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Intersection of Surgical Outcomes and Medical Education
The RRC Perspective
APDS Panel Session IVSurgical Education Week
March 21,2012San Diego, CA
James C Hebert, MD, FACSChair – RRC-Surgery
Disclosures
• No financial disclosures• The views presented are my own
PD
CMO Resident RRC ACS
ABS
What are we trying to describe?
RRC Perspective – AccreditationSpecific Questions
1. Can you satisfy the requirement for a patient safety curriculum and nail the core competencies with the use of outcomes data in surgical education?
2. Does providing 30 day continuous data to your residents reduce the reality of training itinerant surgeons?
Specific Questions – Short Answers1. Can you satisfy the requirement for a patient safety
curriculum and nail the core competencies with the use of outcomes data in surgical education? Depends on how data are generated and reported; core processes that involve residents
2. Does providing 30 day continuous data to your residents reduce the reality of training “itinerant” surgeons? The process of just providing data will not, but integrating residents into a culture of measuring outcomes may.
Let’s analyze it further.
“…Quality isn’t method. It’s the goal toward which the method is aimed.”
Robert Pirsig, Zen and the Art of Motorcycle Maintenance
Education Goal - Safe & Competent Surgeon Demonstrated by Clinical Outcomes
KnowledgePatient Care
ProfessionalismCommunication
Practice-based learning and improvement
Systems based practice
Current Training Model
• Limited patient interactions along the continuum of care for a specific patient
- outpatient management - limited duty hours - changing culture of surgical care - more specialization• More hand-offs – “itinerant “surgery
What Currently Drives the Structure and Content of our Residency Programs?
“Curriculum”ACGME Standards
In the context of local service needs,Choose Educational Experiences
within Institution, Faculty
Identify/Develop Evaluation Idiosyncratic Tools - Formative and Summative
- Experience Tracking
“Educate” Residents
“Circumstantial Practice”
Guarantees that education is institutionally idiosyncratic, and lags rather than anticipates change in the delivery system
Clinical Outcomes – Resident Role
• Patient outcomes are primarily systems-based
• Depend on balance of supervision and independence
• Defined role of resident within system -
Data gatherer Leader
The Continuum of Clinical Professional Development
Authority and Decision Making versus Supervision
Authority and Decision MakingLow High
Sup
erv
isio
n
Low
HighPhysical Diagnosis
Internship
Residency
Fellowship
Sub-Internship
Attending
Clerkship“Graded or Progressive
Responsibility”
Expert
Proficient
Competent
Advanced Beginner
Novice
Increase the Accreditation Emphasis on Educational Outcomes
End PGY 1 Mid PGY 21
2
3
4
5
6
7
8
9
Professionalism
Communications
Medical Knowledge
Patient Care
Practice Based Learning and Improvement
Systems Based Practice
Tracking Milestones along the Continuum of Resident Training
What Will Drive the Structure and Content of our Residency Programs in the Near Future?
Design Educational ExperiencesSelect Faculty
ExpertPhysicians
who aspire toMastery
(Outcomes)
The RequiredOutcomes in Each Clinical Competency(Milestones)
External AccountabilityFor Outcomes
“Intentional Practice”
Introduction of New Competencies
Guarantees that education has the opportunity to anticipate change in the delivery system
National Evaluation Tools to Track Outcomes - Formative and Summative
- Clinical Outcomes Tracking (not just counting)
Program Accreditation
• Structure• Resources • Core Processes – (Clinical outcome measurement)• Detailed Processes- (Program specifics)• Educational Outcomes – “Milestones”
Clinical Outcomes and Accreditation
• Residents should want to train where there are excellent clinical outcomes
which implies good systems of care which implies a strong educational foundation (structure, resources, core &detailed processes)• Residents must be integrated into processes that
measure outcomes and demonstrate competent and proficient levels of achievement AND the program must demonstrate good clinical outcomes
Thank You
• ???????