The reliability of an instrument for identifying and quantifying surgeons' teaching in the operating room.

BACKGROUND: The operating room is an important teaching venue where surgical residents develop their operative skills and clinical judgement. The purpose of this study was to establish reliability for an observation instrument designed to quantify surgeons' teaching behaviors in the operating room. METHODS: An instrument was developed to identify operating room teaching behaviors in four categories: informing, questioning, responding, and setting tone. Two trained observers coded videotaped operations. Cronbach's alpha was used to estimate the instrument's internal consistency, and criterion-related reliability was established through an interobserver agreement level (IOA). RESULTS: Results for each of the teaching behavior categories were as follows: informing (IOA = 86%, alpha = +0.978); questioning (IOA = 97%, alpha = +0.966); responding (IOA = 93%, alpha = +0.97); setting tone (IOA = 97%, alpha = +0.882). CONCLUSIONS: This instrument is reliable in identifying and quantifying surgeons' teaching behaviors in the operating room. Identifying teaching behaviors will be valuable to describing and enhancing teaching in the operating room.

A model for tracking student experiences on surgical clerkships.

UNLABELLED: This study was conducted to identify the range and nature of surgical clerkship experiences in three different hospital settings-university, community, and public. METHODS: An instrument was developed to track the location and type of learning experience, patient demographics, surgical content, and clinical experience of students on their surgical clerkship. Twenty-three students used the instrument to record the events of their surgical clerkship. Data were analyzed to describe the frequency of tasks performed, the nature and location of learning experience, exposure to surgical topics, and patient demographics. RESULTS: Students were involved in an average of 245 common surgical tasks over their 8-week clerkship. Of their exposure to common tasks, students had the opportunity to observe 25% and perform 70% of those tasks. Sixty-six percent of task work occurred on the patient floor and 23% occurred in the operating room. Students were exposed to a broad range of surgical topics, 71% of which were general surgery topics. Only 25% of these experiences were auditory, whereas 39% involved exposure to a patient, and 36% included participation in an operation. Patient load and characteristics tended to vary across hospital settings, and on average, students worked with 164 patients during their clerkship. The smallest patient load (m = 113) occurred in the university hospital and the largest patient load (m = 251) occurred in the public hospital. CONCLUSION: Although surgical services and hospital settings may offer students different clerkship experiences, the common clinical and didactic components of a surgical clerkship can balance a student's exposure to surgical topics and practice of clinical skills. Tracking surgical clerkship experiences is valuable in identifying the range and nature of medical students' didactic, clinical, and operative experiences.

Factors affecting improvement on the American Board of Surgery In-Training Exam (ABSITE).

BACKGROUND: American Board of Surgery In-Training Exam (ABSITE) performance can be used to assess resident knowledge and to evaluate surgical curriculum. To determine factors that lead to improved resident ABSITE performance, a prospective study was performed. MATERIALS AND METHODS: Thirty-four surgical residents in Program Years 2-5 completed pre- and a post-ABSITE questionnaires about their anxiety, self-efficacy, physical preparation, and academic preparation for the ABSITE. Department records were used to determine resident probationary status and conference attendance. A preliminary analysis of ABSITE scores indicated a significant improvement between 1998 and 1999 percentile scores (paired t = -2. 25, P = 0.03; m = 11.9, SD = 30.5, median = 7). An improvement in percentile rank score was calculated and used as the dependent variable in a stepwise regression analysis. The following served as independent variables: previous exam performance, anxiety, probationary status, amount of sleep before exam, confidence to score in the 25th and the 50th percentiles, and attendance at the three conferences rated most valuable by the residents. RESULTS: Results of the regression analysis demonstrate that all factors account for 62.3% of the variance in improvement scores. A stepwise analysis indicated that the combination of attendance (40.2%) and previous performance (18.3%) was significant in explaining 58.5% of the variance in improvement scores. Furthermore, Pearson's correlations indicated that probationary status (+.58, P = 0.001), anxiety (+0.53, P = 0.001), amount of study (+0.61, P = 0.001), past ABSITE performance (-0.60, P = 0.001), and conference attendance (+0. 56, P = 0.001) were correlated with ABSITE improvement. CONCLUSIONS: This study demonstrates that resident individual effort, past ABSITE performance, and academic conference attendance have led to resident ABSITE improvement.