Point/Counterpoint: So you think you can make a vascular surgeon in 5 years?
We have all witnessed exceptional trainees in our programs. These trainees, regardless of their training program, sail through their surgical residencies. They meet all of the defined educational milestones, finish all of the program requirements, and demonstrate ability to care for patients unsupervised way before their set graduation date. For both these types of residents, educational landmarks, as defined by the ACGME, are of secondary importance and since only time determines completion of training, the curriculum becomes irrelevant. The question then becomes: why work to define a body of vascular surgical knowledge or a required set of technical and non-technical skills if competence is defined as time in training? Mal, surely you don’t support graduating a trainee simply because they have spent five years in training? Hopefully you would want to know that this graduating trainee is ready and competent to safely and autonomously practice the full scope of vascular surgical practice.
Competency-based education is gaining momentum around the world as medical educators, physicians, and policy makers try to ensure that our graduating specialists are acquiring and demonstrating the competencies needed to practice in today’s rapidly evolving heath care systems. It is becoming the standard in training of physicians because of the perception that it provides more transparent standards and increased public accountability. Competency-based training is learner centric, outcomes based, and differentiated. A key distinguishing feature of CBE is that residents can progress through the educational process at different rates: the most capable and talented individuals should be able to make career transitions earlier, thus allowing them to enter the workforce at an accelerated rate. Others, requiring more time, would still attain the appropriate level of knowledge, skills, and attitudes needed to enter independent practice, and leave the program only when competent.
With the emerging reality of numerous nonsurgical specialties encroaching upon various traditional domains of vascular surgery, it is essential that our specialty lead the field in vascular education so as to maintain our stronghold on these areas of expertise. Competency-based training is a logical evolutionary step from our traditional years-in-place based system. Such training should improve, or at least verify, the quality of educational outcomes for our vascular trainees and our varying training programs. This model of education will allow comparisons among training programs, differing training tracks and even differing specialty practices. I urge the vascular surgery community to discuss this concept and ultimately to implement it.
Dr. Mitchell is a professor of surgery, program director for vascular surgery, and vice-chair of Quality, Department of Surgery, Division of Vascular Surgery, Oregon Health and Science University, Portland.
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