Teaching and assessing technical proficiency in surgical subspecialty fellowships.
OBJECTIVE
To determine how programs are teaching and assessing procedural skills, and their perceived success.


METHODS
Cross-sectional survey.


METHODS
Accreditation Council for Graduate Medical Education (ACGME) approved training programs in pediatric urology and colorectal surgery.


METHODS
Program directors and recent graduates (2007-2009).


RESULTS
Thirty-nine program directors (60%), and 57 graduates (64%) responded; 89.5% of graduates and 94.9% of program directors felt training occurred successfully for the procedures that trainees were performing in their present practice. Nearly 90% of trainees and all program directors reported that there was no formal assessment of procedural competency at the beginning of training, although 66.7% of program directors reported that trainees were assessed "informally." Both program directors and trainees reported dialogue with faculty was the most frequent method used in preparing for operative procedures. Other methods (textbook/atlas, journals, web-based programs, videos) were used less frequently. Program directors with shorter tenure were more likely to use web-based and video methods; younger trainees were less likely to use textbooks/atlases. Faculty feedback on clinical decision-making and postprocedural review were perceived by both program directors and trainees as the most effective assessment methods for improving performance; however, trainees were more likely than program directors to report that postprocedure reviews were not included in their training (15.8% vs 9%, p = 0.045). Patient outcomes, written feedback from peers, and self-assessment were included in most programs, but valued less. Simulation was used in only about half the programs and was valued more highly by trainees than program directors (p = 0.011).


CONCLUSIONS
Training in procedural proficiency was viewed as successful by both program directors and graduates. Dialogue with, assessment by, and feedback from faculty were frequently used and most valued; stressing the importance of the facilitator role of faculty in the education of the trainee. These findings provide guidance for the development of newer methods of teaching and assessment.
Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA. sdemees1r@jhmi.edu
Susan L
SL
Gearhart
Ming-Hsien
MH
Wang
Marta M
MM
Gilson
Belinda
B
Chen
David E
DE
Kern
D000046:Academic Medical Centers; D000068:Accreditation; D000328:Adult; D002983:Clinical Competence; D003107:Colorectal Surgery / Q000193:education; D003198:Computer Simulation; D003430:Cross-Sectional Studies; D004503:Education, Medical, Graduate / Q000458:organization & administration*; D005257:Fellowships and Scholarships / Q000458:organization & administration; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D008297:Male; D008875:Middle Aged; D010372:Pediatrics; D008486:Physician Executives / Q000458:organization & administration; D015397:Program Evaluation; D012647:Self-Assessment; D013043:Specialties, Surgical / Q000193:education*; D011795:Surveys and Questionnaires; D013663:Teaching / Q000458:organization & administration; D014481:United States; D013520:Urologic Surgical Procedures / Q000193:education