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Original Investigation | Association of VA Surgeons

Identifying and Eliminating Deficiencies in the General Surgery Resident Core Competency Curriculum

Nicole M. Tapia, MD1; Allen Milewicz, MD, MBA1; Stephen E. Whitney, MD, MBA2; Michael K. Liang, MD1,3; Carla C. Braxton, MD, MBA1
[+] Author Affiliations
1Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
2Department of Pediatrics, Baylor College of Medicine, Houston, Texas
3currently with The University of Texas Health Sciences Center at Houston
JAMA Surg. 2014;149(6):514-518. doi:10.1001/jamasurg.2013.4406.
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Importance  Although the Accreditation Council for Graduate Medical Education has defined 6 core competencies required of resident education, no consensus exists on best practices for reaching resident proficiency. Surgery programs must develop resourceful methods to incorporate learning. While patient care and medical knowledge are approached with formal didactics and traditional Halstedian educational formats, other core competencies are presumed to be learned on the job or emphasized in conferences.

Objectives  To test the hypothesis that our residents lack a foundation in several of the nonclinical core competencies and to seek to develop a formal curriculum that can be integrated into our current didactic time, with minimal effect on resident work hours and rest hours.

Design, Setting, and Participants  Anonymous Likert-type scale needs assessment survey requesting residents within a large single general surgery residency program to rate their understanding, working knowledge, or level of comfort on the following 10 topics: negotiation and conflict resolution; leadership styles; health care legislation; principles of quality delivery of care, patient safety, and performance improvement; business of medicine; clinical practice models; role of advocacy in health care policy and government; personal finance management; team building; and roles of innovation and technology in health care delivery.

Main Outcomes and Measures  Proportions of resident responses scored as positive (agree or strongly agree) or negative (disagree or strongly disagree).

Results  In total, 48 surgery residents (70%) responded to the survey. Only 3 topics (leadership styles, team building, and roles of innovation and technology in health care delivery) had greater than 70% positive responses, while 2 topics (negotiation and conflict resolution and principles of quality delivery of care, patient safety, and performance improvement) had greater than 60% positive responses. The remaining topics had less than 40% positive responses, with the least positive responses on the topics business of medicine (13% [6 of 48]) and health care legislation (19% [9 of 48]).

Conclusions and Relevance  General surgery residents in our program do not report being knowledgeable or comfortable with several areas of the nonclinical Accreditation Council for Graduate Medical Education core competencies. We developed a formal health care policy and management curriculum, with integration into preexisting protected surgical didactic time. This curriculum fulfills educational requirements, without negatively affecting resident work hours and without increased expense to the department of surgery. Future studies measuring the effect of this integrated program on resident education, knowledge, and satisfaction are warranted.

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Figure 1.
Self-assessment Survey of ACGME Competency Knowledge

ACGME indicates Accreditation Council for Graduate Medical Education.

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Figure 2.
Resident Learning Objectives

The health care policy and management curriculum work group defined 9 resident learning objectives.

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Figure 3.
Health Care Policy and Management Curriculum

Major and minor topics.

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