SKILLS ACQUISITION IN SURGERY – TRAINING AND ASSESSMENT Surgical Curriculum The Dutch Surgical resident curriculum ‘SCHERP’ is a six-year competency-based program with defined learning goals or attainment levels. The first four years are a ‘general residency’ program with rotations in different subspecialties. Postgraduate year (PGY) 5 and 6 of the Dutch surgical curriculum consist of a differentiation in vascular-, paediatric-, trauma-, oncological- or gastrointestinal surgery.20 Next to the entrustable professional activities (EPAs), that can contain specific non-technical skills and knowledge as well as operative procedures, the professional development of residents is monitored by instruments as short clinical assessments and 360-degree feedback, aimed at development in all CANMEDS domains (Figure 4).21 Figure 4: Dutch Surgical Curriculum EPA = entrustable professional activity, PGY = postgraduate year Technical skills are historically trained by a master-apprentice model in which the role of the resident gradually evolves from assistant to first surgeon. With more strict regulations of workhours and administrative obligations, the time spent in the operating theatre, however, is restricted. In the American ACGME residency program working hours are regulated tot 6080 work hours per week. This regulation of the workhours leads to a decrease in operative case load during training.22 In the Dutch collective employment agreement in the medical sector the working hour maximum is even lower with a maximum of 48 hours, including 10 12 1
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