The Certifying Examination of the American Board of Surgery:

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

2. Authors Pamela A. Rowland, PhD Thadeua L. Trus, MD Nicholas P. Lang, MD Horace Henriques, MD William 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 KennithSartorelli, MD Steven B. Goldin, MD, PhD A. Gerson Greenburg, MD, PhD

3. Nothing to disclose Surgeons/faculty have never been paid for their participation.

5. Rowland et al. J Acad Med, 1991

7. ?

8. The Effect of Improving Communication Competency on the Certifying Examination of the American Board of Surgery Rowland, Coe, Lang, Greenburg, Reed, Spence and Burchard American Journal of Surgery 2002

9. Clinical Performance & Oral Examinations in Surgery Goals: Outcomes: • Increase awareness of variables affecting oral exam scoring • Individual skill development • Maintain course stability • Successful completion of the Certifying Examination

10. Certifying Examination 1991 - 2000 March 2001 - 2010 3 opportunities - 5 years Modified residency 5 opportunities - 5 years Standard Pathway Alternative Pathway No written letters to explain failure

11. Certifying Exam Pass Rates

12. Certifying Exam Pass Rates

13. Certifying Exam Pass Rates

21. Caution

23. Course Changes 1991 - 2001 2007 - 2010 • 5 day format • Fewer residents • 3 day format • More residents - ?

24. Chief Complaint: “Has failed…and doesn’t know why…” “Is likely to fail” Program Director

25. HPC: (History of Present Communication) Already failed Presentation Issues Language Issues High Stress Communication Issues – (“you know,” “and ah”) Low volume Poor professional image

26. PCHx: (Past Communication History) • Learned English late and not well • High stress in household during formative years • Speech impediments, hx speech rx, braces • Public speaking experiences or failures • Sports • Marital Status – Children

27. PCHx: Describe the type of person who would be most challenging for you to talk with… How did you feel in the hotel exam setting?

28. Dx: • Pre-course screening via telephone • Mini 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

29. Rx: • Other review courses (ATLS, content, basic science) • Purchase professional attire • Grooming recommendations • Practice worksheets – articulation / rate • Reading schedules • Personal study & sleep schedules • Psychologist or psychiatrist referrals • Fun

30. Lessons Learned

31. . Rowland and Lang, 2007

32. MORE Stressors • Balancing outside obligations • More residents entering fellowships • Higher stakes for programs: 1st time pass rate

33. 80 hour work week: • Not reduced stress • Not increased CE pass rates • Not reduced thoughts of depression or suicide (Arch Surg 2011)

34. Course Outcomes • 1991 – 2010 • 326 participants • 187 have passed the CE (139 TBD) • When participants followed Rx plan - pass Process has changed, but the goals are the same.

35. Clinical Performance & Oral Examinations in Surgery Goals: Outcomes: • Increase awareness of variables affecting oral exam scoring • Individual skill development • Maintain course stability • Successful completion of the Certifying Examination

36. September 13 – 17, 2011 Pamela_Rowland@med.unc.edu

37. Stress 1991 - 2001 • marriage difficulties • pregnancy • children • financial issues • new employment • moving • relocation • previous failure(s) on orals • childhood incidents in a hotel room