The Anatomy of Change: A Scoping Review of Surgical Curriculum Renewal Processes

Marc A. Seifman; Robyn Woodward-Kron; Roi Y. Kagan; Kirsten Dalrymple; Aimee K. Gardner; Ian Incoll; Lars Konge; John T. Paige; Debra Nestel

doi:10.5334/g7cyhd05

Figures & Tables

Framework	Steps
Kern [20]	Problem Identification and General Needs Assessment
	Targeted Needs Assessment
	Goals and Objectives
Educational Strategies
Implementation
Evaluation and Feedback
Lee et al. [19]	Big picture decisions: the why?
Lee et al. [19]	Defining capabilities of graduates: the what?
Teaching, learning and assessment: the how?
Organisation: the where?
Carraccio et al. [18]	Competency identification
Carraccio et al. [18]	Determination of competency components and performance levels
Competency evaluation
Overall assessment of the process
Knox et al. [54]	Identify specifically what is expected of graduating plastic surgery residents (competencies)
	Break down these competencies into a logical stepwise series of markers of ability (milestones)
	Identify or develop educational strategies to facilitate instruction of these skills
Develop assessment tools that are easy to use and yet capable of accurately placing trainees along this continuum of achievement
Perform an outcomes evaluation to determine the effectiveness of competency-based medical education for achieving competencies and provide feedback for program improvement
Frank et al. [55]	Identify the abilities needed of graduates
Frank et al. [55]	Explicitly define the required competencies and their components
Define milestones along a development path for competencies
	Select educational activities, experiences and instructional methods
	Select assessment tools to measure progress along the milestones
Design an outcomes evaluation of the program
ADDIE	Analysis
	Design
	Development
Implementation
Evaluation

PRISMA flowchart depicting source search and selection process. (alt = ”PRISMA flowchart”).

Table 1

Characteristics of included sources.

CHARACTE RISTICS	SOURCE
CHARACTE RISTICS	SACHDEVA 2007 [36]	LILLEVANG 2009 [53]	WEBB 2009 [37]	MOALEM 2012 [38]	TAPIA 2014 [39]	MANSOURI 2015 [40]	DROLET 2017 [41]	CON FORTI 2018 [42]	NOUSIAINEN 2018 [43]	GARBARINO 2019 [44]	DICKINSON 2020 [46]	GADJRADJ 2020 [50]	INCOLL 2020 [52]	MADOR 2020 [45]	CHAN 2021 [47]	DADA 2022 [51]	KEARNEY 2022 [48]	RYAN 2024 [49]
Region study undertaken
North America (n = 14)	X		X	X	X	X	X	X	X	X	X			X	X		X	X
Europe (n = 2)		X										X
Africa (n = 1)																X
Australia (n = 1)													X
Education-focused journal
Yes (n = 8)		X		X			X	X	X					X	X			X
Open access source
Yes (n = 8)	X	X	X	X	X							X		X	X
Surgical subspecialty
All surgery (n = 2)		X		X
General surgery (n = 7)	X		X		X		X				X			X				X
Neurosurgery (n = 4)						X		X				X				X
Orthopaedic surgery (n = 3)									X				X		X
Plastic and Reconstructive surgery (n = 1)																	X
Obstetrics/Gynaecology (n = 1)										X
Research methods
Assessment tools (n = 2)			X												X
Delphi study (n = 1)																		X
Interviews/Focus groups (n = 3)		X						X						X
Literature review (n = 2)						X										X
Reflection on experience (n = 4)	X								X		X		X
Survey/Questionnaire (n = 7)		X			X		X	X		X		X					X
Educational theory referenced
Yes (n = 1)											X
Curriculum development framework referenced
Carraccio et al. [18] (n = 1)						X
Kern [20] (n = 3)					X						X			X
Knox et al. [54] (n = 1)						X
Lee et al. [19] (n = 1)														X
Evidence of the use of the steps in Kern’s framework
Step 1: Problem identification and general needs assessment (n = 9)				X	X	X				X	X		X	X	X	X
Step 2: Targeted needs assessment (n = 7)			X		X						X	X	X	X	X
Step 3: Goals and objectives (n = 9)	X			X	X				X		X	X	X	X				X
Step 4: Educational strategies (n = 7)					X	X			X	X	X		X					X
Step 5: Implementation (n = 5)		X			X				X		X		X
Step 6: Evaluation and feedback (n = 12)	X	X	X				X	X	X	X	X	X			X	X	X

[i] Note: Assessment tools include: MCQ: multiple choice question examination; ABSITE: American Board of Surgery In-training Examination; OSATS: Objective Structured Assessment of Technical Skill; UM-GCDMA: University of Michigan Geriatrics Clinical Decision-Making Assessment; UCLA Geriatrics Attitudes Scale; ITERs: In-Training Evaluation Reports; RES: Rotation Effectiveness Scores.

Table 2

Composition of curriculum renewal team by participant level.

LEVEL OF PARTICIPANT	DETAILS	SOURCES
Primary	Trainees, trainers/surgeons	[39 49 50]
Secondary	Subspecialty organisations Surgical education organisations Hospital boards/committees University committees Program directors Clinical competency committees	[36 37 39 42 43 47 49 52 53]
Tertiary	Accrediting/regulatory bodies National surgical colleges	[36 42 49 53]
Unclear		[38 40 41 44 45 46 48 51]
Combination: Primary-Secondary		[39]
Combination: Secondary-Tertiary		[36 42 53]
Combination: All levels		[49]

Table 3

Participant involvement by level.

LEVEL OF PARTICIPANT	DETAILS	SOURCES
Primary	Trainees, trainers/surgeons	[37 39 42 45 46 47 49 50 51 52]
Secondary	Subspecialty organisations Surgical education organisations Hospital boards/committees University committees Program directors Clinical competency committees	[41 42 44 45 48 49 52 53]
Tertiary	Accrediting/regulatory bodies National surgical colleges	[49 53]
Unclear/Not applicable		[36 38 40 43]
Combination: Primary-Secondary		[42 45 52]
Combination: Secondary-Tertiary		[53]
Combination: All levels		[49]

Barriers and Enablers of Surgical Curriculum Renewal (alt = ” Barriers and Enablers of Surgical Curriculum Renewal”).

The Anatomy of Change: A Scoping Review of Surgical Curriculum Renewal Processes

Figures & Tables

Figure 1

Table 1

Table 2

Table 3

Figure 2

Paradigm

My account