1. Reformation of Surgical Education and Training
Dr. Douglas Hedden
Walter Stirling Andersen
Professor and Chair
Department of Surgery
University of Alberta

2. Declaration of Conflict of Interest
Douglas Hedden
declare that in the past 3 years:
I have received manufacturer funding from the following companies*:
Yes
Medtronic Canada
I have done consulting work for the following companies*: No
I have done speaking engagements for the following companies*:
Yess
Synthes Spine
I or my family hold individual shares in the following*:
None
*pharmaceutical or medical/dental equipment

3. Restriction of Resident Duty Hours
Stimulated by Patient Safety
Reduced number of hours in a given week for education
Must optimize time spent in training
Little appetite to prolong training
Does it improve patient safety?
Does it improve education and lifestyle of residents?

4. National Steering Committee – On Resident Duty Hours
Jason Frank, Kevin Imrie
Some key findings
The relationship between fatigue, medical error and patient safety is unclear
There is no conclusive data to show that duty hour restrictions (consecutive) are necessary for patient safety
Complicated and needs to be looked at comprehensively

5. Resident Duty Hours Restrictions
No clear evidence that academic performance is altered either positively or negatively
There is evidence suggesting suboptimal patient care and educational outcomes in surgery resulting from the restriction of resident duty hours
Health human resources are affected

6. Resident Duty Hours Restrictions
Must redesign Residency Training to maximize educational experiences and to provide safe patient care

7. Canadian Consensus
Residents have dual roles as care providers and learners
Residents are vital providers in a health care system that is collectively responsible for 24/7 patient care coverage
Duty periods of 24 or more consecutive hours without restorative sleep should be avoided
Efforts to minimize risk and enhance safety are necessary and cannot be undertaken by addressing the resident duty hours alone

8. Canadian Consensus
Given the substantial variation in resident training needs, a tailored and rigorous model for resident duty hours and the provision of after-hour care is needed.

9. Competency Based Medical Education (CBME)
Most training programs are based on time based rotations
Promotion is based upon successful completion of time spent on rotation
Assessment criteria are often not robust
ITER should be based upon Rotation Specific Goals and Objectives – how complete is that assessment?

10. CBME
Must define the competencies that an individual must demonstrate to be considered a surgical specialist
Must assess that the individual has obtained those competencies
Must assess that the individual has maintained and further developed and refined those competencies

11. CanMEDS Medical Expert Intrinsic roles Health Advocate Collaborator
Communicator
Manager
Scholar
Professional

12. CanMEDS 2015 Framework Competency Across the Continuum
Competency milestones within each existing Role
New competency milestones in each existing Role in training and throughout the entire career
New content – patient safety and interprofessionalism
Make it easier to teach and assess the CanMEDS Roles

13. Milestones
The Royal College defines milestones as the abilities expected of a physician or trainee at specific points in their development as professionals.
Educators will be better able to assess the areas where residents require help and identify if the resident is performing adequately

14. CanMEDS 2015
The abilities will be much more specific and related to stage of training
Undergraduate  Residency  Fellowship/Diploma  CPD
The scope of most practices changes with time
The competencies necessary to practice are under continuous change

15. Competency By Design – Time Course
2013/2014 – Development of CanMEDS 2015
Pilot Project – Pilot projects with specialty-specific competency milestones with early adopters – refine the system
E-Portfolio – personalized, spanning entire practice and including summative portfolios

16. What Will be the Challenges
Dedicated faculty – much greater commitment
More frequent and focused assessment
Unknown timelines for completion of training
Manpower issues
Prolonged training

17. The Toronto Orthopedic Model (Reznick, Alman)
Program Directors – Bill Kraemer, Peter Ferguson and Markku Nousiainen
21 modules in 3 phases
Residents move at their own pace
Use of simulation
Evaluation based upon MCQ, OSATS, multi-source feedback, patient assessment and management examination, observed histories and physicals, ward audits,etc.

18. Funding of Residency Education
Dependent on the Provincial Government
Funds allocated according to a ratio based upon undergraduate enrollment
Based upon typical times residents spend in training
Difficult to fund extra years
CBE could lead to both shorter and longer training times

19. Funding of Residency Education
Education based upon the concept of volunteerism is being challenged
Fewer Faculty positions available
Loss of Industry sponsorship for educational events

20. Post Residency Training
Fellowship training is the rule not the exception
Lack of uniformity (Diplomas)
Funding may be difficult
Conflict with residency education
Super Specialists who do not provide the basic care
Reality of lack of manpower planning

21. Post Residency Training
If everyone is doing fellowships what are we doing wrong in residency?
Should be personalizing training
More sub-specialties
Streamed programs