C. Huynh1, N. Wong-Chong2, P. Vourtzoumis3, W. Marini3, S. Lim4, G. Johal1, M. Strickland3, A. Madani5 1University Of British Columbia,Surgery,Vancouver, British Columbia, Canada 2McGill University,Surgery,Montreal, QC, Canada 3University of Toronto,Surgery,Toronto, Ontario, Canada 4University of Manitoba,Surgery,Winnipeg,Manitoba, Canada 5Columbia University College Of Physicians And Surgeons,Surgery,New York, NY, USA
Introduction:
Various pedagogical models have been introduced in an attempt to improve and restructure surgical training. Yet, there remain significant obstacles related to their method of implementation, timing and acceptance. Prior to implementing national guidelines, it is critical to explore residents’ opinions to ensure a successful transition that meets their needs and addresses the practical challenges of reformatting surgical residency. This study aimed to establish a nationwide Delphi consensus statement on the opinions and perceptions of Canadian residents regarding the future of general surgery training.
Methods:
Residents from each Canadian general surgery program participated in a moderated semi-structured focus group using a Nominal Group Technique to discuss issues related to surgical training across three domains: early sub-specialization (streaming), competency-based medical education (CBME), and a dedicated transition-to-practice (TTP) period. Qualitative verbal data was transcribed verbatim, coded, grouped into themes, and synthesized into a list of recommendation statements. Using an online, iterative Delphi survey, these statements were then ranked by a panel of residents on a 5-point Likert scale in terms of agreement. The survey was terminated once consensus was achieved, predefined as ≥2 survey rounds and internal consistency (Cronbach’s α) ≥0.80. Each statement was marked as “positive agreement” (67% majority ranked 4 or 5), “negative agreement” (67% majority ranked 1 or 2), or “no agreement” (neither positive or negative agreement).
Results:
Sixty-six statements were synthesized by 16 members of the Canadian Association of General Surgeons Resident Committee. Forty-nine residents participated in the Delphi consensus (2 voting rounds; Cronbach’s α=0.93). Participants agreed streaming should only be offered in the last clinical years as a bridge to one’s intended career path, and after “core” general surgery milestones and competencies have been achieved. Respondents also agreed there should be an explicit period at the end of residency that allows residents to transition to independent practice, by including rotations tailored to their career path, greater autonomy and patient ownership, opportunities to develop skillsets related to managing and running a practice, and “Resident Clinics”. Panelists agreed that residency should be remodeled to focus on the achievement of standardized competencies and milestones throughout various levels of training, based on residents’ ability to meet specific and measurable metrics. Ten barriers to CBME implementation were identified.
Conclusion:
A nationwide consensus regarding the future of surgical training was established. These findings can be used to implement guidelines and national curricula that meet the needs of residents and address the various challenges that face their training.