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.

Tracking of voluntary exercise behaviour over the lifespan.

BACKGROUND: The aim of many physical activity interventions is to develop life-long habits of regular exercise and sports activities in leisure time. Previous studies that assessed tracking (i.e. the stability of a trait over the lifespan) of leisure time exercise behaviour across various parts of the life span have treated it as a uniform construct by summing all types of leisure time exercise activities into a single summary score for the total volume of exercise. This study provides new insight by additionally determining tracking across leisure time exercise activities in six different domains: (1) team-based versus solitary activities, (2) competitive versus non-competitive activities, and (3) externally paced versus internally paced activities. We also assessed which of the domains of exercise activities best predicted total volume of exercise at follow-up. METHODS: A large dataset (N = 43,889) from the Netherlands Twin Register (NTR) was used to analyse the tracking of exercise behaviour over time. Using this dataset, we were able to examine tracking as a function of baseline age (8 to 80 years) and tracking duration (2 to 22-year follow-up), taking into account sex differences, using generalized estimating equations. RESULTS: Two-year tracking coefficients are moderate to high for total volume of exercise across ages at baseline, ranging from .38 to .77 with a median of .57. Tracking coefficients tend to decrease as the distance to follow-up increases, down to a median of .38 for the 22-year tracking coefficients. The patterns of tracking were largely domain-independent and were largely similar for solitary, competitive, non-competitive, externally and internally paced activities. With the exception of team-based activities, tracking was seen to increase as a function of baseline age. Cross-domain tracking did not favour any specific domain of exercise activity as the best predictor for total volume of exercise behaviour and this was true at all baseline ages. CONCLUSION: We conclude that exercise behaviour is moderately to highly stable across the life span. In particular in adulthood, where the tracking of exercise mimics that of a classical behavioural trait like personality. This stability reinforces existing evidence that exercise habits are hard to change, but at the same time suggests that successful intervention leading to the adoption of exercise habits will tend to last.