09 Oct

AHRQ Patient Safety Network

in Press Releases


Readiness of US general surgery residents for independent practice.

Insufficient trainee supervision may lead to adverse events, but lack of autonomy may leave trainee physicians unprepared for independent practice. In this direct observation surgical education study, attending physicians rated readiness for independent practice and level of supervision for surgical trainees performing specific core procedures throughout the course of their training. At the end of training, 90% of trainees performed competently on average complexity patients, but this proportion dropped to less than 80% for the most complex cases. For about two-thirds of core procedures, surgical residents still had significant supervision in their last 6 months of training. The authors raise concerns about whether graduating residents have sufficient experience practicing independently to enter clinical practice. A previous PSNet perspective advocated for continued appropriate supervision to augment patient safety.

Link to original article: https://psnet.ahrq.gov/resources/resource/31440


Tool Could Enhance Education ; Are Residents Less Competent or Just More Closely Scrutinized?
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PHILADELPHIA – The question of how prepared general surgery residents are to operate independently after their training is longstanding, but clear definitions of competency and readiness have been elusive.

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Research from the Procedural Learning and Safety Collaborative's national trial has been published in the Annals of Surgery.

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07 Dec

SIMPL Android app is launched!

in Press Releases

The SIMPL app has officially been launched for Android!  It is available in the Google Play store for download and can now be used by all study participants.

01 Jul

SIMPL iOS app is now available!

in Press Releases

The SIMPL app has officially been launched for iOS!  It is available in the Apple app store for download and can now be used by all study participants.

This week at the Association for Surgical Education meeting in Seattle, WA, researchers from PLSC held a kick-off meeting for the upcoming multi-institutional trial of the SIMPL system.  This trial will investigate national patterns of resident supervision in the operating room and is being supported by the American Board of Surgery.  Multiple surgical training programs from across the country have already agreed to participate, with the planned start date for the trial this summer.

January 14th, 2015

Procedural Learning and Safety Collaborative, Inc (PLSC) researchers were this week awarded a grant by the American Board of Surgery (ABS) to fund a multi-institutional trial using the SIMPL (System for Improving and Measuring Performance Evaluation) system.  This trial, the first of its kind, represents the next step in a larger national effort to define performance standards for the next generate of surgeons.  This effort is both timely and critical as there is significant concern among surgical educators that general surgery training programs are not adequately preparing residents for independent surgical practice.

The planned trial will examine whether SIMPL is an effective instrument to:

    1. Generate national data to define norms and set standards pertaining to levels of autonomy achieved by residents with specific procedures.
    2. Statistically define the number of procedures residents need to participate in to achieve operative autonomy.
    3. Facilitate acquisition of reliable and valid performance assessments for procedures performed by surgical trainees.
    4. Facilitate timely assessment of the vast majority of residents’ operative performances.
    5. Enhance focus on intra-operative teaching and resident progression to operative autonomy.

Surgeon educators are challenged with balancing their responsibility to patients in ensuring optimal operative outcomes with their responsibility to residents in preparing them for independent practice. Overseeing quality of care and supervising residents is further complicated by shortened work hours for residents and an emphasis on operating room cost efficiency, both of which diminish time critical to teaching and honing residents’ operative judgment and skills. These and other recent changes in the health care environment, the economic climate, and accreditation requirements dictate the need for enhanced educational models for preparing tomorrow’s surgeons. Researchers at PLSC have developed the SIMPL system to monitor surgical residents’ progression towards operative autonomy by documenting the guidance and supervision provided by surgical faculty in the operating room.

SIMPL is a smart phone based assessment system that utilizes the four-level Zwisch scale to assess the level of autonomy achieved by a resident in performing a surgical procedure.  The SIMPL system, which is connected to the OR scheduling system, facilitates the assessment process by delivering text prompts to the supervising faculty surgeons reminding them to complete an evaluation for the procedure they just performed. Completion of the entire assessment requires only a few seconds and therefore does not disrupt busy surgical workflow.

All evaluation data in centrally stored in a secure database and can be used for further analysis.  Longitudinal assessment of resident autonomy progression can be determed by case, rotation, and overall. This can be used for both individual resident assessments and residency program evaluations.  It can also be used to evaluate faculty based on the level of guidance and supervision they provide in the operating room.

The pilot version of SIMPL was evaluated in the general surgery residency training program at Northwestern University where we demonstrated that SIMPL is feasible, reliable, and valid method of evaluating resident operative performance.  Using the Zwisch scale and SIMPL, PLSC researchers have also compared faculty and resident expectations of what level of autonomy residents should be achieving by the end of their residency training to the level of autonomy they are actually achieving.  In partnership with the American Board of Surgery PLSC will be extending this work over the next several years.


Want to participate?  Contact us!