Teaching and Assessing Surgical Competency in Ophthalmology Training Programs

Abstract

<H4>BACKGROUND AND OBJECTIVE</H4> <P> The Accreditation Council for Graduate Medical Education (ACGME) has mandated implementation of six new competencies in resident training in the United States. An implementation strategy is proposed to teach and assess cataract surgical competence. </P> <H4>PATIENTS AND METHODS</H4> <P> An intradepartmental Task Force for the ACGME competencies reviewed the literature for assessment tools to develop an implementation matrix for assessing surgical competence. </P> <H4>RESULTS</H4> <P> “Good practices” (gleaned from the literature) were adapted for the institution’s needs and tested, including (1) written and explicit goals or objectives for each stage of training; (2) substitution of a criterion-referenced (Dreyfus model) scoring rubric for a norm-referenced, peer-benchmarked global evaluation; (3) use of formative rather than summative feedback; (4) incorporation of deliberate practice (Ericsson model); and (5) portfolio-based documentation of sentinel event markers and remediation. </P> <H4>CONCLUSION </H4> <P>An implementation matrix for teaching and assessing surgical competence might be useful for local compliance with the ACGME mandate. </P> <P>[<CITE>Ophthalmic Surg Lasers Imaging</CITE> 2006;37:384-393.] </P> <H4>AUTHORS</H4> <P>From the Departments of Ophthalmology (TAO, AGL, HAB, ATJ, HCB, RO, KC), Neurology (AGL), Neurosurgery (AGL), and Otolaryngology (KC), University of Iowa Hospital and Clinics and University of Iowa Carver College of Medicine; and the Veterans Affairs Medical Center (TAO), Iowa City, Iowa. </P> <P>Accepted for publication May 24, 2006. </P> <P>Supported in part by an unrestricted grant from Research to Prevent Blindness, Inc., New York, New York. </P> <P>Presented in part at the annual meeting of the American Academy of Ophthalmology, Chicago, Illinois, October 14-19, 2005; and the American Society of Cataract and Refractive Surgery, San Francisco, California, March 22, 2006. </P> <P>Address reprint requests to Andrew G. Lee, MD, Department of Ophthalmology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive PFP, Iowa City, IA 52242. </P>

The international forum of ophthalmic simulation: developing a virtual reality training curriculum for ophthalmology

“…This hypothesis was, in part, based on evidence that beginners can experience significant amounts of extra stress in the operative environment, and this can actually impact negatively on performance slowing down their functioning and learning process 15 17. In addition, trainers frequently describe the training of the most junior surgeons as one of the most stressful aspects of their role, and so a programme, as the one described here, may prove more broadly beneficial.…”

“…Highly structured, supervised and assessed wet-lab sessions on animal models and compulsory microsurgical skill courses offer an additional training environment. This model, however, has a more limited ability to objectively track improvement 15. The more frequent use of VR simulators for surgical training could address some of these limitations.…”

Satisfaction with ophthalmology residency training from the perspective of recent graduates: a cross-sectional study

“…In a systematic literature review, it was suggested the use of a laboratory to teach and assess aspects of resident surgical competence [12]. In another study, specific techniques for teaching and assessing surgical competence in ophthalmology residencies were suggested, such as: written and explicit goals or objectives for each stage of training and the use of formative rather than summative feedback [13]. Golnik et al developed a 1-page on-call assessment tool (OCAT) and scoring rubric to evaluate ophthalmology resident on-call performance.…”

Resident surgical training in glaucoma

“…Several standardized instruments have been developed to evaluate resident surgical skills [21–24]. The Global Rating Assessment of Skills in Intraocular Surgery (GRASIS) is a 1-page evaluation form that has been validated and may be used for any intraocular procedure [22].…”