title: A taxonomy of perioperative surgical learning: Trending resident skill acquisition.
abstract: BACKGROUND
  Resident and curriculum evaluation require tracking surgical resident operative performance, yet what and when to measure remains unclear.
  
  
  METHODS
  From a multi-institutional database, we reviewed 611 resident/surgeon-paired assessments of ACGME Milestones and modified OPRS ratings for different cases and postgraduate years.
  
  
  RESULTS
  Faculty Milestone ratings increased with each PGY (p=<0.001) and correlated with resident self-ratings (ICC = 0.83). Mean OPRS scores increased in small increments with substantial intra-year variability. Progression among individual OPRS subcategories was not apparent from more global analyses. Interestingly, male faculty offered lower ratings than female faculty.
  
  
  CONCLUSIONS
  Milestones and modified mean OPRS ratings suggest residents are learning, yet lack sufficient discrimination for promotion or curricular analysis. Differential progression through OPRS subcategories suggests a taxonomy of surgical learning that can be tailored to focus on different skills at each point in the training continuum. The effect of faculty gender on resident ratings awaits further study.
authors.affiliation: College of Human Medicine, Department of Surgery, Michigan State University, 1200 E. Michigan Avenue, Suite 655, Lansing, MI, 48912, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Hardaway
authors.affiliation: University of North Dakota School of Medicine & Health Sciences, 501 North Columbia Road, Stop 9037, Grand Forks, ND, 58202, USA.
authors.forename: Marc D
authors.initials: MD
authors.lastname: Basson
authors.affiliation: College of Human Medicine, Department of Surgery, Michigan State University, 1200 E. Michigan Avenue, Suite 655, Lansing, MI, 48912, USA.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Ali
authors.affiliation: College of Human Medicine, Department of Surgery, Michigan State University, 1200 E. Michigan Avenue, Suite 655, Lansing, MI, 48912, USA; Grand Rapids Medical Education Partners Research Department, 945 Ottawa Ave. NW, Grand Rapids, MI, 49503, USA.
authors.forename: Alan T
authors.initials: AT
authors.lastname: Davis
authors.affiliation: College of Human Medicine, Department of Surgery, Michigan State University, 1200 E. Michigan Avenue, Suite 655, Lansing, MI, 48912, USA.
authors.forename: Pam S
authors.initials: PS
authors.lastname: Haan
authors.affiliation: College of Human Medicine, Department of Surgery, Michigan State University, 1200 E. Michigan Avenue, Suite 655, Lansing, MI, 48912, USA.
authors.forename: Rama N
authors.initials: RN
authors.lastname: Gupta
authors.affiliation: College of Human Medicine, Department of Surgery, Michigan State University, 1200 E. Michigan Avenue, Suite 655, Lansing, MI, 48912, USA.
authors.forename: Andi N
authors.initials: AN
authors.lastname: Peshkepija
authors.affiliation: College of Human Medicine, Department of Surgery, Michigan State University, 1200 E. Michigan Avenue, Suite 655, Lansing, MI, 48912, USA.
authors.forename: Cody A
authors.initials: CA
authors.lastname: Nebeker
authors.affiliation: College of Human Medicine, Department of Surgery, Michigan State University, 1200 E. Michigan Avenue, Suite 655, Lansing, MI, 48912, USA.
authors.forename: Michael K
authors.initials: MK
authors.lastname: McLeod
authors.affiliation: College of Human Medicine, Department of Surgery, Michigan State University, 1200 E. Michigan Avenue, Suite 655, Lansing, MI, 48912, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Osmer
authors.affiliation: College of Human Medicine, Department of Surgery, Michigan State University, 1200 E. Michigan Avenue, Suite 655, Lansing, MI, 48912, USA. Electronic address: Cheryl.Anderson@ht.msu.edu.
authors.forename: Cheryl I
authors.initials: CI
authors.lastname: Anderson
mesh_terms: D002983:Clinical Competence; D003479:Curriculum; D016208:Databases, Factual; D004503:Education, Medical, Graduate; D004521:Educational Measurement / Q000379:methods*; D005180:Faculty, Medical; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D014481:United States
keywords: Milestones; OPRS; Residents; Scaffolding; Surgery; Taxonomy