Maximally-Invasive Curriculum: A Model Curriculum for Osteopathic Surgical Residencies (ACOS) India...
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Maximally-Invasive Curriculum: A Model Curriculum for Osteopathic Surgical Residencies (ACOS) India Broyles, EdD University of New England College of Osteopathic Medicine, 11 Hills Beach Rd, Biddeford, ME 04005 Cynthia Cartwright, MT RN MSEd Maine Health: Center for Outcomes Research and Evaluation, 465 Congress Street, Portland, ME 04101 Conceptual Framework of the Conceptual Framework of the Discipline: Discipline: example from General Surgery example from General Surgery Pre-assessment: Samples from survey of AOA/ACOS Surgery Residency Directors Traditional A pproach C om petency-based A pproach Teacher- Centered Time Based Individu al, s eparate topi cs A ssessment is no rm - refere nced Learner- Centered Demonstration o fknow ledge and skills Integration andappli cation o f content A ssessment is crit erion- refere nced Form ative: ev aluation us ed fo r improvement. Fo rmative evaluation usually in cludes giving feedback Sum ma tive: ev aluation us ed to m ake decisions about a learner, e.g., p romotion or g raduation •Identifies performance markers for all students relative to a particular competency or learning outcome •Indicators are grouped to benchmark a surgical resident’s developmental level Phase I, Phase II, Phase III •Benchmarking is the process of identifying a set of performance indicators a learner is expected to meet at a given developmental level • Benchmarking provides a basis for tracking progress and marking achievement • Not all students are expected to meet all benchmarks at the same time or in the same way Examples from BREAST curriculum : Phase I: Evaluate indications for fine needle aspiration and for open biopsy Phase II: Compare the criteria for using regional therapy including axillary dissection and sentinel node excision Phase III: Evaluate the breast condition and the patient’s desire for breast reconstruction in order to determine the appropriate techniques and the choice of either immediate or delayed reconstruction Performance Indicators Learning Outcomes W hat areyour perceptionsof t he AC O S Curriculum DevelopmentProject? Check all t hat apply. N = 35 Iam looking f orward to t he products of th is p roject 69% Iam wellaware of t he A COS curric ulum development project 63% Itwill i mprove th e quality of Osteopathic s urgery residency training 51% Itwill i mprove th e abili ty ofOsteopathic s urgery residency programs to e valuate r esident p erformance 49% Itwill make my job as r esidency program director easier 37% Itwill make my job as r esidency program director more cumbersome, difficult, t im e consuming.* 3% D on't know 3% H ow do residents i n your program currently use curriculum docum ents? Ch eck one. N = 35 Curric ulum is d istributed at orientati on, may orm ay notbe used during tr aining 54% To s et p ersonal g oalsand m easure achievement 20% Residentshaveownership a nd use t he curriculum because t hey are p art of th e developm entprocess 17% They don’t us e them 17% Competency-Based Curriculum requires a new perspective on teaching, content, instructional time, learner assessment, and program evaluation The Practice, The System , The Profession Practi ce-based Learning & Improvem ent Professionali sm Systems-based Practi ce C li nical Sciences and Skills Blood & Blood Products Incisions, Sutures& W ound Healing Fluid & Electrolytes Laparoscopy Nutrit ion Pain M anagement Shock Surgical Infecti ons Associated Specialties Anesthesiology Hematology Imaging Infecti ous Disease Internal Medicine Neurology Oncology Osteopathic Manipulati ve Medicine Principal SurgicalAreas Breast Burns Critical C are Endocrine Gallbladder/ Bil iaryTree G I T ract Head &Neck Pancreas Pediat rics Liver Spleen Skin/Soft Ti ssue Thoracic Trauma & Emergency Vascular Hernia • Clinical applications of learning • What the resident should be able to do at the end of a course or program • Combines knowledge, skills and attitudes • Places emphasis on the application and integration of knowledge • Generally, not measurable • Reflects AOA Competencies Sample Learning Outcomes from Principal Surgical Area: Breast Upon completion of the general surgical residency, the resident will: •Understand the etiology, pathophysiology, presenting symptoms, differential diagnosis and treatment options of breast diseases •Diagnose abnormal breast conditions by history, physical examination and radiologic diagnostic procedures •Perform diagnostic therapeutic surgeries for benign and malignant breast conditions •Perform or refer osteopathic manipulative treatment (OMT) in the pre- and postoperative period to facilitate early return to normal function and prevention of postoperative complications •Coordinate multidisciplinary care for benign and malignant breast conditions •Counsel patients and families on all aspects of breast diagnosis, surgery and treatment Assessment and Evaluation: Assessment and Evaluation: Evaluation tools and strategies are based on comparison with competencies rather than other residens The most important task in residency education is determining what the residents need to learn, how it should be taught, and how to measure resident performance. In response to the AOA requirements for integration of seven core competencies in residency education, the The ACOS/RESC set up subcommittees of surgeons guided by curriculum consultants to establish a national curriculum. •OPP •Medical Knowledge •Patient Care •Interpersonal and Communication Skills •Professionalism •Practice-Based Learning and Improvement •Systems-Based Practice History of the Project The subcommittee examined the current ACOS mission statement in an effort to bring together vision and values for a sample residency mission statement. During implementation, each residency will write their own mission. Mission: Every sailor knows the importance of the North Star for guidance. With curriculum design, the process is guided by a set of ideas – vision, mission, and values. ACOS MISSION: ACOS is committed to assuring excellence in osteopathic surgical care through education, advocacy, leadership development, and the fostering of professional and personal relationships. SAMPLE RESIDENCY MISSION: The General Surgery Residency is committed to assuring excellence in osteopathic surgical education through training and self-directed learning, patient care and advocacy, and leadership development. We seek to foster continuing personal growth and professional relationships. Implementation Implementation •Assessment: Gathering information about a learner’s knowledge, skills and attitudes •Feedback: Provision of information about a learner’s performance to the learner, teachers and other stakeholders •Evaluation: Comparison of a learner’s performance to an accepted standard What aspects of the old and the new program are similar or different? What parts of the old program will be continued and which parts will be modified or eliminated? Who will provide leadership for subsets of the new program? What are the advantages of the new program to both residents and attending physicians? How do we structure a gradual implementation starting at PGY1 without denying access to new ideas at PGY 4-5? How does resident evaluation change in keeping with competency-based education?
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Transcript of Maximally-Invasive Curriculum: A Model Curriculum for Osteopathic Surgical Residencies (ACOS) India...
Maximally-Invasive Curriculum:A Model Curriculum for Osteopathic Surgical Residencies (ACOS)
India Broyles, EdD University of New England College of Osteopathic Medicine, 11 Hills Beach Rd, Biddeford, ME 04005
Cynthia Cartwright, MT RN MSEdMaine Health: Center for Outcomes Research and Evaluation, 465 Congress Street, Portland, ME 04101
Conceptual Framework of the Discipline: Conceptual Framework of the Discipline: example from General Surgeryexample from General Surgery
Pre-assessment: Samples from survey of AOA/ACOS Surgery Residency Directors
Traditional Approach Competency-basedApproach
Teacher-CenteredTime Based
Individual, separate topics
Assessment is norm-referenced
Learner-CenteredDemonstration of knowledge
and skillsIntegration and application of
contentAssessment is criterion-
referenced
Formative: evaluation used forimprovement. Formative evaluationusually includes giving feedbackSummative: evaluation used to makedecisions about a learner,e.g., promotion or graduation
•Identifies performance markers for all students relative to a particular competency or learning outcome•Indicators are grouped to benchmark a surgical resident’s developmental level Phase I, Phase II, Phase III
•Benchmarking is the process of identifying a set of performance indicators a learner is expected to meet at a given developmental level • Benchmarking provides a basis for tracking progress and marking achievement• Not all students are expected to meet all benchmarks at the same time or in the same wayExamples from BREAST curriculum:Phase I: Evaluate indications for fine needle aspiration and for open biopsyPhase II: Compare the criteria for using regional therapy including axillary dissection and sentinel node excisionPhase III: Evaluate the breast condition and the patient’s desire for breast reconstruction in order to determine the appropriate techniques and the choice of either immediate or delayed reconstruction
Performance Indicators
Learning Outcomes
What are your perceptions of the ACOS CurriculumDevelopment Project? Check all that apply.
N = 35
I am looking forward to the products of this project 69%I am well aware of the ACOS curriculum development project 63%It will improve the quality of Osteopathic surgery residencytraining
51%
It will improve the ability of Osteopathic surgery residencyprograms to evaluate resident performance
49%
It will make my job as residency program director easier 37%It will make my job as residency program director morecumbersome, difficult, time consuming.*
3%
Don't know 3%How do residents in your program currently usecurriculum documents? Check one.
N = 35
Curriculum is distributed at orientation, may or may not beused during training
54%
To set personal goals and measure achievement 20%Residents have ownership and use the curriculum because theyare part of the development process
17%
They don’t use them 17%
Competency-Based Curriculum requires a new perspective on teaching, content, instructional time,
learner assessment, and program evaluation
The Practice,The System,The ProfessionPractice-basedLearning &Improvement
Professionalism
Systems-basedPractice
ClinicalSciences andSkillsBlood & Blood
ProductsIncisions,
Sutures &WoundHealing
Fluid &ElectrolytesLaparoscopyNutritionPainManagementShockSurgicalInfections
AssociatedSpecialtiesAnesthesiologyHematologyImagingInfectiousDiseaseInternalMedicineNeurologyOncologyOsteopathicManipulativeMedicine
PrincipalSurgical AreasBreastBurnsCritical CareEndocrineGallbladder/ BiliaryTreeGI TractHead & NeckPancreasPediatricsLiverSpleenSkin/Soft TissueThoracicTrauma &EmergencyVascularHernia
• Clinical applications of learning • What the resident should be able to do at
the end of a course or program• Combines knowledge, skills and attitudes• Places emphasis on the application and
integration of knowledge• Generally, not measurable • Reflects AOA Competencies
Sample Learning Outcomes from Principal Surgical Area: Breast
Upon completion of the general surgical residency, the resident will:
•Understand the etiology, pathophysiology, presenting symptoms, differential diagnosis and treatment options of breast diseases
•Diagnose abnormal breast conditions by history, physical examination and radiologic diagnostic procedures
•Perform diagnostic therapeutic surgeries for benign and malignant breast conditions
•Perform or refer osteopathic manipulative treatment (OMT) in the pre- and postoperative period to facilitate early return to normal function and prevention of postoperative complications
•Coordinate multidisciplinary care for benign and malignant breast conditions
•Counsel patients and families on all aspects of breast diagnosis, surgery and treatment
Assessment and Evaluation: Assessment and Evaluation: Evaluation tools and strategies are based on comparison
with competencies rather than other residens
The most important task in residency education is determining what the residents need to learn, how it should be taught, and how to measure resident performance. In response to the AOA requirements for integration of seven core competencies in residency education, the The ACOS/RESC set up subcommittees of surgeons guided by curriculum consultants to establish a national curriculum.•OPP•Medical Knowledge•Patient Care•Interpersonal and Communication Skills•Professionalism•Practice-Based Learning and Improvement•Systems-Based Practice
History of the Project
The subcommittee examined the current ACOS mission statement in an effort to bring together vision and values for a sample residency mission statement. During implementation, each residency will write their own mission.
Mission: Every sailor knows the importance of the North Star for guidance. With curriculum design, the process is guided by a set of ideas – vision, mission, and values.
ACOS MISSION: ACOS is committed to assuring excellence in osteopathic surgical care through education, advocacy, leadership development, and the fostering of professional and personal relationships.
SAMPLE RESIDENCY MISSION: The General Surgery Residency is committed to assuring excellence in osteopathic surgical education through training and self-directed learning, patient care and advocacy, and leadership development. We seek to foster continuing personal growth and professional relationships.
ImplementationImplementation•Assessment: Gathering information about a learner’s knowledge, skills and attitudes
•Feedback: Provision of information about a learner’s performance to the learner, teachers and other stakeholders
•Evaluation: Comparison of a learner’s performance to an accepted standard
What aspects of the old and the new program are similar or different?What parts of the old program will be continued and which parts will be
modified or eliminated?Who will provide leadership for subsets of the new program?What are the advantages of the new program to both residents and
attending physicians?How do we structure a gradual implementation starting at PGY1 without
denying access to new ideas at PGY 4-5? How does resident evaluation change in keeping with competency-based
education?How will we gather data and give feedback on the challenges and
successes of the new curriculum in our own setting?
