Surgical education : development of curricula to optimise training and evaluate competency

This PhD by Published Work (Route 2) thesis is comprised of a collection of significant papers I have published with co-authors between the years of 2010 and 2017. These published works are supported by supplemental papers, abstracts, and conference proceedings and comprise a body of work that has sought to understand how surgical education is carried out in surgical residency programs, with particular interest in learning about how surgical educators teach, how surgical trainees perceive the teaching they receive, the creation, use, and evaluation of new tools for surgical education, and the development of new surgical training curricula in an era of competency-based medical education. My research began out of a need to evaluate the problem of a lack of formal guidelines and direction to aid surgical educators in the development, delivery, and evaluation of competency-based residency education programs throughout Canada. Without formal guidelines driving curricula development, surgical trainees could potentially be graduating at different levels of proficiency, which is problematic. In addition to existing standardised testing procedures, other surgical education researchers and I believe that residents must also be evaluated via ongoing thorough assessments of their level of competency when performing in the high stakes environment of the operating room. The Royal College of Physicians and Surgeons of Canada (RCPSC) is well-known for their Canadian Medical Education Directives for Specialists (CanMEDS) physician competency framework, which has been adopted by medical and surgical training programs worldwide. In its most recent CanMEDS iteration (2015), the RCPSC has released a new initiative called Competence by Design (CBD), which will affect all Canadian residency programs. The primary goal of this initiative is to completely remove the time element of residency training and focus on residents’ progression through their respective programs solely based on the passing of pre-defined competency “milestones”. This will cause a paradigm shift whereby the traditional apprenticeship model long-used in surgical teaching may eventually cease to exist. With this thesis, I have included papers that have focused on surgical education within competency-based frameworks and means by which to optimise curricula for surgical training. My research began with the exploratory work around how surgical educators teach and how trainees perceive they are taught, and is followed by a description of simulation and the development of new tools for surgical simulation and training. I then describe the development of new curricula that are focused on competency-based initiatives and can be used to begin the development of residency curricula for CBD. This research is timely, as many accrediting bodies worldwide are currently in the process of adopting and developing competency-based curricula at different training levels. The research presented in this thesis significantly contributes to the existing body of surgical education research, and future work, some of which is described, will focus on expanding the reach of our research initiatives via collaborative efforts with other surgical residency programs within Canada and also abroad.