Assessing Competencies

The development of the dependable measures for evaluating competencies of the anesthesia trainees is a topic of high interest and debate. The Accreditation Council for Graduate Medical Education (ACGME) defines competencies as specific knowledge, skills, behaviors and attitudes and the appropriate educational experiences, and outlines six core competencies to be assessed during training: medical knowledge, patient care, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice. The traditional global “end of rotation” faculty evaluation is now considered largely insufficient alone to measure these new competencies, and accomplishment of certain performance milestones by the trainee is expected. Yet, outside of evaluation of factual knowledge, adequate assessment of the trainee’s dexterity and performance can prove challenging, even over the full course of training.

The SHANA Education Board recognizes that during head and neck anesthesia training, difficulties in assessment of the trainee’s performance will be compounded by a traditionally short (one month or less) duration of the head and neck anesthesia rotation. The Education Board holds an opinion that adequate assessment of ACGME competencies, such as knowledge, technical skills, and patient care should remain the most important tasks during the head and neck anesthesia training. Some of the examples for evaluating these competencies during head and neck anesthesia training are listed below.

1. For evaluation of KNOWLEDGE and SKILLS:
   • List 5 general principles of ENT anesthesia.
   • Describe 6 different tests for assessing the patient’s airway.
   • Draw the ASA Difficult Airway Algorithm.
   • Describe technique of moderate deliberate hypotension.

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Comprehensive pretests, posttests and oral exams in the field of head and neck anesthesia and difficult airway management should be able to adequately assess factual trainee’s knowledge. The development of more complex tests of cognitive and psychomotor skills should be encouraged, especially for advanced learners, and for the head and neck anesthesia fellowship training.

For proper assessment of the trainees, the Education Board highly recommends to clearly define learning outcomes for each educational objective. Such objectives and outcomes should be realistic and aim at the “passing score”, corresponding to the trainee’s “fair” performance. The trainees in head and neck anesthesia should understand the performance expectations and performance grading from the start, and both the trainees and faculty should deem the evaluation process fair.

The Education Board recommends that each of the assessed competencies should be measured on at least three occasions, and by expert multiple evaluators, to ensure intra- and inter-faculty reliability in assessment, and reproducibility of the results (concurrent validity). The assessment tools must be feasible and easy to use, and they should be able to provide quantitative data (grading system) whenever possible. Such summative assessment can be done according to ACGME guidelines (unsatisfactory = several behaviors performed poorly or missed, ratings 1-3; satisfactory = most behaviors performed acceptably, ratings 4-6; superior = all behaviors performed very well, ratings 7-9), or other numeric scales used to grade performance of any element of performance or skill. Formative evaluation of the trainee should ideally be conducted in the beginning, in the middle, and at the end of head and neck anesthesia training, and constructive feedback to the trainees should be provided on the daily basis.

Individual head and neck anesthesia training programs are encouraged to develop their own assessment tools, which suit best their clinical practice and teaching environment.

Evaluation of learning, competence and performance of the established anesthesia practitioners in the field of head and neck anesthesia can be facilitated through the dedicated CME courses and web-based tutorials.