Preliminary Development of a Program ABSITE Dashboard (PAD) to Guide Curriculum Innovation.

PURPOSE: Medical Knowledge for general surgery residents' is assessed by the American Board of Surgery In- Training Examination (ABSITE). ASBITE score reports contain many metrics residency directors can utilize to assess resident progress and perform program evaluation. The purpose of this study was to develop a framework to evaluate program effectiveness in teaching specific subtest and subtopic areas of the ABSITE, using ABSITE score reports as an indicator. The aim is to demonstrate the identification of topic areas of weakness in program-wide performance on the ABSITE to guide proposed modification of the general surgery residency program curriculum, and to initiate development of a data visualizing dashboard to communicate these metrics. METHODS: A single institution retrospective study was performed utilizing ABSITE score reports from general surgery residents at a large academic training program from 2017 to 2020. ABSITE performance metrics from 320 unique records were entered into a database; statistical analysis for linear trends and variance were conducted for standard scores, subtest standard scores, and incorrect subtest topics. Deviation from national average scores were calculated by subtracting the national average score from each subtest score for each trainee. Data were displayed as medians or proportions and are displayed to optimize visualization as a proof-of-concept for the development of a program dashboard. RESULTS: Trends and variance in general surgery program and cohort performance on various elements of the ABSITE were visualized using figures and tables that represent a prototype for a program dashboard. Figure A1 demonstrates one example, in which a heatmap displays the median deviation from national average scores for each subtest by program year. Boxplots show the distribution of the deviation from national average, range for national average scores, and the recorded scores for each subtest by program year. Trends in median deviation from the national average scores are displayed for each program year paneled by subtest or for each exam year paneled by cohort. Median change in overall test scores from one program year to another in a cohort is visualized as a table. Bar graphs show the most often missed topics across all program years and heatmaps were generated showing the proportion of times each topic was missed for each subtest and exam year. CONCLUSIONS: We demonstrate use of ABSITE reports to identify specific thematic areas of opportunities for curriculum modification and innovation as an element of program evaluation. In this study we demonstrate, through data analysis and visualization, feasibility for the creation of a Program ABSITE Dashboard (PAD) that enhances the use of ABSITE reports for formative program evaluation and can guide modifications to surgery program curriculum and educational practices.

Fracture rates by medication type in attention-deficit/hyperactive disorder.

Background: ADHD is a condition with extensively researched increased risks of psychiatric disorders, traumatic injury, impulsivity, and delayed response times. Objectives: To analyze the incidences of fractures in patients with ADHD on various medication regimens. Methods: Using the TriNetX database, we created seven patient cohorts, all of age under 25, based on medication types commonly used for ADHD. The cohorts we created were: no medication use, exclusive use of a -phenidate class stimulant, exclusive use of an amphetamine class stimulant, nonexclusive use of formations of either stimulant, exclusive use of non-stimulant medications approved for ADHD, nonexclusive use, and no medications. We then examined rates while controlling for age, sex, race, and ethnicity. Results: The comparison of ADHD to neurotypical individuals revealed an increased risk for all fracture types. For the controlled analysis, all but one cohort had significant differences in each fracture type compared to the baseline cohort of ADHD patients without any medication use. Patients in the "phenidate" cohort had an insignificant difference in risk of lower limb fractures. Patients in the "any medication," "-etamine," "stimulant," and "not ADHD" groups all had significant decreased risks for all fracture types, with confidence intervals often overlapping between treatment modalities. Conclusions: As patients experiment with different medication regimens, providers should be aware of the difference in risk of fracture by medication type. Our results highlight the need for continued research to better discern appropriate medication regimens with the goal of improving overall risk reduction and producing better outcomes for individuals with ADHD.