Establishing Competency Assessment Standards for Graduating Neurosurgery, Plastic Surgery, and Orthopedic Surgery Residents in Peripheral Nerve Surgery.

Abstract

Background and objectives: Peripheral nerve decompression (PND), including carpal tunnel release and ulnar nerve decompression, is a common procedure performed by neurosurgeons, orthopedic surgeons, and plastic surgeons. Because of the lack of established assessment parameters and performance standards for Entrustable Professional Activities in PND in the current literature, we conducted this study to define these assessment parameters and identify the expected standards of performance for graduating residents across the fields of neurosurgery, plastic surgery, and orthopedic surgery.

Methods: Electronic survey was sent to neurosurgery, plastic surgery, and orthopedic surgery faculty to obtain their perspectives on parameters of assessment and the expected standard competence performance regarding PND.

Results: Sixty-one participants returned fully completed questionnaires giving a completion rate of 53%. The overall recommended number of assessments was 5, and the recommended number of assessors was 2. Regarding each specialty, there was no significant difference in the recommended number of assessments; however, neurosurgeons and orthopedic surgeons recommended a significantly fewer median number of assessors (n = 2) than plastic surgeons (n = 3) (P = .01). Based on total responses, 77% believed that PND was appropriate for the general practice of their specialties. The majority of respondents expected graduating residents to achieve level E (50.8%) or level D (42.6%) for PND. There was no significant difference in the belief that PND was appropriate for general practice of their specialty or considering entrustment level E as a graduation target across the specialties.

Conclusion: Our study found significant agreement across specialties in the parameters of assessment expected of residents and the expected levels of mastery for independent practice. These results are relevant to residency programs and certification bodies like the American Accreditation Council for Graduate Medical Education in designing the assessment of milestones related to peripheral nerve surgery. This study has important implications for the design of residency and fellowship education in peripheral nerve surgery internationally.