219faculty questionnaires supplemented by focus groups, a curriculum affectionately
referred to as “boot camp” was developed in 2000 for interns beginning July of their
PGY-1 year. This program set out to establish learners’ proficiency in training and
offer a foundational baseline to track their progress moving forward. These learning
modules would later become the foundation of the American College of Surgeons
(ACS) and Association of Program Directors in Surgery (APDS) National Surgical
Skills Curriculum [ 3 ].
For each module, a formal overview is provided to the learner in advance that
communicates relevant information including rationale, objectives, a detailed
description along with step-by-step walk-through of the module, and criteria for
proficiency. Weekly curriculum covers basic surgical skills such as tissue handling,
dissection, and wound closure. Learning issues which all PGY-1 surgery residents
are required to complete are covered by modules on knot tying, basic suturing, cen-
tral venous access, chest tube placement, and emergency surgical airway. Attendance
and participation in modules are coordinated with the resident call schedule.
Modules are planned and scheduled utilizing a block system, which arranges for a
learner to experience different modules on days spread over multiple weeks in inter-
vals as opposed to mass practice [ 10 ]. Additional times for open skills practice were
scheduled to better accommodate the demanding responsibilities of an intern.
Learning modules are led by two faculty members assisted by a skills coach to
both lead and assist with discussion of how the skill is integrated into surgery. For
select basic surgical skills training, there was determined to be no difference in
improvement of a student’s performance whether facilitated by a nonphysician
skills coach or faculty surgeon [ 11 ]. By sharing the responsibilities of teaching, a
consistent commitment to a high student/faculty ratio of 4:1 is maintained while
avoiding faculty burnout, which has been paramount to the success of the program.
By informing learners of common critical errors prior to the learning module, acqui-
sition of skills and performance was enhanced during instruction about correct per-
formance of basic surgical skills [ 12 ].
The curriculum culminates in verification of proficiency (VOP) evaluations
developed from previous performance-based assessments of technical skills includ-
ing objective structured assessment of technical skills evaluation methods [ 13 , 14 ].
Residents are required to demonstrate proficiency on each of the VOP modules by
means of the video assessment prior to performing any of the required procedures
on the floor or in the operating room. If a learner didn’t meet the necessary require-
ments of their assessment, additional remediation curricula were scheduled until a
student met the requirements of the module. The VOP evaluations as shown in
Fig. 12.1 empowered educators to swiftly and acutely learn where improvement
was necessary on a learner’s road to proficiency across a broad spectrum of proce-
dures and practices [ 13 ].
We found that faculty volunteerism improved employing an automated video
capturing system. This Internet-based program has proved more flexible in that it
allows faculty to watch a de-identified learner from the comfort of their home or
office. Simultaneously, evaluators are able to fill out their VOP evaluation on a split
screen to objectively assess surgical skills performance. Educators have the ability
12 Role of the Surgeon Educator in Leading Surgical Skills Center Development