Maximally-Invasive Curriculum: A Model Curriculum for Osteopathic Surgical Residencies (ACOS) India Broyles, EdD University of New England College of Osteopathic Medicine, 11 Hills Beach Rd, Biddeford, ME Cynthia Cartwright, MT RN MSEd Maine Health: Center for Outcomes Research and Evaluation, 465 Congress Street, Portland, ME Conceptual Framework of the Discipline: example from General Surgery Pre-assessment: Samples from survey of AOA/ACOS Surgery Residency Directors Identifies performance markers for all students relative to a particular competency or learning outcome Indicators are grouped to benchmark a surgical resident’s developmental level Phase I, Phase II, Phase III Benchmarking is the process of identifying a set of performance indicators a learner is expected to meet at a given developmental level Benchmarking provides a basis for tracking progress and marking achievement Not all students are expected to meet all benchmarks at the same time or in the same way Examples from BREAST curriculum: Phase I: Evaluate indications for fine needle aspiration and for open biopsy Phase II: Compare the criteria for using regional therapy including axillary dissection and sentinel node excision Phase III: Evaluate the breast condition and the patient’s desire for breast reconstruction in order to determine the appropriate techniques and the choice of either immediate or delayed reconstruction Performance Indicators Learning Outcomes Competency-Based Curriculum requires a new perspective on teaching, content, instructional time, learner assessment, and program evaluation Clinical applications of learning What the resident should be able to do at the end of a course or program Combines knowledge, skills and attitudes Places emphasis on the application and integration of knowledge Generally, not measurable Reflects AOA Competencies Sample Learning Outcomes from Principal Surgical Area: Breast Upon completion of the general surgical residency, the resident will: Understand the etiology, pathophysiology, presenting symptoms, differential diagnosis and treatment options of breast diseases Diagnose abnormal breast conditions by history, physical examination and radiologic diagnostic procedures Perform diagnostic therapeutic surgeries for benign and malignant breast conditions Perform or refer osteopathic manipulative treatment (OMT) in the pre- and postoperative period to facilitate early return to normal function and prevention of postoperative complications Coordinate multidisciplinary care for benign and malignant breast conditions Counsel patients and families on all aspects of breast diagnosis, surgery and treatment Assessment and Evaluation: Evaluation tools and strategies are based on comparison with competencies rather than other residens The most important task in residency education is determining what the residents need to learn, how it should be taught, and how to measure resident performance. In response to the AOA requirements for integration of seven core competencies in residency education, the The ACOS/RESC set up subcommittees of surgeons guided by curriculum consultants to establish a national curriculum. OPP Medical Knowledge Patient Care Interpersonal and Communication Skills Professionalism Practice-Based Learning and Improvement Systems-Based Practice History of the Project The subcommittee examined the current ACOS mission statement in an effort to bring together vision and values for a sample residency mission statement. During implementation, each residency will write their own mission. Mission: Every sailor knows the importance of the North Star for guidance. With curriculum design, the process is guided by a set of ideas – vision, mission, and values. ACOS MISSION: ACOS is committed to assuring excellence in osteopathic surgical care through education, advocacy, leadership development, and the fostering of professional and personal relationships. SAMPLE RESIDENCY MISSION: The General Surgery Residency is committed to assuring excellence in osteopathic surgical education through training and self-directed learning, patient care and advocacy, and leadership development. We seek to foster continuing personal growth and professional relationships.Implementation Assessment: Gathering information about a learner’s knowledge, skills and attitudes Feedback: Provision of information about a learner’s performance to the learner, teachers and other stakeholders Evaluation: Comparison of a learner’s performance to an accepted standard  What aspects of the old and the new program are similar or different?  What parts of the old program will be continued and which parts will be modified or eliminated?  Who will provide leadership for subsets of the new program?  What are the advantages of the new program to both residents and attending physicians?  How do we structure a gradual implementation starting at PGY1 without denying access to new ideas at PGY 4-5?  How does resident evaluation change in keeping with competency-based education?  How will we gather data and give feedback on the challenges and successes of the new curriculum in our own setting?