Looking Forward – July 2012

The demands on surgeons in practice and in training to demonstrate competence continue to grow. To appropriately respond to these evolving expectations, professional organizations must now offer an expanded array of educational programs for learners at each stage in their professional development.

The American College of Surgeons (ACS) is deeply committed to improving educational opportunities for all surgeons, particularly those in training, and the College has developed a strategic plan to ensure that we can better fulfill this mission. Under the leadership of Ajit K. Sachdeva, MD, FACS, FRCSC, the College’s Division of Education has made major strides in recent months toward advancing our portfolio of proficiency-based curricula for residents and medical students. This growth has occurred in collaboration with the Association of Program Directors in Surgery (APDS) and the Association for Surgical Education (ASE). Importantly, all three parties have agreed that the ACS should take the lead in making these programs available.

Support for the development, launch, and implementation of these curricula, along with the associated assessment tools, will be provided through the Division of Education. All of these courses incorporate leading-edge education and training methods, including the use of simulators and simulation to provide safe hands-on learning experiences.

Surgical skills curriculum

The ACS has been working with the APDS to create a three-phase surgical skills curriculum for surgical residents. The 20 modules in Phase I of this program address procedures and tasks. New videos produced this past spring increase the educational impact of this component of the curriculum. In addition, robust assessment tools based on the established Objective Structured Assessment of Technical Skills model have been added to each module in Phase I. These instruments will permit program directors to reliably and accurately assess their residents’ surgical skills.

Development of the modules in Phase III is under way. A small group of surgeons and academics was recently charged with reviewing all 10 modules in this part of the curriculum, which focuses specifically on interdisciplinary and inter-professional teamwork. The modules will be revised and updated as needed and rigorous assessment tools will be added to ensure appropriate resident assessment.

After the revisions to Phase I and Phase III are completed, we will begin work on the 15 modules in Phase II, which centers on the development and improvement of hands-on operating skills and techniques. Additional modules will be developed to address the broad range of complex surgical procedures that residents will need to perform in practice. These modules will encompass use of sophisticated simulation technology, and we are in negotiation with several companies that have the technology to develop simulators that can meet specific curriculum objectives.

Resident preparatory curriculum

As we all know, the transition from medical student to surgical resident is a critical phase in a surgeon’s professional development. The scrutiny of this key milestone has intensified in recent years with members of the academic community raising significant concerns regarding whether medical students are adequately prepared to start residency training and provide safe patient care. The ACS, APDS, and ASE are combining forces to develop a surgery resident prep curriculum, a multidimensional and modular program, which will help fourth-year medical students to better prepare for the next stage of surgical training.

During the 2012 Surgical Education Week, March 19–24 in San Diego, CA, the ACS, APDS, and ASE made great progress toward defining specific modules and the associated assessment tools. Several modules in this curriculum will be released this year with the goal of launching the entire program in spring 2013. We anticipate the quick and successful promulgation of this program in light of the fact that the leadership of the Association of American Medical Colleges has offered their support in introducing it in medical schools throughout the nation.

Focus on medical students

The ACS and ASE have produced a Medical Student Simulation-based Surgical Skills Curriculum to assist students in the first through third years of medical school to develop basic surgical skills. A number of modules in this curriculum were highlighted during a workshop at Surgical Education Week this year, and several will be launched this year with the goal of implementing the entire program in late-spring 2013.

In addition, the ACS and ASE recently signed a formal agreement to create a Core Surgery Curriculum for all students in the first three years of medical school. This comprehensive curriculum will center on both surgical knowledge and patient care skills. A steering committee for this program has been appointed and has begun planning the curriculum.

Moreover, we are proceeding with the development of a Special Verification and Validation Examination that program directors would be able to offer to all of their incoming residents to assess their knowledge and skills in various domains. The ACS Division of Education will offer this online exam, which will enable program directors to determine the content areas they need to address to move each resident from direct to indirect supervision in accordance with the new requirements of the Residency Review Committee and the Accreditation Council for Graduate Medical Education. We anticipate that this examination will be a major advance in the early education and training of residents.

Producing better surgeons

Through the strategic plan outlined here, the ACS will be able to provide program directors, clerkship directors, and other surgical educators with objective information on the longitudinal progression of residents and medical students. This set of educational programs will be an invaluable resource to the individuals who have assumed the critical responsibility of educating the next generation of surgical professionals.

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