title: Objective Assessment of General Surgery Residents Followed by Remediation.
abstract: OBJECTIVE
  Surgical training programs often lack objective assessment strategies. Complicated scheduling characteristics frequently make it difficult for surgical residents to undergo formal assessment; actually having the time and opportunity to remediate poor performance is an even greater problem. We developed a novel methodology of assessment for residents and created an efficient remediation system using a combination of simulation, online learning, and self-assessment options.
  
  
  METHODS
  Postgraduate year (PGY) 2 to 5 general surgery (GS) residents were tested in a 5 station, objective structured clinical examination style event called the Surgical X-Games. Stations were 15 minutes in length and tested both surgical knowledge and technical skills. Stations were scored on a scale of 1 to 5 (1 = Fail, 2 = Mediocre, 3 = Pass, 4 = Good, and 5 = Stellar). Station scores ≤ 2 were considered subpar and required remediation to a score ≥ 4. Five remediation sessions allowed residents the opportunity to practice the stations with staff surgeons. Videos of each skill or test of knowledge with clear instructions on how to perform at a stellar level were offered. Trainees also had the opportunity to checkout take-home task trainers to practice specific skills. Residents requiring remediation were then tested again in-person or sent in self-made videos of their performance.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  PGY2, 3, 4, and 5 GS residents at Mayo Clinic in Rochester, MN.
  
  
  RESULTS
  A total of, 35 residents participated in the Surgical X-Games in the spring of 2015. Among all, 31 (89%) had scores that were deemed subpar on at least 1 station. Overall, 18 (58%) residents attempted remediation. All 18 (100%) achieved a score ≥ 4 on the respective stations during a makeup attempt. Overall X-Games scores and those of PGY2s, 3s, and 4s were higher after remediation (p < 0.05). No PGY5s attempted remediation.
  
  
  CONCLUSIONS
  Despite difficulties with training logistics and busy resident schedules, it is feasible to objectively assess most GS trainees and offer opportunities to remediate if performance is poor. Our multifaceted remediation methodology allowed 18 residents to achieve good or stellar performance on each station after deliberate practice. Enticing chief residents to participate in remediation efforts in the spring of their final year of training remains a work in progress.
authors.affiliation: Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Becca L
authors.initials: BL
authors.lastname: Gas
authors.affiliation: Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: EeeLN H
authors.initials: EH
authors.lastname: Buckarma
authors.affiliation: Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Monali
authors.initials: M
authors.lastname: Mohan
authors.affiliation: Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: T K
authors.initials: TK
authors.lastname: Pandian
authors.affiliation: Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota. Electronic address: farley.david@mayo.edu.
authors.forename: David R
authors.initials: DR
authors.lastname: Farley
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000379:methods; D004521:Educational Measurement / Q000379:methods*; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D008297:Male; D008910:Minnesota; D061646:Operative Time; D012073:Remedial Teaching / Q000379:methods*; D013647:Task Performance and Analysis; D058013:Test Taking Skills
keywords: Interpersonal and Communication Skills; Medical Knowledge; Patient Care; assessment; general surgery; remediation; simulation; surgical education