Toward Outcomes-Based Plastic Surgery Training: A Needs ...



Toward Outcomes-Based Plastic Surgery Training: A Needs Assessment of Recent Graduates

Steven J. Kasten, MD, David Eng, BS and Kimberly A. Schenarts, PhD

INTRODUCTION: Phase III of the ACGME Outcome Project, required to be implemented by June, 2011, calls for residency programs to use objective external measures to verify educational outcomes and make “data-driven improvements” to their curricula (1). Although many training programs routinely survey their own graduates for evaluation purposes, there is a paucity of literature for any specialty in this area, particularly in the context of the general competencies. Blumenthal, et al., found that more than ten percent of residents completing their training in eight non-plastic surgery specialties felt unprepared for one or more tasks pertinent to their specialty (2). A survey of graduates of allergy and immunology fellowships demonstrated that the majority of graduates felt that the competencies were important, but training in practice-based learning and improvement and systems-based practice may be deficient (3). Plauth, et al., surveyed practicing hospitalists, who perceived that emphasis given to certain clinical and non-clinical areas in training is at discord with the importance of these areas in practice (4). Within plastic surgery, no published studies exist, and few outcomes measures have been employed beyond the written and oral board examinations, which primarily assess medical knowledge and some elements of patient care. More data are needed. As other studies have demonstrated, recent residency graduates have a keen sense of strengths and deficiencies of their preparation for independent practice, making them an excellent source of information regarding the effectiveness of training (3,4). This study surveyed recent plastic surgery graduates to determine how well we presently teach and assess plastic surgery residents within the context of the general competencies. Our goals were to generate a needs assessment to drive curriculum change, determine which assessment tools are currently used during training, and establish a baseline for future comparison for program evaluation.

METHODS: A survey was conducted by mail and online questionnaire. As no existing instrument was available, a new 68-item instrument was created, piloted and revised. The population of interest was plastic surgeons within six years of completion of training. A sample was drawn by contacting training programs for names of recent graduates and all names from the American Society of Plastic Surgeons roster designated as candidate. Subjects were queried regarding the presence of formal curricular elements pertinent to each competency in their training, which assessment tools were used, and how well they practiced that competency. To keep the length of the survey reasonable, and because the PSEF In-Service Exam and board examinations already provide valid results for medical knowledge, this survey concentrated on the remaining five competencies. For each competency, 10 to 13 survey items were generated. Approximately half of the items concerned how that competency was formally taught and assessed during training. The remaining items for each competency pertained to the graduates' current practices; whether their training within the competency was reflected in their practice habits. Responses were via a five-point Likert scale. Within the competency domains, the percentages of affirmative responses for each item were averaged to produce a composite score for the teaching and practice of that competency. Subjects were also given the opportunity to make open comments. Confidentiality was assured and respondents were not asked to identify their training programs. Chi Square, Student’s t-test and ANOVA were used to evaluate differences in responses across various demographics, including gender, year of graduation, type of training, patient mix and practice type. Significance was determined at p ................
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