The LEGO™ Exercise: An Assessment of Core Competencies in Urology Residency Interviews.

BACKGROUND: In competitive residency specialties such as Urology, it has become increasingly challenging to differentiate similarly qualified applicants. Residency interviews are utilized to rank applicants, yet they are often biased and do not explicitly address ACGME core competencies. OBJECTIVE: We hypothesized a team-based exercise in the urology residency interview centered on building LEGOs assesses core competences. DESIGN: From 2014-2017, students interviewing for urology residency at two institutions participated in a LEGO™ building activity. Applicants were assigned to "architect"- describing how to construct a structure - or "builder" - constructing the same structure with pieces-using only verbal cues to assemble the structure. Participants were graded using a rubric assessing competencies of interpersonal communication, problem-based learning, professionalism, and manual dexterity (indicator of procedural skill). The total minimum score was 16 and maximum was 80. SETTING: The study took place at two tertiary referral centers: University of Michigan Medical School in Ann Arbor, MI, and University of Utah School of Medicine in Salt Lake City, UT. PARTICIPANTS: A total of 176 applicants participated, comprised of applicants interviewing for urology residency at two institutions during the study timeframe. RESULTS: For architects and builders, there was a maximum score of 80, and minimum of 34 and 32, respectively. Both distributions show a right shift with mean scores of 64.3 and 65.9, and median scores of 69 and 65.5. Successful pairs excelled with consistent nomenclature and clear directionality. Ineffective pairs miscommunicated with false affirmations, inconsistent nomenclature, and lack of patience. CONCLUSIONS: The LEGO™ exercise allowed for standardized assessment of applicants based on ACGME core competencies. The rubric identified poor performers who do not rise to the challenge of a team-based task.

Improving Resident and Nurse Communication Practices: Results of a Collaborative Culture Initiative.

INTRODUCTION: Paging is a critical modality for urgent hospital communication. We sought to improve overnight nurse paging practices to reduce noncritical pages, improve resident sleep practices and create a team approach to patient care between residents and overnight nursing staff. METHODS: Residents, overnight urology nurses and a communications liaison met during 2 overnight sessions in October 2014 to develop a training curriculum for overnight paging, which consisted of a paging protocol based on page urgency, and batching nonurgent communication into a cluster page. Overnight (11 p.m. to 7 a.m.) pages per night were assessed from March 2014 to March 2015. Nurses and residents categorized page messages for perceived urgency. Pre-training and post-training surveys examined physician-nurse opinion after collaboration. RESULTS: Before training the nurses and residents had variable agreement across all urgency categories (Cohen's kappa=0.25 indicating poor agreement, sample size 132 pages). On trained floors average nightly pages decreased from 2.6 during training to 1.6 after training (November to January, Mann-Whitney p=0.007). This reduction was stable 5 months after training (1.8 pages per night, p=0.994 compared to after training). There was also a paging decrease on untrained floors (7.9 from 9.8 pages per night, p=0.005) but the decrease was lost at 5 months (6.29 pages per night, p=0.0493). Paging frequency from trained floors was proportionally lower (50% reduction) than from untrained floors (29% reduction). The post-training survey demonstrated that new paging practices improved overnight communication, physician response and mutual respect. CONCLUSIONS: This nurse-physician training collaborative produced a lasting reduction in overnight pages, an improved resident response to urgent pages and an enhanced culture of mutual respect.