Shane McNevin MD FASCRS Spokane, WA. None except I took the ABCRS qualifying/certifying exam before the emphasis on good question writing.

FORMATTING THE STEM – HOW TO WRITE

A GOOD QUESTION

Shane McNevin MD FASCRSSpokane, WA

Disclosures

None except I took the ABCRS qualifying/certifying exam before the emphasis on good question writing

Objectives

Why write test questions for ABCRS Goals for good question writing Inspiration for questions Techniques for writing a good stem

What’s in it for me?

Disadvantages Hard work After hours No recognition

Advantages Deeper clinical knowledge Participation in education Route to leadership position

Goals of questions

Clinical knowledge Does examinee have the requisite knowledge

to practice colorectal surgery Education

Imparting clinical knowledge to next generation of surgeons

Inspiration for questions

We take the written and oral boards everyday!

Derive questions from your own clinical practice Take pictures of interesting clinical

phenomena Save radiographs from exemplary clinical

situations

Techniques for a good stem

ABCRS Manual for Question Writers Read it Know it Live it

A good question writes itself from a good key concept

Techniques for a good stemKey concept

Bad key concept Management of anal fissures

Good key concept Chronic anal fissure failing medical

management can be treated with lateral internal sphincterotomy

STEM

A 35 year old man presents with a 6 month history of severe anal pain and bleeding during defecation. He has a posterior fissure on examination. He has been treated with topical diltiazem ointment without improvement. The most appropriate treatment is:

Techniques for a good stem

Concise Non-ambiguous Testing clinical knowledge not English

comprehension Controversial/Judgement

consistent with ASCRS textbook

Concise question

A 35 year old man presents with a 6 month history of severe anal pain and bleeding during defecation. He has a family history of colorectal cancer. He occasionally has fecal urgency with liquid stool. His vital signs show a heart rate of 65 and blood pressure of 130/80. He has a posterior fissure, grade II internal hemorrhoids and several small anal tags on examination. He has been treated with topical diltiazem ointment without improvement. He is also taking docusate sodium, hydrocodone and ibuprofen. The most appropriate treatment is:

English Comprehension

A 35 year old man presents with a 6 month history of severe anal pain and bleeding during defecation. He has a posterior fissure on examination. He has been treated with topical diltiazem ointment without improvement. The least appropriate treatment is:

English comprehension

A 50 year old man is diagnosed with a cecal cancer. Computed tomography of the abdomen shows no evidence of metastatic disease. His preoperative CEA is 25. Which of the following is true regarding the CEA?

English comprehension

A 50 year old man is diagnosed with a cecal cancer. Computed tomography of the abdomen shows no evidence of metastatic disease. His preoperative CEA is 25. All of the following are true regarding the CEA except:

Controversial topics

Surgeons taking this exam are newly out of fellowship

We want people to hit singles not swing for the fence

Usually direct people to the safest and most conservative approach

Controversial topics

A 25 year old man with genetically proven familial polyposis presents for discussion of prophylactic colectomy. His rectum is carpeted with polyps and he would prefer a sphincter preserving option. The most appropriate management is:

Total colectomy with ileorectal anastomosis One stage restorative proctocolectomy Two stage restorative proctocolectomy Proctocolectomy with ileostomy

Controversial topics

A 45 year old healthy woman is taken to surgery urgently for class III sigmoid diverticulitis. Intra-operatively her vital signs are normal, she has limited purulent peritonitis and a short segment of inflamed sigmoid colon. The most appropriate management is: Resection, primary anastomosis Resection, protected anastomosis Hartmann’s resection Loop transverse colostomy

Techniques for a good stem

A good question answers itself! 1 + 2 = ?

Techniques for a good stem

A 35 year old man presents with a 6 month history of severe anal pain and bleeding during defecation. He has a posterior fissure on examination. He has been treated with topical diltiazem ointment without improvement. The most appropriate treatment is:

Techniques for a good stem

A 50 year old man is diagnosed with a cecal cancer. Computed tomography of the abdomen shows no evidence of metastatic disease. His preoperative CEA is 25. The clinical impact of the elevated preoperative CEA is:

Techniques for a good stemSecond order questions

Clinical practice in reality Synthesize clinical information Make a diagnosis Develop a plan

First order questions Simply making diagnosis “simple recall”

Second order questions Develop plan based on scenario Preferred

First order question

A 42 year old woman presents with a newly diagnosed mucinous adenocarcinoma of the cecum. Her family history is significant for her mother having endometrial cancer at age 52 and maternal grandmother having colon cancer at age 48. The most likely diagnosis is:

Second order question

A 42 year old woman presents with a newly diagnosed mucinous adenocarcinoma of the cecum. Her family history is significant for her mother having endometrial cancer at age 52 and maternal grandmother having colon cancer at age 48. The most appropriate next step is:

How to use radiographs and photographs

A 52 year old woman is diagnosed with a cecal cancer. Staging computed tomography is shown. The most appropriate treatment is:

How to use radiographs and photographs

A 30 year old woman presents with a history of recurrent perineal and perianal infections. Physical examination findings are shown. The pathophysiology of this disorder is:

Conclusions

Use the ABCRS Manual for Question Writers

Keep questions concise, non-ambigous and appropriately formatted

Avoid controversial topics and answers Write questions that don’t require the

answers to complete Write second order questions when

possible HAVE FUN