Growing the 'SEAD': Expansion of the Surgical Exploration and Discovery Program.

BACKGROUND: The declining popularity of surgical specialties among North American medical students has been attributed partially to limited early exposure and minimal involvement of surgeons in preclerkship education; in response, the Surgical Exploration and Discovery (SEAD) program was developed at the University of Toronto in 2012. SEAD is a 2-week curriculum that provides first-year medical students comprehensive exposure to surgical specialties through operating room observerships, simulation workshops, and career discussions. This study is the first to examine implementation of the SEAD program at another site. METHODS: This prospective cohort study evaluated the effectiveness of the SEAD program in improving surgical knowledge and facilitating career decision making when compared with a control group. In all, 18 students participated in the SEAD program, and 18 students from the same class read only the program's instructional manual; both the groups completed multiple-choice tests and questionnaires at baseline and at completion to assess knowledge acquisition and career-related learning. RESULTS: Both the groups significantly improved their surgical knowledge, but there was no difference between groups. SEAD participants made significantly greater progress in refining their career decisions when compared with the control group; all but one SEAD participant either gained interest in or ruled out a surgical specialty as a potential career choice compared with only 10 of the participants reading the manual only. CONCLUSIONS: The SEAD program provides a meaningful opportunity for medical students to explore surgical careers during preclerkship and to make better-informed career decisions. This expansion demonstrates that the program can be successfully reproduced at another institution.

Development and incorporation of hybrid simulation OSCE into in-training examinations to assess multiple CanMEDS competencies in urologic trainees.

INTRODUCTION: As residency training requirements increasingly emphasize a competency-based approach, novel tools to directly evaluate Canadian Medical Education Directives for Specialists (CanMEDS) competencies must be developed. Incorporating simulation allows residents to demonstrate knowledge and skills in a safe, standardized environment. We describe a novel hybrid simulation station for use in a urology resident in-training Objective Structured Clinical Exam (OSCE) to assess multiple CanMEDS competencies. METHODS: An OSCE station was developed to assess Communicator, Health Advocate, Manager, and Medical Expert (including technical skills) CanMEDS roles. Residents interviewed a standardized patient, interacted with a nurse, performed flexible cystoscopy and attempted stent removal using a novel bladder/stent model. Communication was assessed using the Calgary-Cambridge Observational Guide, knowledge was assessed using a checklist, and technical skills were assessed using a previously validated global rating scale. Video debriefing allowed residents to review their performance. Face and discriminative validity were assessed, and feasibility was determined through qualitative post-examination interviews and cost analysis. RESULTS: All 9 residents (postgraduate years [PGY] 3, 4, 5) completed the OSCE in 15 minutes. Communicator and knowledge scores were similar among all PGYs. Scores in technical skills were higher in PGY-5 compared with PGY-3/4 reside nts (mean score 79% vs. 73%). Residents and exam personnel felt the OSCE station allowed for realistic demonstration of competencies. Equipment cost was $218 for the exam station. CONCLUSIONS: We developed and implemented a hybrid simulation-based OSCE station to assess multiple CanMEDS roles. This approach was feasible and cost-effective; it also provided a framework for future development of similar OSCE stations to assess resident competencies across multiple domains.