Perception of Teaching and Assessing Technical Proficiency in American College of Veterinary Surgeons Small Animal Surgery Residency Programs Stanley E. Kim, BVSc, MS, DACVS, J. Brad Case, DVM, MS, DACVS, Daniel D. Lewis, DVM, DACVS, and Gary W. Ellison, DVM, MS, DACVS College of Veterinary Medicine, University of Florida, Gainesville, Florida

Corresponding Author Stanley Kim Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610. E-mail: stankim@ufl.edu Submitted September 2014 Accepted January 2015 DOI:10.1111/vsu.12342

Objective: To determine how American College of Veterinary Surgeons (ACVS) small animal surgery residency programs are teaching and assessing technical skills, and ascertain the perceived value of those methods. Study Design: Internet-based survey. Sample Population: Residents and Diplomate supervisors of ACVS small animal residency programs. Methods: Residents and supervisors were surveyed on their experience of surgery instruction, use of different resources for teaching, type and frequency of feedback, and perceived effectiveness of their programs in imparting technical proficiency. Results: A total of 130 residents (62%) and 119 supervisors (44%) participated. Both residents and supervisors estimated the resident was the primary surgeon for a mean of 64% of cases, although this proportion varied widely between participants. The majority of residents and supervisors considered that direct intraoperative guidance was the most effective way for residents to develop technical skills. Verbal interactions between supervisor and resident occurred frequently and were highly valued. Regular wet laboratories and access to simulation models were uncommon. Despite over 90% of all participants reporting that a sufficient level of technical aptitude would be attained, only 58% of residents were satisfied with their technical skills training. Conclusion: Residents relied on direct interaction with supervisors to develop technical skills. The traditional mode of instruction for veterinary residents is the apprenticeship model, which is partly driven by ACVS requirements of supervisory support. Exposure to other teaching and assessment methods was variable. The current structure of residency programs is successful in imparting technical competency as perceived by supervisors and residents. However, consideration of a more formal method of residency training with structured assessment of technical skills as in human medicine should not be dismissed.

Of the numerous specialties currently recognized in veterinary medicine, the field of surgery has unequivocally the heaviest emphasis on technical proficiency. One of the primary objectives of all approved American College of Veterinary Surgeons (ACVS) residency training programs is “proficiency in the operative treatment of animals.”1 Veterinary surgery residency programs must dedicate sufficient resources toward ensuring that residents acquire technical proficiency in an array of complex procedures that the board certified veterinary surgeon is expected to perform. Numerous methods for developing psychomotor skills have been described for both human and veterinary surgery education.2–5 Providing instruction and delivering feedback on performance are 2 broad objectives that drive the acquisition of skills. Resources and modes of teaching technical skills can

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include textbooks and journal articles, participation in wet laboratories, access to models (both hands-on and virtual), in addition to receiving direct intraoperative instruction from a supervisor.3 Feedback on performance can be provided by immediate verbal communication by the supervising surgeon, written feedback of general performance, and detailed workbased assessments.3,5,6 The availability and value of these techniques has been studied extensively in human medical training.3,5–8 Veterinary surgery residency programs are structured as an apprenticeship,9 where the mentor and mentee work sideby-side and learning is primarily driven by direct interaction between the two via exposure to a required volume of surgery cases. Anecdotal evidence suggests veterinary surgery residency programs are experiencing similar recent challenges

Veterinary Surgery 44 (2015) 790–797 © Copyright 2015 by The American College of Veterinary Surgeons

Kim et al.

Teaching and Technical Proficiency in ACVS Small Animal Surgery Residencies

of human surgery training10,11 where the goals of providing optimal patient care and hospital efficiency conflict with the needs of resident education. Client expectations of specialistlevel, veterinary surgical services may interfere with the need for hand-on development of technical proficiency among residents. There are no specific requirements or guidelines for teaching or assessment within an ACVS residency program and individual programs are afforded latitude in developing a curriculum that they believe facilitates progress toward technical proficiency. The purpose of this survey was to gain an understanding of the current status of teaching and assessment of technical skills in small animal surgical residency programs. The survey recorded the methods of teaching and technical assessment, the perceived success of those methods, and opinions on how to improve the teaching of technical skills.

MATERIALS AND METHODS A survey for ACVS supervisors and a survey for ACVS residents were developed. The anonymity of participants was preserved. The surveys were pilot-tested among 4 faculty supervisors and 4 residents at our institution, and 1 faculty supervisor from a separate institution. An internet survey tool (Survey Monkey) was used to collect and organize responses for analysis. All ACVS small animal surgery residency programs that were training at least 1 resident during June 2012–June 2013 were included in the participant pool. A list of program directors and actively enrolled residents was provided by the ACVS. A list of ACVS Diplomates that were actively supervising residents but were not program directors was not available and email addresses of ACVS small animal surgeons at institutions with actively enrolled residents were obtained by public access such as hospital websites and institutional data bases. Responses from ACVS Diplomates that supervised residents less than 8 weeks a year were excluded. All supervisors and residents were emailed a cover letter that provided access to the survey website. The cover letter asked for participation of the recipient and explained that all information would remain anonymous. Email reminders were sent out approximately every 3 weeks for the first 6 weeks and potential participants were given 6 months to complete the survey. Demographic data including practice type, year of training (residents only), and length of time as a supervisor (supervisors only) were collected. Practice types were categorized as university hospital, private hospital, or combined university and private hospital. Response options for length of time as a supervisor were categorized by 4-year intervals up to 13 years or more. The survey asked a series of questions regarding the availability and use of various resources to prepare for operative procedures, the type and frequency of feedback provided to residents, the perceived effectiveness of educational and assessment tools, and the perceived success of the

training programs in teaching technical proficiency. Participants were also asked to estimate the proportion of time the resident was the primary surgeon with direct intraoperative guidance from the supervisor, without direct intraoperative guidance, or observing or assisting procedures. This time was estimated as a percentage for each year of their residency. Participants were asked to estimate the level of discussion that occurred between the resident and supervisor regarding technical aspects of surgery preoperatively. The frequency with which various teaching and assessment tools were encountered was surveyed with a 7-point scale, ranging from never to several times a week. Participants were asked to rank the 3 most effective forms of technical skills training. Effectiveness of assessment methods, overall level of satisfaction for technical skills training, and predicted ability to obtain adequate technical proficiency by the end of the residency were measured using a 4-point or 5-point Likert scale. The survey asked for opinions regarding the desirability of detailed, written assessment of technical skills during a residency, and whether a technical skills examination should be a component of the ACVS certification process. The same series of questions were asked in both the supervisor and resident surveys, although the questions were phrased according to the participant’s perspective. For instance, the question to residents ‘To what extent do you feel you will have successfully achieved the ability to perform most procedures commonly encountered as a specialist surgeon?’ was phrased to supervisors as ‘To what extent do you feel your residents will have successfully achieved the ability to perform most procedures encountered as a specialist surgeon?’ Where deemed suitable, a free-text comment section was provided at the end of a question, allowing the participant to provide a response that was not provided in the multiple-choice format. Questions were phrased to generate responses based on the entire residency experience rather than an individual supervisor’s methods. Data were reported as a percentage (frequency) of participants per response option or mean ( SD) for quantitative data. The results of the survey were compared between supervisors and residents with a x2 or Fisher’s exact test. Responses of supervisors were analyzed for differences by experience level (8 years,) and focus area (orthopedics, soft tissue surgery). For questions that generated a proportion or percentage response, the percentage was Arcsin transformed and comparisons were made with independent t-tests. For all statistical analyses, P

Perception of Teaching and Assessing Technical Proficiency in American College of Veterinary Surgeons Small Animal Surgery Residency Programs.

To determine how American College of Veterinary Surgeons (ACVS) small animal surgery residency programs are teaching and assessing technical skills, a...
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