Luise I.M. Pernar

A randomized pilot study of the use of concept maps to enhance problem-based learning among first-year medical students

Background: Medical student education is challenging, and concept maps (CMs) can help students link new and existing knowledge, promote critical thinking and identify knowledge gaps. Aims: To study the feasibility, acceptability, and effectiveness of CMs in problem-based learning (PBL) tutorials. Method: Students and tutors were randomized to tutorials that used or did not use CMs. A mixed-methods approach generated qualitative and quantitative results of participants’ perspectives on and the effects of CMs in PBL tutorials. Results: Student survey response rate was 71% (122/172). Most students (82.6%) planned to use CMs in the future at least occasionally, and students in CM tutorials endorsed increased likelihood of using CMs in the future (p = 0.02) versus students in non-CM tutorials. Qualitative analyses identified consistent associations between CMs and recurrent themes: integration of physiological mechanisms, challenging students’ knowledge of the material, and identification of knowledge gaps. Quantitative assessment of final exam scores revealed a statistically significant increase in the students’ scores in CM tutorials versus students in non-CM tutorials with an a priori α of <0.10. Conclusions: CMs are well accepted by students and faculty, feasible to incorporate into PBL tutorials, and may result in improved exam performance and student learning of physiologic concepts.

Preoperative Learning Goals Set by Surgical Residents and Faculty

BACKGROUND The operating room (OR) remains the main teaching venue for surgical trainees. The OR is considered a pure-discovery learning environment; the downsides of this can be putatively overcome when faculty and trainee arrive at a shared understanding of learning. This study aimed to better understand preoperative learning goals to identify areas of commonalities and potential barrier to intraoperative teaching. METHODS Brief, structured preoperative interviews were conducted outside the OR with the resident and faculty member who were scheduled to operate together. Answers were analyzed and grouped using grounded theory. RESULTS Twenty-seven resident-faculty pairs were interviewed. Nine residents (33.3%) were junior (PGY 1 and 2) and 18 (66.7%) were senior (PGY 3 through 5). Learning goal categories that emerged from the response analysis were anatomy, basic and advanced surgical skills, general and specific procedural tasks, technical autonomy, and pre-, intra-, and postoperative considerations. Residents articulated fewer learning goals than faculty (1.5 versus 2.4; P = 0.024). The most frequently identified learning goal by both groups was one classifiable under general procedural tasks; the greatest divergence was seen regarding perioperative considerations, which were identified frequently by faculty members but rarely by residents. CONCLUSIONS Faculty articulate significantly more learning goals for the residents they will operate with than residents articulate for themselves. Our data suggest that residents and faculty align on some learning goals for the OR but residents tend to be more limited, focusing predominantly on technical aspects of the operation. Faculty members tend to hold a broader view of the learning potential of the OR. These discrepancies may present barriers to effective intraoperative teaching.

Impact of online education on intern behaviour around joint commission national patient safety goals: a randomised trial

Purpose To compare the effectiveness of two types of online learning methodologies for improving the patient-safety behaviours mandated in the Joint Commission National Patient Safety Goals (NPSG). Methods This randomised controlled trial was conducted in 2010 at Massachusetts General Hospital and Brigham and Womens Hospital (BWH) in Boston USA. Incoming interns were randomised to either receive an online Spaced Education (SE) programme consisting of cases and questions that reinforce over time, or a programme consisting of an online slide show followed by a quiz (SQ). The outcome measures included NPSG-knowledge improvement, NPSG-compliant behaviours in a simulation scenario, self-reported confidence in safety and quality, programme acceptability and programme relevance. Results Both online learning programmes improved knowledge retention. On four out of seven survey items measuring satisfaction and self-reported confidence, the proportion of SE interns responding positively was significantly higher (p<0.05) than the fraction of SQ interns. SE interns demonstrated a mean 4.79 (36.6%) NPSG-compliant behaviours (out of 13 total), while SQ interns completed a mean 4.17 (32.0%) (p=0.09). Among those in surgical fields, SE interns demonstrated a mean 5.67 (43.6%) NPSG-compliant behaviours, while SQ interns completed a mean 2.33 (17.9%) (p=0.015). Focus group data indicates that SE was more contextually relevant than SQ, and significantly more engaging. Conclusion While both online methodologies improved knowledge surrounding the NPSG, SE was more contextually relevant to trainees and was engaging. SE impacted more significantly on both self-reported confidence and the behaviour of surgical residents in a simulated scenario.

Mini-clinical evaluation exercise as a student assessment tool in a surgery clerkship: Lessons learned from a 5-year experience

BACKGROUND The mini-clinical evaluation exercise (mini-CEX) used for clinical skill assessment in internal medicine provides in-depth assessment of single clinical encounters. The goals of this study were to determine the feasibility and value of implementation of the mini-CEX in a surgery clerkship. METHODS Retrospective review of mini-CEX evaluations collected for surgery clerkship students at our institution between 2005 and 2010. Returned assessment forms were tallied. Qualitative feedback comments were analyzed using grounded theory. Principal components analysis identified thematic clusters. Thematic comment counts were compared to those provided via global assessments. RESULTS For 124 of 137 (90.5%) students, mini-CEX score sheets were available. Thematic clusters identified comments on 8 distinct clinical skill domains. On the mini-CEX, each student received an average of 6.5 ± 2.2 qualitative feedback comments covering 4.5 ± 1.2 separate skills. Of these, 42.7% were critical. Comments provided in global evaluations were fewer (2.9 ± 0.6; P < .001), constrained in scope (0.8 ± 0.2 skills; P < .001), and rarely critical (9.1%). CONCLUSION A mini-CEX can be incorporated into a surgery clerkship. The number and breadth of feedback comments make the mini-CEX a rich assessment tool. Critical and supportive feedback comments, both highly valuable, are provided nearly equally frequently when the mini-CEX is used as an assessment tool.

Master Surgeons' Operative Teaching Philosophies: A Qualitative Analysis of Parallels to Learning Theory

OBJECTIVES Practicing within the Halstedian model of surgical education, academic surgeons serve dual roles as physicians to their patients and educators of their trainees. Despite this significant responsibility, few surgeons receive formal training in educational theory to inform their practice. The goal of this work was to gain an understanding of how master surgeons approach teaching uncommon and highly complex operations and to determine the educational constructs that frame their teaching philosophies and approaches. DESIGN Individuals included in the study were queried using electronically distributed open-ended, structured surveys. Responses to the surveys were analyzed and grouped using grounded theory and were examined for parallels to concepts of learning theory. SETTING Academic teaching hospital. PARTICIPANTS Twenty-two individuals identified as master surgeons. RESULTS Twenty-one (95.5%) individuals responded to the survey. Two primary thematic clusters were identified: global approach to teaching (90.5% of respondents) and approach to intraoperative teaching (76.2%). Many of the emergent themes paralleled principles of transfer learning theory outlined in the psychology and education literature. Key elements included: conferring graduated responsibility (57.1%), encouraging development of a mental set (47.6%), fostering or expecting deliberate practice (42.9%), deconstructing complex tasks (38.1%), vertical transfer of information (33.3%), and identifying general principles to structure knowledge (9.5%). CONCLUSIONS Master surgeons employ many of the principles of learning theory when teaching uncommon and highly complex operations. The findings may hold significant implications for faculty development in surgical education.

An appraisal of the learning curve in robotic general surgery

BackgroundRobotic-assisted surgery is used with increasing frequency in general surgery for a variety of applications. In spite of this increase in usage, the learning curve is not yet defined. This study reviews the literature on the learning curve in robotic general surgery to inform adopters of the technology.MethodsPubMed and EMBASE searches yielded 3690 abstracts published between July 1986 and March 2016. The abstracts were evaluated based on the following inclusion criteria: written in English, reporting original work, focus on general surgery operations, and with explicit statistical methods.ResultsTwenty-six full-length articles were included in final analysis. The articles described the learning curves in colorectal (9 articles, 35%), foregut/bariatric (8, 31%), biliary (5, 19%), and solid organ (4, 15%) surgery. Eighteen of 26 (69%) articles report single-surgeon experiences. Time was used as a measure of the learning curve in all studies (100%); outcomes were examined in 10 (38%). In 12 studies (46%), the authors identified three phases of the learning curve. Numbers of cases needed to achieve plateau performance were wide-ranging but overlapping for different kinds of operations: 19–128 cases for colorectal, 8–95 for foregut/bariatric, 20–48 for biliary, and 10–80 for solid organ surgery.ConclusionAlthough robotic surgery is increasingly utilized in general surgery, the literature provides few guidelines on the learning curve for adoption. In this heterogeneous sample of reviewed articles, the number of cases needed to achieve plateau performance varies by case type and the learning curve may have multiple phases as surgeons add more complex cases to their case mix with growing experience. Time is the most common determinant for the learning curve. The literature lacks a uniform assessment of outcomes and complications, which would arguably reflect expertise in a more meaningful way than time to perform the operation alone.

A checklist for a central venous line-based simulation scenario to measure behavioral compliance with Joint Commission National Patient Safety Goals.

DEMOGRAPHICS Case Title: Central Venous Line Station. Patient Name: John Mitford. Scenario Name: Central Venous Line Station to Measure Behavioral Compliance With National Patient Safety Goals. Simulation Developers: Luise I.M. Pernar, MD; Tim J. Shaw, PhD; Sarah E. Peyre, EdD. Dates of Development: September to October 2009. Learning Group: Residents, postgraduate years 1–5. Specialties: Anesthesiology, Medicine, Surgery, Obstetrics/ Gynecology, Emergency Medicine, Neurology, Psychiatry.

Anatomy and Physiology of the Spleen

Abstract The spleen is the largest lymphoid organ in the body. It also functions as a site for blood cell storage and quality control. Surgeons most frequently are called upon to perform urgent splenectomy in the setting of trauma, but numerous indications also exist for elective splenectomy. An understanding of the spleens anatomy and physiologic function is essential to perform splenectomy safely and to appropriately care for patients after splenectomy.

Resident-as-teacher programs in general surgery residency – A review of published curricula

INTRODUCTION The Liaison Committee on Medical Education (LCME) requires that residents are trained to fulfill their educational duties toward medical students. This study reviews the literature on resident-as-teacher programs (RATPs) aimed at surgical residents. METHODS Literature search with MeSH terms internship, residency, general surgery, teaching, education, and curriculum was performed using PubMed, Embase, Web of Science, and ERIC. Curriculum components and how curriculas success was measured were extracted for each study. Quality was scored using the Medical Education Research Study Quality Instrument (MERSQI). RESULTS For the seven relevant publications the average MERSQI score was 9.9 (range 6.5-13.5). The RATPs were either lecture based (4/7) or content was distributed electronically (3/7). Change in attitude toward teaching was the most frequently assessed outcome. Highly rated curricular components were individualized feedback and iterative reminders to make teaching part of practice. CONCLUSIONS Few published RATPs in general surgery training exist. The literature suggests that pairing lectures with observation and feedback is successful. Distributing the content electronically is a feasible alternative to class-room based teaching in a busy surgical residency.