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Self-Reported Attitudes and Behaviors of General Surgery Residents About Ethical Practices in Academic Test-Taking
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ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS
score of 10), and knowledge of what behaviors constitute abuse and unprofessional behavior from 8 to 9.3 (p ¼ 0.027, maximum score of 10). Conclusion(S): Significant changes in resident awareness of key psychosocial issues in surgical residency were seen after one formal teaching session in our study. Given that the first step in preventing burnout and psychosocial issues is recognizing our own risk, our teaching session was able to achieve changes in how residents viewed their own burn out risk, increased awareness of how to handle mental illness issues and increased knowledge about what behaviors constitute abuse and unprofessional behavior. Formal resident wellness and professionalism curriculums in surgical education should be strongly considered in residency programs. 27.7. Self-Reported Attitudes and Behaviors of General Surgery Residents About Ethical Practices in Academic Test-Taking. V. P. Grignol, A. J. Gans, B. A. Booth, R. J. Markert, P. M. Termuhlen; Wright State University Boonshoft School of Medicine, Dayton, OH Introduction: Studies have shown that unprofessional behavior in medical school correlates with later disciplinary action by state medical boards. Studies amongst engineering, business and nursing students have specifically shown a positive correlation between academic dishonesty and unethical behaviors in training and professional practice. In a time when professionalism in medicine has been questioned general surgery residents must be held to high standards. Although academic dishonesty and what constitutes unethical behavior has been assessed among medical students, it has not been examined among general surgery residents. We sought to describe the attitudes of general surgery residents with regard to ethical and unethical academic practices related to the American Board of Surgery In-Training Exam (ABSITE). Methods: Sixty-two general surgery residents in academic years 2008-2009 and 2009-2010 were asked to participate in the study. A survey with 4 scenarios in which residents are participating in activities related to exam taking that may or may not be considered unethical was developed and administered. Participants were asked to state whether they would participate in such activities, whether they knew of others who have participated, and whether or not they felt such activities were unethical. Results: Fifty-seven of 62 residents (92%) agreed to participate in the survey. For each scenario, more than 80% of participants indicated that they would not participate in such activities and did not know anyone who had. Forty-six percent of participants felt that memorizing ABSITE questions for future use was unethical. Half felt that using those questions to prepare for future ABSITEs was unethical. Ninety percent felt that selling ABSITE questions for financial gain was unethical, and 64% of residents believed that purchasing old ABSITE questions for studying was unethical. No difference was seen between the attitudes of incoming interns, junior level (PGY 1 &2), or senior level (PGY3-5) residents when compared with one another. Conclusion: Overall, general surgery residents in this study indicated that they have not participated in activities they felt to be unethical. The definition of what participants felt to be unethical was less clear. It is noteworthy that the majority of residents felt that using old questions for financial gain would be unethical. However, decidedly fewer felt that way regarding the use of old questions for studying. Our results are similar to those found in studies of medical students. Cheating and unethical behavior is not always clearly evident to the learner and represents an area in which further education is needed. 27.8. Resident Workload, Pager Communications, and Quality of Care. S. P. Patel, R. J. Lynch, J. S. Lee, D. N. Ranney, S. N. Al-Holou, C. M. Frost, M. E. Harris, S. A. Lewin, E. Liu, A. Madenci, A. A. Majkrzak, J. Nelson, S. F. Peterson, K. A. Serecky, D. A. Wilkinson, B. M. Wojcik, M. J. Englesbe; University of Michigan, Ann Arbor, MI Introduction: With the recent policy changes in resident work hours, it has become more important than ever to understand how
residents spend their time. The volume and content of pages they receive are a valuable source of information that provide insight to the resident workload and help identify inefficiencies in hospital communication. We hypothesized that above a certain workload threshold (patient census), paging data will suggest breakdowns in communication and implications on quality of care. Methods: The alphanumeric pages over the course of one academic year (July 2008 - June 2009) of six general surgery interns at the University of Michigan were retrospectively categorized by independent reviewers. Pages were classified by sender type, message type, message modifier, and page quality. Census, discharge, and admission information for each intern service were also collected over the course of all months in the study period. Intern duties were further analyzed with respect to schedule, where ‘on-call’ days were defined as when they bore responsibility for care of all admitted floor patients. Results: There were 9,843 pages reviewed. During on-call shifts, each intern was paged an average of 57 6 3 times, while those on non-call shifts received an average of 12 6 3 pages. Floor/ICU nurses comprised 32% of the page volume received by interns. Interestingly, as patient volume increased, there was a decrease in the number of pages received per patient (Figure). By contrast, at higher patient volumes, there was a trend toward an increasing percentage of urgent and emergent pages per patient.
Conclusions: At high intern workloads, our paging data suggest no major communication breakdowns but reveal the potential for inferior quality of care. 27.9. Improving Surgical Intern Confidence through the Implementation of Expanded Orientation Sessions. M. B. Antonoff, J. A. Swanson, R. D. Acton, J. G. Chipman, M. A. Maddaus, C. C. Schmitz, J. D’Cunha; University of Minnesota, Minneapolis, MN Background: Orientation seminars for surgical residency serve as the first formal programming for new interns transitioning from medical school. Though interns may be equipped with extensive medical knowledge, they may lack readiness for job-related tasks and harbor anxiety that may significantly interfere with job performance. To this end, we extended our intern orientation, with the principal aim of demonstrating the need for expanded instruction on execution of daily tasks. Additionally, we sought to show that an enriched orientation curriculum significantly augments intern confidence, and that orientation-related gains in confidence persist. Methods: 19 surgical interns participated in an extended 2-day orientation program, consisting of interactive didactics, case scenario presentations, and small group discussions. Topics covered included chart documentation, day-to-day inpatient tracking, hospital discharges, handoffs,
ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS
score of 10), and knowledge of what behaviors constitute abuse and unprofessional behavior from 8 to 9.3 (p ¼ 0.027, maximum score of 10). Conclusion(S): Significant changes in resident awareness of key psychosocial issues in surgical residency were seen after one formal teaching session in our study. Given that the first step in preventing burnout and psychosocial issues is recognizing our own risk, our teaching session was able to achieve changes in how residents viewed their own burn out risk, increased awareness of how to handle mental illness issues and increased knowledge about what behaviors constitute abuse and unprofessional behavior. Formal resident wellness and professionalism curriculums in surgical education should be strongly considered in residency programs. 27.7. Self-Reported Attitudes and Behaviors of General Surgery Residents About Ethical Practices in Academic Test-Taking. V. P. Grignol, A. J. Gans, B. A. Booth, R. J. Markert, P. M. Termuhlen; Wright State University Boonshoft School of Medicine, Dayton, OH Introduction: Studies have shown that unprofessional behavior in medical school correlates with later disciplinary action by state medical boards. Studies amongst engineering, business and nursing students have specifically shown a positive correlation between academic dishonesty and unethical behaviors in training and professional practice. In a time when professionalism in medicine has been questioned general surgery residents must be held to high standards. Although academic dishonesty and what constitutes unethical behavior has been assessed among medical students, it has not been examined among general surgery residents. We sought to describe the attitudes of general surgery residents with regard to ethical and unethical academic practices related to the American Board of Surgery In-Training Exam (ABSITE). Methods: Sixty-two general surgery residents in academic years 2008-2009 and 2009-2010 were asked to participate in the study. A survey with 4 scenarios in which residents are participating in activities related to exam taking that may or may not be considered unethical was developed and administered. Participants were asked to state whether they would participate in such activities, whether they knew of others who have participated, and whether or not they felt such activities were unethical. Results: Fifty-seven of 62 residents (92%) agreed to participate in the survey. For each scenario, more than 80% of participants indicated that they would not participate in such activities and did not know anyone who had. Forty-six percent of participants felt that memorizing ABSITE questions for future use was unethical. Half felt that using those questions to prepare for future ABSITEs was unethical. Ninety percent felt that selling ABSITE questions for financial gain was unethical, and 64% of residents believed that purchasing old ABSITE questions for studying was unethical. No difference was seen between the attitudes of incoming interns, junior level (PGY 1 &2), or senior level (PGY3-5) residents when compared with one another. Conclusion: Overall, general surgery residents in this study indicated that they have not participated in activities they felt to be unethical. The definition of what participants felt to be unethical was less clear. It is noteworthy that the majority of residents felt that using old questions for financial gain would be unethical. However, decidedly fewer felt that way regarding the use of old questions for studying. Our results are similar to those found in studies of medical students. Cheating and unethical behavior is not always clearly evident to the learner and represents an area in which further education is needed. 27.8. Resident Workload, Pager Communications, and Quality of Care. S. P. Patel, R. J. Lynch, J. S. Lee, D. N. Ranney, S. N. Al-Holou, C. M. Frost, M. E. Harris, S. A. Lewin, E. Liu, A. Madenci, A. A. Majkrzak, J. Nelson, S. F. Peterson, K. A. Serecky, D. A. Wilkinson, B. M. Wojcik, M. J. Englesbe; University of Michigan, Ann Arbor, MI Introduction: With the recent policy changes in resident work hours, it has become more important than ever to understand how
residents spend their time. The volume and content of pages they receive are a valuable source of information that provide insight to the resident workload and help identify inefficiencies in hospital communication. We hypothesized that above a certain workload threshold (patient census), paging data will suggest breakdowns in communication and implications on quality of care. Methods: The alphanumeric pages over the course of one academic year (July 2008 - June 2009) of six general surgery interns at the University of Michigan were retrospectively categorized by independent reviewers. Pages were classified by sender type, message type, message modifier, and page quality. Census, discharge, and admission information for each intern service were also collected over the course of all months in the study period. Intern duties were further analyzed with respect to schedule, where ‘on-call’ days were defined as when they bore responsibility for care of all admitted floor patients. Results: There were 9,843 pages reviewed. During on-call shifts, each intern was paged an average of 57 6 3 times, while those on non-call shifts received an average of 12 6 3 pages. Floor/ICU nurses comprised 32% of the page volume received by interns. Interestingly, as patient volume increased, there was a decrease in the number of pages received per patient (Figure). By contrast, at higher patient volumes, there was a trend toward an increasing percentage of urgent and emergent pages per patient.
Conclusions: At high intern workloads, our paging data suggest no major communication breakdowns but reveal the potential for inferior quality of care. 27.9. Improving Surgical Intern Confidence through the Implementation of Expanded Orientation Sessions. M. B. Antonoff, J. A. Swanson, R. D. Acton, J. G. Chipman, M. A. Maddaus, C. C. Schmitz, J. D’Cunha; University of Minnesota, Minneapolis, MN Background: Orientation seminars for surgical residency serve as the first formal programming for new interns transitioning from medical school. Though interns may be equipped with extensive medical knowledge, they may lack readiness for job-related tasks and harbor anxiety that may significantly interfere with job performance. To this end, we extended our intern orientation, with the principal aim of demonstrating the need for expanded instruction on execution of daily tasks. Additionally, we sought to show that an enriched orientation curriculum significantly augments intern confidence, and that orientation-related gains in confidence persist. Methods: 19 surgical interns participated in an extended 2-day orientation program, consisting of interactive didactics, case scenario presentations, and small group discussions. Topics covered included chart documentation, day-to-day inpatient tracking, hospital discharges, handoffs,