Consistently training surgical residents to become skilled and confident surgeons is a core mission with significant challenges for academic medical centers. Balancing surgical training, clinical and administrative duties, and research responsibilities requires a carefully structured and supportive training program.
To address these challenges, Duke Head and Neck Surgery & Communication Sciences has implemented an innovative surgical training program. This new framework is designed to gradually increase the independence and responsibility of residents in both the five-year conventional track (directed by Charles Woodard, MD) and the NIH R25 surgeon-scientist track in the Otolaryngology Residency Program (directed by Bradley J. Goldstein, MD, PhD, FACS).
By focusing on structured progression, personalized feedback, and hands-on experience, residency program leadership aims to improve the development of its residents, ensuring they are well-prepared for independent surgical practice.
The program has evolved over time. Initially, the department used a mentor model, where residents followed specific faculty members. But this system often left residents with inconsistent learning experiences.
“The resident’s ability to learn and progress was dependent on the faculty member and their individual processes for development,” says Russel R. Kahmke, MD, Associate Program Director of the Otolaryngology Residency Program.
The program then transitioned to a team-based model, which provided operative experience later in residency and a clinic-based experience earlier. This approach, however, delayed residents’ surgical skill development and gave the impression that junior residents couldn't handle advanced surgeries.
A New Approach
Recognizing these issues, residency program leadership collaborated with the Duke Department of Neurosurgery to develop the program. This approach codifies the steps of key indicator procedures and allows residents to progress through these steps independently as they gain competence.
The program has been refined to focus on case-by-case assessments of each trainee's skills. This individualized approach helps foster a more comprehensive and personalized training experience.
“Assessing each resident is more time-consuming, but currently it allows each trainee to feel that they've gained specific skills and knowledge for each case,” Dr. Kahmke says.
Several mechanisms support the success of the program. Personalized discussions during division meetings provide a platform for regular assessments of residents' strengths, weaknesses, and plans for improvement. Prep sheets, prepared by residents for each case, help them assess procedure indications, steps, postoperative plans, and training goals. Daily debriefs offer real-time feedback on the day's activities, allowing for immediate improvements and continuous learning.
The program stands out for its tailored guidance and opportunities for independent practice.
“We focus on the individual growth of the trainee rather than leaving them to develop skills alone or not giving them the freedom to develop independent decision-making,” Dr. Kahmke says.
Moving forward, the department plans to introduce directed one-on-one debriefing sessions throughout the day, along with monthly reassessments by each subspecialty team. This approach will provide continuous feedback and support, further improving the training experience and ensuring residents develop the skills needed for independent surgical practice.
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