Our road to patient-centred, competency-based education
So, how can an academic surgical unit benefit from the computer code development skills of people such as Wes McKinney of pandas fame or the educational skills of an engineering professor such as Lorena Barba of Numerical MOOC (numerical massive open online course) fame? Answer: A lot. This post is about our efforts to transition from antiquated to more modern forms of surgical training and assessment, all with the help of the one of the best software projects out there, Project Jupyter. This is Groote Schuur after all!
The teaching and assessment paradigm has stood for many, many decades. Do four years of surgical rotations, watch what your superiors do, present on ward rounds, go to the clinic, take calls, assist in theatre, do some cases, attend (most) academic meetings (read: watch yet another PowerPoint presentation), pass three exams. Presto. Specialist. That’s how its done now, that how is was done in the 00’s, the 1990’s, 80’s, 70’s, 60’s, 50’s, 40’s,… You get the point. Hey, depending on which source you read, it was in the the 40’s that the overhead projector was first used by the military in World War II. If you think about it, an overhead transparency projector is just PowerPoint without a computer. If you slipped in one transparency while the other is still showing, it;s just like a slide transition!
Depending on your working environment, you might be surrounded by people in full support of this form of education. It has always worked that way. Why change now? Well, as the argument goes, by that logic bloodletting should still be all the rage. You will note that in contrast to medical education, actual medicine has come on in leaps and bounds. We buy into the new paradigm that is evidence-based medicine. So why is it so difficult to accept and, even more difficult, to practice evidence based medical education?
Some of us are fortunate enough to work in countries where there are national efforts and frameworks in place to motivate for change. Have a look at the CanMEDS program in Canada. Two of the key concepts in their program are patient-centred care and competency-based assessment. Without going into the detail of their programs, I want to concentrate on these two aspects. Reason being, it gives us a practical starting point. For those unfortunate enough not to work in countries with national frameworks and support, small steps have to be taken.
So what solutions have we implemented in the Acute Care Surgery Unit at Groote Schuur Hospital? First and foremost, involve the patients. They are at the centre of what we do after all. Why should they have no say in the evaluation of their care? Fortunately, validated tools are available when you turn to the literature. At this time we use the Jefferson scale of patient’s perception of physician empathy. Moving on to competency assessment, there is the Ward Round Assessment tool amongst many others. Point being, we are moving away from the 20-second, mark either average or above average on the end-of-rotation subjective question scorecard. You know the one: (1) Knowledge, (2) Surgical skill, (3) Punctuality…
Now, the Acute Care Surgery Unit is brand new (you can learn more about us from my talk at this year’s Association of Surgeons of South Africa conference here). We certainly have no research assistants, money, or personnel to help us in our efforts towards patient-centred, competency-based education. This whole process has to be self-driven. Solutions to the problem? Well, that’s the easy bit. The World has changed over the last few years. No longer is knowledge locked away behind expensive paywalls. If you want to learn something, go online. For me, it all started with the Massachusetts Institute of Technology (MIT). Their open courseware opened a whole new world to me. MIT and the massive open online course platforms such as Coursera (to which I will shortly contribute), EdX and FutureLearn (to name but a few) are handing the keys of knowledge to all humankind.
This brings me to Project Jupyter and computer languages such as IPython and Julia. If you have no access to software development teams and big budget research units, do yourself a favor, search for tutorials on these projects. You will find so many wonderful men and women, going out of their way to empower you with these tools. Even a lowly surgeon such as myself have online tutorials. Have a look at these:
The Klopper Lectures on Julia
Mini project: Medical research using Julia
Back to what this post is all about. Here, you will find a link to some of our results using Project Jupiter (Github). To protect patients and trainees, the data have been altered and are not a true reflection of anyone or any given period. What it does show, though, is how easy it is to use data to properly guide the training of our residents; and this is just our first small step.