Assessment Tools in the Training of Surgical Oncologists: Educating Trainees and Educators

I have been the Fellowship Training Program Director at a Society of Surgical Oncology-approved Fellowship Program for almost 20 years. Recently, I was asked by a few members of the Society of Surgical Oncology if this means that I am still very committed to education or if I just need to be committed. I expect that some of the former fellows who have trained during my reign will gleefully weigh-in with opinions on this matter. The only important point (yes, I can come to the point) is that during nearly 20 years, those of us involved in the education and training of young surgeons have seen many changes. In this issue of the Annals of Surgical Oncology, there is an article entitled ‘‘The Use of a Novel, Web-based Educational Platform Facilitates Intraoperative Training in a Surgical Oncology Fellowship Program.’’ All surgeons involved in training residents or fellows are expected to assess the technical competence of their trainees. This includes an assessment of their knowledge base (anatomy, disease processes), preparation (information about the specific patient, collateral reading), emotional responses (performance under pressure, interactions with the faculty and operating room staff, maturity and response to criticism), and technical skill (manual dexterity, hand-eye coordination, recognizing tissue planes, maintaining pace and focus during the procedure). The changes in surgical training that we have witnessed during the past two decades have strengthened the notion that surgical educators must provide timely, accurate, and reproducible feedback to trainees to optimize the educational experience. Given the mandated limits on the number of hours that trainees spend in the hospital, it must be recognized that the number of surgical procedures that trainees will perform, and concomitantly, the number of encounters that we as surgical educators have to assess and provide constructive feedback to our trainees has been reduced. We are still charged with ensuring that our trainees are competent, well prepared, and safe when they complete their training period and are released to go forth and provide care to the populace. Therefore, methods and tools to provide useful information on the completeness and adequacy of training has become an increasingly important focus. The surgical care of patients with vascular disease has undergone radical changes during the past two decades. In fact, the current practice of vascular surgical care would be difficult for those of us who trained in surgical residency more than 20 years ago to recognize at this time. Understanding that these changes have been dramatic and rapid, there have been descriptions of new cognitive and virtual reality training systems to improve performance of trainees doing endovascular procedures. Similarly, the development and continuing evolution of laparoscopic equipment and skills makes assessment of competencies in these procedures a critical part of any training program. Trainees in many programs spend allotted periods of time using computer-based virtual reality programs and hands-on simulators to practice their laparoscopic skills. Some have even suggested that use of these simulators should be included during the interview process to assess the baseline ability of trainees applying for minimally invasive fellowship slots. A significant issue must be considered: many of these virtual reality and simulator-based training programs have not been fully vetted and validated in systematic evaluations to demonstrate improvement in performance of the trainee during actual operations on patients. For example, a recent review of simulation-based training for surgical skills that included the transferability of these skills to the operative setting in patients was published. This review found only ten randomized, Society of Surgical Oncology 2009