Abstract
The paradigm shift within medical education to one that is outcome based has made competency assessment critically important. Currently, residents are expected to meet and exceed specific core competencies prior to completion of training. Furthermore, attending physicians have a litany of challenges in maintaining their training after graduation. Given the multitude of practitioners requiring assessment in some phase of training, it is apparent the number of challenges that exist in creating a framework for competency assessment that will work for everyone. One such tool that can be utilized to create a fully manipulatable assessment that will work for varying levels of practitioners is human simulation, coupled with a clear guide or protocol detailing what observable behaviors are expected. A low- or high-fidelity simulated environment, using a myriad of personnel and devices, can ensure patient safety and at the same time allows for manipulation of variables to guarantee consistent delivery of scenarios to those being assessed. Competency assessment in anesthesiology can and should be used to ensure adequate introduction and preparation to monitor the development and progression of both technical and nontechnical skills, as well as for attending physicians to ensure proper maintenance of licensure to retraining of physicians to reenter practice.
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References
Goldberg A, et al. High-stakes simulation-based assessment for retraining and returning physicians to practice. Int Anesthesiol Clin. 2015;53(4):70–80.
McGaghie WC, et al. A critical review of simulation-based medical education research: 2003–2009. Med Educ. 2010;44(1):50–63.
Issenberg SB, et al. Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Med Teach. 2005;27(1):10–28.
Weller JM, et al. Psychometric characteristics of simulation-based assessment in anaesthesia and accuracy of self-assessed scores. Anaesthesia. 2005;60(3):245–50.
Cook DA. When I say... validity. Med Educ. 2014;48(10):948–9.
Cook DA, et al. A contemporary approach to validity arguments: a practical guide to Kane’s framework. Med Educ. 2015;49(6):560–75.
Kane MT. Validating the interpretations and uses of test scores. J Educ Meas. 2013;50(1):1–73.
Gingerich A, Regehr G, Eva KW. Rater-based assessments as social judgments: rethinking the etiology of rater errors. Acad Med. 2011;86(10 Suppl):S1–7.
Yeates P, et al. Seeing the same thing differently: mechanisms that contribute to assessor differences in directly-observed performance assessments. Adv Health Sci Educ Theory Pract. 2013;18(3):325–41.
Accreditation Council for Graduate Medical Education. Next Accreditation System (NAS) and Milestones – a resident perspective. 2014 [cited 2016 09/25]. Available from: http://www.acgme.org/portals/0/pdfs/resident-services/9nasresidentsmay2014.pdf.
The Accreditation Council for Graduate Medical Education and The American Board of Anesthesiology. The Anesthesiology Milestone Project. 2015 [cited 2016 09/20]. Available from: https://www.acgme.org/Portals/0/PDFs/Milestones/AnesthesiologyMilestones.pdf.
Accreditation Council for Graduate Medical Education and The American Board of Medical Specialties. ACGME competencies: suggested best methods for evaluation (Toolbox of assessment methods). 2000 [cited 2016 09/26]. Available from: https://www.partners.org/Assets/Documents/Graduate-Medical-Education/ToolTable.pdf.
Miller GE. The assessment of clinical skills/competence/performance. Acad Med. 1990;65(9 Suppl):S63–7.
Pangaro L. A new vocabulary and other innovations for improving descriptive in-training evaluations. Acad Med. 1999;74(11):1203–7.
Dreyfus, S.E. A five-stage model of the mental activities involved in directed skill acquisition. 1980 [cited 2016 09/28]. Monograph available online. Available from: http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA084551&Location=U2&doc=GetTRDoc.pdf.
Eraut M. Developing professional knowledge and competence. London: RoutledgeFalmer; 1994. p. 124.
Barrows HS, Abrahamson S. The programmed patient: a technique for appraising student performance in clinical neurology. J Med Educ. 1964;39:802–5.
Abrahamson S, Denson JS, Wolf RM. Effectiveness of a simulator in training anesthesiology residents. J Med Educ. 1969;44(6):515–9.
Kane MT. An argument-based approach to validity. Psychol Bull. 1992;112(3):527–35.
Downing SM, Haladyna TM. Validity and its threats. In: Downing SM, Yudkowsky R, editors. Assessment in health professions education. New York: Routledge; 2009. p. 21–56.
Goldmann K, Steinfeldt T. Acquisition of basic fiberoptic intubation skills with a virtual reality airway simulator. J Clin Anesth. 2006;18(3):173–8.
Maran NJ, Glavin RJ. Low- to high-fidelity simulation – a continuum of medical education? Med Educ. 2003;37(Suppl 1):22–8.
Demaria S Jr, et al. Adding emotional stressors to training in simulated cardiopulmonary arrest enhances participant performance. Med Educ. 2010;44(10):1006–15.
USMLE. Bulletin of Information. 2016 [cited 2016 09/30]. Available from: http://www.usmle.org/pdfs/bulletin/2016bulletin.pdf.
Baker KS, Cormican D, Seidman PA. Summer anesthesiology externship: demonstrating the ability of early clinical involvement to educate and increase specialty interest. J Educ Perioper Med. 2012;14(4):E063.
Fletcher GC, et al. The role of non-technical skills in anaesthesia: a review of current literature. Br J Anaesth. 2002;88(3):418–29.
Glavin RJ. Excellence in anesthesiology: the role of nontechnical skills. Anesthesiology. 2009;110(2):201–3.
Flynn FM, Sandaker K, Ballangrud R. Aiming for excellence – a simulation-based study on adapting and testing an instrument for developing non-technical skills in Norwegian student nurse anaesthetists. Nurse Educ Pract. 2016;22:37–46.
Lyk-Jensen HT, et al. Assessing nurse anaesthetists’ non-technical skills in the operating room. Acta Anaesthesiol Scand. 2014;58(7):794–801.
Wunder LL, et al. Objective structured clinical examination as an educational initiative for summative simulation competency evaluation of first-year student registered nurse anesthetists’ clinical skills. AANA J. 2014;82(6):419–25.
Wunder LL. Effect of a nontechnical skills intervention on first-year student registered nurse anesthetists’ skills during crisis simulation. AANA J. 2016;84(1):46–51.
Accreditation Council for Graduate Medical Education. Specialty-specific Duty Hour Definitions. 2012 [cited 2016 09/29]. Available from: http://www.acgme.org/Portals/0/PDFs/DH_Definitions.pdf.
Mudumbai SC, et al. External validation of simulation-based assessments with other performance measures of third-year anesthesiology residents. Simul Healthc. 2012;7(2):73–80.
Berkenstadt H, et al. Deficits in the provision of cardiopulmonary resuscitation during simulated obstetric crises: results from the Israeli Board of Anesthesiologists. Anesth Analg. 2012;115(5):1122–6.
Ben-Menachem E, et al. Objective structured clinical examination-based assessment of regional anesthesia skills: the Israeli National Board Examination in anesthesiology experience. Anesth Analg. 2011;112(1):242–5.
Flin R, et al. Anaesthetists’ non-technical skills. Br J Anaesth. 2010;105(1):38–44.
Fehr JJ, et al. Simulation-based assessment of pediatric anesthesia skills. Anesthesiology. 2011;115(6):1308–15.
Blum RH, et al. A method for measuring the effectiveness of simulation-based team training for improving communication skills. Anesth Analg. 2005;100(5):1375–80, table of contents
Malec JF, et al. The mayo high performance teamwork scale: reliability and validity for evaluating key crew resource management skills. Simul Healthc. 2007;2(1):4–10.
Blum RH, et al. Simulation-based assessment to identify critical gaps in safe anesthesia resident performance. Anesthesiology. 2014;120(1):129–41.
Goldberg A, et al. Learning through simulated independent practice leads to better future performance in a simulated crisis than learning through simulated supervised practice. Br J Anaesth. 2015;114(5):794–800.
Wayne DB, et al. A longitudinal study of internal medicine residents’ retention of advanced cardiac life support skills. Acad Med. 2006;81(10 Suppl):S9–S12.
Wayne DB, et al. Mastery learning of advanced cardiac life support skills by internal medicine residents using simulation technology and deliberate practice. J Gen Intern Med. 2006;21(3):251–6.
Wayne DB, et al. Simulation-based education improves quality of care during cardiac arrest team responses at an academic teaching hospital: a case-control study. Chest. 2008;133(1):56–61.
Rodgers DL, Securro S Jr, Pauley RD. The effect of high-fidelity simulation on educational outcomes in an advanced cardiovascular life support course. Simul Healthc. 2009;4(4):200–6.
The American Board of Anesthesiology. The American Board of Anesthesiology: APPLIED (Staged Exams). 2016 [cited 2016 09/30]. Available from: http://www.theaba.org/Exams/APPLIED-(Staged-Exam)/About-APPLIED-(Staged-Exam).
The American Board of Anesthesiology. Applied Examination. [cited 2016 12/13/2016]. Available from: http://www.theaba.org/PDFs/APPLIED-Exam/APPLIED-OSCE-ContentOutline.
The American Board of Anesthesiology. MOCA Part 4 Requirements. [cited 2016]. Available from: http://www.theaba.org/PDFs/MOCA/MOCA-2-0-Part-4-Requirements.
Steadman RH, et al. Practice improvements based on participation in simulation for the maintenance of certification in anesthesiology program. Anesthesiology. 2015;122(5):1154–69.
Levine AI, et al. Simulation-based Maintenance of Certification in Anesthesiology (MOCA) course optimization: use of multi-modality educational activities. J Clin Anesth. 2012;24(1):68–74.
Grace ES, et al. Physicians reentering clinical practice: characteristics and clinical abilities. J Contin Educ Heal Prof. 2011;31(1):49–55.
Jewett EA, Brotherton SE, Ruch-Ross H. A national survey of ‘inactive’ physicians in the United States of America: enticements to reentry. Hum Resour Health. 2011;9:7.
Gallagher CJ, Tan JM. The current status of simulation in the maintenance of certification in anesthesia. Int Anesthesiol Clin. 2010;48(3):83–99.
DeMaria S Jr, Levine AI, Bryson EO. The use of multi-modality simulation in the retraining of the physician for medical licensure. J Clin Anesth. 2010;22(4):294–9.
Levine AI, et al. Role of simulation in U.S. physician licensure and certification. Mt Sinai J Med. 2012;79(1):140–53.
Steadman RH, Huang YM. Simulation for quality assurance in training, credentialing and maintenance of certification. Best Pract Res Clin Anaesthesiol. 2012;26(1):3–15.
DeMaria S Jr, et al. Simulation-based assessment and retraining for the anesthesiologist seeking reentry to clinical practice: a case series. Anesthesiology. 2013;119(1):206–17.
Ilgen JS, et al. A systematic review of validity evidence for checklists versus global rating scales in simulation-based assessment. Med Educ. 2015;49(2):161–73.
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Shah, A., DeMaria, S., Goldberg, A. (2020). Competency Assessment. In: Mahoney, B., Minehart, R., Pian-Smith, M. (eds) Comprehensive Healthcare Simulation: Anesthesiology . Comprehensive Healthcare Simulation. Springer, Cham. https://doi.org/10.1007/978-3-030-26849-7_6
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