Proficiency Based Progression Training

Proficiency Based Progression (PBP) Training is an approach to teaching skills which dictates that the trainee must acquire and demonstrate basic skill sets before progressing on to more advanced techniques

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
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