Using the 16PF to Test the Differentiation of Personality by Intelligence Hypothesis.

The differentiation of personality by intelligence hypothesis suggests that there will be greater individual differences in personality traits for those individuals who are more intelligent. Conversely, less intelligent individuals will be more similar to each other in their personality traits. The hypothesis was tested with a large sample of managerial job candidates who completed an omnibus personality measure with 16 scales and five intelligence measures (used to generate an intelligence g-factor). Based on the g-factor composite, the sample was split using the median to conduct factor analyses within each half. A five-factor model was tested for both the lower and higher intelligence halves and were found to have configural invariance but not metric or scalar invariance. In general, the results provide little support for the differentiation hypothesis as there was no clear and consistent pattern of lower inter-scale correlations for the more intelligent individuals.

Resident Operative Reports before and after Structured Education.

The operative note records surgical indication and pertinent events.In addition, it is a central facet in billing, malpractice lawsuits, research, and future medical planning. However, few residencies have structured education concerning dictation and there is little research on effective techniques for dictation training. The purpose of this study was to evaluate the efficacy of an educational intervention on the dictations of operative cases in which the residents were participants. Two hundred and eighty operative reports were reviewed for the presence or absence of criteria listed in Table 1 and given a score equal to the number of items included. One hundred and forty reports were evaluated before and 140 after an educational intervention. The intervention consisted of a lecture provided by a faculty expert while residents received an instructional card similar to Table 1 as a template. Primary endpoint was dictation score before and after the intervention. The pre- and postintervention scores for all residents were 16.28 and 17.37, respectively (P = 0.001). Junior and senior residents' preintervention average differed by 1.18 (P < 0.001), however there was no significant postintervention difference. The four most commonly missed data points were the amount of intravenous fluids given, preoperative indications, intraoperative findings, and whether or not a drain was placed. This study used real operative reports to show the benefit of dictation templates for improving resident dictations. These data support previous studies on dictation templates and depict the benefits within one surgical program after implementing a formal plan for dictation education.

Assessing the Evaluative Content of Personality Questionnaires Using Bifactor Models.

Exploratory bifactor models with keying factors were applied to item response data for the NEO-FFI-3 and HEXACO-PI-R questionnaires. Loadings on a general factor and positive and negative keying factors correlated with independent estimates of item valence, suggesting that item valence influences responses to these questionnaires. Correlations between personality domain scores and measures of self-esteem, depression, and positive and negative affect were all reduced significantly when the influence of evaluative content represented by the general and keying factors was removed. Findings support the need to model personality inventories in ways that capture reactions to evaluative item content.

Breast surgery techniques: preoperative bracketing wire localization by surgeons.

With the development of expertise in image guidance for breast surgery, many surgeons now perform preoperative wire localization themselves. Use of a single wire versus multiple wires to bracket a radiographic breast abnormality has previously been described, although benefits of this technique based on clinical outcomes such as margin status, tissue volume removed, and re-excision rates have not been established. This study is a retrospective analysis of wire-localized breast biopsies performed by 14 surgeons over 29 months; stereotactic and ultrasound guidance were used. During this time, 489 wire localizations were done, of which 159 used multiple wires. Two hundred eleven of these biopsies were done for malignant disease, 86 using multiple wires. After controlling for tumor node metastases stage, single and multiple wire placements were compared using endpoints of margin status, need for re-excision, and total volume of tissue removed. Neither margin status nor re-excision was related to the number of wires placed. However, the number of wires placed was significantly related to the total volume of tissue removed. Use of more than one localizing wire was associated with greater volume of tissue removal (measured in centimeters cubed) in benign disease (46 vs 25, P < 0.001), equivalent volumes in stage 0 disease (73 vs 67), less volume in stage 1 disease (113 vs 164), and less volume in stages 2 through 4 (158 vs 207, P = 0.03). Outcomes based on surgeon case volume during the study period demonstrated that low- (1-40), medium- (41-80), and high-volume (>80) surgeons did not differ in the type or stage of breast pathology treated. Surgeons with high case volumes were more likely to place multiple localizing wires (P < 0.001) and were more likely to do a breast-conserving procedure if re-excision was performed (P < 0.018). Surgeons with low case volumes were more likely to perform a re-excision (P < 0.025). Surgeon experience has a positive impact on quality outcome measures such as performance of a definitive procedure at the time of initial surgery and use of breast-conserving procedures at the time of re-excision. Multiple wire localization can be used to significantly reduce the volume of breast tissue removed in malignant disease without sacrificing margin status or increasing the need for future re-excision.

Is there declining interest in general surgery training?

PURPOSE: To monitor and report the quality of categorical first-year surgery residents matched to U.S. general surgery training programs from 1996 to 2001. METHODS: A survey was sent to 258 program directors of accredited general surgery training programs. In this survey, data were requested regarding United States Medical Licensing Exam (USMLE) Step 1 and 2 scores, matched residents' rank list position, Alpha Omega Alpha (AOA) status, number of applications received, and interviews granted pertaining to all National Residency Matching Program (NRMP) residents matched. In addition, the USMLE and NRMP were petitioned for national data regarding Step 1 and 2 scores in all entering surgery residents and first-time USMLE takers. RESULTS: Usable survey data were received on 1241 residents. The number for each year (and percent of total matched PGY-1 residents) was as follows: 1996-196 (20.0), 1997-206 (20.4), 1998-204 (19.9), 1999-212 (21.0), 2000-212 (20.7), and 2001-211 (21.7). The mean Step 1 scores increased over time (p < 0.001), and programs with 5 or more categorical spots had higher scores than those with 4 or less (p < 0.001). The depth required to fill the rank list increased over the study period (p < 0.05). National data received from the NRMP from 1994 to 2001 (mean of 916 residents at each year) showed a similar increase in USMLE Step 1 scores when compared with our survey. The proportion of AOA students matching into general surgery has decreased from 30% in 1996 to 15% in 2001 (p < 0.001). CONCLUSIONS: Over the 6 years of our study, USMLE Step 1 scores increased and the results of our survey are in agreement with the national data. However, the proportion of AOA students declined, implying the top 10% of the medical school class found general surgery training less attractive. Also, programs went deeper into their rank lists to fill, implying a shrinking pool of candidates.