Resident perception of fundamental endoscopic skills exam: a single institution's experience

BACKGROUND

Graduating general surgery residents are required to pass the FES exam for ABS certification. Trainees and surgery educators are interested in defining the most effective methods of exam preparation. Our aim is to define trainee perceptions, performance, and the most effective preparation methods regarding the FES exam.

METHODS

General surgery residents from a single institution who completed the FES exam were identified. All participated in a flexible endoscopy rotation, and all had access to an endoscopy simulator. Residents were surveyed regarding preparation methods and exam difficulty. Descriptive statistics and a Kruskal-Wallis test were used.

RESULTS

A total of 26 trainees took the FES exam with a first-time pass rate of 96.2%. Of 26 surveys administered, 21 were completed. Twenty trainees (76.9%) participated in a dedicated endoscopy curriculum. Scores were not different among those who received dedicated curricular instruction compared to those who did not (547 [IQR 539-562.5] vs. 516 [484.5-547], p = 0.1484; 535.5 [468.5-571] vs. 519 [464.75-575], p = 0.9514). Written exam difficulty was rated as 5.5 on a 10-point Likert scale, and 85.7% felt it was a fair assessment of endoscopy knowledge; skills exam difficulty was rated as 7, and 71% felt it was a fair assessment of endoscopy skills. Online FES modules, the endoscopy clinical rotation, and an exam preparation session with a faculty member were most effective for written exam preparation. The most effective skills exam preparation methods were independent simulator practice, the endoscopy clinical rotation, and a preparation session with a faculty member. The most difficult skills were loop reduction and retroflexion. Skill decay did not appear to be significant.

CONCLUSIONS

A clinical endoscopy rotation, a method for independent skills practice, and faculty-mediated exam instruction appear to be effective exam preparation methods. When these are present, trainees report minimal need for dedicated exam preparation time prior to taking the FES exam.

The immunologic role of the gastrointestinal tract

During the past few decades, researchers have shed new light on the role of nutritional support in the immunocompromised critically ill patient. "Nutritional pharmacology" has become the catch phrase of the 1990s due to the impact of selected nutrients on host immune defenses. When feasible, enteral nutrition is preferred to parenteral nutrition to preserve the integrity of the gut mucosal barrier, especially when administered jejunally in the early stages of hypermetabolism. Glutamine and fiber provide necessary fuels for the gastrointestinal tract, whereas arginine and omega-3 fatty acids exert beneficial effects on certain cells of the immune system. Daly et al demonstrated that "enteral nutrition with supplemental arginine, RNA nucleotides and omega-3 fatty acids (Impact, Sandoz Nutrition, Minneapolis, MN) compared with a standard enteral diet, significantly improved immune, metabolic and clinical outcomes (22% mean reduction in length of stay) in UGI cancer patients undergoing surgery." Although more research is needed in the area of nutritional pharmacology, newly available nutrient-specific enteral products (Table 1) provide promise for altering the clinical outcome of immunocompromised patients.

Lesions of transmissible gastroenteritis virus infection in experimentally inoculated pigs suckling immunized sows

Intestinal lesions of transmissible gastroenteritis (TGE) virus infection in conventionally reared pigs suckling either nonvaccinated, vaccinated, or previously infected sows were studied by scanning electron microscopy, light microscopy, and immunofluorescent microscopy for TGE viral antigen. Pigs were inoculated with virulent TGE virus when they were 5 or 21 days old and were euthanatized shortly after the onset of diarrhea or 96 hours after inoculation if no diarrhea developed. Pigs inoculated when they were either 5 or 21 days old and suckling nonvaccinated sows developed severe lesions, including swelling and necrosis of enterocytes and severe villus atrophy. Pigs inoculated when they were 5 days old and suckling sows vaccinated with attenuated vaccines developed less-severe villus atrophy, and those suckling sows immunized by exposure to nonattenuated TGE virus developed moderate or no villus atrophy. Pigs inoculated when they were 21 days old and suckling sows vaccinated with attenuated vaccines had severe villus atrophy, whereas those suckling sows immunized by exposure to nonattenuated virus had more-moderate villus lesions. Villus atrophy was inhibited to various degrees in pigs suckling immunized sows, depending in part on the antibody titer in the colostrum and milk.