Keep it SIMPL: Improved Feedback After Implementation of an App-Based Feedback Tool

BACKGROUND

Data defining the utility of the system for improving and measuring procedural learning (SIMPL) in surgical education is limited. The aim of this pilot study is to describe the impact of SIMPL on resident and faculty perspectives regarding operative feedback.

METHODS

Residents and faculty were surveyed prior to and 6 months after SIMPL implementation. Associations were analyzed using χ2 for categorical and Student's t-test for continuous variables. Statistical significance was defined as P-value < .05.

RESULTS

The proportion of residents receiving intraoperative feedback at least once/day increased significantly (35% to 73%, P = .025); there was a trend toward increased postoperative feedback (15% to 33%, P = .201). Faculty reported an increase in intraoperative (55% to 91%, P = .041) and postoperative feedback (21% to 64%, P = .020). Satisfaction with intraoperative feedback improved from a score of 3.50 ± 1.05 to 3.93 ± .62, although not statistically significant (P = .181). Satisfaction with postoperative feedback improved significantly from 2.85 ± .93 to 3.50 ± .65 (P = .032). The proportion of faculty who felt they were providing effective feedback increased (53% to 91%, P = .032). The proportion of residents who perceived that feedback enhanced their surgical skill increased as well (65% to 93%, P = .048).

DISCUSSION

Despite a modest increase in frequency of postoperative feedback, perceived quality of feedback improved substantially after implementation of SIMPL. Introduction of SIMPL also increased the amount of feedback provided by faculty intraoperatively. SIMPL, via direct and indirect effects, has a positive impact on the resident operative learning environment. Further work is necessary to examine the influence this may have on resident operative skill and patient outcomes.

Assessing Content of Accredited Colon and Rectal Surgery Fellowship Websites: Is there Adequate Information for Applicants?

Electronic information is a vital resource used by fellowship applicants. This study aimed to assess the completeness of colon and rectal surgery (CRS) fellowship program online information. Program information on the Association of Program Directors for Colon and Rectal Surgery (APDCRS) website as well as each institutional website was evaluated based on templated criteria. Sixty-eight accredited fellowship programs were identified. Six (9%) programs had complete profiles on the APDCRS platform, with an average of 3.5 details completed per program. Sixty-two (91%) websites were easily accessible. None of these contained all 28 criteria assessed and 47 (69%) contained less than half of assessed content. The most common data point was fellowship program description (96%), while board pass rate (1%) was the least common. Most CRS fellowship websites were grossly incomplete. Electronically available information is vital to fellowship applicants, and programs should try to provide easily accessible information about their program.

Love at First Click: Surgery Residency Websites in the Virtual Era

INTRODUCTION

Frequently, a residency program's website is the first interaction students interested in surgery have with the program. In the setting of virtual interviews for residency in 2020, the online availability of program information is of heightened importance. We sought to assess how academic versus community-based general surgery residency programs compared with respect to certain details on their websites.

METHODS

A total of n = 268 surgery residency programs were investigated. Our database of website characteristics included: direct link to residency website from the American Council on Graduate Medical Education (ACGME) program page, resident research requirement, listing of residents' publications, availability of residents' demographic information, program alumni information, board pass rates, attrition rate, detail of educational/academic activities, residents' evaluation methods, diversity, and mentorship. Inter-group analyses between academic and community-based programs were performed using Pearson's Chi-squared test.

RESULTS

Academic and community-based general surgery residency program websites were compared based on twelve (12) different parameters. Statistically significant differences were observed for eight of these comparisons: direct website access from ACGME (p = 0.007), research highlighted (p < 0.001), resident research requirement (p = 0.002), resident demographic information available (p=0.004), alumni information (p = 0.005), resident evaluation methods (p = 0.016), diversity (p < 0.001), and mentorship (p = 0.012). Across these domains, academic programs had more information available on their websites than the community programs did. The program websites did not differ significantly based on the frequency of mentioning resident publications, board pass rate, attrition rate, or resident education.

CONCLUSION

Many general surgery programs are lacking detailed information on their websites. The amount of website information available on general surgery residency programs differs when comparing academic and community-based programs.

USMLE Step 1 Is Pass/Fail - Should the ABSITE Follow Suit?

The United States Medical Licensing Examination (USMLE) Step 1 was recently made pass/fail. This decision was controversial largely because of the reliance on USMLE Step 1 scores in resident selection. However, these scores do not correlate with resident ability. In this manuscript, we consider if the American Board of Surgery In-Training Examination (ABSITE) should be pass/fail as well. The ABSITE has been used for "high-stakes" purposes, such as preliminary resident advancement and prospective fellow evaluation, for which it was not intended. Moreover, similar to the USMLE Step 1 exam, ABSITE scores have demonstrated no correlation with clinical ability. A pass/fail ABSITE would return the exam to its original purpose and minimize an over-reliance on scores. Moving forward, new objective measures will need to be developed to assess surgical trainees in a more holistic manner.

Understanding the Well-Being of General Surgery Residents

BACKGROUND

In 2017, the Accreditation Council for Graduate Medical Education program guidelines changed to include a section that requires programs to optimize resident and faculty member well-being. There is still a poor understanding of general surgery resident wellness, and there are few well-established wellness programs.

METHODS

We created a novel 50-question anonymous survey to assess burnout, depression, and wellness that was distributed to the general surgery residents as part of a pilot study. Univariate analysis was performed to assess wellness and wellness changes. Bivariate analysis was performed to determine the association between wellness variables and gender, age, and postgraduate year (PGY) level.

RESULTS

Thirty-five of 55 residents participated in the survey. Over half of the residents (54%) reported gaining weight during residency. Nearly 70% reported working while having an ongoing family issue, and 77% worked at least once while ill. Fourteen residents (40%) reported that their wellness worsened over the previous academic year, while 7 (20%) reported that it remained the same, and 11 (31%) reported that it improved. These changes varied significantly by the PGY level (P < .01). Age (younger vs older than 30) and sex were found to be effective measure modifiers of the association between wellness change and PGY level.

DISCUSSION

The overall wellness of the general surgery residents at our institution varies greatly. Poor wellness may lead to inferior patient care, burnout and depression, and negative resident morale. Residency programs need to implement programming to address wellness deficiencies.

The American Board Style Practice In-Training Examination as a Predictor of Performance on the American Board of Surgery In-Training Examination

BACKGROUND

The American Board of Surgery In-Training Examination (ABSITE), is an annual 250 question, multiple-choice test that assesses residents' surgical knowledge in preparation for board examinations. At our program, we developed a Surgical Council on Resident Education-based American Board Style Practice In-Training Examination: The ABSPITE. The 40-question examination was designed to help with test preparation. The purpose of this study was to evaluate the ABSPITE's predictive value on ABSITE performance.

METHODS

From 2013 to 2016, the ABSPITE was administered to residents at our program. Performances (N = 134) were graded based on a standardized scale to determine resident percent and percentile performance, then compared to average ABSITE performance.

RESULTS

Combined analysis showed a statistically significant positive correlation between average ABSITE and ABSPITE percentages and percentiles. This held true when categorical and preliminary residents were compared. When stratified by resident PGY level, the same results were seen for PGY 1 and PGY 2 residents but correlations failed to reach statistical significance for higher resident training levels.

CONCLUSIONS

The practice ABSPITE examination strongly correlates with ABSITE performance among junior residents at our program, and may be a valuable tool to predict ABSITE performance and guide review efforts.