A framework to improve variability in continuing professional education: stepwise teaching and evaluation for practicing surgeons (FIVE-STEPS)

The continual advancement of new surgical technologies and techniques requires surgeons to acquire new skills throughout the duration of their careers. However, the absence of standardized methods by which they do so and demonstrate competence underscores a need for a unified approach, with the overall goal of mastery and safe patient care. We propose a new framework for ongoing skill acquisition and assessment among practicing surgeons.

We reviewed the education literature’s most relevant models on competence, learning, and assessment and integrated them into a comprehensive approach to training and feedback.

Our framework involves a stepwise progression through five phases: 1. cognitive training, 2. informed observation, 3. structured practice, 4. monitored independence, and 5. maintenance. Each phase involves instruction and assessment activities that are tailored to the learner’s skill level.

The strength of this approach is its incorporation of numerous complementary theories, scope across the learning continuum, opportunities to integrate with existing educational programs, and flexibility to accommodate the real-world needs of learners and educators alike. Subsequent work will assess the feasibility of and learner reception to educational programs which follow this framework and lay the groundwork for further investigation on potential impacts for surgeons, patients, and healthcare systems at large. We hope that this proposal will spur broader discussions on the process by which practicing surgeons learn and are evaluated on new skills.