Maximally-Invasive Curriculum:A Model Curriculum for Osteopathic Surgical Residencies (ACOS)

India Broyles, EdD University of New England College of Osteopathic Medicine, 11 Hills Beach Rd, Biddeford, ME 04005

Cynthia Cartwright, MT RN MSEdMaine Health: Center for Outcomes Research and Evaluation, 465 Congress Street, Portland, ME 04101

Conceptual Framework of the Discipline: Conceptual Framework of the Discipline: example from General Surgeryexample from General Surgery

Pre-assessment: Samples from survey of AOA/ACOS Surgery Residency Directors

Traditional Approach Competency-basedApproach

Teacher-CenteredTime Based

Individual, separate topics

Assessment is norm-referenced

Learner-CenteredDemonstration of knowledge

and skillsIntegration and application of

contentAssessment is criterion-

referenced

Formative: evaluation used forimprovement. Formative evaluationusually includes giving feedbackSummative: evaluation used to makedecisions about a learner,e.g., promotion or graduation

•Identifies performance markers for all students relative to a particular competency or learning outcome•Indicators are grouped to benchmark a surgical resident’s developmental level Phase I, Phase II, Phase III

•Benchmarking is the process of identifying a set of performance indicators a learner is expected to meet at a given developmental level • Benchmarking provides a basis for tracking progress and marking achievement• Not all students are expected to meet all benchmarks at the same time or in the same wayExamples from BREAST curriculum:Phase I: Evaluate indications for fine needle aspiration and for open biopsyPhase II: Compare the criteria for using regional therapy including axillary dissection and sentinel node excisionPhase III: Evaluate the breast condition and the patient’s desire for breast reconstruction in order to determine the appropriate techniques and the choice of either immediate or delayed reconstruction

Performance Indicators

Learning Outcomes

What are your perceptions of the ACOS CurriculumDevelopment Project? Check all that apply.

N = 35

I am looking forward to the products of this project 69%I am well aware of the ACOS curriculum development project 63%It will improve the quality of Osteopathic surgery residencytraining

51%

It will improve the ability of Osteopathic surgery residencyprograms to evaluate resident performance

49%

It will make my job as residency program director easier 37%It will make my job as residency program director morecumbersome, difficult, time consuming.*

3%

Don't know 3%How do residents in your program currently usecurriculum documents? Check one.

N = 35

Curriculum is distributed at orientation, may or may not beused during training

54%

To set personal goals and measure achievement 20%Residents have ownership and use the curriculum because theyare part of the development process

17%

They don’t use them 17%

Competency-Based Curriculum requires a new perspective on teaching, content, instructional time,

learner assessment, and program evaluation

The Practice,The System,The ProfessionPractice-basedLearning &Improvement

Professionalism

Systems-basedPractice

ClinicalSciences andSkillsBlood & Blood

ProductsIncisions,

Sutures &WoundHealing

Fluid &ElectrolytesLaparoscopyNutritionPainManagementShockSurgicalInfections

AssociatedSpecialtiesAnesthesiologyHematologyImagingInfectiousDiseaseInternalMedicineNeurologyOncologyOsteopathicManipulativeMedicine

PrincipalSurgical AreasBreastBurnsCritical CareEndocrineGallbladder/ BiliaryTreeGI TractHead & NeckPancreasPediatricsLiverSpleenSkin/Soft TissueThoracicTrauma &EmergencyVascularHernia

• Clinical applications of learning • What the resident should be able to do at

the end of a course or program• Combines knowledge, skills and attitudes• Places emphasis on the application and

integration of knowledge• Generally, not measurable • Reflects AOA Competencies

Sample Learning Outcomes from Principal Surgical Area: Breast

Upon completion of the general surgical residency, the resident will:

•Understand the etiology, pathophysiology, presenting symptoms, differential diagnosis and treatment options of breast diseases

•Diagnose abnormal breast conditions by history, physical examination and radiologic diagnostic procedures

•Perform diagnostic therapeutic surgeries for benign and malignant breast conditions

•Perform or refer osteopathic manipulative treatment (OMT) in the pre- and postoperative period to facilitate early return to normal function and prevention of postoperative complications

•Coordinate multidisciplinary care for benign and malignant breast conditions

•Counsel patients and families on all aspects of breast diagnosis, surgery and treatment

Assessment and Evaluation: Assessment and Evaluation: Evaluation tools and strategies are based on comparison

with competencies rather than other residens

The most important task in residency education is determining what the residents need to learn, how it should be taught, and how to measure resident performance. In response to the AOA requirements for integration of seven core competencies in residency education, the The ACOS/RESC set up subcommittees of surgeons guided by curriculum consultants to establish a national curriculum.•OPP•Medical Knowledge•Patient Care•Interpersonal and Communication Skills•Professionalism•Practice-Based Learning and Improvement•Systems-Based Practice

History of the Project

The subcommittee examined the current ACOS mission statement in an effort to bring together vision and values for a sample residency mission statement. During implementation, each residency will write their own mission.

Mission: Every sailor knows the importance of the North Star for guidance. With curriculum design, the process is guided by a set of ideas – vision, mission, and values.

ACOS MISSION: ACOS is committed to assuring excellence in osteopathic surgical care through education, advocacy, leadership development, and the fostering of professional and personal relationships.

SAMPLE RESIDENCY MISSION: The General Surgery Residency is committed to assuring excellence in osteopathic surgical education through training and self-directed learning, patient care and advocacy, and leadership development. We seek to foster continuing personal growth and professional relationships.

ImplementationImplementation•Assessment: Gathering information about a learner’s knowledge, skills and attitudes

•Feedback: Provision of information about a learner’s performance to the learner, teachers and other stakeholders

•Evaluation: Comparison of a learner’s performance to an accepted standard

What aspects of the old and the new program are similar or different?What parts of the old program will be continued and which parts will be

modified or eliminated?Who will provide leadership for subsets of the new program?What are the advantages of the new program to both residents and

attending physicians?How do we structure a gradual implementation starting at PGY1 without

denying access to new ideas at PGY 4-5? How does resident evaluation change in keeping with competency-based

education?How will we gather data and give feedback on the challenges and

successes of the new curriculum in our own setting?