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Correlation between experience targets and competence for general surgery certification.

J R De Siqueira1, M J Gough1

  • 1Yorkshire School of Surgery, Health Education Yorkshire and the Humber, Leeds, UK.

The British Journal of Surgery
|April 10, 2016
PubMed
Summary
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Surgical training relies on operative numbers, but this study found minimum procedure counts do not guarantee surgeon competence. A significant number of trainees completing required cases still lacked independent operating skills, indicating a need for better assessment tools.

Area of Science:

  • Surgical Education
  • Competency-Based Assessment
  • Surgical Training Metrics

Background:

  • Current surgical training and board accreditation often use operative case numbers as a proxy for surgical competence.
  • This model is increasingly challenged by working hour restrictions and public expectations for demonstrable skills.
  • There is a need to evaluate the validity of these experiential models in assessing true operative competence.

Purpose of the Study:

  • To assess the correlation between trainer-assessed competence and the completion of minimum operative case numbers in general surgical trainees.
  • To determine if completing indicative numbers for specific procedures reliably indicates surgical competence.

Main Methods:

  • Analysis of UK Intercollegiate Surgical Curriculum Programme portfolios for general surgical trainees.

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  • Comparison of Procedure Based Assessment (PBA) scores (competence level) with operative case numbers for cholecystectomy, segmental colectomy, and Hartmann's procedure.
  • Statistical analysis of the correlation between operative volume and PBA scores.

    • Main Results:

    • A positive correlation was observed between operative numbers and PBA scores for all three procedures studied (cholecystectomy, segmental colectomy, Hartmann's).
    • However, a significant proportion of trainees who met the minimum case numbers for certification had not achieved the highest level of competence (Level 4 PBA) for independent operating.
    • Over half of assessments performed after trainees completed their minimum case numbers were scored below Level 4.

    Conclusions:

    • Minimum operative case numbers alone are insufficient indicators of surgical competence.
    • The current experiential model based on indicative procedures does not reliably certify operative proficiency.
    • Development and implementation of more robust assessment tools are necessary for surgical training certification.