How prepared are your interns to take calls? Results of a multi-institutional study of simulated pages to prepare medical students for surgery internship.

BACKGROUND: This study evaluated a simulated pages curriculum that was developed to assess communication and clinical decision making in medical students and interns. METHODS: A curriculum consisting of 14 simulated pages was administered across 5 institutions to 150 senior medical students. A 3-case subset was administered to interns who did not participate in the curriculum. Six expert surgeons identified critical fails and set passing scores for case-specific assessments using the Graphical Hofstee Method. RESULTS: Participants in the curriculum demonstrated superior clinical decision making compared with non-participants across all cases scenarios (P < .01). Average medical student scores for clinical decision making were 46.9%. Global ratings averaged 6.0 for communication and 5.2 for patient care. Passing rates averaged 46%. CONCLUSIONS: Participation in a mock page curriculum improved performance. The performance of participants based on expert standards set for simulated page performance highlight the need for innovative approaches to improve interns' preparedness to take calls.

Identification of technique variations among microvascular surgeons and cases using hierarchical task analysis.

A hierarchical taxonomy was developed for identifying differences among microvascular surgeons and cases and for investigating the impact of those differences on case outcome. Hierarchical task analysis was performed on eight microvascular anastomosis cases. The analysis was simplified by redefining subtasks and elements to only describe actions and adding attributes to describe the work object, method, tool, material, conditions and ergonomics factors. The resulting taxonomy was applied to 64 cases. Differences were found among cases for the frequency and duration of subtask, elements, attributes and element sequences. Observed variations were used to formulate hypotheses about the relationship between different methods and outcomes that can be tested in future studies. The taxonomy provides a framework for comparing alternative methods, determining the best methods for given conditions and for surgical training and retraining. PRACTITIONER SUMMARY: A hierarchical taxonomy, created from a hierarchical task analysis and work attributes, was applied to describe technique variations among microsurgery cases. Variations in time, frequency and sequence were used to form hypotheses on best methods for standardising procedures.

The objective assessment of experts' and novices' suturing skills using an image analysis program.

PURPOSE: To objectively assess suturing performance using an image analysis program and to provide validity evidence for this assessment method by comparing experts' and novices' performance. METHOD: In 2009, the authors used an image analysis program to extract objective variables from digital images of suturing end products obtained during a previous study involving third-year medical students (novices) and surgical faculty and residents (experts). Variables included number of stitches, stitch length, total bite size, travel, stitch orientation, total bite-size-to-travel ratio, and symmetry across the incision ratio. The authors compared all variables between groups to detect significant differences and two variables (total bite-size-to-travel ratio and symmetry across the incision ratio) to ideal values. RESULTS: Five experts and 15 novices participated. Experts' and novices' performances differed significantly (P < .05) with large effect sizes attributable to experience (Cohen d > 0.8) for total bite size (P = .009, d = 1.5), travel (P = .045, d = 1.1), total bite-size-to-travel ratio (P < .0001, d = 2.6), stitch orientation (P = .014,d = 1.4), and symmetry across the incision ratio (P = .022, d = 1.3). CONCLUSIONS: The authors found that a simple computer algorithm can extract variables from digital images of a running suture and rapidly provide quantitative summative assessment feedback. The significant differences found between groups confirm that this system can discriminate between skill levels. This image analysis program represents a viable training tool for objectively assessing trainees' suturing, a foundational skill for many medical specialties.

Web-based curriculum improves residents' knowledge of health care business.

BACKGROUND: Curricular options for teaching and evaluating surgery residents' outcomes in systems-based practice are limited. A Web-based curriculum, MDContent, developed collaboratively by experts in business and surgery, provides learning experiences in the business of health care. The purpose of this study is to describe surgery residents' experience and learning outcomes associated with the curriculum. STUDY DESIGN: Twenty-eight PGY3 to 6 general and plastic surgery residents were enrolled in the Web-based curriculum. Twenty-two residents (79%) completed the pretest, 11 modules, the post-test, and the course evaluation by the end of 1 year. The pretest and the post-test were 30-item multiple-choice exams based on a blueprint of the curricular objectives. Descriptive statistics were calculated on course evaluation and module completion data. Paired t-tests were used to compare pre- and post-test performance. Content analysis was performed on course evaluation written responses. RESULTS: Residents' performance on the multiple choice exam improved significantly (p = 0.0001) from the pre-test (mean 59%, SD 12.1) to the post-test (mean 78%, SD 9.4), with an average gain of 19 percentage points. Participants rated their Web-based learning experience as very positive, with a majority of residents agreeing that the content was well organized, relevant, and an excellent learning experience around content not taught elsewhere in medical school or residency. CONCLUSIONS: Participation in a Web-based curriculum on health care business improves surgery residents' knowledge about health care business concepts and principles. Residents with varying levels of interest in health care business provide positive ratings about their learning experience and indications that lessons learned would be applied in their clinical practice. MDContent is a feasible and effective method for teaching and assessing systems-based practice concepts.