Invited commentary: educational interventions to address the core competencies in surgery

Changes in the health care environment, such as the restriction on resident duty hours and shift of the venue of a major portion of surgical care from inpatient to ambulatory settings, have changed the landscape of competence acquisition and maintenance.

Abstract

A host of powerful influences from within the medical profession and strong pressures from the public have resulted in the recent intense focus on acquisition and maintenance of competence. The Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties (ABMS) have defined 6 core competencies that residents must acquire and practicing physicians must continue to demonstrate. 1. ACGME Outcome Project. General competencies, Accreditation Council for Graduate Medical Education, Chicago. Available at: http://www.acgme.org/outcome/comp/compFull.asp. Accessed September 5, 2003. Google Scholar , 2. Nahrwold D.L. The competence movement: a report on the activities of the American Board of Medical Specialties. Bull Am Coll Surg. 2000; 85: 14-18 PubMed Google Scholar These include medical knowledge, patient care, interpersonal and communication skills, professionalism, practice-based learning and improvement, and systems-based practice. Although these competencies are not entirely new to surgeons, efforts to teach and assess objectively specific elements within these competencies can be challenging. This is especially true for practice-based learning and improvement and systems-based practice, which have not received sufficient attention in most education programs. New and innovative methods are needed to address these 2 competencies. Interpersonal and communication skills and professionalism have traditionally been taught and learned through exemplary role modeling, and their assessment has been essentially subjective. Changes in the health care environment, such as the restriction on resident duty hours and shift of the venue of a major portion of surgical care from inpatient to ambulatory settings, have affected the traditional interactions between residents and senior role models. Thus, special educational interventions are needed to address the competencies of interpersonal and communication skills and professionalism. Medical knowledge and patient care have been the principal foci of residency education and continuing education programs; however, even within the context of these 2 competencies, new educational approaches need to be explored continually to ensure optimum outcomes in the constantly changing milieu of health care. Exponential growth in scientific knowledge, development of new technology, and introduction of novel surgical procedures have all impacted the practice of surgery. Special educational interventions are needed to address these developments satisfactorily. Recent advances in surgical education resulting from leading edge research need broad acceptance and implementation. The advances include use of structured teaching and learning models, experiential learning methods, learner-centered education, and valid and reliable methods of assessment. These would be very helpful in addressing the competencies. Although certain elements of the core competencies may be addressed through redesign of existing educational methods, new approaches are needed to comprehensively address all 6 competency domains. 3. Dunnington G.L. Williams R.G. Addressing the new competencies for residents' surgical training. Acad Med. 2003; 78: 14-21 Crossref PubMed Scopus (35) Google Scholar