"The AIRE Committee felt we should have a consortium, so we spoke with these other doctors and institutions, and redid our proposal."Įven with approvals from ABPS and the RRC, Dr. "There was a little anxiety on ACGME's part about it," Dr. Losee, Nguyen, Weber and Lifchez all worked on similar proposals at their own institutions, it was actually the ACGME's creation of the Advancing Innovating in Residency Education (AIRE) program that brought the doctors together. Kasten authored a PRS piece on competency-based education in 2009, and Drs. Shouldn't we be thinking about teaching doctors the same way? Is it really fair to assume a doctor is better because they graduated faster – or that they're worse because they got there a little slower? All we really want to know is that they have the skill set to provide good, quality care for us or our loved ones." Great minds think alikeĪlthough Dr. "We don't make judgments based on whether someone's going to be an Olympic sprinter if they walk at 9 months or 14 months," Dr. The institution has the opportunity to be more efficient in educating its residents and, at the end, the patient can be satisfied knowing their doctor has demonstrated the competency necessary to graduate. The benefit isn't just for the resident, either. "Now you can assess those people earlier, figure out where they need more help and give them more focus in their area of need." "Similarly, the people who take more time to learn those same concepts are not 'bad' or 'failing' residents," Dr. With a more-focused program, we can identify those who are accelerated for one reason or another, who learn faster, or are more technically competent – whatever that combination is – and potentially shorten their training. "What we want is to get everyone to a similar level of competency, recognizing that on an individual basis, everyone achieves that competency somewhat differently. "Accelerated graduation is the sexy, easy metric, but it's the wrong thing to focus on," he says. Of course, it could also mean seven years for some students, or perhaps longer, according to Dr. It just so happens that in plastic surgery, there's a lot of evidence that suggests it can be done in five years instead of six – perhaps even shorter." Matter of perspective We want to train residents in a way so that they're done and achieve competency at their pace. It's important that people recognize that. "The goal is to train residents as long as they need until they're done. "The goal of a competency-based residency is not necessarily to train residents in a shorter period of time," Dr. Canada's plastic surgery programs last five years, and in the mid-2000s, an ACAPS presentation considered board pass-rates between residents who had done two-year residencies after general surgery three-year residencies five-year integrated and six-year integrated, with the ultimate result being no major statistical difference between the residents in the five- and six-year programs. Weber points out that statistical evidence already demonstrates the feasibility of a five-year curriculum. It doesn't mean the four institutions are now pushing to graduate every resident in five years – although Dr. It simply begs the question: Can we be more efficient about it?" "We're definitely one of the longest-duration clinical training programs of any specialty," Dr. Although the practice has been put into place in Canada in the University of Toronto's orthopedic surgery program, this trial by four plastic surgery departments represents the first attempt in the United States to provide a competency-based curriculum. The idea disrupts the medical training programs that use a fixed time-limit for graduation, instead basing the decision to graduate a resident on his or her ability to demonstrate competency. Weber, along with Joseph Losee, MD, and Vu Nguyen, MD, also at UPMC Steven Kasten, MD, at the University of Michigan and Scott Lifchez, MD, at Johns Hopkins. The initiative, which was recently approved by both ABPS and the Resident Review Committee (RRC), is the culmination of four years of combined efforts from Dr. In addition to BSW, the University of Pittsburgh Medical Center (UPMC) has also begun its own competency-based training program, and the University of Michigan and Johns Hopkins Medical Center will begin their own such programs next year. "What we are describing here is truly revolutionary," he says. It might seem like big talk, but there's a key word that Robert Weber, MD, Temple, Texas, uses when talking about the competency-based education program launched July 1 at Baylor Scott & White (BSW) Health.
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