Instruction and assessment of professionalism for surgery residents.

Surgical professionalism is one of the core competencies for surgery residents. It focuses on professional responsibilities to patients and society. This report summarizes current literature on surgical professionalism to help surgical residency program directors organize appropriate instruction and assessment methods for their residents. The instructional design should be based on 14 key concepts of surgical professionalism outlined by the American College of Surgeons. The professionalism curriculum should be a mixture between faculty-identified concepts and resident input of context that those concepts apply. Surgical faculty should start the instruction with a lecture, which later leads to problem solving of cases related to surgical professionalism. Surgical faculty should integrate professionalism instruction in everyday practice in all clinical settings, using both structured and apprenticeship approaches. A comprehensive assessment of professionalism requires both a maximal and a typical performance assessment. The test of maximal performance in an Objective Structured Clinical Examination (OSCE) format is suggested for the assessment of professionalism in situations that do not occur often. The test of typical performance can be achieved with ratings from faculty, peers, nurses, and patients to evaluate professionalism competence in regular clinical services.

Evaluating the effectiveness of rating instruments for a communication skills assessment of medical residents.

The investigators used evidence based on response processes to evaluate and improve the validity of scores on the Patient-Centered Communication and Interpersonal Skills (CIS) Scale for the assessment of residents' communication competence. The investigators retrospectively analyzed the communication skills ratings of 68 residents at the University of Illinois at Chicago (UIC). Each resident encountered six standardized patients (SPs) portraying six cases. SPs rated the performance of each resident using the CIS Scale--an 18-item rating instrument asking for level of agreement on a 5-category scale. A many-faceted Rasch measurement model was used to determine how effectively each item and scale on the rating instrument performed. The analyses revealed that items were too easy for the residents. The SPs underutilized the lowest rating category, making the scale function as a 4-category rating scale. Some SPs were inconsistent when assigning ratings in the middle categories. The investigators modified the rating instrument based on the findings, creating the Revised UIC Communication and Interpersonal Skills (RUCIS) Scale--a 13-item rating instrument that employs a 4-category behaviorally anchored rating scale for each item. The investigators implemented the RUCIS Scale in a subsequent communication skills OSCE for 85 residents. The analyses revealed that the RUCIS Scale functioned more effectively than the CIS Scale in several respects (e.g., a more uniform distribution of ratings across categories, and better fit of the items to the measurement model). However, SPs still rarely assigned ratings in the lowest rating category of each scale.

Rater errors in a clinical skills assessment of medical students.

The authors used a many-faceted Rasch measurement model to analyze rating data from a clinical skills assessment of 173 fourth-year medical students to investigate four types of rater errors: leniency, inconsistency, the halo effect, and restriction of range. Students performed six clinical tasks with 6 standardized patients (SPs) selected from a pool of 17 SPs. SPs rated the performance of each student in six skills: history taking, physical examination, interpersonal skills, communication technique, counseling skills, and physical examination etiquette. SPs showed statistically significant differences in their rating severity, indicating rater leniency error. Four SPs exhibited rating inconsistency. Four SPs restricted their ratings in high categories. Only 1 SP exhibited a halo effect. Administrators of objective structured clinical examinations should be vigilant for various types of rater errors and attempt to reduce or eliminate those errors to improve the validity of inferences based on objective structured clinical examination scores.