A Competency-Based Approach to Functional Neurosurgery Training: Insights From the Surgical Autonomy Program.

IF 3.2 3区医学 Q2 CLINICAL NEUROLOGY

Neuromodulation Pub Date : 2025-07-18 DOI:10.1016/j.neurom.2025.06.010

Katrina Hon, Pranav Warman, Vishal Venkatraman, Alexander D Suarez, Margot Kelly-Hendrick, Samuel Teshome, Rajeev Dharmapurikar, Michael M Haglund, Shivanand P Lad

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引用次数: 0

Abstract

Background: The Accreditation Council for Graduate Medical Education (ACGME) relies on case minimums as a standard competency indicator, set by expert opinion rather than individual resident performance. We used the Surgical Autonomy Program, a validated method of competency-based resident evaluation, to track autonomy progression across residency and compare the reported number of cases it took residents to reach autonomy with the case minimums set by the ACGME.

Materials and methods: Data from neurosurgery residents across 14 institutions on five functional procedures (deep brain stimulation [DBS], internal pulse generator implantation [IPG], percutaneous spinal cord stimulator placement [SCS], epilepsy vagal nerve stimulation [VNS], and epilepsy stereo electroencephalography [SEEG]) were analyzed. Surgical autonomy was measured using a four-point Teach, Advise, Guide, Solo scale (TAGS), a modified version of the Zwisch scale in which "T" represents the lowest and "S" the highest level of independence. These scores were tracked over time to create learning curves delineating autonomy progression. The number of cases required to achieve competency for the first and second time were determined and compared with ACGME case minimums. Results were analyzed with descriptive statistics.

Results: On average, residents showed advanced competency, defined as scoring among the top two TAGS scores, approximately postgraduate year (PGY) 3 for DBS, VNS, and SCS cases, and approximately PGY-2 for IPG and SEEG cases. Median case volumes for achieving competency (first time, second time) were DBS 16, 16 (ACGME minimum [min.] ten); IPG 12, 13 (min. ten); SCS 14, 16 (min. ten); VNS 6, 12 (min. ten); SEEG five, seven (min. ten). Individual variance in competency levels and rate of progression was observed.

Conclusion: Although DBS, IPG, and SCS procedures required more cases to reach competency than ACGME standards suggest, VNS and SEEG required fewer, indicating that case complexity and learning curves vary significantly across subspecialties. A competency-based approach, recognizing individual progression, could enhance surgical training efficacy and improve assessment of surgical autonomy on graduation. Future studies should explore the long-term outcomes of competency-based training to validate these findings further.

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以能力为基础的功能性神经外科训练方法：来自手术自主计划的见解。

背景：研究生医学教育认证委员会（ACGME）依靠病例最低限度作为标准能力指标，由专家意见而不是个别住院医生的表现设定。我们使用了外科自主计划，这是一种基于住院医师能力评估的有效方法，来跟踪住院医师的自主进展，并将住院医师达到自主所需的报告病例数与ACGME设定的病例最少数量进行比较。材料和方法：对来自14家医院的神经外科住院医师的5项功能手术（深部脑刺激[DBS]、内脉冲发生器植入[IPG]、经皮脊髓刺激器放置[SCS]、癫痫迷走神经刺激[VNS]和癫痫立体脑电图[SEEG]）数据进行分析。手术自主性采用4点Teach， Advise, Guide， Solo量表（TAGS）进行测量，这是Zwisch量表的修改版本，其中“T”代表最低水平，“S”代表最高水平的独立性。随着时间的推移，这些分数被跟踪，以创建描述自主进步的学习曲线。确定了获得第一次和第二次资格所需的病例数，并将其与ACGME的最低病例数进行了比较。结果用描述性统计进行分析。结果：平均而言，住院医生表现出高级能力，定义为得分在前两名之间，DBS， VNS和SCS病例约为研究生学年（PGY） 3， IPG和SEEG病例约为PGY-2。实现能力（第一次，第二次）的中位数病例量为DBS 16,16 (ACGME最低[min.] 10)；IPG 12,13 (min. 10)；SCS 14,16（分钟10分钟）；VNS 6,12 (min. 10)；见五，七（分十）。观察到能力水平和进步速度的个体差异。结论：虽然DBS、IPG和SCS程序需要比ACGME标准更多的病例才能达到能力，但VNS和SEEG程序所需的病例较少，这表明不同亚专科的病例复杂性和学习曲线差异显著。以能力为基础的方法，认识个体的进步，可以提高外科培训的效果，改善毕业时的手术自主性评估。未来的研究应该探索基于能力的培训的长期结果，以进一步验证这些发现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neuromodulation 医学-临床神经学

CiteScore

6.40

自引率

3.60%

发文量

978

审稿时长

54 days

期刊介绍： Neuromodulation: Technology at the Neural Interface is the preeminent journal in the area of neuromodulation, providing our readership with the state of the art clinical, translational, and basic science research in the field. For clinicians, engineers, scientists and members of the biotechnology industry alike, Neuromodulation provides timely and rigorously peer-reviewed articles on the technology, science, and clinical application of devices that interface with the nervous system to treat disease and improve function.