title: Surgeons' attitude toward a competency-based training and assessment program: results of a multicenter survey.
abstract: BACKGROUND
  Currently, most surgical training programs are focused on the development and evaluation of professional competencies. Also in the Netherlands, competency-based training and assessment programs were introduced to restructure postgraduate medical training. The current surgical residency program is based on the Canadian Medical Education Directives for Specialists (CanMEDS) competencies and uses assessment tools to evaluate residents' competence progression. In this study, we examined the attitude of surgical residents and attending surgeons toward a competency-based training and assessment program used to restructure general surgical training in the Netherlands in 2009.
  
  
  METHODS
  In 2011, all residents (n = 51) and attending surgeons (n = 108) in 1 training region, consisting of 7 hospitals, were surveyed. Participants were asked to rate the importance of the CanMEDS competencies and the suitability of the adopted assessment tools. Items were rated on a 5-point Likert scale and considered relevant when at least 80% of the respondents rated an item with a score of 4 or 5 (indicating a positive attitude). Reliability was evaluated by calculating the Cronbach's α, and the Mann-Whitney test was applied to assess differences between groups.
  
  
  RESULTS
  The response rate was 88% (n = 140). The CanMEDS framework demonstrated good reliability (Cronbach's α = 0.87). However, the importance of the competencies 'Manager' (78%) and 'Health Advocate' (70%) was undervalued. The assessment tools failed to achieve an acceptable reliability (Cronbach's α = 0.55), and individual tools were predominantly considered unsuitable for assessment. Exceptions were the tools 'in-training evaluation report' (91%) and 'objective structured assessment of technical skill' (82%). No significant differences were found between the residents and the attending surgeons.
  
  
  CONCLUSIONS
  This study has demonstrated that, 2 years after the reform of the general surgical residency program, residents and attending surgeons in a large training region in the Netherlands do not acknowledge the importance of all CanMEDS competencies and consider the assessment tools generally unsuitable for competence evaluation.
authors.affiliation: Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands. Electronic address: c.hopmans@erasmusmc.nl.
authors.forename: Cornelis J
authors.initials: CJ
authors.lastname: Hopmans
authors.forename: Pieter T
authors.initials: PT
authors.lastname: den Hoed
authors.forename: Iris
authors.initials: I
authors.lastname: Wallenburg
authors.forename: Lijkckle
authors.initials: L
authors.lastname: van der Laan
authors.forename: Erwin
authors.initials: E
authors.lastname: van der Harst
authors.forename: Maarten
authors.initials: M
authors.lastname: van der Elst
authors.forename: Guido H H
authors.initials: GH
authors.lastname: Mannaerts
authors.forename: Imro
authors.initials: I
authors.lastname: Dawson
authors.forename: Jan J B
authors.initials: JJ
authors.lastname: van Lanschot
authors.forename: Jan N M
authors.initials: JN
authors.lastname: Ijzermans
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003162:Competency-Based Education / Q000458:organization & administration; D003625:Data Collection; D004521:Educational Measurement; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D009426:Netherlands; D015397:Program Evaluation
keywords: Interpersonal and Communication Skills; Medical Knowledge; Practice-Based Learning and Improvement; Professionalism; Systems-Based Practice; clinical competence; educational measurement; general surgery; postgraduate training; program evaluation; quantitative research methods