Faculty Bibliography

BACKGROUND: Experiential learning in medical education, as exemplified by objective structured clinical examinations (OSCEs), is a well-validated approach for improving trainee performance. Furthermore, the Accreditation Council for Graduate Medical Education (ACGME) has identified OSCEs as an ideal method for assessing the core competency of interpersonal and communication skills. The field of inflammatory bowel disease (IBD) challenges clinicians to communicate effectively due to the complex multidisciplinary nature of its management. Here, we describe a novel educational tool (the IBD OSCE) to assess and improve this clinical skillset in Gastroenterology (GI) fellows. METHODS: Twelve second-year GI fellows from 5 fellowship programs participated in a 4-station OSCE. Previously validated OSCE checklists were used to assess the GI fellows' performance in IBD-specific cases. In the first case ("New Diagnosis") the goal of the GI fellow was to educate a patient on her recent diagnosis of ulcerative colitis and to navigate a complex conversation about her risk of colon cancer. In the second case ("Shared Decision Making") the objective was to evaluate a patient with Crohn's disease who would benefit from combination therapy with infliximab and azathioprine. A third case ("Emergency Department Flare") involved evaluating how the fellow performs in the initial triage and management of an ulcerative colitis patient in flare through an observed telephone encounter with an actual emergency department physician. In the final case ("Pre-conception Counseling"), the fellow was asked to discuss the pre-conceptive management of active ulcerative colitis with a "real-life" obstetrician/gynecologist. Each station was videotaped and observed live by faculty gastroenterologists. Checklists were scored independently by a physician-observer and the Standardized Patient (SP), who both provided feedback to the fellow immediately following each case. Fellow performance was scored across multiple domains and individ!

BACKGROUND: Stress, depression, and suicide are universal but frequently unrecognized issues for women and men in residency training. Stress affects cognitive and psychomotor performance both inside and outside of the operating room. Stress impairs the 2 key components of a surgeon's responsibilities: intellectual judgment and technical skill. We hypothesized that the recognition of depression, substance abuse, failing personal relationships, and potential suicide is poor among surgeons. If residents can recognize the signs of stress, depression, and suicide among colleagues, we believe it will not only improve their quality of life but also may preserve it. METHODS: We first determined baseline resident knowledge of the signs of surgical stress including fatigue; burn out; depression; physician suicide; drug and alcohol abuse; and their effects on family, friends, and relationships. We then developed a curriculum to identify these signs in first, second, third, and fourth year surgical residents were identified as the target learners. The major topics discussed were depression; physician suicide; drug and alcohol abuse; and the effects of stress on family, friends, and our goals. Secondary objectives included identifying major sources of stress, general self-awareness, understanding professional choices, and creating a framework to manage stress. Residents participated in an interactive seminar with a surgical facilitator. Before and after the seminar, a multiple-choice test was administered with questions to assess knowledge of the signs of stress (eg, fatigue, burn out, and depression). RESULTS: Twenty-one residents participated in this study. Seventeen completed the pretest, and 21 participated in the interactive seminar and completed the post-test. The pretest revealed that surgical residents were correct in 46.8% (standard deviation [SD] = 25.4%) of their responses. The postseminar test showed an improvement to 89.7% (SD = 6.1%, P < .001, paired Student t test = 5.37). The same test administered 4 months later to 17 of the 21 learners revealed 76.9% (SD = 18.7%) correct answers, suggesting that the information had been internalized. Cronbach alpha was calculated to be .67 for the pretest and .76 for the post-test, suggesting a moderate to high degree of internal consistency. CONCLUSIONS: Stress is a significant and regularly overlooked component of a surgeon's life. Because its effects often go unrecognized, stress frequently remains unresolved. To prevent its associated consequences such as depression, substance abuse, divorce, and suicide, educating house staff about stress is crucial. This study suggests that the symptoms, causes, and treatment of stress among surgeons can be taught effectively to surgical resident learners.

OBJECTIVES: Educators of trainees in procedure-based specialties need focused assessment tools that are valid, objective, and assess technical skills in a realistic context. A framework for hybrid assessment using standardized patient scenarios and bench skills testing might facilitate evaluation of competency. METHODS: Seven PGY-1 obstetrics and gynecology residents participated in a hybrid assessment that used observed structured clinical examination (OSCE) by a standardized patient who had sustained a vaginal laceration during vaginal delivery. The residents elicited a history and counseled the patient, and then completed a laceration repair on a pelvic model. The residents were rated on their performance in the scenario, which included issues of cultural competency, rapport-building, patient counseling. The technical skills were videotaped and rated using a modified global assessment form by 2 faculty members on a 3-point scale from "not done" to "partly done" to "well-done." Residents also completed a subjective assessment of the station. RESULTS: Mean technical performance of the residents on the technical skills was 55% "well-done," with a range of 20%-90%. The assessment identified 3 residents as below the mean, and 1 resident with areas of deficiency. Subjective assessment by the residents was that juggling the technical, cognitive, and affective components of the examination was challenging. CONCLUSIONS: Technical skills can be included in a case-based assessment using scenarios that address a range of cognitive and affective skills required of physicians. Results may help training programs assess individuals' abilities as well as identify program needs for curricular improvement. This framework might be useful in setting standards for competency and identifying poor performers.