Assessment of the Non-Technical Skills for Surgeons (NOTSS) framework in the USA.

BACKGROUND: Surgeons' non-technical skills are important for patient safety. The Non-Technical Skills for Surgeons assessment tool was developed in the UK and recently adapted to the US surgical context (NOTSS-US). The aim of this study was to evaluate the reliability and distribution of non-technical skill ratings given by attending (consultant) surgeons who underwent brief online training. METHODS: Attending surgeons across six specialties at a large US academic medical centre underwent a 10-min online training, then rated 60-s standardized videos of simulated operations. Intraclass correlation coefficient (ICC), and mean(s.d.) values for NOTSS-US ratings were determined for each non-technical skill category (score range 1-5, where 1 indicates poor, 3 average and 5 excellent) and for total NOTSS-US score (range 4-20; sum of 4 category scores). Outcomes were adjusted for rater characteristics including sex, specialty and clinical experience. RESULTS: A total of 8889 ratings were submitted by 81 surgeon raters on 30 simulated intraoperative videos. The mean(s.d.) total NOTSS-US score for all videos was 9·5(4·8) of 20. The within-video ICC for total NOTSS-US score was 0·64 (95 per cent c.i. 0·57 to 0·70). For individual non-technical skill categories, the ICC was highest for social skills (communication/teamwork: 0·63, 95 per cent c.i. 0·56 to 0·71; leadership: 0·64, 0·55 to 0·72) and lowest for cognitive skills (situation awareness: 0·54, 0·45 to 0·62; decision-making: 0·50, 0·41 to 0·59). Women gave higher total NOTSS-US scores than men (adjusted mean difference 0·93, 95 per cent c.i. 0·44 to 1·43; P = 0·001). CONCLUSION: After brief online training, the inter-rater reliability of the NOTSS-US assessment tool achieved moderate strength among trained surgeons rating simulated intraoperative videos.

ANTECEDENTES: Las habilidades no técnicas de los cirujanos (Non-Technical Skills for Surgeons, NOTSS) son importantes para la seguridad del paciente. La herramienta de evaluación de habilidades no técnicas para cirujanos se desarrolló en el Reino Unido y se adaptó recientemente al contexto quirúrgico de los Estados Unidos (NOTSS-US.). El objetivo de este estudio fue evaluar la fiabilidad y distribución de las calificaciones de habilidades no técnicas obtenidas por cirujanos adjuntos de cirugía (consultores) que recibieron una breve formación online. MÉTODOS: Cirujanos adjuntos de 6 especialidades en un gran centro universitario de Estados Unidos recibieron una formación online de 10 minutos de duración y seguidamente puntuaron vídeos estandarizados de operaciones simuladas de 60 minutos de duración. Se calcularon el coeficiente de correlación intraclase (intraclass correlation coefficient, ICC), la media y la desviación estándar (standard deviation, SD) para la puntuación de cada categoría de habilidad no técnica del NOTSS-US (rango 1-5, siendo 1 = pobre, 3 = promedio, 5 = excelente) y para la puntuación global de NOTSS-US (rango 4-20, suma de las puntuaciones de las cuatro categorías). Los resultados se ajustaron de acuerdo con las características del evaluador, incluyendo sexo, especialidad, experiencia clínica. RESULTADOS: En 30 videos intraoperatorios simulados, 81 cirujanos evaluadores proporcionaron 8.889 puntaciones. La puntuación media global de NOTSS-US para todos los vídeos fue de 9,5 sobre 20 (SD 4,8). El ICC de los vídeos para la puntuación global de NOTSS-US fue 0,64 (i.c. del 95% 0,57-0,70). Para las categorías individuales de habilidades no técnicas, el ICC más alto fue para las habilidades sociales (comunicación / trabajo en equipo: 0,63, (i.c. del 95% 0,56-0,71); liderazgo, 0,64 (i.c. del 95% 0,55-0,72)) y el más bajo para las habilidades cognitivas (conciencia de la situación 0,54 (i.c. del 95% 0,45-0,62); toma de decisiones 0,50 (i.c. del 95% 0,41-0,59)). Las evaluadoras femeninas presentaron puntuaciones globales de NOTSS-US más altas que los evaluadores masculinos (diferencia 0,93, i.c. del 95% 0,44-1,43; P = 0,001)). CONCLUSIÓN: Después de una breve formación online, la fiabilidad de la herramienta de evaluación NOTSS-US mostró una correlación moderada entre los cirujanos que puntuaron vídeos de simulaciones de intervenciones quirúrgicas.

Development and evaluation of the General Surgery Objective Structured Assessment of Technical Skill (GOSATS).

BACKGROUND: Technical skill acquisition is important in surgery specialty training. Despite an emphasis on competency-based training, few tools are currently available for direct technical skills assessment at the completion of training. The aim of this study was to develop and validate a simulated technical skill examination for graduating (postgraduate year (PGY)5) general surgery trainees. METHODS: A simulated eight-station, procedure-based general surgery technical skills examination was developed. Board-certified general surgeons blinded to the level of training rated performance of PGY3 and PGY5 trainees by means of validated scoring. Cronbach's α was used to calculate reliability indices, and a conjunctive model to set a pass score with borderline regression methodology. Subkoviak methodology was employed to assess the reliability of the pass-fail decision. The relationship between passing the examination and PGY level was evaluated using χ2 analysis. RESULTS: Ten PGY3 and nine PGY5 trainees were included. Interstation reliability was 0·66, and inter-rater reliability for three stations was 0·92, 0·97 and 0·76. A pass score of 176·8 of 280 (63·1 per cent) was set. The pass rate for PGY5 trainees was 78 per cent (7 of 9), compared with 30 per cent (3 of 10) for PGY3 trainees. Reliability of the pass-fail decision had an agreement coefficient of 0·88. Graduating trainees were significantly more likely to pass the examination than PGY3 trainees (χ2  = 4·34, P = 0·037). CONCLUSION: A summative general surgery technical skills examination was developed with reliability indices within the range needed for high-stakes assessments. Further evaluation is required before the examination can be used in decisions regarding certification.

ANTECEDENTES: La adquisición de habilidades técnicas es importante en el entrenamiento especializado en cirugía. A pesar del énfasis en la capacitación basada en competencias, actualmente hay pocas herramientas disponibles para la evaluación directa de habilidades técnicas al finalizar el periodo de formación. El objetivo de este estudio fue desarrollar y validar un examen simulado de habilidades técnicas para postgraduados en formación en cirugía general (5º año postgraduado). MÉTODOS: Se desarrolló un examen simulado de habilidades técnicas de procedimientos de ocho estaciones. Cirujanos generales certificados y ciegos respecto al nivel de formación puntuaron la actuación de 10 postgraduados de tercer año (PGY3) y 9 postgraduados de quinto año (PGY5) usando una puntuación validada. Se utilizó el coeficiente alfa de Cochrane para calcular los índices de fiabilidad, y un modelo conjuntivo para establecer la nota de paso del examen mediante un método de regresión borderline. La fiabilidad de la decisión pasar/no pasar el examen se evaluó usando la metodología Subkoviak. La relación entre pasar el examen y el nivel PGY se analizó mediante la prueba de ji al cuadrado. RESULTADOS: La fiabilidad entre estaciones fue de 0,66 y la fiabilidad entre evaluadores de 0,92, 0,97 y 0,76. Se estableció una puntuación para pasar el examen de 176,8/280 (63,1%). La tasa de paso del examen para postgraduados PGY5 fue del 78% (7/9) en comparación con el 30% (3/10) para los posgraduados PGY3. La fiabilidad de la decisión pasar/no pasar fue pₒ= 0,88. Los postgraduados PGY5 presentaban una probabilidad significativamente superior de pasar el examen en comparación con los postgraduados PGY3 (χ2 = 4,34, P = 0,037). CONCLUSIÓN: Se desarrolló un examen sumatorio de habilidades técnicas de cirugía general con índices de fiabilidad dentro del rango necesario para este tipo de valoraciones. Se requiere una evaluación adicional antes de que el examen se pueda utilizar en las decisiones de certificación.

Faculty development and support needed to integrate the learning of prevention in the curricula of medical schools.

Comprehensive coverage of prevention-related topics in the curricula of medical schools is important for the training of future physicians; however, the changes needed in educational programs to include such topics are likely to challenge many institutions. Faculty members are central to the successful adoption of any new curricular paradigm, yet many of the impediments to change are also likely to be found within the faculty ranks. Achieving major curricular change requires institution leaders to define a new vision and allocate sufficient resources to support faculty efforts. Appropriate steps should be taken to actively involve the faculty early in the process of change and to recruit stakeholders from within the faculty ranks to play prominent roles. The educational models should be based on educationally and scientifically sound underpinnings that will facilitate acceptance of the models by the faculty, and faculty members must be offered appropriate opportunities to develop the skills to successfully implement the models. A school-wide faculty development program should address organizational development, instructional development, and personal development. The expertise needed to design and implement these activities may be secured from within or outside the institution. Individuals who have played key roles in the curricular change process must be rewarded and given appropriate recognition for their contributions. These steps will help in the successful integration of prevention-related topics into the curriculum, which will add a much-needed dimension, resulting in students' being better prepared to address the needs of their patients and the community.

Paraganglionoma of extrahepatic biliary tract causing obstructive jaundice.

We report a young woman with paraganglionoma arising from the extrahepatic bile duct presenting with acute obstructive jaundice. The patient underwent excision of the gall bladder and extrahepatic bile duct with the tumor, and Roux-en-Y hepaticojejunostomy. She is asymptomatic 9 months later, with normal biochemical investigations and imaging.

A new educational role for plastic surgery in the fourth year of medical school.

At most medical schools, students are offered limited or sporadic experiences in plastic surgery. This is unfortunate because all physicians need to possess the knowledge and skills to evaluate skin lesions and participate in wound management. Also, students who are considering a career in plastic surgery do not have adequate information to make informed decisions. With the restructuring of plastic surgery training programs, career decisions of individuals interested in plastic surgery are being made earlier than ever before in the education continuum, and the aforementioned problem assumes greater magnitude both for the students and the faculty. At MCP-Hahnemann School of Medicine, basic plastic surgery experiences have been integrated into the third-year surgery clerkship as a requirement for all students, and a Plastic Surgery Pathway has been designed in conjunction with the school's pathway system for fourth-year students. The Pathway provides a framework for the student to select a combination of rotations that will best provide an appropriate broad-based education in preparation for training in plastic surgery, and it provides extensive guidance by faculty members in the discipline to assist with career decisions, rotation selection, and preparations for the residency application process. Students in the Plastic Surgery Pathway are required to take rotations in medicine, neurology, and plastic surgery. The remaining rotations are selected from a list of options based on the student's individual learning needs, interests, and career aspirations. Early experience with the Plastic Surgery Pathway has shown that it has been well received by students and faculty, has assisted students with their career decisions, and has led to an increased student awareness of the importance and relevance of the specialty.

Redesigning the surgery clerkship at MCP Hahnemann School of Medicine to address the educational needs of generalists.

This article describes how the surgery clerkship at MCP Hahnemann School of Medicine was redesigned to provide all students a well-rounded general professional education and to address the specific educational needs of generalists. During the 12-week clerkship, students spend eight weeks on two different general surgery rotations, which include significant experiences in outpatient settings. The evaluation and management of common general surgical problems, as well as the holistic approach to patient care, are emphasized. A nurse educator, recruited through funding obtained from The Robert Wood Johnson Foundation's Generalist Physician Initiative, provides formal instruction in holistic care and teaches bedside procedures. Two weeks are devoted to focused surgical subspecialty experiences addressing common conditions and are conducted primarily in outpatient settings. The remaining two weeks include an integrated musculoskeletal disease rotation, including orthopaedic surgery, rheumatology, physiatry, and radiology. Didactic teaching includes criteria for referral of patients from generalists to specialists. The new clerkship model has been well received by the students. Review of student logs for the first six months indicates the breadth of surgical experience has been maintained and appropriate balance achieved between simple and complex surgical cases. Further evaluation of the model will continue through longitudinal follow-up.

A new model for recognizing and rewarding the educational accomplishments of surgery faculty.

Faculty members' educational endeavors have generally not received adequate recognition. The Association for Surgical Education in 1993 established a task force to determine the magnitude of this problem and to create a model to address the challenges and opportunities identified. To obtain baseline information, the task force reviewed information from national sources and the literature on recognizing and rewarding faculty members for educational accomplishments. The group also developed and mailed to surgery departments at all U.S. and Canadian medical schools a questionnaire asking about the educational endeavors of the surgery faculty and their recognition for such activities. The response rate after two mailings was only 56%, but the responses reaffirmed the inadequacy of systems for rewarding and recognizing surgeon-teachers and surgeon-educators, and confirmed that the distinction between the roles of teacher and educator was rarely made. The task force created a four-tier hierarchical model based on the designations teacher, master teacher, educator, and master educator as a framework to offer appropriate recognition and rewards to the faculty, and endorsed a broad definition of educational scholarship. Criteria for various levels of achievement, ways to demonstrate and document educational contributions, appropriate support and recognition, and suggested faculty ranks were defined for these levels. The task force recommended that each surgery department have within its faculty ranks a cadre of trained teachers, a few master teachers, and at least one educator. Departments with a major commitment to education should consider supporting a master educator to serve as a resource not only for the department but also for the department's medical school and other medical schools. Although this model was created for surgery departments, it is generalizable to other disciplines.

Use of a paper-cut as an adjunct to teaching the Whipple procedure by video.

BACKGROUND: Medical students often experience difficulty comprehending anatomic relationships of complex operations to which they are exposed during surgical clerkship. Pancreaticoduodenectomy, the Whipple procedure, is one such operation. Although video recordings are available to facilitate the learning of the Whipple procedure, commercially available tapes are not self-explanatory to the uninitiated. Since we have previously demonstrated that third-year medical students could learn the operative steps of inguinal herniorraphy by a paper-cutting exercise, we set out to determine whether an exercise of similar design could enhance a student's comprehension of the Whipple procedure. METHODS: Using Adobe Illustrator 5.5 for MacIntosh, an exercise was developed on a 8.5 x 11-inch paper that could be distributed to students for self-administration. The exercise was performed using a #15 scalpel or an iris scissors. Thirty-seven students were randomized into two groups. Each student received a pretest of questions focusing on the Whipple procedure. Group I was shown an 18-minute commercially available teaching video on the Whipple procedure. Group II was given the Whipple origami exercise, which required 20 minutes to complete. A first posttest was administered to each group. Next, the groups switched exercises, and a second posttest was administered. RESULTS: There was no significant difference between the groups' pretest scores (two-tailed t test, P = 0.290). Group I improved its score from an average of 64.21 (SD 14.27) to 67.89 (SD 13.16) after watching the video, and further to 77.89 (SD 14.37) after completing the paper-cut exercise. Group II improved from 60.00 (SD 9.43) to 78.95 (SD 11.00) after performing the paper-cut, but derived no additional measurable benefit from watching the video, average score 74.74 (SD 18.37). After the first exercise, students who performed the paper-cut showed a significantly greater improvement in test scores compared with students who saw the video (P = 0.0035 by Mann-Whitney U). After both groups had completed the exercises, the mean changes from baseline were no longer significantly different (P = 0.58 by Mann-Whitney U). CONCLUSION: As a single educational intervention, the paper-cut exercise was a more effective teaching device than the video in the given time frame. The origami model may be generalized to a variety of surgical procedures and appears to be a valuable adjunct to traditional teaching.

Teaching three-dimensional surgical concepts of inguinal hernia in a time-effective manner using a two-dimensional paper-cut.

BACKGROUND: Because inguinal hernia repair is difficult for third-year students to comprehend, a 2-dimensional paper-cut was developed to teach the concepts of inguinal hernia in a time-effective manner before students' observation of herniorrhaphy in the operating room. METHODS: Using Adobe Illustrator 5.5 for MacIntosh, a 2-dimensional inexpensively printed paper-cut was created to allow students to perform their own simulated hernia repair before observing surgery. The exercise was performed using a no.15 scalpel or an iris scissors and was evaluated by comparing 10-question pre-tests and post-tests. RESULTS: Seventy-five students performed the exercise, most completing it within 15 minutes. The mean pre-test score was 7.4/10 and the mean post-test score was 9.1/10. Students performing the paper-cut reported better understanding when observing actual herniorrhaphy. CONCLUSIONS: A 2-dimensional paper-cut ("surgical origami") may be a time-effective method to prepare students for the observation of hernia repair.

Impact of a standardized patient intervention to teach breast and abdominal examination skills to third-year medical students at two institutions.

BACKGROUND: This study examined whether a single intervention with standardized patients (SPs) as a supplement to traditional teaching during the surgery clerkship would enhance the breast and abdominal examination skills of third-year medical students. METHODS: During the academic year 1994-1995, 153 students from two institutions were assigned to control or experimental groups. At institution A, all students underwent pretests and posttests with SPs; at institution B, no pretest was conducted. All experimental students received group and one-to-one instruction with SPs during the intervention session. RESULTS: At posttest, the experimental group performed better than the control group on breast examination (P = 0.002), professionalism during this examination (P <0.001), abdominal examination (P <0.001), and professionalism during the latter examination (P = 0.050). The improvement from pretest to posttest at institution A was significantly greater in the experimental group than the control group for the breast examination (P = 0.036) and the abdominal examination (P <0.001). Analyses on a variety of specific tasks within each examination were also performed. CONCLUSION: A single intervention with SPs teaching breast and abdominal examinations resulted in significant enhancement of these clinical skills.

Who should teach medical students surgery?

BACKGROUND: Medical schools are undergoing major curricular reform, partly in attempts to increase the number of graduates pursuing careers in the generalist disciplines. These reforms have often resulted in a shortening of the surgery clerkship, decreasing students' experiences in several domains important to the generalist. METHODS: A seven-question survey of clerkship directors of US medical schools was administered to measure the magnitude of curriculum change during the past 5 years affecting the surgery and family practice clerkships. The survey also addressed attitudes about the purpose of the surgery clerkship. RESULTS: There was an 80% (103 of 129) response rate. Between 1989 and 1994, surgery clerkships decreased on average from 11 to 10.2 weeks (P <0.05) while family practice clerkships increased from 4.2 to 6.8 weeks (P <0.05). Ninety-one percent of clerkship directors felt the primary goal of the clerkship should be to train generalists. CONCLUSIONS: The length of the surgery clerkship has decreased at several institutions. In order to ensure an appropriate educational experience for medical students, surgeons must participate actively in curriculum reform within medical schools and highlight their unique role in training generalists.

Description and evaluation of the Surgeons as Educators course.

BACKGROUND: Since 1993, the American College of Surgeons has sponsored an annual 6-day course entitled the Surgeons as Educators. The course was designed to provide academic surgeons with the knowledge and skills necessary to enhance the surgical education curriculum, teaching strategies, educational program administration, and performance evaluation. This article describes the development, implementation, and effect of the course on the classes graduating in 1993 and 1994. STUDY DESIGN: The effect of the course was studied by using a longitudinal survey approach. A survey was mailed to participants 3 to 6 months after they completed the course. Graduates were asked to describe any education-related actions taken attributable to attending the Surgeons as Educators course. The quality of course content and presentations were evaluated by using end-of-course evaluation forms and daily feedback forms and by an external reviewer. RESULTS: Within 6 months of returning from the course, more than one half of the graduates initiated actions related to curriculum development, teaching strategies, or educational administration. One third or more of the graduates modified their performance and program evaluation systems. Using a five-point scale, ratings of the course content ranged from 3.78 to 4.64 for "value of topic" and from 3.77 to 4.76 for "quality of presentation." Items evaluated by the graduates on the end-of-course evaluation forms ranged from 7.8 to 8.7 on a nine-point scale. CONCLUSIONS: The Surgeons as Educators course offered an opportunity for participants to interact among themselves and with course faculty about educational issues and to practice teaching skills. The course was highly rated for educational quality and value. The retreat environment and the length of the program helped attendees become immersed during this "protected time" to analyze strengths and weaknesses of their programs and devise achievable plans to improve their abilities as educators and the effectiveness of their programs.

von Hippel Lindau syndrome presenting as obstructive jaundice with involvement of pancreas in two siblings.

Von Hippel Lindau disease is rare autosomal dominant disorder. In our patient's family, 4 out of 7 siblings had manifestations of the disease; 3 of those affected had pancreatic lesions with obstructive jaundice in 2 siblings caused by pancreatic cysts is reported for the first time.

Preserving the best of the art of teaching.

Teachers often develop unique methods to help students learn, but these techniques may be lost when they retire from the profession. In the 15 years that they have conducted the Effective Teaching Workshop: Improving Your Skills, the authors of this paper have observed presentations of many innovative teaching methods. The article describes five methods recently presented at the annual workshop: the use of a flipchart with slides; the use of Polarmotion overhead transparencies; an asthma simulation; a breast-mass simulation; and teamwork and game-playing. The authors present these techniques in the hope of reaching a broader audience, and to stimulate other teachers to submit descriptions of innovative teaching methods for possible publication in the Ideas for Medical Education column.

Use of effective questioning to enhance the cognitive abilities of students.

Skillful questioning can be very effective in enhancing the cognitive abilities of medical students, residents, fellows, and students from the various health professions. Teachers should be able to use one of the taxonomies of thinking skills described in the literature in order to pose a variety of questions corresponding to various levels of cognition. Bloom's taxonomy is very useful in this regard. It includes a hierarchy starting with knowledge as the lowest-level cognitive skill, advancing through comprehension, application, analysis, and synthesis to evaluation at the highest level. Teachers should be able to construct questions that require different levels of thinking and use them during interactive discussions. The process of effective questioning includes establishing an appropriate environment, creating a climate conducive to learning, using an appropriate mix of questions, phrasing questions accurately, interposing sufficient wait time, and using various probes in response to the answers given by students. Teachers should be trained to enhance their own questioning skills through workshops, peer observation and critique, videotaping and feedback, and use of self-study modules.

Teaching medical students by role playing: a model for integrating psychosocial issues with disease management.

BACKGROUND: Medical students on third-year rotations seem to be focused more on the particulars of disease management than on patient management. They often pay too little attention to the psychological and social needs of the patient and to the importance of working in a multidisciplinary team. The authors postulated that a model for teaching breast cancer management that included role playing, self-study, and active student involvement would facilitate the integration of psychosocial and affective issues into scientific content and would demonstrate the importance of the team approach in managing patients with breast cancer. METHODS: One month following a problem-oriented, case-based, interactive session focusing on clinical management of breast disease, each student was assigned the role of either "patient" or one of four "specialists"-1) a general surgeon, 2) a medical oncologist, 3) a radiation oncologist, or 4) a plastic surgeon. A packet of readings containing discipline-specific information was distributed to each "specialist" and a similar preparation packet was distributed to each "patient." One week later students from each specialty met in "multidisciplinary groups" and five "patients" with written scenarios of recently diagnosed primary breast cancer rotated among them. Important decision-making choices were discussed in each consultation. Following their consultations in the "multidisciplinary" groups, the "patients" met with the entire group of 20-25 students and with physician faculty to discuss differences in the information obtained. They compared "specialists'" styles of presentation and attitudes. Specific issues involving coordination of care among "specialists" were carefully highlighted. RESULTS: All students participated and the teaching sessions were well received. CONCLUSIONS: Role playing facilitates the discussion of psychosocial issues and aptly demonstrates to students the need for a multidisciplinary approach to breast cancer treatment. This model is applicable to other types of cancer and to other groups of cancer educators.

Use of effective feedback to facilitate adult learning.

Effective feedback plays a critical role in helping adult learners achieve their educational goals and reach their maximum potential. It should be an integral part of every adult education program. Both formal and informal feedback should be provided by teachers, based on the underpinnings of effective feedback techniques. The feedback source, message, and recipient exert influences on the process and must be considered in this context. For maximum impact, the source of feedback must be considered credible and trustworthy by the recipient. The message should provide clear information about performance standards and the performance of the student, in order to elucidate any differences. Positive information should be shared before negative information, and the feedback should be specific, objective, consistent, and timely. The environment in which feedback is provided must be supportive, and should encourage an open dialog between the teacher and the student. Both parties should discuss various items in a spirit of collaboration, and clearly define the goals that need to be achieved. A plan for follow-up and ongoing reinforcement must be developed and implemented. In addition to oral and written feedback, other modes of providing feedback, such as computers, audiotapes, and videotapes, should be considered, and used as appropriate. Skills of faculty members in providing effective feedback may be enhanced through faculty-development programs, such as workshops and self-study modules.

Preceptorship, mentorship, and the adult learner in medical and health sciences education.

Preceptorship and mentorship are both based on principles of adult education and involve experiential, student-centered learning. Preceptorial relationships are especially useful in developing the practical skills of students. The preceptor works either with small groups of students or one-on-one with individual students, and serves as a teacher, role model, and evaluator. Preceptorial relationships between a teacher and a student are relatively short, and generally span the duration of a course or student rotation. Mentoring involves an intense, global, and long-term relationship between a mentor and a protégé/e, and-encompasses both professional and personal domains. It spans several years and may extend far beyond the period of the structured mentorship. The mentor serves as a teacher, role model, coach, and confidant for the protégé/e and works one-on-one with a protégé/e to achieve various outcomes. Both parties reap significant rewards as a result of the mentorship, and are transformed in the process. Preceptors and mentors must be appropriately selected and adequately trained. Comprehensive faculty development courses and workshops should be designed and implemented to enhance the requisite skills of both groups. The effectiveness of preceptorship and mentorship needs to be continually assessed and appropriate steps taken to further enhance these special educational options. Both options should be included in medical and health sciences education to train competent and well-rounded professionals for the future.

An adult education model for training third-year medical students in use of the Physician Data Query (PDQ) System.

BACKGROUND AND METHODS: An adult education model was developed to familiarize third-year medical students with the Physician Data Query (PDQ) system, a computerized, full-text database of state-of-the-art cancer information developed by the National Cancer Institute. The educational model was designed in collaboration with a medical librarian and was implemented within the context of a busy surgery clerkship using only modest resources that were readily available within the medical school. RESULTS: During three years, 275 medical students participated in the exercise and evaluated both the PDQ system and the educational model. Overall, 87% of the students considered the PDQ system to be a valuable source of information, and 84% anticipated using PDQ after completing their surgical rotations. Ninety-six percent of the students agreed that the objectives of the exercise were met. CONCLUSIONS: This article provides a description of the educational model and discusses the principles of adult education and andragogy on which it was developed. The importance of emphasizing the process of learning as well as the content is described relative to self-directed and life-long learning.