Planning for Surgical Competency: The University of Iowa Experience

Oetting TA, Beaver HA, Johnson AT, Greenlee E, Henderson BA, Doan A, and Lee AG


Medical educators feel increasing pressure from external public and private organizations, including insurers, patient advocacy groups, and hospitals to improve resident education and to provide “proof of quality” [1]. The current training of resident physicians is believed by some to be producing physicians with an unreliable skill set that may not be aligned with the demands of today’s healthcare market. The measurement of resident surgical skill for accreditation and certification purposes in the past was based on “minimum numbers” and not actual outcomes. The emphasis was on medical knowledge and not performance in other domains. Here we present a detailed strategy to plan for teaching and assessing competency in cataract surgical skills for residents. We propose the use of distinct stages of professional development similar to those of Dreyfus [2] with each stage of resident training defined by clear expectations that can be used to measure progress. We recommend sustained and frequent short formative encounters rather than a single end of rotation summative feedback alone. We hope this will serve as a starting point as other programs prepare their competency based educational programs. This article is our perspective on the lessons learned, the barriers encountered, and our institutional and programmatic experience with overcoming the cultural, organizational, resource, time, and financial barriers to local implementation of the assessment of resident competency in cataract surgery.

Journal of Academic Ophthalmology 2009: 2: 23-32. (c) Journal of Academic Ophthalmology

View full article in the Virtual JAO Online.


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