title: From time-based to competency-based standards: core transitional competencies in plastic surgery.
abstract: OBJECTIVE
  Competency-based medical education is becoming increasingly prevalent and is likely to be mandated by the Royal College in the near future. The objective of this study was to define the core technical competencies that should be possessed by plastic surgery residents as they transition into their senior (presently postgraduate year 3) years of training.
  
  
  METHODS
  A list of potential core competencies was generated using a modified Delphi method that included the investigators and 6 experienced, academic plastic surgeons from across Canada and the United States. Generated items were divided into 7 domains: basic surgical skills, anesthesia, hand surgery, cutaneous surgery, esthetic surgery, breast surgery, and craniofacial surgery. Members of the Delphi group were asked to rank particular skills on a 4-point scale with anchored descriptors. Item reduction resulted in a survey consisting of 48 skills grouped into the aforementioned domains. This self-administered survey was distributed to all Canadian program directors (n = 11) via e-mail for validation and further item reduction.
  
  
  RESULTS
  The response rate was 100% (11/11). Using the average rankings of program directors, 26 "core" skills were identified. There was agreement of core skills across all domains except for breast surgery and esthetic surgery. Of them, 7 skills were determined to be above the level of a trainee at this stage; a further 15 skills were agreed to be important, but not core, competencies.
  
  
  CONCLUSIONS
  Overall, 26 competencies have been identified as "core" for plastic surgery residents to possess as they begin their senior, on-service years. The nature of these skills makes them suitable for teaching in a formal, simulated environment, which would ensure that all plastic surgery trainees are competent in these tasks as they transition to their senior years of residency.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Western University, St. Joseph's Health Care, London, Ontario, Canada.
authors.forename: Kristina
authors.initials: K
authors.lastname: Lutz
authors.affiliation: LHSC - Victoria Hospital, London, Ontario, Canada.
authors.forename: Arjang
authors.initials: A
authors.lastname: Yazdani
authors.affiliation: Roth-McFarlane Hand and Upper Limb Centre, St. Joseph's Health Centre, London, Ontario, Canada. Electronic address: dross@uwo.ca.
authors.forename: Douglas
authors.initials: D
authors.lastname: Ross
mesh_terms: D002170:Canada; D002983:Clinical Competence; D003162:Competency-Based Education / Q000592:standards*; D003430:Cross-Sectional Studies; D003697:Delphi Technique; D004503:Education, Medical, Graduate / Q000379:methods*; D004521:Educational Measurement; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D008297:Male; D058996:Quality Improvement; D012015:Reference Standards; D013518:Surgery, Plastic / Q000193:education*; D013647:Task Performance and Analysis; D055815:Young Adult
keywords: Patient Care; Practice-Based Learning and Improvement; Systems-Based Practice; competency based; education; plastic surgery