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This study evaluated a simulated pages curriculum that was developed to assess communication and clinical decision making in medical students and interns.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.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%.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.

This project sought to study the effectiveness of a curriculum to enhance the intraoperative clinical judgment and procedural skill of surgical residents.A multiinstitutional, prospective, randomized study was performed. A cognitive task analysis of laparoscopic cholecystectomy (LC) was conducted on which instructional activities and measurement instruments were designed. Residents were randomly assigned to a control or intervention group. Subjects took written pre- and posttests examining procedure-related judgment and knowledge. The intervention group participated in a three-session curriculum emphasizing LC critical decisions and error prevention. All subjects were evaluated performing the procedure on a cadaveric model. Scores from written and practical exams were compared using independent-sample and paired Student t tests.Written examination scores increased for both groups. The intervention group scored significantly higher (P.05) on the written posttest than the control group. There were no differences between groups on the practical examination. Reliability coefficients for the written examination ranged from .65 to .75. Reliability coefficients for the oral exam, technical skill, and error items on the porcine practical exam were .83, .90, and .53.The curriculum resulted in enhanced performance on a written exam designed to assess intraoperative judgment, but no differences in technical skills, showing important implications for future skills lab curriculum formats.

Since the implementation of duty hours regulations (DHR), there has been a great deal of discussion about their effect on surgical education. These regulations were designed to enhance patient safety, resident education, and resident working conditions.1 Researchers have been interested in the effects of DHR on continuity of patient care and resident education,2 and studies have demonstrated the positive impact that DHR has had on patient care3,4 and resident quality of life.2,5 Furthermore, early studies of resident operative experience have indicated that DHR have had no impact on the number of operative procedures residents perform.6,7 Surgical programs have seemingly maintained or enhanced resident education after DHR, and to date, no substantial decrease in clinical or operative experience has been documented.2 In addition to evaluating the effects on resident education, it is important to study the impact of the ACGME's DHR mandate on student education. Surgical residents play a crucial role in educating medical students. It has been shown that students are more satisfied with their clerkship experience when residents actively fulfill their teaching role.8 Many medical and surgical educators have studied clinical teaching roles and teaching effectiveness.9–12 An exploration of learners’ perceptions of the clinical teaching role has yielded a model describing 4 roles of the clinical teacher: The teacher role—being interested in teaching, making an effort to teach, being available and spending time with the resident, explaining, discussing and answering questions. Instructor as a person—supportive, easy and fun to work with, helpful, and friendly. The physician role—the clinical teacher is knowledgeable and clinically competent, is seen as a role model, has good rapport with patients, and has an appropriate attitude. The supervisor role—the clinical teacher gives the resident responsibility for patient care and opportunities to do procedures, involves the resident, and reviews patients with the resident.12 In evaluating the effects that DHR have had on surgical education, medical students’ experiences cannot be overlooked. The purpose of this study is to describe medical students’ perceptions about surgical residents as teachers and examine students’ perceptions before and after the implementation of DHR.

Background The purpose of the study is to describe the academic preparation, scope of duties, and scholarly activity of professional educators in surgery departments. Methods Educators with doctoral degrees employed as full-time faculty in surgery departments were surveyed to determine terms of employment, academic preparation, scope of duties, and job satisfaction. Results Twelve of 13 educators responded and participated in the study. Educators spent, on average, 22% of their time on research activities, 33% on administrative responsibilities, 13% on teaching, 13% counseling students and residents, and 7% writing grants. They spent approximately 34% of their time with surgical faculty, 19% with residents/fellows, and 14% with medical students. Educators' contributions to surgery departments included improvements in assessment and evaluation, educational conferences, recruitment, and research productivity. Conclusions Professional educators provide support needed to meet the growing demands and requirements of surgical education. Study findings may inform those interested in recruiting a professional educator to their faculty.

Phase I of this study compared students’ experiences regarding patient demographics, surgical content, and clinical skill practice in three different hospital settings: university, community, and public. Phase II examines the aspects of clerkship performance that contribute to students’ final grades. An instrument to track the experiences of students on their surgical clerkship was developed and piloted. Data were analyzed to compare the frequency of common surgical tasks performed and exposure to various surgical topics and patient demographics as well as to identify factors that explain variance on student grades. Students performed an average of 33 clinical tasks per week and were exposed to a broad range of surgical topics. Analysis of variance results demonstrated no significant differences between public, private, or university settings with respect to students’ clinical practice opportunities or content exposure. Clinical evaluations and National Board of Medical Examiners scores account for 75.5 per cent of the variance in students’ final grades. There was no significant correlation between patient load and clinical task load with final clerkship grades. The common clinical and didactic components of a surgical clerkship can balance a student's experience with surgical topics and tasks performed. It is important to utilize this information in program review of multisite clerkships to ascertain and enhance the validity of student performance measures.

Background. American Board of Surgery In-Training Exam (ABSITE) performance can be used to assess resident knowledge and to evaluate surgical curriculum. To determine factors that lead to improved resident ABSITE performance, a prospective study was performed. Materials and methods. Thirty-four surgical residents in Program Years 2–5 completed pre- and a post-ABSITE questionnaires about their anxiety, self-efficacy, physical preparation, and academic preparation for the ABSITE. Department records were used to determine resident probationary status and conference attendance. A preliminary analysis of ABSITE scores indicated a significant improvement between 1998 and 1999 percentile scores (paired t = −2.25, P = 0.03; m = 11.9, SD = 30.5, median = 7). An improvement in percentile rank score was calculated and used as the dependent variable in a stepwise regression analysis. The following served as independent variables: previous exam performance, anxiety, probationary status, amount of sleep before exam, confidence to score in the 25th and the 50th percentiles, and attendance at the three conferences rated most valuable by the residents. Results. Results of the regression analysis demonstrate that all factors account for 62.3% of the variance in improvement scores. A stepwise analysis indicated that the combination of attendance (40.2%) and previous performance (18.3%) was significant in explaining 58.5% of the variance in improvement scores. Furthermore, Pearson's correlations indicated that probationary status (+.58, P = 0.001), anxiety (+0.53, P = 0.001), amount of study (+0.61, P = 0.001), past ABSITE performance (−0.60, P = 0.001), and conference attendance (+0.56, P = 0.001) were correlated with ABSITE improvement. Conclusions. This study demonstrates that resident individual effort, past ABSITE performance, and academic conference attendance have led to resident ABSITE improvement.

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.

Background This study compares a laparoscopic skill training protocol without proficiency targets to the same protocol with explicit targets and notification of progress. Methods Fourteen surgery interns were randomized into 2 groups. The intervention group received task-specific proficiency criteria to guide practice. The control group did not. After training, participants were evaluated by blinded faculty during laparoscopic cholecystectomy. Results The control group met significantly fewer of the 7 LapSim (Surgical Science Sweden AB, Goteborg) targets (mean = 1.14) than the intervention group (mean = 7.00; P = .001) and significantly fewer of the 5 video trainer targets (mean = .86) than the intervention group (mean = 5.00; P = .001). Ratings of depth perception, bimanual dexterity, efficiency, tissue handling, autonomy, and overall competence were higher for the intervention group. Effect sizes ranged from medium to large (.394–.981), indicating an impact of the proficiency-based training protocol. Conclusions Delineation of proficiency targets with reporting of progress improves interns' practice results, and appears to have a positive effect on their early operating room (OR) performance of laparoscopic cholecystectomy.

The purpose of this study was to examine faculty ratings of resident candidates in closed and open file conditions.Surgical faculty conducted interviews of 70 resident candidates. Interviewers completed an evaluation following a closed file interview then reviewed the candidate's Electronic Residency Application Service file and completed the evaluation again.A multivariate analysis of variance (MANOVA) yielded significant file x familiarity (P.01), familiarity x attribute (P.01), and file x familiarity x attribute (P.05) interactions. Analyses for each attribute revealed consistent findings in ratings of candidates' intelligence, maturity, interpersonal skills, motivation for learning, ability to work with others, qualifications to succeed in surgery, and likelihood to succeed in surgery. Known candidates were rated higher until files were examined. After file review, unknown candidates were seen to be as strong as or stronger than known candidates.Interviewers rate known and unknown candidates differently in open and closed file conditions.

Background Medical students enter the clinical education years with minimal exposure to procedural skills. This study aims to determine the effect of a pre-clinical skills course on students’ ratings of proficiency, confidence, and anxiety levels. Methods An elective pre-clinical course in procedural skills was given to medical students prior to clinical rotations. Self-assessment of proficiency, confidence, and anxiety in performing these skills was made prior to and on completion of the course. Results Course participants reported low proficiency and confidence, and high anxiety regarding performing procedural skills. Following the course, there was significant improvement in self-assessed proficiency, confidence, and anxiety. There were no gender differences in responses. Conclusions Medical students entering clinical rotations have poor self-assessment of proficiency, low confidence, and high anxiety regarding procedural skills. A concentrated course in procedural skills significantly improved students’ assessment of their proficiency, confidence, and anxiety levels.

Background The purpose of this study was to evaluate the study habits (SHs) of surgery residents preparing for the annual American Board of Surgery In-Training Examination (ABSITE). Methods A validated instrument developed to assess SHs in college students, the Survey of Study Habits and Attitudes (SSHA), was modified slightly for use with residents. The modified SSHA contains 2 subscale scores, work methods and delay avoidance, and a combined overall study habit score. A total of 59 residents from 2 academic general surgical residency programs were administered the modified SSHA. The SSHA scores were correlated to performance on the in-training examination. Results There was a small but significant correlation between scores on the modified SSHA instrument and performance on the ABSITE overall ( r = 0.29; P r 2 = 0.0841). Linear-regression analysis showed that the clinical component and overall performance on the ABSITE were significantly predicted by the total SH scores. Overall total ABSITE percent correct scores were significantly predicted by residency levels of training and the overall SSHA scales (delay avoidance and work methods). Together they predicted 63% of the total variance in the overall performance scores. Residency level was the strongest predictor. SH performance accounted for 5.9% of the total variance beyond that contributed by residency level of training. Conclusions The correlations of surgical resident ABSITE performance with SSHA scores were on the same order of magnitude as those of college students and academic performance with the original SSHA. Although SH in this study accounted for a measurable yet small contribution to ABSITE performance, this contribution was not enough to consider using the SSHA instrument in its current modified form as a diagnostic and counseling tool. Published instruments not specifically designed for residents may not be tailored enough to measure residents' unique SH.

This study was conducted to identify the range and nature of surgical clerkship experiences in three different hospital settings—university, community, and public. Methods. An instrument was developed to track the location and type of learning experience, patient demographics, surgical content, and clinical experience of students on their surgical clerkship. Twenty-three students used the instrument to record the events of their surgical clerkship. Data were analyzed to describe the frequency of tasks performed, the nature and location of learning experience, exposure to surgical topics, and patient demographics. Results. Students were involved in an average of 245 common surgical tasks over their 8-week clerkship. Of their exposure to common tasks, students had the opportunity to observe 25% and perform 70% of those tasks. Sixty-six percent of task work occurred on the patient floor and 23% occurred in the operating room. Students were exposed to a broad range of surgical topics, 71% of which were general surgery topics. Only 25% of these experiences were auditory, whereas 39% involved exposure to a patient, and 36% included participation in an operation. Patient load and characteristics tended to vary across hospital settings, and on average, students worked with 164 patients during their clerkship. The smallest patient load (m = 113) occurred in the university hospital and the largest patient load (m = 251) occurred in the public hospital. Conclusion. Although surgical services and hospital settings may offer students different clerkship experiences, the common clinical and didactic components of a surgical clerkship can balance a student's exposure to surgical topics and practice of clinical skills. Tracking surgical clerkship experiences is valuable in identifying the range and nature of medical students' didactic, clinical, and operative experiences.

Purpose. The purpose of this study was to describe the development, implementation, and outcomes of a vascular anatomy course for general surgery residents. Methods. A vascular anatomy course was developed to include sessions on thoracic and neck anatomy, upper extremity and abdominal region, and lower extremity. Twenty-four PGY3-5 residents were convened in small groups to dissect and explore assigned regions of cadavers. A pre- and posttest for each session included a quiz of relevant anatomy, ratings of confidence, and ratings of anxiety toward independently performing related procedures. Data were analyzed to examine differences between pre- and posttest measures of knowledge, confidence, and anxiety for each session. Results. Results of paired t-tests on the knowledge, confidence, and anxiety measures from each session are displayed in the table below. TABLE—ABSTRACT 63 . Session 1: Neck and Thoracic Anatomy Quiz score Confidence Anxiety Mean diff (post − pre) 2.14 (max = 6) 19.91 (max = 60) −13.03 (max = 60) Paired t-test Results −8.3, P = .0005 (n = 22) −7.2, P = .0005 (n = 20) 3.1, P = .007 (n = 18) Session 2: Upper Extremities and Abdominal Region Mean diff (post − pre) 2.24 (max = 8) 15.72 (max = 50) −8.69 (max = 50) Paired t-test Results −4.7, P = .0005 (n = 17) −10.7, P = .0005 (n = 16) 4.8, P = .0005 (n = 16) Session 3: Lower Extremities Mean diff (post − pre) 3.92 (max = 13) 20.34 (max = 80) −16.40 (max = 80) Paired t-test Results −4.7, P = .001 (n = 13) −3.54, P = .005 (n = 11) 1.32, P = .256 (n = 5) Conclusions. Surgical residents demonstrate significant improvements in knowledge, confidence, and anxiety following a faculty-directed vascular anatomy course.