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Orlando C. Kirton, M.D., F.A.C.S., F.C.C.M., F.C.C.P. Ludwig J. Pyrtek, M.D. Chair in Surgery

Development and Evaluation of an Objective and Simulation-Based Core Curriculum for Surgery Residents. Orlando C. Kirton, M.D., F.A.C.S., F.C.C.M., F.C.C.P. Ludwig J. Pyrtek, M.D. Chair in Surgery Director of Surgery, Chief Division of General Surgery Hartford Hospital

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Orlando C. Kirton, M.D., F.A.C.S., F.C.C.M., F.C.C.P. Ludwig J. Pyrtek, M.D. Chair in Surgery

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  1. Development and Evaluation of an Objective and Simulation-Based Core Curriculum for Surgery Residents Orlando C. Kirton, M.D., F.A.C.S., F.C.C.M., F.C.C.P. Ludwig J. Pyrtek, M.D. Chair in Surgery Director of Surgery, Chief Division of General Surgery Hartford Hospital Professor of Surgery Program Director, Integrated General Surgery Residency Program Vice Chair, Department of Surgery University of Connecticut School of Medicine

  2. Essential ACGME Requirement • Create a knowledge-based and clinical curriculum based on six educational competencies: - Medical Knowledge - Patient Care - Interpersonal and Communication Skills - Professionalism - Practice-Based Learning and Improvement - Systems-Based Practice

  3. The Perfect Storm faced by Program Directors • Restricted resident duty hours • I.e.;80 hours; PGY 1- no more than 16hrs • Falling reimbursements for hospitals and faculty • Less non-clinical time available to the Teaching Faculty • An increasing # of educational requisites • The ACGME milestone project, robust simulation curriculum, patient safety and quality objectives

  4. The University of Connecticut Integrated General Surgery Residency Program • 1 of 8 general surgery residency training programs in Connecticut • Integration of 3 separate training programs in 1990 • 46 Residents ; 6 chiefs • 5 Hospital integrated program • 110 teaching Faculty • 60% private practice

  5. The Residents’ Concerns with the Curriculum Program Director (October 2009) • Diminished available time for residents • Less non-clinical time available to teaching faculty • Resident dissatisfaction with the didactic curriculum • Regurgitation from textbooks • Lack of audience interaction • Session taught by resident lacked depth and scope • Inadequate simulation exposure • Inadequate preparation time (learner & presenter)

  6. Methods • A core curriculum steering committee of residents and faculty: • Program Director • Incoming 2 Administrative Chief Residents • A peer–elected categorical resident representative (PGY 1-3) • A faculty member from each teaching hospital • A simulation curriculum steering committee also created • Similar composition + simulation coordinator and education specialist • Starts meeting in February; Curriculum completed by May

  7. The Core Curriculum • Focuses on specific goals and objectives • 2 year bundled curriculum of 85 standing (annual) and 25 bi-annual learning topics • Utilizes online teaching materials • SCORE Modules, ACS Fundamentals of SurgeryTM Curriculum • Various on-line texts : e.g.; Schwartz, Sabiston, etc • Interactive lecture format • An audience response system • Compulsory simulation curriculum • SCORE system-based practice modules • Professionalism in Surgery: Challenges and ChoicesTM, ACS Division of Education (2008)

  8. Chief Resident – Teaching FacultyModerator Team (Monthly Curriculum) • Define content and format • Identify and confirm presenters • Utilize the ABSITE program report • Moderate interactive sessions • Vignettes, case scenarios, question/answer • Focus on critical knowledge; decision making • Exhaustive literature review prohibited

  9. The Monthly Curriculum Fridays; 8:30 AM – 11:00 AM

  10. Intern Boot CampJuly / August • Fluids and electrolytes • Cardiac • Pulmonary • GI • MS • Wounds • Nutrition • Pain management • Post-op emergencies • Fever work -up • Hypotension • Pre-op evaluation • Safety Wednesday 2:00 – 4:30 PM; Friday 8:30 – 11:00 AM - Fundamental of Surgery Curriculum – 25 essential modules - Clinical Skills Lab

  11. Simulation / Skills Modules PGY I PGY II-V Sim man Cholecystectomy/ Advanced laparoscopy EGD; colonoscopy Vascular anastomosis Biolab/fresh tissue lab Robotics • Asepsis and instrument identification • Knot tying; tissue handling • Latex allergy; anaphylaxis • Chest tube and thoracentesis • Basic laparoscopy • CVP and foley placement • Patient hand-off • FLS ACS e-learning site

  12. Evaluation • Anonymous Survey Questionnaire • Baseline (June, 2010); 6 months (December, 2010); 1 year (June, 2012) • Fifteen, 5-point Likert-type items • Conferences in relation to ACGME competencies • PBI, SBP, IC, Professionalism • The learning objectives of the curriculum • Quality of teaching presentations • Faculty and Residents • Quality of the supplementary teaching materials • Chi-square tests of proportions; Kruskal Wallis to compare full distribution of responses

  13. Survey Questions

  14. Survey Questions(con’t)

  15. Survey Questions(con’t)

  16. The Following Likert-Scales Were Used for Survey Questions

  17. The Following Likert-Scales Were Used for Survey Questions(con’t)

  18. Results

  19. Percent of Residents Responding:Two Most Positive Categories 6/10 – 42 respondents; 12/10 – 38 respondents; 6/11 – 22 respondents

  20. Percent of Residents Responding: Two Most Positive Categories(con’t) 6/10 – 42 respondents; 12/10 – 38 respondents; 6/11 – 22 respondents

  21. American Board of Training Inservice Examination [ABSITE] Percentage Scores(Lower Quartiles; Top Quartile)

  22. American Board Of Surgery Intraining-ExamaminationProportion of Residents in Top Quartile (76-100%) Introduction of new curriculum

  23. Study Limitations • Unequal # of respondents at the 3 times of the survey • Unable to separate the survey data by PGY years or categoricals vs. preliminaries • ? Factor of survey fatigue

  24. The Residents’ Concerns prior to the new approach to Core Curriculum Development Diminished available time for residents Less non-clinical time available to teaching faculty Resident dissatisfaction with the didactic curriculum Regurgitation from textbooks Lack of audience interaction Session taught by residents lacked depth and scope Inadequate simulation exposure Inadequate preparation time (learner & presenter)

  25. Residents’ comments post implementation • All lectures more structured and beneficial • Presenters and learners better prepared • Presentations much more interactive and engaging • The best lectures were those that invite audience participation • The intern boot camp is an extremely valuable component of the core curriculum • Taught us from Day 1 important concepts • Audience response system engaging and great prep for ABSITE • Avoid resident presentations all together • I enjoyed the practical portions that have been included in the curriculum • Pig lab, lap trainer • Great chance to practice new skills in an environment not quite so high stress as the OR

  26. Conclusions • The systematic collaborative approach (faculty and residents) to curriculum development with interactive, objective competency-based presentations, robust simulation, use of online teaching tools, engaged teaching faculty resulted in: •  Resident satisfaction with the curriculum and their self-reported clinical and academic abilities •  Increase in the number of residents scoring in the top quartile in the ABSITE •  Effectively addresses the ACGME competencies

  27. Thank you!

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