Improving Skills Development in Residency Using a Deliberate-Practice and Learner-Centered Model

Objectives/Hypothesis: Work-hour restrictions, increased workload, and subjective assessment of competency are major threats to the efficacy of the traditional apprenticeship model of surgical training in modern surgical practice. In response, medical educators are developing time-and resource-efficient competency-based models of surgical training. The purpose of our project was to develop, implement, and measure the outcomes of such objective and structured programs in otolaryngology. We also investigated factors affecting the learning curve, especially deliberate practice, formative feedback, and learners' autonomy. Study Design: Prospective, longitudinal study. Methods: To measure the surgical skills of residents, we first developed and tested objective tools for otolaryngology procedures. Based on these instruments, we identified milestones of the procedures. Training on a virtual-reality simulator was validated to shorten the learning curve. We also studied a learner-centered approach of training, factors affecting the learning curve, and barriers to a competency-based model. Results: The objective tools were found to be a feasible, reliable, and valid opportunity for measuring competency in both the laboratory and operating room. With the formative assessment from these tools, residents had a remediation target to be achieved by deliberate practice. The milestones helped identify the threshold of competency, and deliberate practice on the simulator gave an opportunity for improving skills. The learner-centered approach allowed flexibility and personalized learning by shifting the responsibility of the learning process to the learners. Conclusion: The competency-based model of residency, based on the principles of deliberate practice and a learner-centered approach, is a feasible model of residency training that allows development of competent surgeons and hence improves patient outcomes. Despite these advantages, challenges to this model require a concerted effort to overcome and fully implement these principles of training beyond just technical skills, ultimately creating well-rounded medical professionals and leaders in the surgical field.