Surgical education
What makes a competent surgeon?: Experts' and trainees' perceptions of the roles of a surgeon

https://doi.org/10.1016/j.amjsurg.2009.01.015Get rights and content

Abstract

Background

Assessment of surgical competence is a priority; however little is known about surgeons' perceptions of competence. We investigated components of competence and adequacy of training in achieving them.

Methods

Using questionnaires, Surgical Attendings and trainees rated the importance of 7 CanMEDS roles that define a competent surgeon (Medical Expert; Communicator; Collaborator; Manager; Health Advocate; Scholar; Professional) and whether training enabled them to achieve competency in each role.

Results

Ninety-two of 125 questionnaires (74%) were completed. Junior trainees attributed lower importance to the roles of Manager, Communicator, Collaborator, and Professional than senior trainees or Attendings. No surgeon stated that they had achieved competency in every role.

Conclusion

Trainee surgeons do not appreciate the importance of all the roles required of a competent surgeon and current training does not ensure competence in all roles. These gaps must be addressed to develop surgeons able to provide the highest quality of care.

Section snippets

Participants

One hundred twenty-five surgeons in a District General Hospital and a Teaching hospital in London were recruited into the study. Participants were identified by medical personnel lists and randomly selected from the fields of General, Orthopedic, Urology, Cardiothoracic, and Pediatric surgery within these hospitals (Table 1). Surgeons outside a formal accredited training program were excluded. The process of random selection was as follows: all potential names were first entered into a column

Results

In total, 92 of 125 participants (response rate 74%) responded to the questionnaire. We first present the importance of the different roles to defining a competent surgeon as perceived by the surgeons. We examine whether this was affected by the participants' grade (level of experience) using ANOVA. We then present the participants' views on whether they feel competent to perform each one of the roles using chi-square analysis. Finally, we present the multivariate analyses examining whether

Achievement of competency in each role

Table 3 shows participants' judgments of whether they have achieved competency at each one of the 7 roles. These judgments were submitted to chi-square analyses. The results of these analyses demonstrate that most participants perceived that they have reached competency levels in the role of a Professional. With regards to Medical Expert, Residents and Attendings reported having achieved this competency, but FYs reported not having done so. Senior Residents and Attendings also reported having

Comments

The 7 roles defined by the CanMEDS model reflect what every patient needs from a competent surgeon.12, 13 In this era of increased accountability, it is crucial that trainees recognize these needs and the surgical attributes required to meet them.18 More importantly, it is essential that modern, competency-based surgical training allows trainees to meet these needs. In this study, we aimed to evaluate whether trainee and senior surgeons understand the importance of each of the proposed

Conclusions

Surgical competence requires a complex set of interdependent roles and abilities. These include psychomotor, cognitive, and interpersonal abilities. Highlighted by the CanMEDS model, the making of a competent surgeon is dependent upon acquiring expertise in each of these roles. However, surgical trainees do not fully appreciate the importance of all of these roles to their development. Surgical training must highlight key elements of expertise, both in and out of the operative environment, thus

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    • Using Job Analysis for Identifying the Desired Competencies of 21st-Century Surgeons for Improving Trainees Selection

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      In this respect, an alternative method would be to focus on core competencies shared by all surgical programs and fields, which would allow the development of assessment methods suitable for selection to various surgical programs. The feasibility of this approach is supported by evidence showing that different surgical specialties share similar requirements and competencies,25-29 and by the existence of “core competencies” which are used for the selection and assessment of trainees across all surgical fields in many organizations who train surgeons, such as the Royal Australasian College of Surgeons, the Royal College of Surgeons in the United Kingdom, the American College of Surgeons, and the Royal College of Physicians and Surgeons of Canada. The present study was therefore conducted to (1) systematically identify the competencies required to become a competent surgeon in the 21st-century using job analysis across various surgical specialties, and (2) to evaluate their relative importance for selection for surgical training.

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    Funded by the BUPA Foundation.

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