Competency based surgical training
Keywords:
Competency-based training, Work-based assessments, European working time directives, AssessmentsAbstract
With the implementation of the European working time directive and the “new deal” document in the NHS; not only led to a shorter duration of training but also increased the workload intensity on trainee doctors. This leads to a reduced opportunity for personal reflection and feedback from colleagues i.e., consultants, registrars, and fellow senior house officers that leading to a shift from the traditional experiential learning to “competency-based training,” where various workplace-based assessments (WBAs) tools are used. This article is about the use of WBAs in improving trainee doctor’s competence and workplace performance; explore why they are so unpopular amongst both trainees and trainers and what can be done to improve their work based learning.
References
Raven Department of Education. Assessment of Surgical Trainees: Training the Trainers, Module 1: Learning and Teaching. London: Royal College of Surgeons of England; 2006: 44.
Holm HA. Postgraduate education. In: Norman GR, van der Vleuten CPM, Newble DI, editors. International Handbook of Research in Medical Education. Dordrecht: Kluwer; 2002: 381-24, 413.
Van der Vleuten CPM. The assessment of professional competence: Development, research and practical implications. Adv Health Sci Educ. 1996;1:41-67.
Anwar M, Irfan S, Daly N, Amen F. EWTD has negative impact on training for surgeons. BMJ. 2005;331(7530):1476.
Department of Health Hours of Work of Doctors in Training: The New Deal. London: Department of Health; 1991.
Dean BJ, Duggleby PM. Foundation doctors’ experience of their training: A questionnaire study. JRSM Short Rep. 2013;4(1):5.
Saedon H, Salleh S, Balakrishnan A, Imray CH, Saedon M. The role of feedback in improving the effectiveness of workplace based assessments: A systematic review. BMC Med Educ. 2012;12:25.
Carr SJ. Assessing clinical competency in medical senior house officers: How and why should we do it? Postgrad Med J. 2004;80(940):63-6.
Southgate L. Professional competence in medicine. Hosp Med. 1999;60(3):203-5.
Epstein RM, Hundert EM. Defining and assessing professional competence. JAMA. 2002;287(2):226-35.
Epstein RM, Hundert EM. Defining and assessing professional competence. JAMA. 2002;287:226-34.
Leach DC. Competence is a habit. JAMA. 2002;287(2):243-4.
Fraser SW, Greenhalgh T. Coping with complexity: Educating for capability. BMJ. 2001;323(7316):799-803.
Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med. 2002;136(5):358-67.
Borrell-Carrió F, Epstein RM. Preventing errors in clinical practice: A call for self-awareness. Ann Fam Med. 2004;2(4):310-6.
Jaques H. NHS clinical negligence claims are up by 30%. BMJ Career Report. [Publication date 11 Aug 2011].
Islam S, Deekes A, Lee A, Hoffman G, Isgar B. Junior doctor titles following implementation of Modernising Medical Careers in the UK. JRSM Short Rep. 2011;2(3):22.
Southgate L, Grant J. Principles and standards for an assessment system for postgraduate medical training. PMETB Subgroup on Assessment; 2003.
Williamson JML, Osborne AJ. Critical analysis of case based discussions. BJMP. 2012;5:a514.
Al-Wardy NM. Assessment methods in undergraduate medical education. Sultan Qaboos Univ Med J. 2010;10(2):203-9.
Glavin RJ, Maran NJ. Development and use of scoring systems for assessment of clinical competence. Br J Anaesth. 2002;88(3):329-30.
Veloski JJ, Rabinowitz HK, Robeson MR, Young PR. Patients don’t present with five choices: An alternative to multiple-choice tests in assessing physicians’ competence. Acad Med. 1999;74(5):539-46.
Harden RM, Gleeson FA. Assessment of clinical competence using an objective structured clinical examination (OSCE). Med Educ. 1979;13(1):41-54.
Harden R, Cairncross C. Assessment of practical skills. Stud Higher Educ. 1980;5:187.
Department of Health. Modernising Medical Careers; The Response of the Four UK Health Ministers to the Consultation on “Unfinished Business Proposals for Reform of the Senior House Grade”. London: Department of Health; 2003.
Department of Health. Modernising Medical Careers: The Next Steps. The Future Shape of Foundation, Specialist and General Practice Training Programmes. London: Department of Health; 2004.
Rethans JJ, Norcini JJ, Barón-Maldonado M, Blackmore D, Jolly BC, LaDuca T, et al. The relationship between competence and performance: Implications for assessing practice performance. Med Educ. 2002;36(10):901-9.
Weller JM, Jones A, Merry AF, Jolly B, Saunders D. Investigation of trainee and specialist reactions to the mini-Clinical Evaluation Exercise in anaesthesia: Implications for implementation. Br J Anaesth. 2009;103(4):524-30.
Curriculum for the Foundation Years in Postgraduate Education and Training Foundation Programme Committee of the Academy of the Royal Colleges, in cooperation with Modernising Medical Careers in the Departments of Health. Available at http://www.mmc.nhs.uk/pages/foundation/Curriculum 2005. Accessed 12 Aug 2013.
McKavanagh P, Smyth A, Carragher A. Hospital consultants and workplace based assessments: How foundation doctors view these educational interactions? Postgrad Med J. 2012;88(1037):119-24.
Burkill GJ. Work-based assessment for trainees – More than just a few new tools? Clin Radiol. 2008;63(1):12-4.
Beard J. Workplace-based assessment: The need for continued evaluation and refinement. Surgeon. 2011;9 Suppl 1:S12-3.
Carr S. The Foundation Programme assessment tools: An opportunity to enhance feedback to trainees? Postgrad Med J. 2006;82(971):576-9.
Norcini JJ, Blank LL, Arnold GK, Kimball HR. The mini-CEX (clinical evaluation exercise): A preliminary investigation. Ann Intern Med. 1995;123(10):795-9.
Norcini JJ. Current perspectives in assessment: The assessment of performance at work. Med Educ. 2005;39(9):880-9.
Kathirgamanathan A, Woods L. Educational tools in the assessment of trainees in anaesthesia. Contin Educ Anaesth Crit Care Pain. 2011;11:138-42.
Rabinowitz HK, Babbott D, Bastacky S, Pascoe JM, Patel KK, Pye KL, et al. Innovative approaches to educating medical students for practice in a changing health care environment: The National UME-21 Project. Acad Med. 2001;76(6):587-97.
Holmboe ES, Sherbino J, Long DM, Swing SR, Frank JR. The role of assessment in competency-based medical education. Med Teach. 2010;32(8):676-82.
Collins J. Foundation for Excellence; an Evaluation of the Foundation Programme. Medical Education England. Available at http://www.mee.nhs.uk/pdf/401339_MEE_FoundationExcellence_acc.pdf. Accessed 12 Aug 2013.
Chaired by Dr. ED Neville, Supervised learning events evaluation. Academy of Royal College of Medicine. Available at http://www.gmc-uk.org/Learning_and_assessment_in_the_clinical_environment.pdf_45877621.pdf. Accessed 12 Aug 2013.
General Medical Council. Workplace Based Assessment: A Guide for Implementation. A GMC/AoMRC Guidance Paper. 2010. Available at http://www.gmc-uk.org/Workplace_Based_Assessment–A_guide_for_implementation_0410.pdf_48905168.pdf. Accessed 25 Dec 2012.
Wilkinson JR, Crossley JG, Wragg A, Mills P, Cowan G, Wade W. Implementing workplace-based assessment across the medical specialties in the United Kingdom. Med Educ. 2008;42(4):364-73.
Burford B, Illing J, Kergon C, Morrow G, Livingston M. User perceptions of multi-source feedback tools for junior doctors. Med Educ. 2010;44(2):165-76.
Whitehouse A, Hassell A, Bullock A, Wood L, Wall D. 360 degree assessment (multisource feedback) of UK trainee doctors: Field testing of team assessment of behaviours (TAB). Med Teach. 2007;29(2-3):171-6.
Pereira EA, Dean BJ. British surgeons’ experiences of mandatory online workplace-based assessment. J R Soc Med. 2009;102(7):287-93.
Menon S, Winston M, Sullivan G. Workplace-based assessment: Survey of psychiatric trainees in Wales. Psychiatr Bull. 2009;33:468-74.
Hrisos S, Illing JC, Burford BC. Portfolio learning for foundation doctors: Early feedback on its use in the clinical workplace. Med Educ. 2008;42(2):214-23.
Sabey A, Harris M. Training in hospitals: What do GP specialist trainees think of workplace-based assessments? Educ Prim Care. 2011;22(2):90-9.
McGill DA, van der Vleuten CP, Clarke MJ. Supervisor assessment of clinical and professional competence of medical trainees: A reliability study using workplace data and a focused analytical literature review. Adv Health Sci Educ Theory Pract. 2011;16(3):405-25.
