Is Chief Resident Operative Volume Associated with ...
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Is Chief Resident Operative Volume Associated with Milestone Competency Achievement? Ilana G. Margulies, MS, Hope Xu, BA, Farah Sayegh, MD, Paymon Sanati-Mehrizy, MD, Felipe Molina-Burbano, MD, Michael Ingargiola MD, Peter J. Taub MD, MS
Transcript of Is Chief Resident Operative Volume Associated with ...
Is Chief Resident Operative
Volume Associated with
Milestone Competency
Achievement?
Ilana G. Margulies, MS, Hope Xu, BA, Farah Sayegh, MD, Paymon Sanati-Mehrizy, MD, Felipe Molina-Burbano, MD, Michael Ingargiola MD, Peter J. Taub MD, MS
Disclosures
I have nothing to disclose.
Competency Evaluations in Plastic Surgery
• Milestones established by the ACGME
in Plastic Surgery to provide
competency based evaluations in
resident training
• 36 Milestones covering
reconstructive, cosmetic, and
general competencies
• Goals of improving resident education
and individualizing training length
• Paucity of literature studying
association of Milestones
competencies and clinical exposure
Version 08/2013 Plastic Surgery Milestones, ACGME Report Worksheet
Copyright © 2013 Accreditation Council for Graduate Medical Education and American Board of Plastic Surgery. All rights reserved. The copyright owners grant third parties the right to use the Plastic Surgery Milestones on a non-exclusive basis for educational purposes. 1
Surgical Care — Patient Care
Level 1 Level 2 Level 3 Level 4 Level 5
• Performs history and physical examination of the surgical patient and employs algorithms such as advanced trauma life support (ATLS) and advanced cardiac life support (ACLS)
• Manages several uncomplicated patients, with assistance
• Independently performs basic techniques in the care of the surgical patient, (e.g., nasogastric [NG] tube placement, urethral catheterization, knot tying)
• Gathers and categorizes information
• Manages a surgical patient with single system disease with assistance, and deviates from algorithms when indicated
• Provides surgical consultations with assistance
• Independently performs routine procedures (e.g., incision and drainage, central line placement, chest tube placement, biopsy, wound closures and laceration repair)
• Recognizes patterns and establishes major priorities while being able to describe at least one solution
• Manages a surgical patient with multiple system diseases with assistance
• Independently manages multiple patients and surgical consultations
• Recognizes exceptions and describes three or more solutions
• Independently manages a surgical patient with multiple system diseases; manages a surgical patient with one or more life threatening conditions with consultation
• Manages a surgical service
• Applies known solutions in novel ways; anticipates and has a plan for potential problems
• Teaches and supervises other learners who manage patients
• Develops and employs simulation for teaching and assessment of surgical skills
Comments:
Not yet rotated
Association of Milestones Competences and Operative
Volume: Building on Prior Research
• No significant association
between chief resident
cosmetic case volume and
respective Milestone
achievement
• Facial aesthetics
• Non-cancer breast surgery
• Cosmetic trunk and lower
extremity0 5 10 15 20 25
2.5
3.0
3.5
4.0
4.5
5.0
Facial Aesthetics
Number of Cases
Milesto
nes L
evel
Patient Care
Medical Knowledger = 0.53p = 0.18
r = - 0.58p = 0.25
0 10 20 302.5
3.0
3.5
4.0
4.5
5.0
Non-Cancer Breast Surgery
Number of Cases
Milesto
nes L
evel
Patient Care
Medical Knowledge
r = 0.43p = 0.29
r = - 0.58p = 0.13
0 5 10 15 203.6
3.8
4.0
4.2
4.4
4.6
4.8
Cosmetic Trunk and Lower Extremity
Number of Cases
Milesto
nes L
evel
Patient Care
Medical Knowledge
r = - 0.58p = 0.25
r = 0.23p = 0.64
Aim of the Present Study:
Evaluate the relationship between chief resident case volume and
respective reconstructive and general Milestone competencies
Methods
Operations by 8
chief residents at
primary training
hospital
(2015 – 2018)
Reconstructive
cases isolated and
categorized:
tissue transfer,
congenital
anomalies, head
and neck etc.
0 50 100 150 200
3.0
3.5
4.0
4.5
5.0
5.5
# Cases
Milesto
ne A
ch
ievem
en
t Patient Care
Medical Knowledge
r = 0.27p = 0.51
r = 0.58p = 0.51
Evaluate the
association between
Milestone achievement
and operative volume
with Spearman’s rank
correlation coefficient
(p<0.05)
Association of Milestones and Chief Resident Case Volume
0 50 100 150 200
3.0
3.5
4.0
4.5
5.0
5.5
Surgical Care
# Cases
Milesto
ne A
ch
ievem
en
t Patient Care
Medical Knowledge
r = 0.27p = 0.51
r = 0.58p = 0.15
No statistically significant association found between
Milestones achievement and resident case volume
0 50 100 150 200
3.0
3.5
4.0
4.5
5.0
Wound Care
# Cases
Milesto
ne A
ch
ievem
en
t Patient Care
Medical Knowledge
r = 0.52p = 0.19
r = -0.52p = 0.19
0 10 20 30
3.0
3.5
4.0
4.5
5.0
Tissue Transfer
# Cases
Milesto
ne A
ch
ievem
en
t Patient Care
Medical Knowledge
r = 0.51p = 0.23
r = 0.13p = 0.79
0 5 10 15 20
2.5
3.0
3.5
4.0
4.5
5.0
5.5
Congenital Anomalies
# CasesM
ilesto
ne A
ch
ievem
en
t Patient Care
Medical Knowledge
r = 0.17p = 0.71
r = 0.17p = 0.71
No statistically significant association found between
Milestones achievement and resident case volume
Association of Milestones and Chief Resident Case Volume
0 10 20 30 40
3.0
3.5
4.0
4.5
5.0
Trunk and Perineum
# Cases
Milesto
ne A
ch
ievem
en
t Patient Care
Medical Knowledge
r = 0.09p = 0.85
r = -0.76p = 0.07
0 10 20 30 40
2.5
3.0
3.5
4.0
4.5
5.0
5.5
Head and Neck
# Cases
Milesto
ne A
ch
ievem
en
t Patient Care
Medical Knowledge
r = -0.10p = 0.81
r = 0.26p = 0.54
0 2 4 6 8 10
2.5
3.0
3.5
4.0
4.5
5.0
Maxillofacial Trauma
# Cases
Milesto
ne A
ch
ievem
en
t Patient Care
Medical Knowledge
r = 0.22p = 0.63
r = 0.19p = 0.71
No statistically significant association found between
Milestones achievement and resident case volume
Association of Milestones and Chief Resident Case Volume
0 10 20 30 40
3.0
3.5
4.0
4.5
5.0
Breast Reconstruction
# Cases
Milesto
ne A
ch
ievem
en
t Patient Care
Medical Knowledger = 0.29p = 0.50
r = 0.00p = >0.99
Only significant finding was a negative association between upper
extremity trauma case volume and medical knowledge Milestone
Association of Milestones and Chief Resident Case Volume
0 2 4 6 8 10
3.0
3.5
4.0
4.5
5.0
5.5
Non-Trauma Hand
# Cases
Milesto
ne A
ch
ievem
en
t Patient Care
Medical Knowledge
r = -0.25p = 0.54
r = -0.06p = 0.89
0 5 10 15
3.0
3.5
4.0
4.5
5.0
5.5
Upper Extremity Trauma
# Cases
Milesto
ne A
ch
ievem
en
t Patient Care
Medical Knowledge
r = -0.42p = 0.30
r = -0.86p = 0.01
0 5 10 15
3.0
3.5
4.0
4.5
5.0
Lower Extremity
# Cases
Milesto
ne A
ch
ievem
en
t Patient Care
Medical Knowledge
r = 0.23p = 0.63
r = -0.03p = 0.92
Discussion
• Overall lack of significant
association between chief resident
case volume and Milestones
suggests non-linear relationship
between competency achievement
and clinical exposure
• Importance of also examining how
Milestones evaluations are
determined
• Ongoing research into looking
at the structure of CCC
meetings nationwide
or
Limitations
• Minimal variation in chief resident Milestone achievements
• Small sample size, single center study at one training site
• Restricted use of single year case volume as opposed to
compounded case volume taking into account prior operative
experience
Conclusion and Future Research
• No overall significant association found between chief year case
volume and respective Milestones achievements
• Future and ongoing studies:
• To investigate the relationship between Milestones competencies
and resident case volume throughout all years of Plastic Surgery
training
• To examine nature of CCC meetings nationwide
