- Flin, R., Yule, S., Paterson-Brown, S., Maran, N., Rowley, D.R. - (ed.) (2005) The CanMEDS 2005 Physician Competency Framework.. - (1996) Human factors in the operating room:. - (1994) Team performance in the operating room.. - Hoffmann, R., Crandall, B., and Shadbolt, N. - The American Journal of Surgery . - Klampfer, B., Flin, R., Helmreich, R.L., Hausler, R., Sexton, B., Fletcher, G., et al.. - Development and Evaluation of the NOTSS Behaviour Rating System 25. - (2007) Distracting communications in the operating theatre. - Studdert, D.M., Mello, M.M., Gawande, A.A., et al. - World Journal of Surgery . - British Journal of Medicine . - Yule, S., Flin, R., Paterson-Brown, S. - (2006a) Non-technical skills for surgeons: A review of the literature. - Yule, S., Flin, R., Paterson-Brown, S., Maran, N. - Yule, S., Flin, R., Maran, N., Rowley, D. - and Paterson-Brown, S.. - (2008a) Surgeons’ non-technical skills in the operating room: Reliability testing of the NOTSS behaviour rating system. - Yule, S., Flin, R., Rowley, D., Mitchell, A., Youngson, G.G., Maran, N. - and Paterson-Brown, S. - Yule, S., Rowley, D., Flin, R., Maran, N., Youngson, G.G., Duncan, J. - and Paterson- Brown, S. - Australian Journal of Surgery . - Competence Evaluation in Orthopaedics – A. - The design and implementation of what we now know as Procedure Based Assessments (PBAs) began in the UK in the early 1990s. - In 2008, PBAs are in use in all UK surgical specialties, embedded in all surgical curricula as the primary tool for evaluating perioperative competence in the middle and later years of surgical training. - In this respect their development has much in common with other ‘need pull’ innovations (Langrish et al. - Their development has involved not only the design of an assessment tool but also the battle to gain acceptance of the concept and practice of overt competence evaluation in the surgical workplace. - This chapter describes the evolution of PBAs from instigation to practical usage and describes ongoing evaluation of the outcome in terms of the instrument and its use.. - Until the publication of the Calman Report (Department of Health 1993), surgical training in the UK involved a lengthy apprenticeship punctuated by knowledge tests but without any assessment of practical skills and no formal requirement to. - Although the Calman reforms introduced some degree of structure, it was not until the Richards Report of 1997 (Richards 1997) and the subsequent report of the Competence Working Party of the Joint Committee for Higher Surgical Training (JCHST) in 2001 (Rowley et al. - Simply recording a minimum number of operations is insufficient – the quality of the training experience is more important than the number of experiences. - (Rowley et al.. - Following the publication of Unfinished Business (Donaldson 2002), a report on the current state of training, further reforms were introduced and the ‘Modernizing Medical Careers’ project coincided with the inception of the Postgraduate Medical Education and Training Board (PMETB) in 2003 which insisted on the introduction of comprehensive curricula for each specialty and principles established whereby regular assessment of practical skills was encouraged. - The Trauma and Orthopaedics surgical curriculum (the first time such a document has been produced in the specialty in the UK), in which competence- based training and assessment were enshrined, was approved by PMETB in September 2006 (Pitts et al. - High mortality rates in the Bristol Paediatric Cardiac Unit resulted in action from the Department of Health in 1994 and the suspension of operating in that unit in 1995. - trial and eventual incarceration of Harold Shipman, a general practitioner, for actions resulting in the deaths of a number of his patients. - The Donaldson White Paper in 2007, for new revalidation processes in the UK for clinicians and other medical professionals (Department of Health 2007), has been one of the longer-term outcomes of the Shipman Inquiry which will undoubtedly culminate in the use of PBAs or similar tools in the revalidation process.. - The European Working Time Directive introduced in 1998 reduced the number of hours a trainee might stay in the workplace to 58 in 2004 and are likely to reduce those hours further, to 48 in 2009. - An individual PBA provides a formative assessment to the trainee and evidence for the trainer on which to base their future input and level of supervision. - A collection of PBAs (assembled over several years, conducted by a variety of trainers) provides summative evidence of the trainee’s progress and competence in learning surgical procedures and techniques, performing them to the required protocol and quality.. - It is normally undertaken, without pressure, between a trainee and their trainer (with whom a relationship is already established) surrounded by an operating team who will not take any unusual measures to support the trainee. - It is normally conducted on a procedure with which the trainee is already familiar.. - All of these conditions help the trainee to give a ‘normal’ performance and, more importantly, protect the patient.. - Most elements are identical across all procedures but in some domains there is opportunity for procedure-specific items which identify the trainee’s grasp of the unique aspects of particular surgical procedures. - Although superficially the structure of a PBA resembles a two-page checklist (see Figure 3.1) a PBA is not a schedule of how to perform the procedure, rather it identifies places in the procedure where competence is observable. - In the same. - Table 3.2 example elements for total hip replacement PBA, taken from T&O curriculum (Pitts et al. - Figure 3.1 Total hip replacement PBA T&O curriculum (Pitts et al. - way that a driving examiner looks for key behaviours (mirrors, signal, manoeuvre) the assessor is guided by the PBA to key performance points in the procedure.. - The trainee conducts the agreed sections of the procedure taking care to verbalize their intentions (in order to not only enable more effective assessment but also to avoid any compromise in the quality of patient care). - At any point, the trainer may step in and perform all or some remaining sections of the procedure, if there is the slightest risk that the trainee will provide less than optimal care.. - After the surgery is complete the trainee and trainer review the PBA form and complete it. - The final domain of the PBA is the global assessment (see Table 3.3).. - The global assessment gives the trainer the opportunity to comment on the trainee’s overall performance. - For example, the trainee may have been slow or hesitant or struggled to deal with an unexpected complication.. - The results of the PBA are transferred to a PBA summary sheet where they are seen alongside results from other PBA assessments. - This document’s key function is to demonstrate clearly, to the annual review panel, whether the trainee is making progress, to indicate if certain areas of competence require further attention or highlight whether there are serious causes for concern.. - Level at which completed elements of the PBA were. - Level 2 Able to perform the procedure under supervision. - Table 3.3 global assessment taken from T&O curriculum (Pitts et al.
Xem thử không khả dụng, vui lòng xem tại trang nguồn hoặc xem
Tóm tắt