Low-cost materials yield high resolution assessment of anatomic knowledge in surgical residents.

INTRODUCTION: Knowledge of anatomy is essential for surgeons. We sought to determine whether it is possible to effectively assess and differentiate the anatomic knowledge of general surgery residents, using pieces of fabric and yarn. METHODS: Postgraduate years 2, 3, and 4 general surgery residents were assessed during a simulation-based assessment known as the Surgical X-Games. Residents were allowed 3 minutes to assemble the anatomic structures of the right upper quadrant region and 2 minutes to create the right lower quadrant of the abdomen, using colored felt and yarn. One point (each) was given for naming and placing the structures in the correct position. A checklist was used to assess trainees with a maximum combined score of 150 points. RESULTS: A total of 34 residents (postgraduate year 2 = 16, postgraduate year 3 = 8, postgraduate year 4 = 10) participated in the 2017 fall Surgical X-Games and 31 residents (postgraduate year 2 = 13, postgraduate year 3 = 9, postgraduate year 4 = 9) participated in the spring Surgical X-Games. Total scores increased respective to the level of clinical training in both the fall Surgical X-Games (postgraduate year 2 = 77, postgraduate year 3 = 84, postgraduate year 4 = 93, P = .04) and the spring Surgical X-Games (postgraduate year 2 = 94, postgraduate year 3 = 101, postgraduate year 4 = 109). We observed significant improvement in the right upper quadrant, right lower quadrant, and total scores from the fall to the spring postgraduate year (P < .001). CONCLUSION: Surgical residents showed an increase in mean anatomical scores from postgraduate years 2 to postgraduate years 3 to postgraduate years 4, using low-fidelity models. This inexpensive, 5-minute test based on a simple checklist may offer surgical educators insight in to residents' anatomic knowledge and potential readiness for clinical rotations.

Attitudes and Perceptions of Surgical Oncology Fellows on ACGME Accreditation and the Complex General Surgical Oncology Certification.

BACKGROUND: With the first qualifying examination administered September 15, 2014, complex general surgical oncology (CGSO) is now a board-certified specialty. We aimed to assess the attitudes and perceptions of current and future surgical oncology fellows regarding the recently instituted Accreditation Council for Graduate Medical Education (ACGME) accreditation. METHODS: A 29-question anonymous survey was distributed to fellows in surgical oncology fellowship programs and applicants interviewing at our fellowship program. RESULTS: There were 110 responses (79 fellows and 31 candidates). The response rate for the first- and second-year fellows was 66 %. Ninety-percent of the respondents were aware that completing an ACGME-accredited fellowship leads to board eligibility in CGSO. However, the majority (80 %) of the respondents stated that their decision to specialize in surgical oncology was not influenced by the ACGME accreditation. The fellows in training were concerned about the cost of the exam (90 %) and expressed anxiety in preparing for another board exam (83 %). However, the majority of the respondents believed that CGSO board certification will be helpful (79 %) in obtaining their future career goals. Interestingly, candidate fellows appeared more focused on a career in general complex surgical oncology (p = 0.004), highlighting the impact that fellowship training may have on organ-specific subspecialization. CONCLUSIONS: The majority of the surveyed surgical oncology fellows and candidates believe that obtaining board certification in CGSO is important and will help them pursue their career goals. However, the decision to specialize in surgical oncology does not appear to be motivated by ACGME accreditation or the new board certification.

Cost and logistics for implementing the American College of Surgeons objective structured clinical examination.

BACKGROUND: The American College of Surgeons has developed a reliable and valid OSCE (objective structured clinical examination) to assess the clinical skills of incoming postgraduate year 1 surgery residents, but the cost and logistics of implementation have not been described. METHODS: Fixed costs included staff time, medical supplies, facility fee, standardized patient (SP) training time, and one OSCE session. Variable costs were incurred for additional OSCE sessions. Costs per resident were calculated and modeled for increasing the number of test takers. RESULTS: American College of Surgeons OSCE materials and examination facilities were free. Fixed costs included training 11 SPs for 4 hours ($1,540), moulage and simulation material ($469), and administrative effort for 44 hours ($2,200). Variable cost for each session was $1,540 (SP time). Total cost for the first session was $6,649 ($664/resident), decreased to $324/resident for 3 sessions, and projected to further decline to $239/resident for 6 sessions. CONCLUSIONS: The cost decreased as the number of residents tested increased. To manage costs, testing more trainees by regional collaboration is recommended.

Simulated Colonoscopy Objective Performance Evaluation (SCOPE): a non-computer-based tool for assessment of endoscopic skills.

BACKGROUND: The Simulated Colonoscopy Objective Performance Evaluation (SCOPE) was developed to fill the need for a lower-cost, non-virtual-reality (VR)-based assessment tool. This study aimed to evaluate the ability of SCOPE to assess endoscopic skills objectively. METHODS: Four tasks were created using the Kyoto Kagaku colonoscopy model (Kyoto Kagaku Co., Ltd., Kyoto, Japan). The SCOPE tasks included Scope Manipulation (SM) requiring torque and tip deflection to align a shape in the colon with a matching shape on the monitor; Tool Targeting (TT) requiring coordination with biopsy forceps to contact a metal target; Loop Management (LM) requiring prevention, recognition, and reduction of a redundant sigmoid colon with navigation to the cecum; and Mucosal Inspection (MI) requiring identification of simulated polyps during withdrawal and retroflexion. Key performance metrics were identified, and a normalized scoring system was developed. For the study, 35 subjects were stratified into three cohorts based on colonoscopy experience: novice (0-50 colonoscopies; n = 11), intermediate (51-139 colonoscopies; n = 13), and experienced (>140 colonoscopies; n = 11). The subjects performed two trials of all four tasks. RESULTS: Across all four tasks, the experienced endoscopists (E) consistently outperformed the intermediates (I), who in turn outperformed the novices (N). The mean normalized scores with 95 % confidence intervals (CI) are as follows: SM: N (54; range, 26-82), I (92; range, 79-106), E (106; range, 93-118) (p = 0.0006). TT: N (40; range, 24-55), I (77; range, 63-91), E (88; range, 72-105) (p < 0.0001). LM: N (51; range, 24-79), I (80; range, 59-101), E (101; range, 98-105) (p = 0.003). MI: N (73; range, 53-92), I (85; range, 76-95), E (100; range, 91-108) (p = 0.013). Total score: N (218; range, 155-280), I (335; range, 299-371), E (395; range, 371-419) (p < 0.0001). The test-retest reliability (0.6) for the expert total score was respectable. CONCLUSIONS: The validity evidence from this study shows that scores on SCOPE tasks can differentiate between groups expected to have different levels of technical skill. This model shows promise as a low-technology tool for objective assessment or training of endoscopic skills.

Cost-effective framework for basic surgical skills training.

BACKGROUND: The importance of basic surgical skills is entirely agreed among surgical educators. However, restricted by ethical issues, finance etc, the basic surgical skills training is increasingly challenged. Increasing cost gives an impetus to the development of cost-effective training models to meet the trainees' acquisition of basic surgical skills. In this situation, a cost-effective training framework was formed in our department and introduced here. METHODS: Each five students were assigned to a 'training unit'. The training was implemented weekly for 18 weeks. The framework consisted of an early, a transitional, an integrative stage and a surgical skills competition. Corresponding training modules were selected and assembled scientifically at each stage. The modules comprised campus intranet databases, sponge benchtop, nonliving animal tissue, local dissection specimens and simulating reality operations. The training outcomes used direct observation of procedural skills as an assessment tool. The training data of 50 trainees who were randomly selected in each year from 2006 to 2011 year, were retrospectively analysed. RESULTS: An excellent and good rate of the surgical skills is from 82 to 88%, but there is no significant difference among 6 years (P > 0.05). The skills scores of the contestants are markedly higher than those of non-contestants (P < 0.05). The average training cost per trainee is about $21.85-34.08. CONCLUSION: The present training framework is reliable, feasible, repeatable and cost-effective. The skills competition can promote to improve the surgical skills level of trainees.

Trastorno por deficit de atención e hiperactividad (TDAH) en adultos / Attention deficit disorder and hyperactivity (ADHD) in adults

Introducción: El interés por el TDAH en el adulto es relativamente reciente. Este artículo revisa aspectos del diagnóstico, evolución y tratamiento del TDAH en adultos. Fuentes: Llevamos a cabo una búsqueda en Internet de artículos en lenguaje inglés y español publicados en los últimos 16 años. Desarrollo: Se estima que la prevalencia de TDAH en la población adulta general es de 4%. Más del 50% de niños con el trastorno continuarán padeciéndolo. Los síntomas pueden ser diferentes en los adultos, teniendo menos hiperactividad y un leve decremento de la impulsividad, pero con los mismos síntomas de inatención. En la edad adulta, el TDAH está vinculado con serias repercusiones económicas, ocupacionales, académicas y familiares, así como a accidentes automovilísticos y a presencia de otras patologías psiquiátricas. Diferentes pruebas psicométricas están disponibles en para la evaluación de este trastorno. El tratamiento farmacológico en adultos es esencialmente el mismo utilizado en niños con uso de fármacos psicoestimulantes y no estimulantes, además de la terapia cognitivo-conductual. Conclusión: El TDAH es un trastorno neurobiológico que inicia en la infancia y puede extenderse a la edad adulta, etapa en la que está infra diagnosticado e incorrectamente tratado. Los medicamentos nivelan el campo neurobiológico y permiten que los adultos con TDAH aprendan y desarrollen las destrezas que necesitan para tener éxito...

Curriculum resource use and relationships with educational outcomes in an online curriculum.

PURPOSE: Web-based continuing education (CE) offerings have increased dramatically, yet educators know little about factors influencing resource use within online curricula or relationships between resource use and educational outcomes. METHOD: The authors conducted a study of online curriculum delivery to health care professionals in 2004 and 2005. The authors assessed knowledge and confidence regarding content (herbs and dietary supplements) at baseline and completion. They assessed hours spent and use of three resources (modules read, links accessed, and listserv participation) and how these effected change of knowledge and confidence. RESULTS: Median time spent on the curriculum was 7 to 10 hours. Three quarters of participants read 36 to 40 modules; half accessed <30 of 335 Internet links. Listserv participation varied; 149 participants (19%) read or=41 postings. Those receiving modules incrementally across several weeks reported more hours spent, more modules read, and more links accessed, but less listserv participation than those receiving all modules at once (all P

Developing an institution-based assessment of resident communication and interpersonal skills.

PURPOSE: The authors describe the development and validation of an institution-wide, cross-specialty assessment of residents' communication and interpersonal skills, including related components of patient care and professionalism. METHOD: Residency program faculty, the department of medical education, and the Clinical Performance Center at the University of Illinois at Chicago College of Medicine collaborated to develop six standardized patient-based clinical simulations. The standardized patients rated the residents' performance. The assessment was piloted in 2003 for internal medicine and family medicine and was subsequently adapted for other specialties, including surgery, pediatrics, obstetrics-gynecology, and neurology. We present validity evidence based on the content, internal structure, relationship to other variables, feasibility, acceptability, and impact of the 2003 assessment. RESULTS: Seventy-nine internal medicine and family medicine residents participated in the initial administration of the assessment. A factor analysis of the 18 communication scale items resulted in two factors interpretable as "communication" and "interpersonal skills." Median internal consistency of the scale (coefficient alpha) was 0.91. Generalizability of the assessment ranged from 0.57 to 0.82 across specialties. Case-specific items provided information about group-level deficiencies. Cost of the assessment was about $250 per resident. Once the initial cases had been developed and piloted, they could be adapted for other specialties with minimal additional effort, at a cost saving of about $1,000 per program. CONCLUSION: Centrally developed, institution-wide competency assessment uses resources efficiently to relieve individual programs of the need to "reinvent the wheel" and provides program directors and residents with useful information for individual and programmatic review.

Administration of open-ended test questions by computer in a clerkship final examination.

PURPOSE: To evaluate the reliability, efficiency, and cost of administering open-ended test questions by computer. METHODS: A total of 1,194 students in groups of approximately 30 were tested at the end of a required surgical clerkship from 1993 through 1998. For the academic years 1993--94 and 1994--95, the administration of open-ended test questions by computer was compared experimentally with administration by paper-and-pencil for two years. The paper-and-pencil mode of the test was discontinued in 1995, and the administration of the test by computer was evaluated for all students through 1998. Computerized item analysis of responses was added to the students' post-examination review session in 1996. RESULTS: There was no significant difference in the performances of 440 students (1993--94 and 1994--95) on the different modes of test administration. Alpha reliability estimates were comparable. Most students preferred the computer administration, which the faculty judged to be efficient and cost-effective. The immediate availability of item-analysis data strengthened the post-examination review sessions. CONCLUSION: Routine administration of open-ended test questions by computer is practical, and it enables faculty to provide feedback to students immediately after the examination.

Running an objective structured clinical examination on a shoestring budget.

BACKGROUND: A major obstacle in the wide implementation of objective clinical structured examinations (OSCEs) is their high cost, averaging $200 to $300 (Canadian dollars, CDN) per candidate and estimated at up to CDN$900 per candidate if all "hidden" administrative costs are included. METHODS: A detailed cost analysis of preparing and administering OSCEs at 1 institution was undertaken over 2 years. An 18-station, 6-minute-per-station OSCE was given to a 72-student third-year medical class. RESULTS: The total cost of the OSCE was CDN$5,010, or $70 per student. The key factors in reaching this significantly lower per-student OSCE cost included: judicious use of standardized patients, use of academic faculty for preparing and marking the stations, and decreased secretarial and other administrative costs. CONCLUSIONS: Data suggest that OSCEs can be set up with reasonable cost and limited resources even in smaller institutions. Cost should not be considered a major obstacle in implementing this excellent examination type in undergraduate medical education.

Evolution of a Mock Oral Board Examination Program in Surgery.

This paper describes the evolution of a Mock Oral Board Examination Program for surgical residents in a university-affiliated community setting. The Mock Oral Board Examination Program has familiarized residents with the process of the Certifying Examination, assisted program directors in improving their training programs and creating a scholarly environment, and improved our community exchange of information through this collaborative effort.

A comparative analysis of the costs of administration of an OSCE (objective structured clinical examination).

BACKGROUND: The objective structured clinical examination (OSCE) has become an accepted technique for the evaluation of clinical competence in medicine. Although advances have been made in our knowledge of the psychometric aspects of the OSCE, extremely little has been written about feasibility and cost issues. Given the current economic imperative to control costs and the extremely scant literature on the costs of developing and administering an examination in medicine, the authors felt it timely and relevant to explore issues related to the cost of the OSCE. METHOD: In 1991-92 and in 1992-93, costs and time requirements to implement and administer a structured oral (SO) examination and a six-station OSCE for a surgical clerkship at the University of Toronto Faculty of Medicine were gathered by review of invoices, interviews with those involved, and perusal of diaries kept by staff. RESULTS: To develop and administer the six-station OSCE, 327.5 hours of staff and faculty time were required for each rotation of surgical clerks (8.2 hours per student). The SO examination required 110 hours of staff and faculty time (2.75 hours per student). Direct expenses for the OSCE amounted to U.S. $6.90 per student per station, compared with no direct expense for the SO examination. CONCLUSION: The OSCE was more time-consuming and more expensive in human and material costs than the SO examination. However, costs of the OSCE can be substantially reduced from approximately U.S. $35 to U.S. ! per student per station if test developers, standardized patients, support staff, and examiners can donate their time. The authors compare the costs and time requirements of their OSCE with those of other OSCEs reported in the literature, and they provide guidelines to assist educators in deciding whether the costs of an OSCE are justifiable in the educators' individual settings.

Is it worth it? A look at the costs and benefits of an OSCE for second-year medical students.

For the past two years, the Bowman Gray School of Medicine has used an Objective Structured Clinical Exam (OSCE) to measure the performance of 117 first- and second-year medical students at the end of introductory courses on differential and physical diagnosis. Given the surprisingly high costs of conducting the OSCE ($1300 for supplies and 527 person-hours of donated time), data about the format's perceived benefits were collected. All of the faculty involved in the examination who responded to a questionnaire (80%) reported that it was worth the time they had volunteered to evaluate students by observation and that the format should be used in the future. The majority of student examinees also reported that the OSCE format was appropriate for the course and should continue to be used.