abos cord surgical skills assessment program · surgical skills assessment program abos essential...
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American Board of Orthopaedic SurgeryEstablishing Education & Performance Standards for Orthopaedic Surgeons
ABOS/CORD Surgical Skills Assessment ProgramABOS Essential Knowledge, Skills, and Behaviors Task Force
Purpose
• Your program is participating in a process to allow faculty to assess resident surgical skills in performing certain orthopaedic procedures.
• The resident is responsible for requesting assessments on specific cases.
• The faculty is responsible for completing the assessments.
• Completed assessments are sent back to the resident for documentation and feedback real-time.
Background: Goals of Process
• Orthopaedic surgeons are surgeons. In addition to knowledge and behavior, assessment of surgical skills is an important aspect of evaluating competence.
• Competence in medical knowledge has been developed, but a deficiency exists in documenting competence in surgical skills.
Background: Why is a new tool necessary?
• Presently, the residency program director attests that the graduate has completed 60 months of training in an ACGME accredited residency program and is “competent in the independent practice of orthopedic surgery”.
• The ABOS, representing the public interest, desires greater documentation of surgical skills competence of individual candidates during residency training.
Methods
• Each G2-G5 resident requests at least one assessment each week that the resident participates in any of the listed procedures (currently 25 milestone procedures and 10 additional common procedures).
Interface
• A mobile-optimized web page to request an evaluation: • The resident logs in, selects the procedure/date/time/faculty, and click
Send. The evaluator receives a text/email with a link to be taken to the assessment form.
• The assessment form is a mobile-optimized web page with one question per page. Faculty using smartphones with dictation capability may dictate the feedback comments.
. V.
Resident requests faculty evaluation by sending email or text request real-time
I have a list of 35 procedures that I need to be evaluated on. Can you evaluate my performance on the IM TibialRod we are going to do? I will send you a text at the end of the surgery.
Of course. I will be sure to make
careful observations
15 MILESTONES 25 PROCEDURES Definition
Anterior Cruciate Ligament Performs diagnostic arthroscopy with notchplasty, and/or graft harvest Level 3
Performs graft passage and fixation Level 4
Ankle Arthritis Performs straightforward ankle/midfoot fusions Level 4
Ankle Fracture Performs ORIF of simple ankle fx (bimalleolar) Level 3
Performs ORIF of moderately complex ankle fx (trimalleolar, pilon) Level 4
Carpal Tunnel Performs Carpal Tunnel Release Level 4
Degenerative Spine Performs Exposure C or L-spine Level 3
Decorticates for PSF Level 4
Diaphyseal Femur and Tibia Fx Performs Simple IM Nail Tibia Level 4
Performs Simple IM Nail Femur Level 4
Distal Radius Fracture Performs ORIF extra-articular Level 3
Performs ORIF Intra-articular Level 4
Adult Elbow Performs ORIF olecranon fx Level 3
Performs ORIF distal humerus fx Level 4
Hip and Knee Arthritis Performs Primary THA Level 4
Performs Primary TKA Level 4
Hip Fracture Performs ORIF stable hip fx Level 3
Performs ORIF complex hip fx Level 4
Metastatic Bone Lesion Performs ORIF pathologic or impending fx Level 4
Meniscal Tear Performs diagnostic scope/debride Level 3
Performs meniscal repair Level 4
Pediatric Septic Hip Performs hip arthrotomy/drainage Level 4
Rotator Cuff Injury Performs diagnostic shoulder scope, decompression Level 3
Performs Rotator Cuff Repair Level 4
Pediatric Supracondylar Fracture Performs CR/PP Level 4
ADDITIONAL COMMON PROCEDURES
Debridement of open fx
Lumbar laminectomy
Lumbar discectomy
Removal of deep implant
Tendon sheath incision (trigger finger)
Ulnar nerve transposition
ORIF clavicle fx
Primary total shoulder arthroplasty
Excision of ganglion, wrist
Excision of lesion of tendon sheath or joint capsule, hand/finger
Placement of pedicle screw
Exposure for idiopathic scoliosis
Epiphysiodesis/8 plates
Irrigation and Debridement and THA/TKA Liner Exchange
. V.
Resident requests faculty evaluation by sending email or text request real-time
I just got a text from my resident to evaluate his performance on the surgery. This will be quick and easy, so I will complete it right now while I remember! The text links to a web-based evaluation.
Formative Evaluation for 8 Steps of Surgical Procedure
1. Pre-procedure plan: Gathers/assesses required information to reach diagnosis and determine correct procedure required
2. Case preparation: Patient correctly prepared and positioned, describes approach and lists required instruments, prepared to deal with probable complications
3. Knowledge of specific procedural steps: Can sequence steps of procedure, articulates potential risks, and means to avoid/overcome them
4. Technical performance: Efficiently performs steps, avoiding pitfalls and respecting soft tissues
5. Visuospatial skills: 3D spatial orientation and able to position instruments/hardware where intended
6. Post-procedure plan: Appropriate complete post procedure plan
7. Efficiency and flow: Obvious planned course of procedure with economy of movement and flow
8. Communication: Professional and effective communication/utilization of staff
5 Point Ottawa Surgical Competency Operating Room Evaluation
1. “I had to do”—i.e., requires complete hands on guidance, did not do, or was not given the opportunity to do.
2. “I had to talk them through”—i.e., able to perform tasks, but requires constant direction.
3. “I had to prompt them from time to time”—i.e., demonstrates some independence, but requires intermittent direction.
4. “I needed to be in the room just in case”—i.e., independence, but still requires supervision for safe practice.
5. “I did not need to be there”—i.e., complete independence, understands risks and performs safely, practice ready.
5 Point SummativeComments Field: Feedback to residents including targeted areas for improvement
1. Novice: Attending surgeon provides maximum assistance. Demonstrates knowledge of anatomy. Demonstrates basic operative skills (e.g., incision, excision, wound closure). Positions patient. First assists and observes.
2. Low Intermediate: Attending surgeon provides significant assistance and direction. Performs approach with minimal assistance. Identifies anatomical landmarks. Identifies most of the critical steps. Demonstrates proficiency with the component technical skills. Demonstrates an increasing ability to perform different key parts of the operation with attending assistance. Demonstrates room set up and equipment management.
3. High Intermediate: Attending provides modest assistance and direction. Capable of performing the approach. Familiar with anatomic landmarks. Identifies and is capable of performing almost all of the critical steps. Demonstrates proficiency with the component technical skills. Attending assistance required for the most challenging portions of the procedure.
4. Competent – requires only supervision: Attending Surgeon not required to provide active assistance. Knows steps and transitions easily. Able to direct and assist a more junior resident. Aware of environment and can manage patient safety and coordinate the operation team. Capable of performing the procedure in practice independently.
5. Advanced Expertise: Performance matches that of advanced surgeon. Capable of performing complex procedures independently. Capable of independent management of intraoperative complications.
Feedback to Resident
• Once submitted, the resident receives a text/email informing him/her that the assessment has been completed with a link to view the assessment.
• Each resident has a My Skills Assessmentspage, showing the assessment scores for each procedure. Clicking on an assessment shows the completed assessment form.
. Now I know where I am at and what I need to work on!.
17 SKILLS MODULES
Module 1 Sterile Technique - Operating Room Setup
Module 2 Suturing and Knot Tying
Module 3 Microsurgical Suturing Technique
Module 4 Soft Tissue Handling and Dissection
Module 5 Casting and Splinting: Splints, Casts, and Removal
Module 6 Traction Techniques
Module 7 Compartment Syndrome: Diagnosis and Treatment
Module 8 Bone Handling Techniques - Osteotomy
Module 9 Fluoroscopic Knowledge and Skills
Module 10 K-Wire Techniques
Module 11 Techniques Basic to Internal Fixation of Fractures
Module 12 Principles and Techniques of Fracture Reduction
Module 13 Basics Techniques in External Fixation
Module 14 Basic Arthroscopy Skills
Module 15 Basic Arthroplasty Skills (TKA & THA)
Module 16 Joint Aspiration and Injection
Module 17 Patient Safety, Team Training, Obtaining Consent
G1 Skills Modules may also be assessed
Login: https://www.abos.org/r
Skills Assessment Request
Skills Assessment Request Confirmation
Skills Assessment Request Email
Skills Assessment: Case Complexity
Skills Assessment: Pre-Procedure Plan
O-Score Rating System
Skills Assessment: Case Preparation
Skills Assessment: Knowledge of Specific Procedural Steps
Skills Assessment: Technical Performance
Skills Assessment: Visuospatial Skills
Skills Assessment: Post-Procedure Plan
Skills Assessment: Efficiency and Flow
Skills Assessment: Communication
Skills Assessment: P-Score (Global Evaluation)
P-Score Rating System
P-Score Rating System
Skills Assessment: Feedback to Resident
Skills Assessment Results Confirmation
Skills Assessment Results Email
Other Online Functions
• View My Skills Assessments
• View and update My Profile
• Select contact preference (email or text) on My Profile
My Skills Assessment
My Profile
Program Director Online Functions
• View All Skills Assessments
• View Milestones Report
• View, add to, and update roster of Residents
• Download Resident List
• View and update Faculty
• View and update My Profile
All Skills Assessments
Reports: Milestones Report
Milestones Report
Resident Roster
Faculty/Attending
My Profile