coded, and document summary tables were created to analyze the assessments.
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About 32 ACGME documents and 9 board websites were examined. Among ACGME documents, all specialties mandated case logs as a measure of surgical experience and 6 specialties stipulated minimum case log numbers for select procedures or procedure categories. All specialties distinguished between resident roles (e.g., assistant surgeon versus resident surgeon) other than plastic surgery. Only otolaryngology-head and neck surgery and ophthalmology specified the assessment of skills in surgical simulation labs. All specialties mandated programs to have semi-annual evaluations of surgical competence, but none specified a format for the assessment. Out of 68 patient-care milestones for the 9 specialties, only 20 included assessments of competency performing specific surgeries. No specialty mandated the use of any specific standardized instruments or workplace-based assessments. However, select specialty boards required workplace-based assessments such as general surgery and orthopedic surgery (skills program). General surgery, thoracic surgery, and obstetrics and gynecology also required specific surgical skills training programs such as fundamentals of laparoscopic skills.
ACGME mandated skill assessments in surgical specialties often lack specificity for the types of assessments to be used and/or the procedures to be evaluated. However, many boards are showing interest in using more novel assessment instruments.
研究生医学教育中手术技能评估的情况广泛且复杂。为了梳理从培训开始到初始认证所需的评估，我们系统地整理了研究生医学教育认证委员会（ACGME）和专业认证委员会规定的9个外科专业评估手术技能的要求。
我们进行了定性文献分析，以审查ACGME特定专业的文件。还查阅了外科专业委员会网站，以获取初始认证前评估要求的信息。对研究结果进行反复编码，并创建文件汇总表来分析评估情况。
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共审查了约32份ACGME文件和9个委员会网站。在ACGME文件中，所有专业都要求有病例日志作为手术经验的衡量标准，6个专业规定了特定手术或手术类别的最低病例日志数量。除整形外科外，所有专业都区分住院医师的角色（如助理外科医生与住院外科医生）。只有耳鼻咽喉头颈外科和眼科规定了在手术模拟实验室进行技能评估。所有专业都要求项目对手术能力进行半年一次的评估，但没有一个专业规定评估的形式。在9个专业的68个患者护理里程碑中，只有20个包括对进行特定手术能力的评估。没有一个专业强制要求使用任何特定的标准化工具或基于工作场所的评估。然而，部分专业委员会要求进行基于工作场所的评估，如普通外科和整形外科（技能项目）。普通外科、胸外科以及妇产科还要求开展特定的手术技能培训项目，如腹腔镜技能基础培训。
ACGME规定的外科专业技能评估通常在所用评估类型和/或评估程序方面缺乏明确性。然而，许多委员会对使用更新颖的评估工具表现出兴趣。
