Computer Simulation Modeling of a Time Variable Competency Based Surgical Training Paradigm
As surgical training paradigms have evolved, standards developed including fixed length of training and case volume requirements, which, along with program director evaluations stating competency, served as basis for training and determining competence. This model has always been “service” focused, rather than “competency” focused, ie, centered around the delivery of care rather than the educational benefit to the trainee. In more recent years, significant and appropriate changes have occurred within surgical training, including work hour limitations, increased trainee oversight, and increasing specialization of different fields. The current time and case volume based training paradigm has not evolved despite these regulatory changes. There is a critical need to develop training paradigms that account for these changes in modern surgical practice while also ensuring that all graduating trainees are competent. One of the greatest challenges to implementing a new time variable, competency-based training program is logistical. It is unknown, however, how these logistical constraints might interact with the variability in how trainees learn to operate. It is also unknown how alternative work models (scheduling strategies) might impact trainees, their training programs, and their institutions. We will develop new work models and investigate the interaction between work models, learning curves, and multiple outcomes related to feasibility. This project represents a first step in creating a time variable, competency based training program.