December 10, 2007
The Surgical Council on Resident Education (SCORE) met in Philadelphia on November 27 to continue work on a new curriculum for U.S. surgical education. Discussion centered on the curriculum's educational content, as well as the teaching of specific procedural and operational skills at different stages of residency. The American Board of Surgery (ABS) is taking a lead role in this curriculum project, which aims to reduce variability in U.S. surgical training and ensure that residents are obtaining sufficient training and education in all aspects of general surgery.
At the meeting, the members of SCORE gave their approval for a content outline that will serve as the basis for the new curriculum. The outline was created by the Association of Program Directors in Surgery (APDS) and the ABS General Surgery Residency Committee to specify the necessary depth and breadth of training in each curriculum area. At the curriculum's foundation are 28 organ system-based categories, which are further divided into "diseases/conditions" and "operations/procedures." The diseases/conditions are divided into those for which a resident should be able to provide comprehensive management, and others requiring only focused knowledge related to diagnosis and initial management. Operations/procedures are similarly divided into three categories: "essential-common," (frequently performed by general surgeons) "essential-uncommon" (not as frequently seen) and "complex" (not commonly done, but some general familiarity is necessary).
The curriculum topics will be reviewed annually by SCORE for their continued relevance to general surgery training. The ABS plans to use this framework in its definition of general surgery so the definition more precisely defines what knowledge and skills a certified general surgeon should have. The curriculum outline will be shared with surgery program directors in the coming months as it becomes more finalized.
The second key topic at the meeting was the teaching and assessment of technical surgical skills. The current state of the art of skills teaching and evaluation was covered by Richard K. Reznick, M.D., M.Ed., chair of surgery at the University of Toronto and an internationally recognized leader in this area. The surgical skills curriculum being developed by the American College of Surgeons' (ACS) division of education and the APDS was then presented by Gary L. Dunnington, M.D., of Southern Illinois University. The skills curriculum contains incremental learning objectives, lesson plans and standards for the teaching and evaluation of residents' surgical skills. Phase I of the curriculum has been completed and focuses on 20 basic surgical skills, such as inserting a central line, suturing and knot-tying; Phase II will contain 10 advanced procedures broken down into steps; and Phase III will instruct and evaluate residents on team-based skills. SCORE members enthusiastically agreed to continue to work with Dr. Dunnington to integrate this project into the new surgical curriculum.
SCORE members also agreed to continue with the development of a website that will deliver content in support of the new curriculum to all U.S. surgical residents. The website will feature a powerful search engine so residents can quickly find information and will mostly use existing content gathered from the ACS, specialty societies, medical publishers and other sources. It will be organized into "modules" based on the curriculum outline described above, each containing images, video, step-by-step "walk-throughs" of procedures and recent publications. The website is targeted for launch in six to eight months for initial evaluation by residents, with more content to be added over time.
Another highlight of the meeting was a presentation on the Intercollegiate Surgical Curriculum Project (ICSP) recently implemented in the United Kingdom and Ireland, by Mr. William E. G. Thomas, M.S., chairman of education of the Royal College of Surgeons of England (RCS). The intent of the ICSP was to provide an explicit, web-based curriculum that would more efficiently manage residents' time in light of a new 48-hour workweek requirement. In addition, it would provide clear standards at different stages for both trainee and trainer, and assist trainers in providing better, more specific feedback. Mr. Thomas also gave a presentation on tools that the RCS has developed for assessment of technical skills. The U.K. and Canada face many of the same issues in developing curriculum for surgical training, and SCORE intends to work with both countries to identify areas for collaboration.
For more information on SCORE, see recent issues of the ABS newsletter or visit www.surgicalcore.org. SCORE is composed of representatives from the principal organizations involved in U.S. surgical education - the ACS, APDS, American Surgical Association, Residency Review Committee for Surgery, and Association for Surgical Education, in addition to the ABS.
The American Board of Surgery is an independent, nonprofit organization founded in 1937 for the purpose of certifying surgeons who have met a defined standard of education, training and knowledge. Surgeons certified by the ABS, known as diplomates, have completed a minimum of five years of surgical training and successfully completed a written and oral examination process. The ABS certifies surgeons in the following fields: general surgery, vascular surgery, pediatric surgery, surgical critical care, and surgery of the hand. The ABS is one of the 24 member boards of the American Board of Medical Specialties.