Current surgery最新文献_第2页

The Surgical Learning and Instructional Portfolio (SLIP) as a Self-Assessment Educational Tool Demonstrating Practice-Based Learning 外科学习和教学组合(SLIP)作为一种自我评估教育工具，展示了基于实践的学习

Current surgery Pub Date : 2006-11-01 DOI: 10.1016/j.cursur.2006.04.001

Travis P. Webb MD, Charles Aprahamian MD, John A. Weigelt MD, Karen J. Brasel MD

{"title":"The Surgical Learning and Instructional Portfolio (SLIP) as a Self-Assessment Educational Tool Demonstrating Practice-Based Learning","authors":"Travis P. Webb MD, Charles Aprahamian MD, John A. Weigelt MD, Karen J. Brasel MD","doi":"10.1016/j.cursur.2006.04.001","DOIUrl":"10.1016/j.cursur.2006.04.001","url":null,"abstract":"<div><h3>Purpose</h3><p>Time constraints on the teaching and evaluation of residents continue to alter the way in which medical knowledge must be imparted and assessed. Lifelong learning is a component of the practice-based learning competency. A portfolio is one way to assess practice-based learning, but its use is unfamiliar to most surgical programs. The authors describe the evolution of the Surgical Learning and Instructional Portfolio (SLIP) into a worthwhile educational tool.</p></div><div><h3>Methods</h3><p>In March 2001, the authors began a program to encourage residents to develop a case-based portfolio to document their experience and demonstrate acquisition of knowledge in caring for a variety of surgical diseases. The monthly case topic was chosen by the resident and reported using a template: case history, supporting diagnostic studies, differential diagnosis, final diagnosis with ICD-9 coding, management options, treatment used, 3 lessons learned, embellishment of 1 lesson, and 2 articles supporting the experience. Initially, cases were submitted to the program coordinator and reviewed every 6 months with a faculty advisor to provide feedback.</p></div><div><h3>Results</h3><p>After the first 18 months of this program, resident compliance was less than 50%, satisfaction was low, and formal review did not occur. In July 2004, a single faculty member became responsible for evaluating and providing feedback on the monthly SLIPs. The assignments were handled electronically with feedback delivered within the month via e-mail. SLIP quality as measured by resident compliance and satisfaction improved.</p></div><div><h3>Conclusion</h3><p>These SLIPs have matured into a valuable educational tool satisfying multiple ACGME competencies. This portfolio system required direct faculty feedback to become successful.</p></div>","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 6","pages":"Pages 444-447"},"PeriodicalIF":0.0,"publicationDate":"2006-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.04.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26405255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 39

Is it Appropriate to Use Core Clerkship Grades in the Selection of Residents? 以核心见习职系遴选住院医师是否合适?

Current surgery Pub Date : 2006-11-01 DOI: 10.1016/j.cursur.2006.06.012

Hiroo Takayama MD , Rebecca Grinsell MD , Douglas Brock PhD , Hugh Foy MD , Carlos Pellegrini MD , Karen Horvath MD

{"title":"Is it Appropriate to Use Core Clerkship Grades in the Selection of Residents?","authors":"Hiroo Takayama MD , Rebecca Grinsell MD , Douglas Brock PhD , Hugh Foy MD , Carlos Pellegrini MD , Karen Horvath MD","doi":"10.1016/j.cursur.2006.06.012","DOIUrl":"10.1016/j.cursur.2006.06.012","url":null,"abstract":"<div><h3>Objective</h3><p>This study challenges the appropriateness of using core clerkship grades for resident selection. The authors hypothesize that substantial variability occurred in the system of grading.</p></div><div><h3>Design</h3><p>In this retrospective cross-sectional study, variability in the grading systems for third-year core clinical clerkships were examined. From the Medical Student Performance Evaluation of applicants from U.S. medical schools for residency training in the authors’ department in 2004 and 2005, the authors gathered the following variables: medical school, third-year core clerkship grading systems, and percentage of students in each grade category. Descriptive analyses were conducted and within institution variability across clerkship scores was analyzed using repeated measure analysis of variance (ANOVA) and t-test.</p></div><div><h3>Setting</h3><p>University teaching hospital.</p></div><div><h3>Participants</h3><p>The survey covered 121 of 122 U.S. medical schools accredited by the AAMC/LCME.</p></div><div><h3>Results</h3><p>Grading systems used included: variations of Honors/Pass/Fail (H,P,F) system in 76 schools, letter grade systems in 22 schools, and other variants (eg, Outstanding, Advanced, and Proficient in 6 schools and Pass/Fail in 4 schools). Thirteen schools (10%) provided either no grading system or no interpretable system. Grading systems included were further defined into 2 scores in 6 schools, 3 in 34 schools, 4 in 38 schools, 5 in 23 schools, and more than 6 in 6 schools. For schools using a grading system containing 3 or more scores, the percentage of students given the highest grade was significantly less in Surgery (28%) compared with Family Medicine (34%) and Psychiatry (35%) (p = 0.001).</p></div><div><h3>Conclusions</h3><p>Core clerkship grading systems and the percentage to which institutions grade students as having achieved the highest performance level vary greatly among U.S. medical schools. Within institutions, significant variability exists among clerkships in the percentage of the highest grade given, which makes interpersonal comparison based on core clerkship grades difficult and suggests that this method may not be a reliable indicator of performance.</p></div>","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 6","pages":"Pages 391-396"},"PeriodicalIF":0.0,"publicationDate":"2006-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.06.012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26405830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 49

Current surgery Pub Date : 2006-11-01 DOI: 10.1016/j.cursur.2006.07.002

Daniel R. Baillie MD

引用次数: 0

Does Academic Intervention Impact ABS Qualifying Examination Results? 学术干预会影响ABS资格考试成绩吗?

Current surgery Pub Date : 2006-11-01 DOI: 10.1016/j.cursur.2006.06.007

Karen R. Borman MD

{"title":"Does Academic Intervention Impact ABS Qualifying Examination Results?","authors":"Karen R. Borman MD","doi":"10.1016/j.cursur.2006.06.007","DOIUrl":"10.1016/j.cursur.2006.06.007","url":null,"abstract":"<div><h3>Objectives</h3><p>To assess the impact of a focused academic support program on American Board of Surgery In-Training Examination (ABSITE) scores and Qualifying Examination (QE) outcomes.</p></div><div><h3>Methods</h3><p>A mandatory intervention program was begun in April 2001 for residents with ABSITE Total Test (TT) percentiles <31. Program elements included: 1) individual faculty mentoring and personal learning plan 2) QE videotape review sessions 3) Surgical Education and Self-Assessment Program (SESAP) 4) monthly rotation evaluations, and 5) quarterly status feedback. A free medical evaluation was offered. Mock orals participation, educational psychologist consultation, and voluntary followup mentoring were added later. Study data were reviewed for 2003-2005 Chief Residents including ABSITE scores, QE results, conference attendance, rotation Overall Performance ratings, and resident surgeon case volumes. Results were compared for the academic intervention (AI) and no intervention (NI) groups.</p></div><div><h3>Results</h3><p>Fifteen residents graduated during the study period. Eight residents completed nine interventions; seven returned to TT percentiles >30 (7/8, 88%). First post-intervention ABSITE gains were large compared to NI and national peer groups. Standard Score (SS) TT gains were maintained until residency completion by four AI residents. Median AI PGY-5 TT percentile was 32 and three scores were ≤25. Six AI residents (6/8, 75%) and all NI residents (7/7, 100%) passed the QE on their first attempts. AI and NI groups were similar for conference attendance, rotation evaluations, and operative log totals.</p></div><div><h3>Conclusions</h3><p>A focused academic support intervention for residents with marginal ABSITE TT percentiles can produce immediate substantial gains. Gains are variably maintained through remaining residency years. PGY-5 TT percentiles ≤25, seen with three AI residents (3/8, 38%), are associated with a 40% first QE failure rate. Therefore, our 75% QE first-time pass rate for AI residents argues for intervention success.</p></div>","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 6","pages":"Pages 367-372"},"PeriodicalIF":0.0,"publicationDate":"2006-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.06.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26405828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 40

Presidential Address 总统地址

Current surgery Pub Date : 2006-11-01 DOI: 10.1016/j.cursur.2006.08.006

Joseph B. Cofer MD

引用次数: 0

The Electronic Journal Club: An Asynchronous Problem-Based Learning Technique Within Work-Hour Constraints 电子期刊俱乐部:在工作时间限制下的异步基于问题的学习技术

Current surgery Pub Date : 2006-11-01 DOI: 10.1016/j.cursur.2006.07.003

Jeffrey Hammond MD, Thomas Whalen MD

引用次数: 15

General Surgery Resident Applicants Perception of Program Coordinators 普通外科住院医师申请人对项目协调员的看法

Current surgery Pub Date : 2006-11-01 DOI: 10.1016/j.cursur.2006.08.010

Ruth Nawotniak MS , Ellie Gray

引用次数: 2

Work Hours Restrictions as an Ethical Dilemma for Residents: A Descriptive Survey of Violation Types and Frequency 工作时间限制作为居民的道德困境:违反类型和频率的描述性调查

Current surgery Pub Date : 2006-11-01 DOI: 10.1016/j.cursur.2006.06.003

Robert O. Carpenter MD , John Spooner MD , Patrick G. Arbogast PhD , John L. Tarpley MD , Marie R. Griffin MD , Kimberly D. Lomis MD

{"title":"Work Hours Restrictions as an Ethical Dilemma for Residents: A Descriptive Survey of Violation Types and Frequency","authors":"Robert O. Carpenter MD , John Spooner MD , Patrick G. Arbogast PhD , John L. Tarpley MD , Marie R. Griffin MD , Kimberly D. Lomis MD","doi":"10.1016/j.cursur.2006.06.003","DOIUrl":"10.1016/j.cursur.2006.06.003","url":null,"abstract":"<div><h3>Background</h3><p>The Accreditation Council for Graduate Medical Education (ACGME) implemented requirements regarding allowable duty hours for resident training in the United States in July 2003. In a previous pilot study at Vanderbilt University Medical Center, a significant number of residents reported violation of requirements. In addition, almost half of those individuals admitted under-reporting their hours worked. The authors’ goal was to further delineate the type and frequency of violations and under-reporting.</p></div><div><h3>Methods</h3><p>A survey tool was designed to assess specific types of violations as well as factors that influence the number of hours residents worked and reported. Approval was obtained from the Vanderbilt Institutional Review Board and Office of Graduate Medical Education before enrollment of subjects. The program directors of Pediatrics, Internal Medicine, Medicine-Pediatrics, and General Surgery supported the participation of their residents. A voluntary anonymous survey of these residents was conducted 1 year after the pilot study.</p></div><div><h3>Results</h3><p>Of 263 eligible residents, 175 were surveyed. Of 175 residents, 125 (71%) residents responded. Eighty-five percent of residents reported violation of duty-hour requirements within the preceding 3 months. Residents reported violation of specific requirements as follows: 1 day off in 7, 28%; 80-hour weekly average, 65%; and “24+6” consecutive hours, 85%. Residents were asked to estimate the number of hours by which they exceeded requirements. Hours over the 80-hour weekly requirement were reported as follows: 1 hour, 12%; 2 hours, 15%; 3 hours, 21%; 4 hours, 5%; 5 hours, 14%; and 6 or more hours, 33%. Hours over the “24+6” requirement were reported as follows: 1 hour, 30%; 2 hours, 42%; 3 hours, 18%; 4 hours, 7%; 5 hours, 1%; and 6 or more hours, 2%.</p><p>Forty-eight percent of respondents admitted under-reporting violations to their program director.</p></div><div><h3>Conclusions</h3><p>Eighty-five percent of residents reported at least 1 violation, and 48% admitted under-reporting violations. These results support the previous findings of 80% and 49%, respectively. Of the various requirements, the “24+6” rule was most frequently violated. Of those in violation of the “24+6” requirement, the majority (90%) exceeded limits by no more than 3 hours. Of those in violation of the 80-hour weekly average requirement, the majority (57%) exceeded limits by no more than 5 hours. Per the ACGME website, “an RRC may grant exceptions for up to 10% of the 80-hour limit, to individual programs based on a sound educational rationale.” Although the overall percent of residents reporting violation remains high, the number of excess hours worked is small relative to established standards (within 10%). The authors propose that systems adaptations could be developed to improve compliance. Special attention is warranted to investigate the activities of residents","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 6","pages":"Pages 448-455"},"PeriodicalIF":0.0,"publicationDate":"2006-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.06.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26405256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 40

Medical Student Entry into General Surgery Increases with Early Exposure to Surgery and to Surgeons 医学生进入普通外科增加与早期接触手术和外科医生

Current surgery Pub Date : 2006-11-01 DOI: 10.1016/j.cursur.2006.05.005

John C. Kirkham BA , Warren D. Widmann MD , Doris Leddy , Michael J. Goldstein MD , Benjamin Samstein MD , Mahmoud El-Tamer MD , Avital Harari MD , Tracey D. Arnell MD , Rena John BA , Mark A. Hardy MD

引用次数: 34

Current surgery Pub Date : 2006-11-01 DOI: 10.1016/j.cursur.2006.06.015

Terrill E. Theman MD

引用次数: 0