The Impact of a Comprehensive Resident Curriculum and Required Participation in "This Week in SCORE" on General Surgery ABSITE Performance and Well-Being

Flipping the Classroom in Residency Didactics Leads to Higher American Board of Surgery in-Training Examination Scores

OBJECTIVE

Didactic education in General Surgery (GS) residency typically follows a nationally standardized curriculum; however, instructional format varies by institution. In recent years, GS residents at our institution expressed discontentment with weekly didactics and were not meeting their goals on the American Board of Surgery In-Training Examination (ABSITE). We sought to develop improvements in our didactic curriculum to increase resident satisfaction and ABSITE scores of GS junior residents (Jrs).

DESIGN

In a quality improvement project, we changed the weekly didactic curriculum format from hour-long lectures in the 2018 to 2019 academic year (AY) to a partially-flipped classroom in the 2019 to 2020 AY, involving a 30-minute faculty-led presentation followed by 30 minutes of resident-led practice questions. The outcomes measured were ABSITE scores taken in 2019 and 2020 and resident opinions via an anonymous survey.

SETTING

This study was conducted at the University of Minnesota (Minneapolis, MN).

PARTICIPANTS

The cohort for this study included all GS Jrs in our GS residency program, including postgraduate year (PGY) 1 nondesignated preliminary, PGY1 to 3 categorical GS residents, and residents in their lab time. Senior residents attended a separate didactics session.

RESULTS

After curriculum changes, the ABSITE percentile scores for GS Jrs rose from 52% ± 5% to 66% ± 4% (p = 0.03). No categorical GS Jr scored <30% in 2020, compared to 20% (6/30) of categorical General Surgery residents in 2019. All residents preferred the new format overall and reported greater engagement in and preparation for didactics.

CONCLUSIONS

After changing didactic education from hour-long lectures in the 2018 to 2019 AY to a flipped classroom model in the 2019 to 2020 AY including 30 minutes of faculty-led lecture followed by 30 minutes of resident-led practice questions, ABSITE scores and resident satisfaction at the University of Minnesota General Surgery Program improved.

Establishing the Preface for a Unified Otolaryngology Residency Curriculum: Implications and Considerations

Otolaryngology residency training, along with the world of online medical education, has been continuously evolving and refining methods to educate and produce competent otolaryngologists. Numerous resources have been developed to assist otolaryngology residents in enhancing their clinical training. Although these resources greatly enhance clinical training, the growing volume of material presents a challenge within the constrained schedule of otolaryngology residents. This challenge is compounded by the variability in quality among resources which lack standardization or validation. Recently, the Academy of Otolaryngology-Head and Neck Surgery Foundation has proposed a unified otolaryngology curriculum designed to address these issues. This curriculum aims to incorporate high-quality educational materials, evidence-based adult learning principles, accessible learning sources, and diverse instructional methods within a structured program. Such a curriculum promises a significant positive impact, mirroring successes observed in various other surgical specialties.

Vascular Surgery In-Training Examination performance following implementation of the Vascular Surgical Council on Resident Education curriculum

OBJECTIVE

The Vascular Surgery Surgical Council on Resident Education (VSCORE) program is a standardized curriculum intended to prepare Vascular Surgery trainees for the annual Vascular Surgery In-Training Examination (VSITE). This study evaluated the performance of 0+5 and 5+2 Vascular Surgery trainees on the VSITE prior to and following implementation of the VSCORE curriculum.

METHODS

VSITE scores, measured as percentage of questions correct, were collected for Vascular Surgery trainees at a United States academic medical center between 2015 and 2022. The VSITE scores were compared for the periods prior to (2015-2021) and following (2022) implementation of the VSCORE curriculum.

RESULTS

Fifty-seven VSITE scores were evaluated, including 46 examinations completed prior to and 11 after the implementation of the VSCORE curriculum. The mean VSITE score across all training levels (post-graduate year [PGY] 1-7) increased significantly from 68.4% ± 1.5% prior to implementation of VSCORE curriculum to 76.5% ± 3.1% following implementation (P = .03). Two-way analysis of variance identified pre- and post-VSCORE implementation as a statistically significant categorical variable when residents were stratified into junior (PGY 1-2), senior (PGY 3-5), and fellow (PGY 6-7) training levels (P < .001). The mean change in score between consecutive years also increased following VSCORE implementation (14.1% ± 2.3%) compared with the pre-VSCORE era (5.7% ± 1.7%; P = .002) CONCLUSIONS: The implementation of the VSCORE curriculum at an academic medical center improved VSITE scores across vascular surgery trainees at all levels.

Muffins and Meditation: Combatting Burnout in Surgical Residents

OBJECTIVE

To quantify the prevalence of burnout in our surgical residency program and to assess the impact of a weekly wellness program for surgical residents through validated tools measuring mindfulness, self-compassion, flourishing, and burnout. Our hypothesis was that participants with more frequent attendance would: (1) be more mindful and self-compassionate and (2) experience less burnout and more flourishing.

DESIGN

An optional one-hour weekly breakfast conference was facilitated by a senior surgical faculty member with the time protected from all clinical duties. Following a guided meditation, participants were given time for reflection and dialogue about their training experiences or led in a wellness exercise. TRANCE (tolerance, respect, anonymity, nonretaliation, compassion, egalitarianism) principles were utilized to create a safe and open environment. Residents were surveyed at the end of the study period, which was from March 2017 through June 2018.

SETTING

The conference and data analysis was conducted at Denver Health Medical Center, affiliated with the University of Colorado School of Medicine.

PARTICIPANTS

This study analyzed survey responses from 85 surgical residents.

RESULTS

Following the wellness program, when answering the 2-question Maslach Burnout Inventory, 35.7% of residents reported feeling burned out by their work once a week or more, and 29.7% reported feeling more callous toward people once a week or more. After multivariate analysis, the only independent predictors of increased burnout were "not being married or in a committed relationship," lower positive affect, and higher negative affect. Written feedback was overwhelmingly positive, and residents expressed gratitude for the conference, the opportunity for self-reflection, and open dialogue with attendings and colleagues.

CONCLUSIONS

The prevalence of burnout is high among surgical residents. Allowing time to practice a mindfulness meditation while providing space for residents to share their experiences may be protective, and efforts should be made to reduce barriers to participation.

Trends in Surgeon Burnout in the US and Canada: Systematic Review and Meta-Regression Analysis

BACKGROUND

Burnout among surgeons is increasingly recognized as a crisis. However, little is known about changes in burnout prevalence over time. We evaluated temporal trends in burnout among surgeons and surgical trainees of all specialties in the US and Canada.

STUDY DESIGN

We systematically reviewed MEDLINE, Embase, and PsycINFO for studies assessing surgeon burnout from January 1981 through September 2021. Changes in dichotomized Maslach Burnout Inventory scores and mean subscale scores over time were assessed using multivariable random-effects meta-regression.

RESULTS

Of 3,575 studies screened, 103 studies representing 63,587 individuals met inclusion criteria. Publication dates ranged from 1996 through 2021. Overall, 41% of surgeons met criteria for burnout. Trainees were more affected than attending surgeons (46% vs 36%, p = 0.012). Prevalence remained stable over the study period (-4.8% per decade, 95% CI -13.2% to 3.5%). Mean scores for emotional exhaustion declined and depersonalization declined over time (-4.1 per decade, 95% CI -7.4 to -0.8 and -1.4 per decade, 95% CI -3.0 to -0.2). Personal accomplishment scores remained unchanged. A high degree of heterogeneity was noted in all analyses despite adjustment for training status, specialty, practice setting, and study quality.

CONCLUSIONS

Contrary to popular perceptions, we found no evidence of rising surgeon burnout in published literature. Rather, emotional exhaustion and depersonalization may be decreasing. Nonetheless, burnout levels remain unacceptably high, indicating a need for meaningful interventions across training levels and specialties. Future research should be deliberately designed to support longitudinal integration through prospective meta-regression to facilitate monitoring of trends in surgeon burnout.

How to Prepare for the American Board of Surgery In-Training Examination (ABSITE): A Systematic Review

INTRODUCTION

Performance on ABSITE is an important factor when monitoring resident progress. It predicts future performance and has lasting effects. Understanding the highest-yield preparation strategies can help residents in their study efforts and optimize performance.

METHODS

A literature search was conducted searching PubMed, EMBASE and JAMA Network in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches were performed for the terms "ABSITE" and "American Board of Surgery In-Training Examination". Only studies discussing individual study habits from May 2011 to May 2021 were included.

RESULTS

19 studies were included in qualitative synthesis. Year-round clinical study failed to show significant correlation to ABSITE performance although year-round ABSITE review was more consistently correlated. During a dedicated study period, increased time and increased total practice questions completed are associated with improved performance. The correlation of individual resources such as ABSITE review books, textbooks, audio podcasts and ABSITE preparatory courses to improved ABSITE performance was not proven.

CONCLUSIONS

Residents should optimize study strategies based on methods that have consistently shown to improve performance. Recommendations for best preparation strategies are provided.

United States medical licensing examination Step 1 scores are a quantifiably better predictor of American Board of Surgery In-Training Examination success compared to Step 2 scores

BACKGROUND

United States Medical Licensing Examination Step 1 (STEP 1) and Step 2 (STEP 2) scores are used in the selection of surgery residents. The American Board of Surgery In-Training Examination (ABSITE) is employed to assess resident knowledge. We sought to determine whether both STEP 1 and/or STEP 2 were predictive of ABSITE performance.

METHODS

We performed a 10-year retrospective analysis of all PGY levels comparing STEP 1 and 2 scores with raw ABSITE scores and percentile rank. Additionally, we analyzed STEP 1 and 2 scores for the likelihood of scoring above the 20th percentile on the ABSITE.

RESULTS

When STEP 1 and STEP 2 scores were evaluated separately, both were independent predictors of ABSITE performance. However, when STEP 1 and STEP 2 scores were evaluated together, only STEP 1 scores were predictive of ABSITE performance. Finally, only STEP 1 scores were predictive of scoring above the 20th percentile.

CONCLUSION

STEP 1 scores are a better predictor of ABSITE performance than STEP 2.

For the People and the Profession

In 1982 Dean Warren delivered the presidential address "Not for the Profession… For the People" in which he identified substandard surgical residency programs graduating residents who were unable to pass American Board of Surgery exams. Drs. Warren and Shires as members of the independent ACGME began to close the substandard programs in order to improve surgical care for average Americans i.e. "for the people". By 2003 these changes dramatically reduced the failure rate for the ABS exams and trained good surgeons who could operate independently however the residents were on duty for every other or every third night. In 2003 the ACGME mandated duty hour restrictions in order improve resident wellness and improve the training environment for the profession. However, work hour restrictions reduced the time surgical residents spent in the hospital environment primarily when residents had more autonomy and had exposure to emergency cases which degraded readiness for independent practice. Surgical educators in the 2 decades after the work hour restrictions have improved techniques of training so graduates could not only pass the board exams but also be prepared for independent practice. Surgical residency training has improved by both the changes implemented by the independent ACGME in 1981 and by the work hour restrictions mandated in 2003. Five recommendations are made to ensure that Dr Warren's culture of excellence in surgical training continues in an environment that enhances wellbeing of the trainee i.e. "For the People and the Profession".

Trainee Utilization of the SCORE Curriculum is Associated With Improved ABSITE Performance: A Multi-institutional Study

BACKGROUND

The Surgical Council on Resident Education's (SCORE) structured educational curriculum for general surgery residents uses a 2-year repeating cycle of modules and quizzes called "This Week in SCORE" (TWIS) to organize and sequence the curricular content on the SCORE portal. The purpose of this study was to evaluate the impact of using the SCORE content and TWIS curriculum on American Board of Surgery In-Training Examination (ABSITE) performance. To date, no multi-institutional studies have examined this effect.

METHODS

Eight residency programs participated, including university and community-based programs. SCORE usage overall, TWIS usage, and ABSITE percentile scores (adjusted for post-graduate year [PGY]) were analyzed for the academic years 2017 to 2020. SCORE usage was defined as number of SCORE logins annually per resident with "low usage" ≤10 times and "high usage" >10 times. TWIS usage was defined as "low usage" (no TWIS quizzes done) or "high usage" (≥1 TWIS quiz per year).

RESULTS

Four hundred and twenty-eight trainees were evaluated. Trainees with high SCORE and TWIS usage consistently achieved a higher ABSITE percentile score. This difference was maintained in subgroup analysis by PGY with the greatest impact in PGY-1 and PGY-2 levels.

CONCLUSIONS

Utilization of multiple aspects of SCORE content appears to have a significant positive impact on ABSITE performance across all levels of postgraduate training. This multi-institutional study of a large number of users is the first to demonstrate that increased usage of SCORE content appears to be a predictor of ABSITE performance success.

Power of the collective: A review of multimodal internet-based surgical education resources in the 21st century

Electronic resources have changed surgical education in the 21st century. Resources spanning from digital textbooks to multiple choice question banks, online society meetings, and social media can facilitate surgical education. The COVID pandemic drastically changed the paradigm for education. The ramifications of Zoom lectures and online surgical society meetings will last into the future. Educators and learners can be empowered by the many available electronic resources to enhance surgical training and education.

Learning to Read: Successful Program-Based Remediation Using the Surgical Council on Resident Education (SCORE) Curriculum

BACKGROUND

The Surgical Council on Resident Education (SCORE) curriculum is aligned with the American Board of Surgery (ABS) objectives. Our program adopted the SCORE curriculum in 2015 after poor ABS In-Training Examination (ABSITE) performance and lowest quartile ABS Certifying Exam (CE) and Qualifying Exam (QE) first-time pass rates. We examined the association of SCORE use with ABSITE performance and ABS board exam first-time pass rate.

STUDY DESIGN

At a single institution, a retrospective review of surgery residents' SCORE metrics and ABSITE percentile was conducted for academic years 2015 to 2019. Metrics analyzed on the SCORE web portal were mean total minutes and total visits per resident for all residents using SCORE that year. First-time pass rates of the ABS QE and CE were examined from 2013 to 2019. Chi-square and linear regression analysis were performed, and a 95% level of confidence was assumed (alpha = 0.05).

RESULTS

Yearly data from categorical general surgery residents showed a significant increase in total minutes, total visits, and ABSITE percentile. Combined first time pass rates for the ABS QE and CE significant increased from 70.8% in 2013 to 2015 to 93.9% in 2016 to 2019 (p = 0.018).

CONCLUSIONS

Increased longitudinal use of the SCORE curriculum was associated with programmatic improvements in ABSITE performance and ABS board exam first-time pass rate.

A National Obstetrics and Gynecology Residency Education Curriculum: National Needs Assessment

While standardized national residency education curricula have been successfully implemented in other specialties, there is no such curriculum in Obstetrics & Gynecology (Ob/Gyn). With this study, we sought to evaluate: (1) the current state of and satisfaction with resident didactic education (2) perceptions regarding centralization and standardization of resident didactic education and (3) the need for a standardized national Ob/Gyn residency education curriculum. In 2019, a web-based needs assessment survey was administered to residents and program leadership from all 267 Ob/Gyn residency programs nationwide. Main outcomes were reported with descriptive statistics. A total of 782 (83 program directors, 46 assistant program directors, and 653 residents) participants completed the survey. Respondents represented a diverse range of regions, program types, and program sizes. Almost all (97%) participants agreed or strongly agreed that residents nationwide should have equal access to high quality Ob/Gyn educational resources. Further, 92% agreed or strongly agreed that core resources should be centrally located. A majority (78%) agreed or strongly agreed that there is a need for a national Ob/Gyn residency education curriculum. Our results demonstrate a perceived need for a centrally located, standardized, national residency education curriculum in Ob/Gyn.

A Standardized Obstetrics and Gynecology Residency Education Curriculum: Multi-Institutional Needs Assessment Survey

At the completion of training in obstetrics and gynecology (Ob/Gyn), residents are expected to have comprehensive knowledge of the field. However, there is no comprehensive Ob/Gyn residency education curriculum. We hypothesize that there is a need for a standardized curriculum. A needs assessment survey was administered to determine the current state of resident didactic education, the perceptions that Ob/Gyn residents, program directors (PDs), and assistant program directors (APDs) have regarding centralization and standardization of education, and the need for a standardized Ob/Gyn residency education curriculum. In 2019, a web-based survey was distributed to Ob/Gyn residents and program leadership from three institutions. The main outcomes were measured on a 5-pt Likert scale. A total of 50 (3 PDs, 5 APDs, and 42 residents) participants completed the survey with a response rate of 68% (50/73). Almost all (94%) participants agreed or strongly agreed that residents nationwide should have equal access to high-quality Ob/Gyn educational resources. Further, 92% agreed or strongly agreed that core Ob/Gyn resources should be centrally located. A majority, 76%, agreed or strongly agreed that there is a need for a national curriculum. This study demonstrates a perceived need for a centrally located, standardized Ob/Gyn residency education curriculum.

Assessing the Breadth of Laryngology Training in Otolaryngology Residency Programs

INTRODUCTION

Laryngology is an expanding field with incorporation in resident training nationwide. However, the breadth of training in laryngology reported by residents has not been previously evaluated. This project assesses the variability in laryngology training among otolaryngology residents.

METHODS

A cross sectional, multi-institutional study was performed with an anonymous survey sent to residents and laryngology fellows nationally to assess different laryngology training practices.

RESULTS

There were 151 responses to the survey with 9.6% response rate. 49 (32.9%) did not have a designated laryngology rotation. 134 (89.3%) had a fellowship-trained laryngologist as part of their institution. The greatest percentage of respondents intended to pursue general ENT (31; 20.7%). PGY5 responses were analyzed for total residency exposure showing, 66.7% of PGY5s received training to identify different types of dysphonic voices through auditory findings alone. 61.9% could interpret a videoflouroscopic swallow study.  Regarding surgical cases, 52.4% had been involved in open cricopharyngeal myotomies, 76.2% in endoscopic cricopharyngeal myotomies, and 100% in subglottic stenosis cases. Residents pursuing a career in laryngology and those with a designated laryngology rotation had more exposure to laryngeal surgeries and office-based procedures than their peers.

CONCLUSION

Laryngology training and exposure varies across the country. Residents are more familiar with airway than voice and swallowing related pathology. Residents with a designated laryngology rotation and those pursing laryngology fellowships were more likely to have exposure to laryngeal surgery and office-based procedures. Programs with a laryngologist likely had higher response rates so the true laryngology exposure may be more limited than our data suggests.