Interval assessment using task- and procedure-based simulations: an attempt to supplement neurosurgical residency curriculum.

OBJECTIVE: The longer learning curve and smaller margin of error make nontraditional, or "out of operating room" simulation training, essential in neurosurgery. In this study, the authors propose an evaluation system for residents combining both task-based and procedure-based exercises and also present the perception of residents regarding its utility. METHODS: Residents were evaluated using a combination of task-based and virtual reality (VR)-based exercises. The results were analyzed in terms of the seniority of the residents as well as their laboratory credits. Questionnaire-based feedback was sought from the residents regarding the utility of this evaluation system incorporating the VR-based exercises. RESULTS: A total of 35 residents were included in this study and were divided into 3 groups according to seniority. There were 11 residents in groups 1 and 3 and 13 residents in group 2. On the overall assessment of microsuturing skills including both 4-0 and 10-0 microsuturing, the suturing skills of groups 2 and 3 were observed to be better than those of group 1 (p = 0.0014). Additionally, it was found that microsuturing scores improved significantly with the increasing laboratory credits (R2 = 0.72, p < 0.001), and this was found to be the most significant for group 1 residents (R2 = 0.85, p < 0.001). Group 3 residents performed significantly better than the other two groups in both straight (p = 0.02) and diagonal (p = 0.042) ring transfer tasks, but there was no significant difference between group 1 and group 2 residents (p = 0.35). Endoscopic evaluation points were also found to be positively correlated with previous laboratory training (p = 0.002); however, for the individual seniority groups, the correlation failed to reach statistical significance. The 3 seniority groups performed similarly in the cranial and spinal VR modules. Group 3 residents showed significant disagreement with the utility of the VR platform for improving surgical dexterity (p = 0.027) and improving the understanding of surgical procedures (p = 0.034). Similarly, there was greater disagreement for VR-based evaluation to identify target areas of improvement among the senior residents (groups 2 and 3), but it did not reach statistical significance (p = 0.194). CONCLUSIONS: The combination of task- and procedure-based assessment of trainees using physical and VR simulation models can supplement the existing neurosurgery curriculum. The currently available VR-based simulations are useful in the early years of training, but they need significant improvement to offer beneficial learning opportunities to senior trainees.

Establishing a Self-sustaining Emergency Medicine Point-of-Care Ultrasound Curriculum in an Academic Teaching Hospital in Ethiopia.

Background: Point-of-care ultrasound (POCUS) training has become a standard component of Canadian emergency medicine (EM) residency programs. In resource-limited contexts, including Ethiopia, there is a critical shortage of local clinicians who can perform and teach POCUS. Our aim was to establish an introductory POCUS rotation within the EM residency program at Addis Ababa University (AAU) through The Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM). Methods: Through stakeholder engagement, the authors completed a quality improvement initiative and conducted a survey of AAU EM faculty and residents to understand which POCUS scans should be included in a core residency POCUS curriculum, "POCUS1". Results: 17 residents completed the POCUS1 program and 16 residents completed the written survey. Focused assessment with sonography for trauma, inferior vena cava, and lung (pneumothorax, pleural effusions, and interstitial syndrome) were identified as core introductory topics. Seventeen residents completed the initial POCUS1 program. Three program graduates were supported to become "POCUS1 Master Instructors" to continue the program during the SARS-CoV-2 global pandemic. Conclusion: The authors identified the highest yield POCUS scans through a written survey, successfully introduced a sustainable core POCUS curriculum at AAU for EM residents, and graduated three master instructors for curriculum continuation. We outline the structure and materials for implementation of POCUS programs for EM trainees and staff in similar low- and middle-income countries.

Impact of Coding Curriculum on Dermatology Resident Billing.

Background Competent medical coding is key to maintaining a successful dermatology practice. Resident billing performance can have significant financial implications for the academic institutions employing them. During their residency training, dermatology residents commonly find themselves responsible for the billing of patient encounters. However, despite the importance of adequate knowledge and skill in medical coding, recent data show inadequacies in this aspect of resident education. The goal of this study is to evaluate the impact of an interventional coding curriculum on dermatology residents' billing accuracy at our institution. Methodology Billing data, including evaluation and management (E/M) level of service, procedural codes, and current procedural terminology modifiers (if applicable) were queried from the electronic medical records (EMR) at a resident clinic seeing patients on three half-days each week. Billing codes were gathered from patient visits occurring in two separate time periods, before and after the intervention. The intervention consisted of monthly resident lectures on E/M and procedural billing in outpatient dermatology with associated quizzes. Billing accuracy was verified by three attending dermatologists through chart review and compared between the two time periods. Results Overall, billing data from 532 patient visits, 267 from the pre-intervention period and 265 from the post-intervention period, were checked for accuracy. The accuracy of resident-billed E/M levels of service was similar between the pre- and post-intervention periods (44.3% vs. 44.8%). Similar rates of undercoding and overcoding were noted between the pre- and post-intervention periods (35.2% undercoded and 8% overcoded vs. 35.7% and 8.9%, respectively). However, substantial improvements were noted in the rate of errors with procedural codes and modifiers in the post-intervention period. Overall, 21.9% of procedural codes were incorrectly billed pre-intervention compared to 3.7% post-intervention (p < 0.05). Moreover, 55.2% of modifiers were incorrectly billed pre-intervention versus 27.3% post-intervention (p < 0.05). Conclusions Our analysis suggests that billing lectures yielded a clear improvement in resident billing accuracy at our institution. While there was no improvement in E/M coding, there was a significant improvement in the usage of procedural codes and modifiers. Similar analyses can be used by other residency programs to monitor resident billing performance and the efficacy of educational programs on medical billing.