Connie C. Schmitz

A Novel Critical Skills Curriculum for Surgical Interns Incorporating Simulation Training Improves Readiness for Acute Inpatient Care

INTRODUCTION Surgical interns encounter complex, acute care situations often managed with limited supervision. Furthermore, medical school training does not adequately prepare students for special surgical considerations. Using simulation training, we implemented a course aimed at improving surgical intern readiness for responding to unique, life-threatening issues encountered in daily surgical care. METHODS Twenty University of Minnesota surgical interns participated in the 3-week course. The first session consisted of interactive didactics and simulation covering hypoxia, shock, and metabolic disturbances; the second session addressed cardiopulmonary emergencies, including ventricular assist device and pacemaker use. Electronic simulation scenarios comprised the third session, allowing learners to demonstrate learned/practiced skills. The outcomes were assessed objectively (pretest and posttest) and subjectively (standardized feedback evaluations). RESULTS Fifteen learners completed the pretest and posttest. The mean absolute score increase was 14% with average relative score improvement of 43%. Twenty learners completed feedback evaluations using a standard 5-point Likert scale. Respondents scored the first 2 sessions on topic importance (5 = very important), giving the first session 4.90 (+/- 0.31) and the second session 4.45 (+/- 0.89). Respondents ranked their confidence in executing practiced skills on actual patients (5 = very confident) as 4.24 (+/- 0.71). There was uniform support for the value of the electronic simulation scenarios as enhanced learning tools. CONCLUSIONS We developed a course for surgical interns incorporating didactics and simulation. Learners demonstrated objective improvement in testing and reported that the course topics were highly important. After course completion, learners provided feedback indicating a high level of confidence in executing practiced skills, suggesting improved preparation for acute surgical care.

Structured teaching versus experiential learning of palliative care for surgical residents

BACKGROUND Previous end-of-life and palliative care curricula for surgical residents have shown improved learner confidence, but have not measured cognitive knowledge or skill acquisition. METHODS A nonrandomized trial evaluated a structured palliative care curriculum for 7 postgraduate year 2 surgical residents (intervention group) compared with 6 postgraduate year 5 surgical residents (comparison group). Outcomes were measured using an 18-item knowledge test, a 20-minute objective structured clinical examination simulating an intensive care unit family conference, and a survey measuring self-confidence. RESULTS The mean knowledge test scores for the intervention group, both before and after undergoing the structured palliative care curriculum, were no different from the comparison group. There was also no difference in objective structured clinical examination scores between the 2 groups. The intervention group felt less comfortable managing pain, breaking bad news, or addressing ethical issues. CONCLUSIONS Junior surgical residents have similar palliative care knowledge to senior residents without a palliative care curriculum. After participating in a palliative care curriculum, they have simulated skills that are similar to chief residents. However, self-confidence is lower among junior residents despite undergoing a palliative care curriculum.

How much guidance is given in the operating room? Factors influencing faculty self-reports, resident perceptions, and faculty/resident agreement

BACKGROUND Guidance in the operating room impacts resident confidence and ability to function independently. The purpose of this study was to explore attending surgeon guidance practices in the operating room as reported by faculty members themselves and by junior and senior residents. METHODS This was an exploratory, cross-sectional survey research study involving 91 categorical residents and 82 clinical faculty members at two academic general surgery training programs. A series of analyses of variance along with descriptive statistics were performed to understand the impact of resident training year, program, and surgeon characteristics (sex and type of surgery performed routinely) on guidance practices. RESULTS Resident level (junior versus senior) significantly impacted the amount of guidance given as reported by faculty and as perceived by residents. Within each program, junior residents perceived less guidance than faculty reported giving. For senior guidance practices, however, the differences between faculty and resident practices varied by program. In terms of the effects of surgeon practice type (mostly general versus mostly complex cases), residents at both institutions felt they were more supervised closely by the faculty who perform mostly complex cases. CONCLUSION More autonomy is given to senior than to junior residents. Additionally, faculty report a greater amount of change in their guidance practices over the training period than residents perceive. Faculty and resident agreement about the need for guidance and for autonomy are important for achieving the goals of residency training.

Improving surgery intern confidence through the implementation of expanded orientation sessions

BACKGROUND New surgical interns may be unprepared for job-related tasks and harbor anxiety that could interfere with job performance. To address these problems, we extended our intern orientation with the principal aim of demonstrating the need for expanded instruction on execution of daily tasks. Additionally, we sought to show that an enriched orientation curriculum durably augments intern confidence. METHODS Twenty-one surgical interns participated in an extended orientation program, consisting of interactive didactics, case scenario presentations, and small group discussions. Evaluations collected at completion of orientation and 1-month follow-up assessed self-reported confidence levels on job-related tasks before, immediately afterward, and 1-month after orientation. Statistical analyses were performed using Student t tests (P < .05 significant). RESULTS Self-reports of confidence on job-related tasks before the orientation sessions were low; however, program participation resulted in immediate confidence increases in all areas. Evaluations at 1-month follow-up showed persistence of these gains. CONCLUSION Interns reported considerable anxiety in all job-related tasks before orientation. After the sessions, confidence levels were significantly and durably improved in all areas. Our findings suggest the need for specific instruction on job-related tasks of surgical internship and demonstrate the effectiveness of an expanded orientation in improving intern confidence in execution of these tasks.

The Readiness for Interprofessional Learning Scale: To RIPLS or not to RIPLS? That is only part of the question

We live in two inter-related worlds of interprofessional education and collaborative practice (IPECP) by simultaneously implementing and evaluating the University of Minnesota IPECP program, across...

Development and verification of a taxonomy of assessment metrics for surgical technical skills.

Purpose To create and empirically verify a taxonomy of metrics for assessing surgical technical skills, and to determine which types of metrics, skills, settings, learners, models, and instruments were most commonly reported in the technical skills assessment literature. Method In 2011–2012, the authors used a rational analysis of existing and emerging metrics to create the taxonomy, and used PubMed to conduct a systematic literature review (2001–2011) to test the taxonomy’s comprehensiveness and verifiability. Using 202 articles identified from the review, the authors classified metrics according to the taxonomy and coded data concerning their context and use. Frequencies (counts, percentages) were calculated for all variables. Results The taxonomy contained 12 objective and 4 subjective categories. Of 567 metrics identified in the literature, 520 (92%) were classified using the new taxonomy. Process metrics outnumbered outcome metrics by 8:1. The most frequent metrics were “time,” “manual techniques” (objective and subjective), “errors,” and “procedural steps.” Only one new metric, “learning curve,” emerged. Assessments of basic motor skills and skills germane to laparoscopic surgery dominated the literature. Novices, beginners, and intermediate learners were the most frequent subjects, and box trainers and virtual reality simulators were the most frequent models used for assessing performance. Conclusions Metrics convey what is valued in human performance. This taxonomy provides a common nomenclature. It may help educators and researchers in procedurally oriented disciplines to use metrics more precisely and consistently. Future assessments should focus more on bedside tasks and open surgical procedures and should include more outcome metrics.

Preimplementation predictors of website use: Preliminary findings from the SCORE portal pilot study

BACKGROUND in 2008, the Surgical Council on Resident Education selected 33 residency programs to pilot its General Surgery Resident Curriculum Website Portal. The portal aims to reduce program variability in curricula, align teaching and learning with essential content, and improve resident study and performance. METHODS two online surveys were sent to all program directors and their residents before releasing the portal. Data from 32 programs and 899 residents (84%) were analyzed to determine the extent to which preimplementation characteristics supported the portals rationale and illuminated barriers to its use and impact on learning. RESULTS the need for curriculum content and access to online texts varied markedly across programs. Residents had easy onsite access to the Internet and used it heavily for immediate purposes. Fewer residents used the Web for planned activities and proactive study. On average, residents reported studying an hour or less a day. CONCLUSIONS the portal appears to serve curricular resource needs and may better direct resident study. Programs are advised to consciously integrate the SCORE curriculum and portal into residency training and faculty development.

Learning by (video) example: a randomized study of communication skills training for end-of-life and error disclosure family care conferences.

BACKGROUND Teaching residents to lead end of life (EOL) and error disclosure (ED) conferences is important. METHODS We developed and tested an intervention using videotapes of EOL and error disclosure encounters from previous Objective Structured Clinical Exams. Residents (n = 72) from general and orthopedic surgery programs at 2 sites were enrolled. Using a prospective, pre-post, block group design with stratified randomization, we hypothesized the treatment group would outperform the control on EOL and ED cases. We also hypothesized that online course usage would correlate positively with post-test scores. RESULTS All residents improved (pre-post). At the group level, treatment effects were insignificant, and post-test performance was unrelated to course usage. At the subgroup level for EOL, low performers assigned to treatment scored higher than controls at post-test; and within the treatment group, post graduate year 3 residents outperformed post graduate year ​1 residents. CONCLUSIONS To be effective, online curricula illustrating communication behaviors need face-to-face interaction, individual role play with feedback and discussion.

Establishing a Usable Electronic Portfolio for Surgical Residents: Trying to Keep It Simple

Elaborate web-based portfolios may not be needed for resident evaluation and career development. An approach for busy academic medical departments is described.

The Interprofessional Collaborative Competency Attainment Survey (ICCAS): A replication validation study

ABSTRACT This study replicates a validation of the Interprofessional Collaboration Competency Attainment Survey (ICCAS), a 20-item self-report instrument designed to assess behaviours associated with patient-centred, team-based, collaborative care. We appraised the content validity of the ICCAS for a foundation course in interprofessional collaboration, investigated its internal (factor) structure and concurrent validity, and compared results with those obtained previously by ICCAS authors. Self-assessed competency ratings were obtained from a broad spectrum of pre-licensure, health professions students (n = 785) using a retrospective, pre-/post-design. Moderate to large effect sizes emerged for 16 of 20 items. Largest effects (1.01, 0.94) were for competencies emphasized in the course; the smallest effect (0.35) was for an area not directly taught. Positive correlations were seen between all individual item change scores and a separate item assessing overall change, and item-total correlations were moderate to strong. Exploratory factor analysis was used to understand the interrelationship of ICCAS items. Principal component analysis identified a single factor (Cronbach’s alpha = 0.96) accounting for 85% of the total variance—slightly higher than the 73% reported previously. Findings suggest strong overlaps in the proposed constructs being assessed; use of a total average score is justifiable for assessment and evaluation.