January 14th, 2015
Procedural Learning and Safety Collaborative, Inc (PLSC) researchers were this week awarded a grant by the American Board of Surgery (ABS) to fund a multi-institutional trial using the SIMPL (System for Improving and Measuring Performance Evaluation) system. This trial, the first of its kind, represents the next step in a larger national effort to define performance standards for the next generate of surgeons. This effort is both timely and critical as there is significant concern among surgical educators that general surgery training programs are not adequately preparing residents for independent surgical practice.
The planned trial will examine whether SIMPL is an effective instrument to:
- Generate national data to define norms and set standards pertaining to levels of autonomy achieved by residents with specific procedures.
- Statistically define the number of procedures residents need to participate in to achieve operative autonomy.
- Facilitate acquisition of reliable and valid performance assessments for procedures performed by surgical trainees.
- Facilitate timely assessment of the vast majority of residents’ operative performances.
- Enhance focus on intra-operative teaching and resident progression to operative autonomy.
Surgeon educators are challenged with balancing their responsibility to patients in ensuring optimal operative outcomes with their responsibility to residents in preparing them for independent practice. Overseeing quality of care and supervising residents is further complicated by shortened work hours for residents and an emphasis on operating room cost efficiency, both of which diminish time critical to teaching and honing residents’ operative judgment and skills. These and other recent changes in the health care environment, the economic climate, and accreditation requirements dictate the need for enhanced educational models for preparing tomorrow’s surgeons. Researchers at PLSC have developed the SIMPL system to monitor surgical residents’ progression towards operative autonomy by documenting the guidance and supervision provided by surgical faculty in the operating room.
SIMPL is a smart phone based assessment system that utilizes the four-level Zwisch scale to assess the level of autonomy achieved by a resident in performing a surgical procedure. The SIMPL system, which is connected to the OR scheduling system, facilitates the assessment process by delivering text prompts to the supervising faculty surgeons reminding them to complete an evaluation for the procedure they just performed. Completion of the entire assessment requires only a few seconds and therefore does not disrupt busy surgical workflow.
All evaluation data in centrally stored in a secure database and can be used for further analysis. Longitudinal assessment of resident autonomy progression can be determed by case, rotation, and overall. This can be used for both individual resident assessments and residency program evaluations. It can also be used to evaluate faculty based on the level of guidance and supervision they provide in the operating room.
The pilot version of SIMPL was evaluated in the general surgery residency training program at Northwestern University where we demonstrated that SIMPL is feasible, reliable, and valid method of evaluating resident operative performance. Using the Zwisch scale and SIMPL, PLSC researchers have also compared faculty and resident expectations of what level of autonomy residents should be achieving by the end of their residency training to the level of autonomy they are actually achieving. In partnership with the American Board of Surgery PLSC will be extending this work over the next several years.
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