Pathways to Competence: Exploring the Basis of Operative Competency Decisions in Trauma & Orthopaedics Training
Bibliographic record
Abstract
Purpose of study Postgraduate surgical training is grounded in the expectation that individuals acquire increasing levels of responsibility and independence, supported by evidence from assessments, within an operative competency framework. It remains unclear and controversial as to whether current training frameworks are sufficiently effective at supporting competency decisions, which has patient safety implications. The purpose of this research was, using trauma and orthopaedics as context, to explore what operative competence means and how it is assessed by key stakeholders. It also probed how they perceive competence and make competence judgements about others. Methods Sixteen participants were purposively sampled from two geographically distinct T&O communities, the UK (n = 5) and Canada (n = 11). Grounded theory, a qualitative methodology, was used. This prioritises participants’ experiences and recognises that data are co-constructed by participants and researchers. Semi-structured interviews were used for data-collection and were analysed in an iterative and emergent fashion using the constant comparative method. Results The components that emerged as necessary clinician qualities in order for them to be deemed competent appeared to align with four Ps (practicality, preparedness, professionalism and planning). These were framed by insight, to be deemed competent. This research also revealed the intangibility of the concept of operative competency and highlighted the use of gestalts. It highlights work-based assessments as tools to facilitate and evidence feedback conversations, instead of their intended role as evaluations. Conclusions This research suggests that decisions around operative competence may not reflect cognitive, affective processes or skills. This raises uncertainties regarding current approaches in which operative competency is judged and evidenced, with participants claiming to “know it when I see it”. Technical competence was found to be a minor part of determining competence, with data drawing attention to something in the research questions’ margins; insight as the most valued marker and fundamental to operative competency.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.050 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.003 | 0.001 |
| Science and technology studies | 0.004 | 0.011 |
| Scholarly communication | 0.009 | 0.006 |
| Open science | 0.001 | 0.007 |
| Research integrity | 0.001 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".