A Competency-Based Approach to Functional Neurosurgery Training: Insights From the Surgical Autonomy Program.

Area of Science:

• Neurosurgery
• Medical Education
• Surgical Training

Background:

• Accreditation Council for Graduate Medical Education (ACGME) uses case minimums for competency assessment.
• Current standards are based on expert opinion, not individual resident performance.
• The Surgical Autonomy Program offers a competency-based evaluation method.

Purpose of the Study:

• To compare resident autonomy progression using the Surgical Autonomy Program with ACGME case minimums.
• To analyze the number of cases required for neurosurgery residents to achieve competency.
• To evaluate the efficacy of competency-based assessment in surgical training.

Main Methods:

• Data from 14 institutions on five neurosurgical procedures (DBS, IPG, SCS, VNS, SEEG) were analyzed.
• Surgical autonomy was measured using the Teach, Advise, Guide, Solo (TAGS) scale.
• Learning curves were created to track autonomy progression and determine cases needed for competency.

Main Results:

• Residents achieved advanced competency around postgraduate year 3 for DBS, VNS, SCS, and PGY-2 for IPG, SEEG.
• Median cases to competency varied: DBS (16), IPG (12-13), SCS (14-16), VNS (6-12), SEEG (5-7).
• Observed individual variance in competency levels and progression rates.

Conclusions:

• Deep Brain Stimulation (DBS), Internal Pulse Generator (IPG), and Spinal Cord Stimulator (SCS) procedures required more cases than ACGME minimums.
• Vagal Nerve Stimulation (VNS) and Stereo Electroencephalography (SEEG) required fewer cases than ACGME minimums.
• Competency-based training enhances surgical training efficacy and assessment of surgical autonomy.