Constance C. Schmitz

Characteristics of the successful researcher and implications for faculty development

To understand better the role of faculty development in training family medicine researchers, the authors examined in a comprehensive literature review the characteristics of productive researchers, their training, and their work environment. Areas reviewed were faculty development and evaluation, career development, professional socialization, organizational development, and faculty vitality in higher education, medicine, and corporate research and development. Findings reveal that, besides prerequisite knowledge and skills in a research area, successful researchers have academic values and attitudes derived from specific socialization experiences. They also receive meaningful support from their organization, mentors, and peers.

Assessment of Technical Skills of Orthopaedic Surgery Residents Performing Open Carpal Tunnel Release Surgery

BACKGROUND Motor skills assessment is an important part of validating surgical competency. The need to test surgical skills competency has gained acceptance; however, assessment methods have not yet been defined or validated. The purpose of the present study was to evaluate the reliability and validity of four testing measures for the integrated assessment of orthopaedic surgery residents with regard to their competence in performing carpal tunnel release. METHODS Twenty-eight orthopaedic residents representing six levels of surgical training were tested for competence in performing carpal tunnel release on cadaver specimens. Four measures were used to assess competency. First, a web-based knowledge test of surgical anatomy, surgical indications, surgical steps, operative report dictation, and surgical complications was administered. Second, residents participated in an Objective Structured Assessment of Technical Skills; each resident performed surgery on a cadaver specimen. All residents were evaluated independently by two board-certified orthopaedic surgeons with a subspecialty certificate in hand surgery with use of a detailed checklist score, a global rating scale, and a pass/fail assessment. The time for completion of the surgery was also recorded. Each assessment tool was correlated with the others as well as with the residents level of training. RESULTS Significant differences were found between year of training and knowledge test scores (F = 7.913, p < 0.001), year of training and detailed checklist scores (F = 5.734, p = 0.002), year of training and global rating scale (F = 2.835, p = 0.040), and year of training and percentage pass rate (F = 26.3, p < 0.001). No significant differences were found between year of training and time to completion of the carpal tunnel release (F = 2.482, p < 0.063). CONCLUSIONS The results of the present study suggest that both knowledge and cadaver testing discriminate between novice and accomplished residents. However, although failure of the knowledge test can predict failure on technical skills testing, the presence of knowledge does not necessarily ensure successful performance of technical skills, as cognitive testing and technical skills testing are separate domains.

Professionalism and communication in the intensive care unit: reliability and validity of a simulated family conference.

Objective: An Objective Structured Clinical Exam was designed to assess physician’s ability to discuss end-of-life (EOL) and disclose iatrogenic complications (DOC) with family members of intensive care unit patients. The study explores reliability and validity based on scores from contrasting rater groups (clinicians, SPs, and examinees). Methods: Two 20-minute stations were administered to 17 surgical residents and 2 critical fellows at a university-based training program. The exam was conducted, videotaped, and scored in a standardized setting by 8 clinical raters (MD and RN) and 8 standardized families using separate rating tools (EOL and DOC). Examinees assessed themselves using the same tools. We analyzed the internal consistency, inter-rater agreement, and discriminant validity of both cases using data from each rater group. Cross-rater group comparisons were also made. Results: The internal consistency reliability correlations were above 0.90 regardless of case or rater group. Within rater groups, raters were within 1 point of agreement (5-pt and 6-pt scales) on 81% of the DOC and between 74% and 79% of the EOL items. Family raters were more favorable than clinical raters in scoring DOC, but not EOL cases. Large raw differences in performance by training level favored more experienced trainees (3rd year residents and fellows). These differences were statistically significant when based on residents own self-ratings, but not when they were based on clinical or family ratings. Discussion: The Family Conference Objective Structured Clinical Exam is a reliable exam with high content validity. It seems unique in the literature for assessing surgical trainees’ ability to discuss “bad news” with family members in intensive care.

The US National Center for Interprofessional Practice and Education Measurement and Assessment Collection

Since 1999, the pace of change and transformation of the United States (U.S.) healthcare delivery system has exponentially increased since the publication of the Institute of Medicine (IOM) “Trilogy,” To Err is Human, Crossing the Quality Chasm, and Health Professions Education: A Bridge of Quality (Committee on Quality of Health Care in America, 2000; Committee on Quality of Health Care in America, Institute of Medicine, 2001; Committee on the Health Professions Education Summit, Board on Health Care Services, 2003). With the passage of the Patient Protection and the Affordable Care Act (ACA, or “Obamacare”) in 2010, significant efforts have focused on moving toward a system based upon new models of care and practice transformation (Burwell, 2015). These practice models focus on patient and family engagement, community orientation, chronic disease management, health and well-being, and the deployment of health teams that incorporate community health workers, care coordinators, patient navigators, and health coaches among others. Unlike other countries in the world, the United States struggles with a primarily fee-for-service reimbursement model. Recent national efforts in Medicare reimbursement and by third-party insurers in response to new regulation and legislation have moved some portion of reimbursement to riskand value-based payments for “merit” and outcomes rather than based upon medical procedures (Oberlander & Laugesen, 2015; Rosenthal, 2015). Given the 2016 national election, the United States is once again on the cusp of significant change in health policy direction with calls to repeal the ACA. In the face of uncertainty, what appears to be consistent in the discussions about this shift, however, is a move toward reforming the payment system to one that is risk-based. This emphasis reflects Congressional bipartisan concerns about the cost and unsustainability of the U.S. healthcare system. As U.S. health systems focus on the bottom line in an uncertain environment, their corporate offices will follow where the financial incentives of the payers will take them; and today, the reward system, while evolving, still favours physicians over teams (Schneider & Hall, 2017). Today, greater emphasis is being placed on collaboration, higher quality, more affordable care, and “proven approaches,” particularly in caring for high-need, highcost patients. Emerging attributes point to communication and coordination among members of the care team. These emerging models of care are novel and complex and not easily transferrable because they require cultural adaptation in individual environments (Blumenthal, Chernof, Fulmer, Lumpkin, & Selberg, 2016). Therefore, health systems are seeking hard data and evidence that links processes of care, which may or may not be team-based, to outcomes, to report to government agencies and thirdpayer insurers. Furthermore, they are seeking data to make decisions about the composition of health professionals in their workforce, how they work together, and how to train them in real time. Experts in teamwork and interprofessional approaches have much to bring to these conversations, particularly around the measurement of team functioning and how to use proven tools in practice to link to evidence around outcomes, quality, affordability, and access to care.

A multi-institutional survey of newer surgery faculty on the impacts of education debt and debt repayment strategies.

BACKGROUND The cost associated with becoming a physician is significant, and studies have shown that surgeons, in particular, accrue higher debts than matched controls from other specialties, and the public. These findings, along with the current era of economic turmoil, prompted our investigation into the effects of educational debt on the career, family and lifestyle choices of recently graduated surgeons. Our goal was to query young surgical faculty about the education debt carried, the burden it presents as they embark on a career, and the financial management strategies employed to pay down their debt. STUDY DESIGN This study is a one-time, cross-sectional survey of regular and adjunct faculty from the University of Minnesota and the Mayo Clinic-Rochester. Participation was voluntary and responses were collected anonymously via SurveyMonkey. Respondents were sorted into two groups: those with and without education debt at the time of residency graduation. We compared these groups on a number of variables. RESULTS Of the 111 respondents (111/152, 73% response rate), 69 (62.2%) carried debt at the time of graduation from residency. The median educational debt at graduation was

Using Objective Structured Assessment of Technical Skills to Evaluate a Basic Skills Simulation Curriculum for First-Year Surgical Residents

100,000, and surgeons with educational debt carried a significantly higher burden of consumer and total debt than those without educational debt at graduation (p < 0.001). This continued after graduation with 74% (51/69) of residents with debt at graduation falling below the benchmark 36% debt-to-income ratio, and 45% (17/32) of those without debt at graduation in this same high risk financial situation. CONCLUSIONS Educational debt places a large financial responsibility on the shoulders of most newer faculty. The debt-to-income ratio demonstrated through our results was considerable for both study groups, and unwise according to financial literature. This is of utmost importance to leaders in academe, as salaries are generally lower than private practice colleagues. This can begin in residency with explicit and practical information on surgeon reimbursement, income ranges, and revenue sources (faculty, clinical), debt repayment strategies, and overall training on financial matters early in their residency.