In reply I want to thank the ARCHIVES for giving me the opportunity to respond to the recent letter by Dr Maizel regarding our article. I am pleased to see that Dr Maizel has passionate opinions about education in surgery. Unfortunately, I feel that he missed some of the important points of our article. Nevertheless, Dr Maizel's letter gives me the chance to clarify his several misconceptions about our study and to update him on some of the recent changes in surgical education. At Harbor–UCLA Medical Center, our surgical residents have historically performed very well from the academic and career standpoints. They enter our residency having achieved high scores on the United States Medical Licensing Examination, which is a testament to their intelligence and self-motivation to read and study. Likewise, our residents have consistently performed higher than the national average on the ABSITE examination without weekly assigned reading and tests. The question we asked in our study was whether we could further improve performance in an already high-achieving group. Thus, we were not out to remedy unmotivated underachievers, as Dr Maizel suggests. In designing the study, we assigned a topic each week and left it up to each resident to choose the reading source of his or her choice. As noted in our study conclusions, the residents' scores on the weekly tests did not correlate with ABSITE performance, suggesting that the process of independent reading was more important than the content of the weekly tests, which were written and prepared primarily by me. Dr Maizel's comment that we "teach for the examination" is not accurate. Rather, we were encouraging and directing the residents to pursue self-education. There is no escaping the fact that medical school and surgical training involve a series of objective assessments of the fund of knowledge. These tests ultimately culminate in the qualifying and certifying examinations administered by the American Board of Surgery. Low performance on the ABSITE has been shown to correlate with an inability to pass those examinations. When our residents apply for fellowships or when our nondesignated preliminary residents seek categorical positions in other programs, most program directors inquire about their ABSITE performance. Thus, there are other practical reasons to encourage residents to read and perform well on the ABSITE. Is the ABSITE the best test to determine a competent surgeon? Of course not. It is only one measure of competence. On the other hand, augmenting the frequency of bedside rounds, although extremely valuable and increasingly neglected in modern resident training, has not been shown to improve examination performance. The Accreditation Council on Graduate Medical Education has recently introduced 6 competencies (patient care, medical knowledge, practice-based learning, interpersonal and communication skills, professionalism, and system-based learning) by which resident education is measured. Residency programs are required to demonstrate written documentation for each of these competencies. The ABSITE examination is only 1 outcome measure that we use at Harbor–UCLA to measure medical knowledge, and the weekly tests represent a small fraction of the myriad educational tools used to create complete, competent, professional, and independent surgeons. To suggest that the ABSITE is our primary or sole outcome measure to evaluate resident competence, as suggested by Dr Maizel, represents a very myopic viewpoint. Correspondence: Dr de Virgilio, Division of Vascular Surgery, Department of Surgery, Harbor–UCLA Medical Center, 1000 W Carson St, Box 25, Torrance, CA 90509 (firstname.lastname@example.org).
Archives of Surgery – American Medical Association
Published: Aug 1, 2004
Keywords: internship and residency,surgical procedures, operative,surgeons
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