Comprehensive Multicenter Graduate Surgical Education Initiative Incorporating Entrustable Professional Activities, Continuous Quality Improvement Cycles, and a Web-Based Platform to Enhance Teaching and Learning - 25/06/18

Doi : 10.1016/j.jamcollsurg.2018.02.014

Cheryl I. Anderson, RN, BSN, MSA ^a,^⁎ , Marc D. Basson, MD, PhD, MBA, FACS ^g, Muhammad Ali, BS, MA ^a, Alan T. Davis, PhD ^a,^c, Robert L. Osmer, MD, FACS ^a, Michael K. McLeod, MD, MBA, FACS ^a, Pam S. Haan, RN, BSN ^a, Robert G. Molnar, MD, FACS ^e, Andi N. Peshkepija, MD ^a, John C. Hardaway, MD, PhD ^h, Karen A. Chojnacki, MD, FACS ⁱ, Christopher C. Pfeifer, DO, FACOS ^f, Jeffrey M. Gauvin, MD, FACS ^j, Mark W. Jones, DO, FACOS ^b, M. Ashraf Mansour, MD, FACS ^a,^d
for the
Michigan State University Guided Operative Assessment and Learning Consortium
Tahereh Soleimani, MD, Cody A. Nebeker, MD, Rama N. Gupta, BS, MPH, Charles J. Yeo, MD, FACS, Anthony S. Pozzessere, MD, Sarah Langdon, MD, Caitlin Loseth, MD, Rondi B. Gelbard, MD, FACS, Keith A. Delman, MD, FACS, Denny R. Martin, DO, FACOOG, Lawrence Narkiewicz, MD, FACS, Shawn H. Obi, DO, FACS, Daniel E. Smith, DO, Meghan L. Czajka, DO, Jeffrey G. Deppen, DO, FACOS, Troy M. Ferguson, DO, FACOS, Suzanne M. Hanses, DO, Nicholas J. St Hilaire, DO, Matthew J. Deere, DO, Werner H. Henning, DO, Nickolas J. Welle, DO, Jason T. Collins, DO, Ariel E. Toomey, DO, Jessica A. Henderson, DO, Anthony J. Chen, DO, Justin R. Harris, DO, Leandra A. Jelenek, DO, Michelle M. Olson, MD, MACM, FACS, FASCRS

^a Department of Surgery, Michigan State University College of Human Medicine, Lansing, MI
^b McLaren Greater Lansing General Surgery Residency, Lansing, MI
^c Spectrum Health GME, Research and Scholarly Activity, Grand Rapids, MI
^d Spectrum Health, Grand Rapids, MI
^e Michigan Vascular Center, McLaren Regional Medical Center, Flint, MI
^f Henry Ford Allegiance Health General Surgery Residency, Jackson, MI
^g University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND
^h Department of Surgical Oncology, Roger Williams Medical Center, Providence, RI
ⁱ Thomas Jefferson University General Surgery Residency, Philadelphia, PA
^j Santa Barbara Cottage Hospital, General Surgery Residency, Santa Barbara, CA

^∗Correspondence address: Cheryl I Anderson, RN, BSN, MSA, Director, Quality Improvement and Surgical Education, Department of Surgery and Integrated Residency Program in General Surgery, Michigan State University, College of Human Medicine, 1200 E Michigan Ave, Suite 655, Lansing, MI, 48912.Quality Improvement and Surgical EducationDepartment of Surgery and Integrated Residency Program in General SurgeryMichigan State UniversityCollege of Human Medicine1200 E Michigan Ave, Suite 655LansingMI48912

Abstract

Background

It is increasingly important for faculty to teach deliberately and provide timely, detailed, and formative feedback on surgical trainee performance. We initiated a multicenter study to improve resident evaluative processes and enhance teaching and learning behaviors while engaging residents in their education.

Study Design

Faculty from 7 US postgraduate training programs rated resident operative performances using the perioperative briefing, intraoperative teaching, debriefing model, and rated patient visits/academic performances using the entrustable professional activities model via a web-based platform. Data were centrally analyzed and iterative changes made based on participant feedback, individual preferences, and database refinements, with trends addressed using the Plan, Do, Check, Act improvement methodology.

Results

Participants (92 surgeons, 150 residents) submitted 3,880 assessments during July 2014 through September 2017. Evidence of preoperative briefings improved from 33.9% ± 2.5% to 95.5% ± 1.5% between April and September 2014 compared with April and September 2017 (p < 0.001). Postoperative debriefings improved from 10.6% ± 2.7% to 90.2% ± 2.5% (p < 0.001) for the same period. Meaningful self-reflection by residents improved from 28.6% to 67.4% (p < 0.001). The number of assessments received per resident during a 6-month period increased from 6.4 ± 6.2 to 13.4 ± 10.1 (p < 0.003). Surgeon-entered assessments increased from 364 initially to 685 in the final period, and the number of resident assessments increased from 308 to 445. We showed a 4-fold increase in resident observed activities being rated.

Conclusions

By adopting recognized educational models with repeated Plan, Do, Check, Act cycles, we increased the quality of preoperative learning objectives, showed more frequent, detailed, and timely assessments of resident performance, and demonstrated more effective self-reflection by residents. We monitored trends, identified opportunities for improvement and successfully sustained those improvements over time, applying a team-based approach.

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Abbreviations and Acronyms : ABS, BID, EPA, GOAL, MSU, PDCA

Plan

	Disclosure Information: Nothing to disclose.
	Members of the Michigan State University Guided Operative Assessment and Learning Consortium who co-authored this article are listed in the Appendix.