Dana T. Lin

Effectiveness of the Surgery Core Clerkship Flipped Classroom: a prospective cohort trial.

BACKGROUND The flipped classroom has been proposed as an alternative curricular approach to traditional didactic lectures but has not been previously applied to a surgery clerkship. METHODS A 1-year prospective cohort of students (n = 89) enrolled in the surgery clerkship was taught using a flipped classroom approach. A historical cohort of students (n = 92) taught with a traditional lecture curriculum was used for comparison. Pretest and post-test performance, end-of-clerkship surveys, and National Board of Medical Examiners (NBME) scores were analyzed to assess effectiveness. RESULTS Mean pretest and post-test scores increased across all modules (P < .001). There was no difference between mean NBME examination score in the prospective and historical cohorts (74.75 vs 75.74, P = .28). Mean ratings of career interest in surgery increased after curriculum completion (4.75 to 6.50, P < .001), with 90% reporting that the flipped classroom contributed to this increase. CONCLUSIONS Implementation of a flipped classroom in the surgery clerkship is feasible and results in high learner satisfaction, effective knowledge acquisition, and increased career interest in surgery with noninferior NBME performance.

Validity evidence for Surgical Improvement of Clinical Knowledge Ops: a novel gaming platform to assess surgical decision making

BACKGROUND Current surgical education curricula focus mainly on the acquisition of technical skill rather than clinical and operative judgment. SICKO (Surgical Improvement of Clinical Knowledge Ops) is a novel gaming platform developed to address this critical need. A pilot study was performed to collect validity evidence for SICKO as an assessment for surgical decision making. METHODS Forty-nine subjects stratified into 4 levels of expertise were recruited to play SICKO. Later, players were surveyed regarding the realism of the gaming platform as well as the clinical competencies required of them while playing SICKO. RESULTS Each group of increasing expertise outperformed the less experienced groups. Mean total game scores for the novice, junior resident, senior resident, and expert groups were 5,461, 8,519, 11,404, and 13,913, respectively (P = .001). Survey results revealed high scores for realism and content. CONCLUSIONS SICKO holds the potential to be not only an engaging and immersive educational tool, but also a valid assessment in the armamentarium of surgical educators.

The Assessment of Emotional Intelligence Among Candidates Interviewing for General Surgery Residency

BACKGROUND There is an increasing demand for physicians to possess strong personal and social qualities embodied in the concept of emotional intelligence (EI). However, the residency selection process emphasizes mainly academic accomplishments. In this system, the faculty interview is the primary means of evaluating the nontangible, nonacademic attributes of a candidate. OBJECTIVE To determine whether the impressions derived from faculty interviews correlate with an applicants actual EI as measured by a validated objective instrument. STUDY DESIGN Participating applicants interviewing for a surgical residency position at Stanford completed an EI inventory Trait Emotional Intelligence Questionnaire (TEIQue). Faculty estimated the EI of the applicants they interviewed using a corresponding 360° evaluation form. Multivariate linear regression was performed to identify demographic and academic factors predictive of EI. Applicant TEIQue scores and faculty 360° impressions were correlated using Pearson coefficients. RESULTS Mean EI of the cohort was higher than that of the average population (5.43 vs 4.89, p<0.001). Age was the only demographic variable that significantly informed EI (B = 0.07, p = 0.005). Among the academic factors considered, United States Medical Licensing Examination Step 1 score was a slight negative predictor of EI (B =-0.007, p = 0.04). Applicant global EI scores did not correlate with faculty impressions of overall EI (r = 0.27, p = 0.06). Of the 4 domains that comprise global EI, sociability and emotionality demonstrated a moderate correlation between applicant and faculty scores (r = 0.31, p = 0.03 and r = 0.27, p = 0.05, respectively). None of the fifteen individual facets of EI demonstrated any correlation between applicant and faculty ratings (r =-0.12 to 0.26, p = 0.06-0.91). No association was found between applicant TEIQue and traditional faculty interview evaluations (r = 0.18, p = 0.19). CONCLUSIONS Applicant EI correlated poorly with academic parameters and was not accurately assessed by faculty interviews. Methods that better capture this dimension should be incorporated into the residency selection process.

A Mixed-methods Analysis of a Novel Mistreatment Program for the Surgery Core Clerkship

Purpose To review mistreatment reports from before and after implementation of a mistreatment program, and student ratings of and qualitative responses to the program to evaluate the short-term impact on students. Method In January 2014, a video- and discussion-based mistreatment program was implemented for the surgery clerkship at the Stanford University School of Medicine. The program aims to help students establish expectations for the learning environment; create a shared and personal definition of mistreatment; and promote advocacy and empower ment to address mistreatment. Counts and types of mistreatment were compared from a year before (January–December 2013) and two years after (January 2014–December 2015) implementation. Students’ end-of-clerkship ratings and responses to open-ended questions were analyzed. Results From March 2014–December 2015, 141/164 (86%) students completed ratings, and all 47 (100%) students enrolled from January–August 2014 provided qualitative program evaluations. Most students rated the initial (108/141 [77%]) and final (120/141 [85%]) sessions as excellent or outstanding. In the qualitative analysis, students valued that the program helped establish expectations; allowed for sharing experiences; provided formal resources; and provided a supportive environment. Students felt the learning environment and culture were improved and reported increased interest in surgery. There were 14 mistreatment reports the year before the program, 9 in the program’s first year, and 4 in the second year. Conclusions The authors found a rotation-specific mistreatment program, focused on creating shared understanding about mistreatment, was well received among surgery clerkship students, and the number of mistreatment reports decreased each year following implementation.

Determining the educational value of a technical and nontechnical skills medical student curriculum

BACKGROUND Residency application rates to general surgery remain low. The purpose of this study is to describe the educational value of a curriculum designed to increase preclinical medical student interest in surgical careers to better understand the process by which medical students decide to pursue a career in surgery. MATERIALS AND METHODS We used qualitative methodology to describe the educational value of a technical and nontechnical skills curriculum offered to preclinical medical students at our institution. We conducted semistructured interviews of students and instructors who completed the curriculum in 2016. The interviews were recorded, transcribed, and inductively coded. The data were analyzed for emergent themes. RESULTS A total of eight students and five instructors were interviewed. After analysis of 13 transcripts, four themes emerged: (1) The course provides a safe environment for learning, (2) acquisition and synthesis of basic technical skills increases preclinical student comfort in the operating room, (3) developing relationships with surgeons creates opportunities for extracurricular learning and scholarship, and (4) operative experiences can inspire students to explore a future career in surgery. CONCLUSIONS These factors can help inform the design of future interventions to increase student interest, with the ultimate goal of increasing the number of students who apply to surgical residency programs.

Social Belonging as a Predictor of Surgical Resident Well-being and Attrition

OBJECTIVE In light of the predicted shortage of surgeons, attrition from surgical residency is a significant problem. Prior data have shown that those who are happier are more productive, and those who are less well have higher rates of absenteeism. This study sought to identify the role of social belonging and its relationship to well-being and risk of attrition. DESIGN Surgical residents were invited to participate in an online survey containing measures of social belonging (a 10-item scale adapted from previous studies), well-being (the Dupuy Psychological General Well-Being Scale, Beck Depression Inventory Short Form, and Maslach Burnout Inventory), and risk of attrition (indicated by frequency of thoughts of leaving the program). SETTING We surveyed residents at 2 tertiary care centers, Stanford Health Care (2010, 2011, and 2015) and Washington University in St. Louis (2017). PARTICIPANTS Categorical general surgery residents, designated preliminary residents going into 7 surgical subspecialties, and nondesignated preliminary residents were included. RESULTS One hundred sixty-nine residents responded to the survey for a response rate of 66%. Belonging was positively correlated with general psychological well-being (r = 0.56, p < 0.0001) and negatively correlated with depression (r = -0.57, p < 0.0001), emotional exhaustion (r = -0.58, p < 0.0001), and depersonalization (r = -0.36, p < 0.0001). Further, belonging was negatively correlated with frequency of thoughts of leaving residency (r = -0.45, p < 0.0001). In regression analysis controlling for demographic variables, belonging was a significant positive predictor of psychological well-being (B = 0.95, t = 8.18, p < 0.0001) and a significant negative predictor of thoughts of leaving (B = -1.04, t = -5.44, p < 0.0001). CONCLUSIONS Social belonging has a significant positive correlation with well-being and negative correlation with thoughts of leaving surgical training. Lack of social belonging appears to be a significant predictor of risk of attrition in surgical residency. Efforts to enhance social belonging may protect against resident attrition.