Metric-Based Training to Proficiency: What Is It and How Is It Done?

  • Anthony G. Gallagher
  • Gerald C. O’Sullivan
  • Gerald C. O’Sullivan
Part of the Improving Medical Outcome - Zero Tolerance book series (IMOZT)


In countries such as the UK and Ireland, high profile medical error cases had ­profound implications for the process under which doctors were deemed qualified to practice medicine. It also brought to the fore once again the debate about competency.


Skill Acquisition Carotid Artery Stenting Virtual Reality Simulator Trainee Surgeon Educational Supervisor 
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  1. Ahlberg G, Enochsson L, Gallagher AG, et al. Proficiency-based virtual reality training significantly reduces the error rate for residents during their first 10 laparoscopic cholecystectomies. Am J Surg. 2007;193(6):797-804.PubMedCrossRefGoogle Scholar
  2. Aretz HT. How good is the newly graduated doctor and can we measure it? Med J Aust. 2003;178(4):147-147.PubMedGoogle Scholar
  3. Barrows HS, Abrahamson S. The programmed patient: a technique for appraising student performance in clinical neurology. Acad Med. 1964;39(8):802.Google Scholar
  4. Beall DP. The ACGME institutional requirements: what residents need to know. J Am Med Assoc. 1999;281(24):2352.CrossRefGoogle Scholar
  5. Bryant J. Health and the Developing World. Ithaca: Cornell University Press; 1969.Google Scholar
  6. Dictionary CC. Thesaurus. New York: Harper Collins; 1995.Google Scholar
  7. Dreyfus HL. What Computers Can’t Do: the Limits of Artificial Intelligence. New York: HarperCollins Publishers; 1979.Google Scholar
  8. Dreyfus HL, Dreyfus SE, Athanasiou T. Mind over Machine. New York: Free Press; 1986.Google Scholar
  9. Dreyfus HL, Dreyfus SE, Athanasiou T. Mind over Machine: The Power of Human Intuition and Expertise in the Era of the Computer. USA: Simon and Schuster; 2000.Google Scholar
  10. Epstein RM, Hundert EM. Defining and assessing professional competence. J Am Med Assoc. 2002;287(2):226.CrossRefGoogle Scholar
  11. Frank JR. The CanMEDS 2005 Physician Competency Framework. Better Standards. Better Physicians. Better Care. Ottawa: The Royal College of Physicians and Surgeons of Canada; 2005.Google Scholar
  12. Gallagher AG, Cates CU. Approval of virtual reality training for carotid stenting: what this means for procedural-based medicine. J Am Med Assoc. 2004a;292(24):3024-3026.CrossRefGoogle Scholar
  13. Gallagher AG, Cates CU. Virtual reality training for the operating room and cardiac catheterisation laboratory. Lancet. 2004b;364(9444):1538-1540.PubMedCrossRefGoogle Scholar
  14. Gallagher AG, Satava RM. Virtual reality as a metric for the assessment of laparoscopic psychomotor skills. Learning curves and reliability measures. Surg Endosc. 2002;16(12):1746-1752.PubMedCrossRefGoogle Scholar
  15. Gallagher AG, Richie K, McClure N, McGuigan J. Objective psychomotor skills assessment of experienced, junior, and novice laparoscopists with virtual reality. World J Surg. 2001;25(11):1478-1483.PubMedCrossRefGoogle Scholar
  16. General Medical Council. Tomorrow’s Doctors: Recommendations on Undergraduate Medical Education. London: GMC; 1993.Google Scholar
  17. Grantcharov TP, Kristiansen VB, Bendix J, Bardram L, Rosenberg J, Funch-Jensen P. Randomized clinical trial of virtual reality simulation for laparoscopic skills training. Br J Surg. 2004;91(2):146-150.PubMedCrossRefGoogle Scholar
  18. Harden RM, Stevenson M, Downie WW, Wilson GM. Assessment of clinical competence using objective structured examination. Br Med J. 1975;1(5955):447.PubMedCrossRefGoogle Scholar
  19. Lurie SJ, Mooney CJ, Lyness JM. Measurement of the general competencies of the accreditation council for graduate medical education: a systematic review. Acad Med. 2009;84(3):301.PubMedCrossRefGoogle Scholar
  20. Marshall JB. Technical proficiency of trainees performing colonoscopy: a learning curve. Gastrointest Endosc. 1995;42(4):287-291.PubMedCrossRefGoogle Scholar
  21. Miller GE. The assessment of clinical skills/competence/performance. Acad Med. 1990;65(9):S63.PubMedCrossRefGoogle Scholar
  22. Neufeld VR, Maudsley RF, Pickering RJ, et al. Educating future physicians for Ontario. Acad Med. 1998;73(11):1133.PubMedCrossRefGoogle Scholar
  23. Norcini JJ, Blank LL, Duffy FD, Fortna GS. The mini-CEX: a method for assessing clinical skills. Ann Intern Med. 2003;138(6):476.PubMedGoogle Scholar
  24. Pitts D, Rowley DI, Marx C, Sher L, Banks T, Murray A. A Competency Based Curriculum for Specialist Training in Trauma and Orthopaedics. London: British Orthopaedic Association; 2006.Google Scholar
  25. Popper KR. Objective Knowledge: An Evolutionary Approach. Oxford: Clarendon Press; 1979.Google Scholar
  26. Reinhardt-Rutland AH, Gallagher AG. Visual depth perception in minimally invasive surgery. In: Robertson SA, ed. Contemporary Ergonomics. London: Taylor & Francis; 1995:531-536.Google Scholar
  27. Rosenfield K, Babb JD, Cates CU, et al. Clinical competence statement on carotid stenting: training and credentialing for carotid stenting–multispecialty consensus recommendations: a report of the SCAI/SVMB/SVS Writing Committee to develop a clinical competence statement on carotid interventions. J Am Coll Cardiol. 2005;45(1):165-174.PubMedCrossRefGoogle Scholar
  28. Seymour NE, Gallagher AG, Roman SA, et al. Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann Surg. 2002;236(4):458-463; discussion 463-454.PubMedCrossRefGoogle Scholar
  29. Van Sickle K, Ritter EM, Baghai M, et al. Prospective, randomized, double-blind trial of curriculum-based training for intracorporeal suturing and knot tying. J Am Coll Surg. 2008;207(4):560-568.PubMedCrossRefGoogle Scholar
  30. Verheugen G. (2005) Good Clinical Practice. Retrieved. from (accessed 10 July 2010).

Copyright information

© Springer-Verlag London Limited 2011

Authors and Affiliations

  • Anthony G. Gallagher
    • 1
  • Gerald C. O’Sullivan
    • 2
  • Gerald C. O’Sullivan
    • 3
  1. 1.School of MedicineUniversity College CorkCorkIreland
  2. 2.Mercy University HospitalCorkIreland
  3. 3.Cork Cancer Research CentreUniversity College CorkCorkIreland

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