ABOS/CORD Surgical Skills Assessment Program

Transcription

1 American Board of Orthopaedic Surgery Establishing Education & Performance Standards for Orthopaedic Surgeons ABOS/CORD Surgical Skills Assessment Program ABOS Essential Knowledge, Skills, and Behaviors Task Force

2 Purpose Your program is participating in a process to allow faculty to assess resident surgical skills in performing certain orthopaedic procedures. The resident is responsible for requesting assessments on specific cases. The faculty is responsible for completing the assessments. Completed assessments are sent back to the resident for documentation and feedback real-time.

3 Background: Goals of Process Orthopaedic surgeons are surgeons. In addition to knowledge and behavior, assessment of surgical skills is an important aspect of evaluating competence. Competence in medical knowledge has been developed, but a deficiency exists in documenting competence in surgical skills.

4 Background: Why is a new tool necessary? Presently, the residency program director attests that the graduate has completed 60 months of training in an ACGME accredited residency program and is competent in the independent practice of orthopedic surgery. The ABOS, representing the public interest, desires greater documentation of surgical skills competence of individual candidates during residency training.

5 Methods Each G2-G5 resident requests at least one assessment each week that the resident participates in any of the listed procedures (currently 25 milestone procedures and 10 additional common procedures).

6 Interface A mobile-optimized web page to request an evaluation: The resident logs in, selects the procedure/date/time/faculty, and click Send. The evaluator receives a text/ with a link to be taken to the assessment form. The assessment form is a mobile-optimized web page with one question per page. Faculty using smartphones with dictation capability may dictate the feedback comments.

7 Resident requests faculty evaluation by sending or text request real-time I have a list of 35 procedures that I need to be evaluated on. Can you evaluate my performance on the IM Tibial Rod we are going. V. to do? I will send you a text at the end of the surgery. Of course. I will be sure to make careful observations

8 15 MILESTONES 25 PROCEDURES Definition Anterior Cruciate Ligament Performs diagnostic arthroscopy with notchplasty, and/or graft harvest Level 3 Performs graft passage and fixation Level 4 Ankle Arthritis Performs straightforward ankle/midfoot fusions Level 4 Ankle Fracture Performs ORIF of simple ankle fx (bimalleolar) Level 3 Performs ORIF of moderately complex ankle fx (trimalleolar, pilon) Level 4 Carpal Tunnel Performs Carpal Tunnel Release Level 4 Degenerative Spine Performs Exposure C or L-spine Level 3 Decorticates for PSF Level 4 Diaphyseal Femur and Tibia Fx Performs Simple IM Nail Tibia Level 4 Performs Simple IM Nail Femur Level 4 Distal Radius Fracture Performs ORIF extra-articular Level 3 Performs ORIF Intra-articular Level 4 Adult Elbow Performs ORIF olecranon fx Level 3 Performs ORIF distal humerus fx Level 4 Hip and Knee Arthritis Performs Primary THA Level 4 Performs Primary TKA Level 4 Hip Fracture Performs ORIF stable hip fx Level 3 Performs ORIF complex hip fx Level 4 Metastatic Bone Lesion Performs ORIF pathologic or impending fx Level 4 Meniscal Tear Performs diagnostic scope/debride Level 3 Performs meniscal repair Level 4 Pediatric Septic Hip Performs hip arthrotomy/drainage Level 4 Rotator Cuff Injury Performs diagnostic shoulder scope, decompression Level 3 Performs Rotator Cuff Repair Level 4 Pediatric Supracondylar Fracture Performs CR/PP Level 4

9 10 ADDITIONAL COMMON PROCEDURES Debridement of open fx Lumbar laminectomy Lumbar discectomy Removal of deep implant Tendon sheath incision (trigger finger) Ulnar nerve transposition ORIF clavicle fx Primary total shoulder arthroplasty Excision of ganglion, wrist Excision of lesion of tendon sheath or joint capsule, hand/finger

10 Resident requests faculty evaluation by sending or text request real-time I just got a text from my resident to evaluate his performance on the surgery. This will be quick. V. and easy, so I will complete it right now while I remember! The text links to a web-based evaluation.

11 Formative Evaluation for 8 Steps of Surgical Procedure 1. Pre-procedure plan: Gathers/assesses required information to reach diagnosis and determine correct procedure required 2. Case preparation: Patient correctly prepared and positioned, describes approach and lists required instruments, prepared to deal with probable complications 3. Knowledge of specific procedural steps: Can sequence steps of procedure, articulates potential risks, and means to avoid/overcome them 4. Technical performance: Efficiently performs steps, avoiding pitfalls and respecting soft tissues 5. Visuospatial skills: 3D spatial orientation and able to position instruments/hardware where intended 6. Post-procedure plan: Appropriate complete post procedure plan 7. Efficiency and flow: Obvious planned course of procedure with economy of movement and flow 8. Communication: Professional and effective communication/utilization of staff

12 5 Point Ottawa Surgical Competency Operating Room Evaluation 1. I had to do i.e., requires complete hands on guidance, did not do, or was not given the opportunity to do. 2. I had to talk them through i.e., able to perform tasks, but requires constant direction. 3. I had to prompt them from time to time i.e., demonstrates some independence, but requires intermittent direction. 4. I needed to be in the room just in case i.e., independence, but still requires supervision for safe practice. 5. I did not need to be there i.e., complete independence, understands risks and performs safely, practice ready.

13 5 Point Summative Comments Field: Feedback to residents including targeted areas for improvement 1. Novice: Attending surgeon provides maximum assistance. Demonstrates knowledge of anatomy. Demonstrates basic operative skills (e.g., incision, excision, wound closure). Positions patient. First assists and observes. 2. Low Intermediate: Attending surgeon provides significant assistance and direction. Performs approach with minimal assistance. Identifies anatomical landmarks. Identifies most of the critical steps. Demonstrates proficiency with the component technical skills. Demonstrates an increasing ability to perform different key parts of the operation with attending assistance. Demonstrates room set up and equipment management. 3. High Intermediate: Attending provides modest assistance and direction. Capable of performing the approach. Familiar with anatomic landmarks. Identifies and is capable of performing almost all of the critical steps. Demonstrates proficiency with the component technical skills. Attending assistance required for the most challenging portions of the procedure. 4. Competent requires only supervision: Attending Surgeon not required to provide active assistance. Knows steps and transitions easily. Able to direct and assist a more junior resident. Aware of environment and can manage patient safety and coordinate the operation team. Capable of performing the procedure in practice independently. 5. Advanced Expertise: Performance matches that of advanced surgeon. Capable of performing complex procedures independently. Capable of independent management of intraoperative complications.

14 Feedback to Resident. Now I know where I am at and what I need to work on!. Once submitted, the resident receives a text/ informing him/her that the assessment has been completed with a link to view the assessment. Each resident has a My Skills Assessments page, showing the assessment scores for each procedure. Clicking on an assessment shows the completed assessment form.

15 G1 Skills Modules may also be assessed 17 SKILLS MODULES Module 1 Sterile Technique - Operating Room Setup Module 2 Suturing and Knot Tying Module 3 Microsurgical Suturing Technique Module 4 Soft Tissue Handling and Dissection Module 5 Casting and Splinting: Splints, Casts, and Removal Module 6 Traction Techniques Module 7 Compartment Syndrome: Diagnosis and Treatment Module 8 Bone Handling Techniques - Osteotomy Module 9 Fluoroscopic Knowledge and Skills Module 10 K-Wire Techniques Module 11 Techniques Basic to Internal Fixation of Fractures Module 12 Principles and Techniques of Fracture Reduction Module 13 Basics Techniques in External Fixation Module 14 Basic Arthroscopy Skills Module 15 Basic Arthroplasty Skills (TKA & THA) Module 16 Joint Aspiration and Injection Module 17 Patient Safety, Team Training, Obtaining Consent

16 Login:

17 Skills Assessment Request

18 Skills Assessment Request Confirmation

19 Skills Assessment Request

20 Skills Assessment: Case Complexity

21 Skills Assessment: Pre-Procedure Plan

22 O-Score Rating System

23 Skills Assessment: Case Preparation

24 Skills Assessment: Knowledge of Specific Procedural Steps

25 Skills Assessment: Technical Performance

26 Skills Assessment: Visuospatial Skills

27 Skills Assessment: Post-Procedure Plan

28 Skills Assessment: Efficiency and Flow

29 Skills Assessment: Communication

30 Skills Assessment: P-Score (Global Evaluation)

31 P-Score Rating System

32 P-Score Rating System

33 Skills Assessment: Feedback to Resident

34 Skills Assessment Results Confirmation

35 Skills Assessment Results

36 Other Online Functions View My Skills Assessments View and update My Profile Select contact preference ( or text) on My Profile

37 My Skills Assessment

38 My Profile

39 Program Director Online Functions View All Skills Assessments View Milestones Report View, add to, and update roster of Residents Download Resident List View and update Faculty View and update My Profile

40 All Skills Assessments

41 Reports: Milestones Report

42 Milestones Report

43 Resident Roster

44 Faculty/Attending

45 My Profile