The Certifying Examination of the American Board of Surgery:

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The Certifying Examination of the American Board of Surgery: The Effect of Improving Communication & Professional Competency:Twenty-Year Results

1AuthorsPamela A. Rowland, PhD Thadeua L. Trus, MDNicholas P. Lang, MD Horace Henriques, MDWilliam P. Reed, MD Parvis J. Sadighi, MD John E. Sutton, MD Adnan Alseidi, MD Michael J. Cahalane, MD Jeffrey Gauvin, MD Walter E. Pofahl, MD Kennith Sartorelli, MD Steven B. Goldin, MD, PhD A. Gerson Greenburg, MD, PhD

2Nothing to discloseSurgeons/faculty have never been paid for their participation.

These are extremely small programs and tuitions are used solely to support the costs of the program.3

In 1985, a small research group began looking at variables that affected applicant success on the oral CERTIFYING EXAMINATION of the American Board of Surgery. This led to multiple quantitative research projects.

Clearly, all studies found that 4Rowland et al. J Acad Med, 1991

As illustrated in this study:

A score to a question can be significantly augmented by social skills.

5

6?So the question for us and everyone presenting papers this week Was SO WHAT?

We decided to design an oral examination course to see if we could teach these variables.

7The Effect of Improving Communication Competency on the Certifying Examination of the American Board of SurgeryRowland, Coe, Lang, Greenburg, Reed, Spence and BurchardAmerican Journal of Surgery 2002Results form the first ten years of this course were presented in 2001 and published in 2002.8Clinical Performance & Oral Examinations in SurgeryGoals:Outcomes:Increase awareness of variables affecting oral exam scoring

Individual skill development

Maintain course stability

Successful completion of the Certifying Examination

9Certifying Examination1991 - 2000March 2001 - 20103 opportunities - 5 years

Modified residency5 opportunities - 5 years

Standard Pathway

Alternative Pathway

No written letters to explain failure10Certifying Exam Pass RatesYEARNumber of ExamineesPass Rate20021,16883.4%20031,18483.8%20041,21683.4%20051,25283.2%20061,30184%20071,26181%20081,29080%20091,18177%20101,14677%11Certifying Exam Pass RatesYEARNumber of ExamineesPass Rate20021,16883.4%20031,18483.8%20041,21683.4%20051,25283.2%20061,30184%20071,26181%20081,29080%20091,18177%20101,14677%12Certifying Exam Pass RatesYEARNumber of ExamineesPass Rate20021,16883.4%20031,18483.8%20041,21683.4%20051,25283.2%20061,30184%20071,26181%20081,29080%20091,18177%20101,14677%131991 - 2001n = 1222002 - 2010n = 204 Age 30 5428 54Women27%28%Failed once68%39%Other courses27%69% nonresidentsHigh stressors7%9%Residents52%Rejected 3%2%Presentation issues77%21%141991 - 2001n = 1222002 - 2010n = 204 Age 30 - 5428 54Women27%28%Failed once68%39%Other courses27%69% nonresidentsHigh stressors7%9%Residents52%Rejected 3%2%Presentation issues77%21%151991 - 2001n = 1222002 - 2010n = 204 Age 30 - 5428 54Women27%28%Failed once68%39%Other courses27%69% nonresidentsHigh stressors7%9%Residents52%Rejected 3%2%Presentation issues77%21%161991 - 2001n = 1222002 - 2010n = 204 Age 30 - 5428 54Women27%28%Failed once68%39%Other courses27%69% nonresidentsHigh stressors7%9%Residents52%Rejected 3%2%Presentation issues77%21%171991 - 2001n = 1222002 - 2010n = 204 Age 30 - 5428 54Women27%28%Failed once68%39%Other courses27%69% nonresidentsHigh stressors7%9%Residents52%Rejected 3%2%Presentation issues77%21%181991 - 2001n = 1222002 - 2010n = 204 Age 30 - 5428 54Women27%28%Failed once68%39%Other courses27%69% nonresidentsHigh stressors7%9%Residents52%Rejected 3%2%Presentation issues77%21%191991 - 2001n = 1222002 - 2010n = 204 Age 30 - 5428 54Women27%28%Failed once68%39%Other courses27%69% nonresidentsHigh stressors7%9%Residents52%Rejected 3%2%Presentation issues77%21%20Caution

They all finished residencies. They were allowed to continue in the certification process.

We believed that some had dangerous knowledge deficits & others lacked moral fiber. We would not continue to work with them.211991 - 2001n = 1222002 - 2010n = 204 Age 30 - 5428 54Women27%28%Failed once68%39%Other courses27%69% nonresidentsHigh stressors7%9%Residents0 25 %52%Rejected 3%2%Presentation issues77%21%22Course Changes1991 - 20012007 - 20105 day format

Fewer residents3 day format

More residents - ?23Chief Complaint:Has failedand doesnt know why

Is likely to fail Program Director

24HPC: (History of Present Communication)Already failedPresentation IssuesLanguage IssuesHigh StressCommunication Issues (you know, and ah)Low volumePoor professional image

25PCHx: (Past Communication History)Learned English late and not wellHigh stress in household during formative yearsSpeech impediments, hx speech rx, bracesPublic speaking experiences or failuresSportsMarital Status Children

26PCHx:Describe the type of person who would be most challenging for you to talk with

How did you feel in the hotel exam setting?27Dx:Pre-course screening via telephoneMini oral examination (group)Case presentation with bad outcomes (group)Individual communication assessment (1:1)Individual high stress consultation (prn)Review past letters re: CE performance

28Rx:Other review courses (ATLS, content, basic science)Purchase professional attireGrooming recommendationsPractice worksheets articulation / rateReading schedulesPersonal study & sleep schedulesPsychologist or psychiatrist referralsFun

29Lessons Learned30.Rowland and Lang, 2007

31MORE StressorsBalancing outside obligationsMore residents entering fellowshipsHigher stakes for programs: 1st time pass rate3280 hour work week:Not reduced stressNot increased CE pass ratesNot reduced thoughts of depression or suicide (Arch Surg 2011)

33Course Outcomes1991 2010 326 participants187 have passed the CE (139 TBD)When participants followed Rx plan - pass

Process has changed, but the goals are the same.

This program continues to be effective at identifying and improving behaviors that interfere with success on the CE of the ABS

EARLY INTERVENTION of those at risk by Program Directors - leads to success.

34Clinical Performance & Oral Examinations in SurgeryGoals:Outcomes:Increase awareness of variables affecting oral exam scoring

Individual skill development

Maintain course stability

Successful completion of the Certifying Examination

We have met our goals..

35September 13 17, 2011

[email protected]

We plan return to the 5 DAY format in September to allow us more time to identify behavioral deficits and address individual stressors...

36Stress 1991 - 2001marriage difficultiespregnancychildrenfinancial issuesnew employmentmovingrelocationprevious failure(s) on oralschildhood incidents in a hotel room3/24/201137The participants have consistently reported the following types of stressors in addition to the certifying examination.

8 persons were encouraged to participate in professional counseling programs for reasons associated with high levels of stress.

Almost 3/4 of the participants who had failed the certifying examination at least once, said it was difficult to find other surgeons willing devote time for practice.