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Developing criteria for proficiency-based training of surgical technical skills using simulation:: Changes in performances as a function of training year

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JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS 2008年第2期206卷 205-211页

作者： Brydges, Ryan Kurahashi, Allison Bruemmer, Vera Satterthwaite, Lisa Classen, Roger Dubrowski, Adam Univ Toronto Wilson Ctr Toronto ON M5G 2C5 Canada Univ Toronto Dept Surg Toronto ON M5G 2C5 Canada Univ Toronto Fac Nursing Toronto ON M5G 2C5 Canada German Sport Univ Cologne Inst Motor Control & Movement Tech Cologne Germany S Pointee Hosp Warrensville Heights OH USA

BACKGROUND: Proficiency-based residency training programs can be more efficient than the current duration-based formats. For their successful implementation, appropriate proficiency criteria must be developed. The objective of this study was to investigate the relationship between technical skill performances assessed using computer- and expert-based methods and training year. An assumption was that asymptotes in performance as a function of training year can be used to set the proficiency level for a technical skill, so the value at which the asymptote occurs can be labeled as the proficiency criteria. STUDY DESIGN: Thirty-eight general surgery residents performed one-handed knot tying on bench-top simulators at two levels of difficulty: superficial and deep. Motion-efficiency measures and expert-based measures were used to evaluate performance. Total number of operations (ie, surgical volume) that each trainee participated in during residency was also acquired. RESULTS: On the superficial model, asymptotes were observed at year I for motion-cfficiency and year 3 for expert-based measures. On the deep model, asymptotes were observed at year 2 for motion-efficiency and year 4 for expert-based measures. CONCLUSIONS: The data demonstrate the challenges associated with defining technical skills proficiency criteria. Different asymptotes were observed for the two assessment methods and neither covaried substantially with surgical volume. These data suggest that this asymptote approach in defining proficiency criteria can be suitable for development of proficiency-based residency training programs. The sensitivity of this approach to the type of assessment method and to the functional difficulty of the simulators used for assessment must be considered.

关键词： Clinical Competence Competency-Based Education Computer Simulation Cross-Sectional Studies 临床工作能力基于能力的教育计算机模拟横断面研究教育考核实习医师和住院医师职务 evaluation method Residency Competency-Based Education asymptotes Surgery simulator Cross-Sectional Studies Functional training technical skill Clinical Competence

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Does US Medical Licensing Examination Step 1 score really matter in surgical residency match outcomes (and should it)?

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JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS 2008年第3期206卷 533-539页

作者： Andriole, Dorothy A. Yan, Yan Jeffe, Donna B. Washington Univ Sch Med Dept Surg St Louis MO 63110 USA Washington Univ Sch Med Dept Med St Louis MO 63110 USA

BACKGROUND: The relationship between US Medical Licensing Examination Step 1 scores and core surgical-specialty match outcomes has not been well defined. STUDY DESIGN: With IRB approval, we measured associations between aggregate Step 1 scores and other specialty-specific, match-process variables for 3 surgical-specialty matches. Chi-square tests measured differences between proportions of US students and independent applicants (ie, all non-US allopathic student applicants) who matched. Independent samples t-tests compared differences in Step 1 scores between matched- and unmatched-applicant groups. Pearson correlations measured the magnitude and direction of associations between matched-applicants' Step 1 scores and other variables of interest and between Step 1 scores for all match participants and percentage of positions filled by US students (two-tailed p values). RESULTS: Step 1 scores were lower for unmatched than matched-applicant groups for each specialty examined (each p < 0.0001). Matched-applicant groups' Step I scores positively correlated with each unmatched-applicant groups' Step 1 scores (r=.82, p < 0.0001), Step 1 gap between matched- and unmatched-applicant groups' scores (r=.40, p=0.035), percentage of positions filled by US students (r=.62, p < 0.0001), and mean number of applications filed/applicant (r=.50, p < 0.0001). Step 1 scores for all match participants correlated with percentage of positions filled by US students (r=.61, p=0.0006). CONCLUSIONS: Step 1 scores were closely related to match process outcomes and match participation itself, with increasing Step 1 scores among both matched- and unmatched-applicant groups as specialty selectivity increased.

关键词： Career Choice Case-Control Studies Humans Internship and Residency Licensure Medical 职业选择病例对照研究实习医师和住院医师职务许可证医学试验预期值 Licensure Students licensing Steps Occupational Choice Medical Case-Control Studies United States Internship and Residency Association (Psychology)

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Construct validity of anterior segment anti-tremor and forceps surgical simulator training modules: Attending versus resident surgeon performance

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JOURNAL OF CATARACT AND REFRACTIVE SURGERY 2008年第6期34卷 980-985页

作者： Mahr, Michael A. Hodge, David O. Mayo Clin Dept Ophthalmol Rochester MN 55905 USA

PURPOSE: To compare the performance of the anterior segment forceps and anti-tremor training modules of the EYESi surgical simulator (VRmagic) by residents and experienced attending surgeons using the simulator for the first time. SETTING: Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA. METHODS: Twelve residents (4 per year) in the Mayo Clinic ophthalmology residency program and 3 experienced anterior segment surgeons participated. Each participant completed a total of 20 task trials on the EYESi forceps and anti-tremor level 4 training modules. Thus, the 15 participants completed a total of 300 task trials. RESULTS: For the forceps module, experienced surgeons achieved significantly better total scores (P = .03), with lower total task time (P = .007) and instrument-in-eye time (P = .006) measurements. For the anti-tremor module, experienced surgeons achieved significantly better total scores (P = .02), with lower task time (P = .04) and instrument-in-eye time (P = .02) measurements. In addition, experienced surgeons performing the anti-tremor task had 76% more precise surgical outcomes as measured by the out-of-tolerance percentage (P = .03). All forceps and antitremor-measured parameters indicated significantly lower performance (P < .05) for the first 1 or 2 trials, with the exception of anti-tremor module incision stress, out-of-tolerance percentage, and average tremor values. Experienced surgeons had more consistent (lower variance) total scores on the forceps (P = .05) and anti-tremor (P = .03) training modules. CONCLUSION: The EYESi surgical simulator anterior segment forceps and anti-tremor modules showed significant (P <.05) construct validity.

关键词： Adult Anterior Eye Segment Clinical Competence Computer Simulation Education Medical Graduate 成年人眼前半段临床工作能力计算机模拟教育医学研究生实习医师和住院医师职务 Surgeons Residency Forceps Construct Validity Anterior Eye Segment Medical Clinical Competence Adults graduate

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Electronic medical record metadata: Uses and liability

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JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS 2008年第3期206卷 405-411页

作者： McLean, Thomas R. Burton, Lori Haller, Chris C. McLean, Patrick B. Dwight D Eisenhower VA Med Ctr Surg Serv VA Eastern Kansas Hlth Care Syst Leavenworth KS 66048 USA 3rd Millennium Consultants LLC Shawnee KS USA

BACKGROUND: Minimal information exists concerning the use and liability of electronic medical record (EMR) metadata. STUDY DESIGN: We performed a retrospective review of Vista Imaging (VI) metadata concerning when and which images residents and medical students on a surgery service actually visualized;and the laws governing e-discovery were reviewed. RESULTS: During a 5-month period, PGY III surgery residents logged in to VI 191 +/- 18.3 times;PGY 11 surgery residents logged in 164 +/- 34.3 times;and PGY I surgery residents logged in 92.0 +/- 14.8 times. Family practice residents logged in 21.0 +/- 4.6 times, and medical students logged in 32.0 +/- 5.7 times (p < 0.01). Surgery residents logged about once a day (1.0 +/- 0.06 log-ins/ day);family practice residents (0.2 +/- 0.2 log-ins/day) and medical students (0.3 +/- 0.1 log-ins/ day) logged about only once a week. CT scans were the most frequently viewed image: surgery residents viewed CT scans during 81.9 +/- 14.9% ofVista Imaging sessions to view 69.3 +/- 36.5 images (range 1 to 863 images);family practice residents viewed CT scans during 58.0 +/- 43.8% of Vista Imaging sessions to view 19.3 +/- 22.8 images (range I to 112 images);and medical students viewed CT scans during 89.8 +/- 30.3% of Vista Imaging sessions to view 24.4 +/- 6.3 images (range 1 to 95 images). Changes in the Federal Rules of Civil Procedure and the need to authenticate electronic medical records will mean more metadata will be discovered during litigation. CONCLUSIONS: Electronic medical records metadata allow for creation of detailed physician profiles and will likely be used increasingly to discredit physicians during medical malpractice litigation.

关键词： Diagnostic Imaging Humans Internship and Residency Liability Legal Medical Records Systems Computerized 诊断显像实习医师和住院医师职务责任法律病案系统计算机化医师医疗模式 Family Practice Electronic Health Records X-Ray Computed Tomography Internship and Residency diagnostic imaging E-discovery Computerized Surgery medical student long shot Metadata RECORDING SYSTEMS liability

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System-based practice: Proposal for a comprehensive curriculum

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ACADEMIC RADIOLOGY 2008年第1期15卷 119-126页

作者： Otero, Hansel J. Weissman, Barbara N. Rybicki, Frank J. Harvard Univ Brigham & Womens Hosp Sch Med Dept RadiolAppl Imaging Lab Boston MA 02115 USA

Systems-based practice (SBP) is the sixth competency of the required ACGME core competencies in US-based residency programs. SBP aims to ensure that residents (1) are aware of a larger context and system of health care and (2) have the ability to effectively call upon system resources to provide care of optimal value (1). Therefore diagnostic radiology residency training programs must provide SBP *** core competencies were introduced in 1999 and implemented between 2001 and 2002 as part of the outcome project by ACGME (1). The outcome project is still ongoing, currently in its second phase that aims at \"sharpening the focus and definition of the competencies and assessment tools\" (1). The SBP competency has received far less attention than the other five competencies, mostly because of its less defined nature when compared to the others (2). Little has been published about this requirement in radiology, and its implications remain relatively unexplored (3). In a relatively recent report only 3% of senior medical students identified system-based practice as the most relevant competency during residency and later in their careers (4).

关键词： Clinical Competence Costs and Cost Analysis Curriculum Education Medical Graduate 临床工作能力成本及成本分析课程教育医学研究生教育考核实习医师和住院医师职务 competence Clinical Competence Medical Costs and Cost Analysis graduate SHBG wt Allele medical student Residency Health Care Systems system resources Curriculum

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Impact of urologic resident training on patient pain and morbidity associated with office-based cystoscopy

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UROLOGY 2008年第5期71卷 782-786页

作者： Nguyen, Carvell T. Babineau, Denise C. Jones, J. Stephen Cleveland Clin Fdn Glickman Urol & Kidney Inst & Quantitat Hlth Sci Cleveland OH 44195 USA

OBJECTIVES To determine whether pain and morbidity experienced by patients undergoing cystoscopy were affected by whether a staff urologist or resident was the primary surgeon. METHODS Patients scheduled to undergo cystoscopy were assigned to either the staff urologist or a resident as the primary surgeon. After cystoscopy, patients were given a visual analogue scale WAS, 0 to 100 mm) to assess pain. A two-part model was fit to investigate the effect that staff or resident had on pain scores. Confounding factors, such as age, gender, viewing of the procedure on video, and resident training year, were accounted for with multivariable regression techniques. RESULTS There was no statistically significant difference between the VAS scores for patients undergoing cystoscopy regardless of whether staff or resident performed the procedure. Further comparisons indicated no statistically significant differences in the effect that resident training year had on pain scores. CONCLUSIONS Office-based cystoscopy can be performed by residents under staff supervision, with pain and morbidity comparable to when a staff urologist performs the procedure. The impact of urologic resident training on patient care is an area that is relatively unexplored in the literature.

关键词： Aged Cystoscopy Female Humans Internship and Residency Male Medical Staff Hospital 老年人膀胱镜检查实习医师和住院医师职务医务人员医院门诊就医疼痛

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The In-Training Examination: An analysis of its predictive value on performance on the General Pediatrics Certification Examination

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JOURNAL OF PEDIATRICS 2008年第3期153卷 425-428页

作者： Althouse, Linda A. McGuinness, Gail A. Amer Board Pediat Inc Chapel Hill NC 27514 USA

Objective This study investigates the predictive validity of the In-Training Examination (ITE). Although studies have confirmed the predictive validity of ITEs in other medical specialties, no study has been done for general pediatrics. Study design Each year, residents in accredited pediatric training programs take the ITE as a self-assessment instrument. The ITE is similar to the American Board of Pediatrics General Pediatrics Certifying Examination. First-time takers of the certifying examination over a 5-year period who took at least 1 ITE examination were included in the sample. Regression models analyzed the predictive value of the ITE. Results The predictive power of the ITE in the first training year is minimal. However, the predictive power of the ITE increases each year, providing the greatest power in the third year of training. Conclusions Even though ITE scores provide information regarding the likelihood of passing the certification examination, the data should be used with caution, particularly in the first training year. Other factors also must be considered when predicting performance on the certification examination. This study continues to support the ITE as an assessment tool for program directors, as well as a means of providing residents with feedback regarding their acquisition of pediatric knowledge.

关键词： Certification Child Educational Measurement Humans Internship and Residency 证明儿童教育考核实习医师和住院医师职务儿科学可重复性结果回顾性研究 Statistical Validity Pediatrics Predictive certification Internship and Residency Educational Measurement Child

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Urology residency and research: Round table discussion and plea for innovation

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UROLOGY 2008年第5期71卷 762-765页

作者： Montie, James Faerber, Gary Schaeffer, Anthony Steers, William Liebert, Monica Stoll, Doris Macoska, Jill Univ Michigan Hlth Syst Dept Urol Ann Arbor MI USA Northwestern Univ Feinberg Sch Med Dept Urol Chicago IL 60611 USA Univ Virginia Hlth Syst Dept Urol Charlottesville VA USA Amer Urol Assoc Fdn Res Off Linthicum MD USA Accreditat Council Grad Med Educ Chicago IL USA

OBJECTIVES To evaluate the current and future states of resident research experience in,urology residencies in the United States. METHODS Round table discussion with leading educators and Urology faculty from a university urology residency. RESULTS Research exposure has rapidly diminished in urology residencies for a variety of reasons. There are multiple barriers to resident research and only a small number of residencies will be able to provide protected time. Nevertheless, an understanding of research methodology and biostatistics is required to be a successful clinician. CONCLUSIONS Some barriers to resident research can be addressed by better integration of residency and fellowships. Flexibility in the format of resident education may allow introduction of new methods to encourage resident research scholarship. An education program with a research curriculum is needed for all residencies.

关键词： Biomedical Research Internship and Residency United States Urology 实习医师和住院医师职务美国泌尿科学 Residency Biostatistics Education provision Urology Biomedical Research United States Technological Innovations Internship and Residency

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Guidelines for hospital privileges in vascular and endovascular surgery: Recommendations of the Society for Vascular Surgery

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JOURNAL OF VASCULAR SURGERY 2008年第1期47卷 1-5页

作者： Calligaro, Keith D. Toursarkissian, Boulos Clagett, G. Patrick Towne, Jonathan Hodgson, Kim Moneta, Gregory Sidawy, Anton N. Cronenwett, Jack L. Penn Hosp Clin Practice Council Soc Vasc Surg Vasc Surg Sect Philadelphia PA 19106 USA Univ Texas San Antonio San Antonio TX USA Univ Texas SW Dallas TX USA Med Coll Wisconsin Milwaukee WI 53226 USA So Illinois Univ Springfield IL USA Univ Oregon Portland OR USA George Washington Univ Washington DC USA Dartmouth Med Sch Lebanon NH USA

The Clinical Practice Council of the Society for Vascular Surgery (SVS) was charged with providing an updated consensus on guidelines for hospital privileges in vascular and endovascular surgery. One compelling reason to update these recommendations is that vascular surgery as a specialty has continued to evolve with a significant shift towards endovascular therapies. The Society for Vascular Surgery is making the following four recommendations concerning guidelines for hospital privileges for vascular and endovascular surgery. First, anyone applying for new hospital privileges to perform vascular surgery should have completed an Accreditation Council for Graduate Medical-accredited vascular surgery residency and should obtain American Board of Surgery certification in vascular surgery within 3 years of completion of their training. Second, we reaffirm and provide updated recommendations concerning previous established guidelines for peripheral endovascular procedures, thoracic and abdominal aortic endograft replacements, and carotid artery balloon angioplasty and stenting for trainees and already credentialed physicians who are adding these new procedures to their hospital credentials. Third, we endorse the Residency Review Committee for Surgery recommendations regarding open and endovascular cases during vascular residency training. Fourth, we endorse the Inter-societal Commission for Accreditation of Vascular Laboratories (ICAVL) recommendations for noninvasive vascular laboratory interpretations and examinations to become a registered physician in vascular interpretation (RPVI) or a registered vascular technologist (RVT).

关键词： Accreditation Clinical Competence Education Medical Graduate Humans 聘任鉴定临床工作能力教育医学研究生实习医师和住院医师职务医务人员权利 Accreditation Clinical Competence Medical graduate endovascular surgery Review Committees Vascular Surgical Procedures hospital

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Analysis of the pathology section of the OITE will aid in trainee preparation

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CLINICAL ORTHOPAEDICS AND RELATED RESEARCH 2008年第6期466卷 1323-1328页

作者： Frassica, Frank J. Papp, Derek McCarthy, Edward Weber, Kristy Johns Hopkins Univ Dept Orthopaed Surg Baltimore MD 21287 USA Johns Hopkins Univ Dept Oncol Baltimore MD USA Johns Hopkins Univ Dept Pathol Baltimore MD USA

We analyzed the tumor-related questions on the Orthopaedic In-Training Examinations (OITE) over a 5-year period (2002-2006). Each year approximately 27 of the 275 examination questions (10%) are tumor-related. Malignant conditions are tested more than benign ones (1.2:1). Approximately nine questions per year are immediate recall of specific entities, while eight questions tested the examinees' ability to establish a diagnosis from imaging studies with or without biopsy material. Participants were required to establish a diagnosis from imaging studies and/or biopsy material and then choose treatment an average of seven times per examination. The examinees' abilities in evaluation and decision making of patients was only tested an average of twice during each examination. Analysis of the content and type of question on the OITE might enable trainees to prepare more systematically. We determined the content, classified the questions, and quantified the interpretive material.

关键词： Bone Neoplasms Clinical Competence Competency-Based Education Educational Measurement 骨肿瘤临床工作能力基于能力的教育教育考核实习医师和住院医师职务医学肿瘤学 Competency-Based Education Trainees Bone Neoplasms Clinical Competence Immediate Recall Educational Measurement

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