Finding Value in Surgical Didactics: Longitudinal Resident Feedback From Case-Based and Traditional Lectures in an Orthopaedic Residency.

To evaluate orthopedic resident perceptions of a didactic curriculum presented in traditional and case-based formats. Prospective cohort study using anonymous web-based survey after each conference evaluating resident perceptions of faculty participation, didactic delivery, content, and overall conference value. Conferences were structured as primarily case-based or traditional lecture. Logistic analysis was performed to determine factors predictive of rating a conference as valuable time spent. Orthopedic residency training program at single institution over an academic year. Orthopedic residents in postgraduate training year 1 to 5 attending mandatory didactic conference. Cased-based conferences received higher Likert ratings on residents' perception of faculty participation, instructor delivery, and improvement in topic understanding when compared to traditional lecture-based conferences (p < 0.0001 for each factor). Residents also were more likely to rate case-based conferences as valuable time spent (p < 0.0001). In our logistic model, factors associated with a negative likelihood of rating a conference as valuable were lecture format (odds ratio [OR] = 0.155, 95% CI: 0.115-0.208), PGY-2 level presenter (OR = 0.288, 95% CI: 0.169-0.490), and PGY-3 level presenter (OR = 0.433, 95% CI: 0.269-0.696). Timing in the year, surgical subspeciality, and conference identity were not significant predictors of conference value rating. Longitudinal resident feedback demonstrates highly favorable resident perceptions toward case-based formats in didactic sessions. Junior levels residents are not perceived as effective as senior residents and faculty in presenting material in either format. These methods allow for a dynamic approach to identifying strengths and weaknesses in a resident curriculum as a well as a means for more focused and real-time improvements.

Barnwell JC ，Halvorson JJ ，Teasdall RD ，Carroll EA ... -  《-》

Orthopaedic Surgery Residents and Program Directors Agree on How Time Is Currently Spent in Training and Targets for Improvement.

Camp CL ，Martin JR ，Karam MD ，Ryssman DB ，Turner NS ... -  《-》

Improving Orthopedic Resident Knowledge of Documentation, Coding, and Medicare Fraud.

Most residency programs still lack formal education and training on the basic clinical documentation and coding principles. Today's physicians are continuously being held to increasing standards for correct coding and documentation, yet little has changed in the residency training curricula to keep pace with these increasing standards. Although there are many barriers to implementing these topics formally, the main concern has been the lack of time and resources. Thus, simple models may have the best chance for success at widespread implementation. The first goal of the study was to assess a group of orthopedic residents' fund of knowledge regarding basic clinical documentation guidelines, coding principles, and their ability to appropriately identify cases of Medicare fraud. The second goal was to analyze a single, high-yield educational session's effect on overall resident knowledge acquisition and awareness of these concepts. Orthopedic residents belonging to 1 of 2 separate residency programs voluntarily and anonymously participated. All were asked to complete a baseline assessment examination, followed by attending a 45-minute lecture given by the same orthopedic faculty member who remained blinded to the test questions. Each resident then completed a postsession examination. Each resident was also asked to self-rate his or her documentation and coding level of comfort on a Likert scale (1-5). Statistical significance was set at p < 0.05. A total of 32 orthopedic residents were participated. Increasing postgraduate year-level of training correlated with higher Likert-scale ratings for self-perceived comfort levels with documentation and coding. However, the baseline examination scores were no different between senior and junior residents (p > 0.20). The high-yield teaching session significantly improved the average total examination scores at both sites (p < 0.01), with overall improvement being similar between the 2 groups (p > 0.10). The current healthcare environment necessitates better physician awareness regarding clinical documentation guidelines and coding principles. Very few adjustments to incorporate these teachings have been made to most residency training curricula, and the lack of time and resources remains the concern of many surgical programs. We have demonstrated that orthopedic resident knowledge in these important areas drastically improves after a single, high-yield 45-minute teaching session.

Varacallo MA ，Wolf M ，Herman MJ 《-》

Boot cAMP: educational outcomes after 4 successive years of preparatory simulation-based training at onset of internship.

Preparatory training for new trainees beginning residency has been used by a variety of programs across the country. To improve the clinical orientation process for our new postgraduate year (PGY)-1 residents, we developed an intensive preparatory training curriculum inclusive of cognitive and procedural skills, training activities considered essential for early PGY-1 clinical management. We define our surgical PGY-1 Boot Camp as preparatory simulation-based training implemented at the onset of internship for introduction of skills necessary for basic surgical patient problem assessment and management. This orientation process includes exposure to simulated patient care encounters and technical skills training essential to new resident education. We report educational results of 4 successive years of Boot Camp training. Results were analyzed to determine if performance evidenced at onset of training was predictive of later educational outcomes. Learners were PGY-1 residents, in both categorical and preliminary positions, at our medium-sized surgical residency program. Over a 4-year period, from July 2007 to July 2010, all 30 PGY-1 residents starting surgical residency at our institution underwent specific preparatory didactic and skills training over a 9-week period. This consisted of mandatory weekly 1-hour and 3-hour sessions in the Simulation Center, representing a 4-fold increase in time in simulation laboratory training compared with the remainder of the year. Training occurred in 8 procedural skills areas (instrument use, knot-tying, suturing, laparoscopic skills, airway management, cardiopulmonary resuscitation, central venous catheter, and chest tube insertion) and in simulated patient care (shock, surgical emergencies, and respiratory, cardiac, and trauma management) using a variety of high- and low-tech simulation platforms. Faculty and senior residents served as instructors. All educational activities were structured to include preparatory materials, pretraining briefing sessions, and immediate in-training or post-training review and debriefing. Baseline cognitive skills were assessed with written tests on basic patient management. Post-Boot Camp tests similarly evaluated cognitive skills. Technical skills were assessed using a variety of task-specific instruments, and expressed as a mean score for all activities for each resident. All measurements were expressed as percent (%) best possible score. Cognitive and technical performance in Boot Camp was compared with subsequent clinical and core curriculum evaluations including weekly quiz scores, annual American Board of Surgery In-Training Examination (ABSITE) scores, program in-training evaluations (New Innovations, Uniontown, Ohio), and operative assessment instrument scores (OP-Rate, Baystate Medical Center, Springfield, Massachusetts) for the remainder of the PGY-1 year. Performance data were available for 30 PGY-1 residents over 4 years. Baseline cognitive skills were lower for the first year of Boot Camp as compared with subsequent years (71 ± 13, 83 ± 9, 84 ± 11, and 86 ± 6, respectively; p = 0.028, analysis of variance; ANOVA). Performance improved between pretests and final testing (81 ± 11 vs 89 ± 7; p < 0.001 paired t test). There was statistically significant correlation between Boot Camp final cognitive test results and American Board of Surgery In-Training Examination scores (p = 0.01; n = 22), but not quite significant for weekly curriculum quiz scores (p = 0.055; n = 22) and New Innovations cognitive assessments (p = 0.09; n = 25). Statistically significant correlation was also noted between Boot Camp mean overall skills and New Innovations technical skills assessments (p = 0.002; n = 25) and OP-Rate assessments (p = 0.01; n = 12). Individual simulation-based Boot Camp performance scores for cognitive and procedural skills assessments in PGY-1 residents correlate with subjective and objective clinical performance evaluations. This concurrent correlation with multiple traditional evaluation methods used to express competency in our residency program supports the use of Boot Camp performance measures as needs assessment tools as well as adjuncts to cumulative resident evaluation data.

Fernandez GL ，Page DW ，Coe NP ，Lee PC ，Patterson LA ，Skylizard L ，St Louis M ，Amaral MH ，Wait RB ，Seymour NE ... -  《-》

Personality Factors Associated With Resident Performance: Results From 12 Accreditation Council for Graduate Medical Education Accredited Orthopaedic Surgery Programs.

To understand the personality factors associated with orthopedic surgery resident performance. A prospective, cross-sectional survey of orthopedic surgery faculty that assessed their perceptions of the personality traits most highly associated with resident performance. Residents also completed a survey to determine their specific personality characteristics. A subset of faculty members rated the performance of those residents within their respective program on 5 dimensions. Multiple regression models tested the relationship between the set of resident personality measures and each aspect of performance; relative weights analyses were then performed to quantify the contribution of the individual personality measures to the total variance explained in each performance domain. Independent samples t-tests were conducted to examine differences between the personality characteristics of residents and those faculty identified as relevant to successful resident performance. Data were collected from 12 orthopedic surgery residency programs1 throughout the United States. The level of clinical care provided by participating institutions varied. Data from 175 faculty members and 266 residents across 12 programs were analyzed. The personality features of residents were related to faculty evaluations of resident performance (for all, p < 0.01); the full set of personality measures accounted for 4%-11% of the variance in ratings of resident performance. Particularly, the characteristics of agreeableness, neuroticism, and learning approach were found to be most important for explaining resident performance. Additionally, there were significant differences between the personality features that faculty members identified as important for resident performance and the personality features that residents possessed. Personality assessments can predict orthopedic surgery resident performance. However, results suggest the traits that faculty members value or reward among residents could be different from the traits associated with improved resident performance.

Phillips D ，Egol KA ，Maculatis MC ，Roloff KS ，Friedman AM ，Levine B ，Garfin S ，Schwartz A ，Sterling R ，Kuivila T ，Paragioudakis SJ ，Zuckerman JD ... -  《-》