Proficiency Based Progression Training

At the core of the curriculum are unambiguously defined metrics that include:

• Steps (tasks to complete)
• Errors (deviations from optimal performance)
• Both steps and errors are derived from a careful task deconstruction of the procedure (or set of skills to be mastered) by experienced practitioners
• Notably, the enactment of errors has repeatedly been shown to be the greatest discriminator between the performance of novice and experienced surgeons
• The product represents a comprehensive performance characterization of the procedure to be learned

Building a PBP Training Program at AANA

• The AANA Copernicus Initiative was a 4-year series of research studies investigating the merit and impact of the PBP training model
• Performance assessments are based on the binary scoring of the individual metrics (i.e. the event either “was” or “was not” observed to occur by the evaluator)
• The result is that the assessment of a trainee’s performance is objective, transparent, and fair
• Attainment of the proficiency benchmark quality assures that the trainee has acquired the desired skills

Outcomes of PBP Training at AANA

• A prospective, randomized, and blinded trial demonstrated that orthopedic residents randomized to the PBP curriculum completed significantly more tasks and enacted 55% fewer errors
• The PBP group were also 5 – 7 times more likely to achieve the proficiency benchmark than the group who were trained with conventional methods
• The striking results of the Copernicus research represent the need for a paradigm shift in surgical skills training from the apprenticeship to the PBP training model

Application of PBP Training Outside of AANA

• The PBP training and assessment methodology is applicable to any scenario in which high quality skills training is essential
• The Copernicus strategy has special merit when applied to new and innovative techniques
• Superior training would ensure that sophisticated and technically demanding tools, instruments, and implants were employed safely and effectively
• Metric-based assessment strategies could be employed to establish appropriate barriers to entry thresholds in which the scope of practice and competency issues are a potential concern