Ross E. Willis, PhD Richard M. Peterson, MD Daniel L. Dent, MD

1. Utility of the ACS Fundamentals of Surgery Curriculum as a Knowledge Preparatory Tool for Incoming Interns Ross E. Willis, PhD Richard M. Peterson, MD Daniel L. Dent, MD University of Texas Health Science Center at San Antonio

2. Intern Supply Chain

3. Purpose • Examine the utility of the ACS Fundamentals of Surgery Curriculum as a knowledge preparatory tool for incoming interns.

4. FSC Overview • Developed by ACS Division of Education • Case-based scenarios • Examine patient • Identify symptoms • Order/evaluate tests • Formulate diagnosis • Formulate treatment plan

5. FSC Categories • Preoperative Assessment • On-Call Issues • Postoperative Hypotension • Postoperative Fever • Fluid and Electrolyte Management • Nutritional Support • Pain Management • Respiratory Management

6. FSC Categories • Cardiac Conditions • Unresponsive & Agitated Patients • Gastrointestinal Conditions • Lower GI Bleeding • Perianal Disease • Bowel Obstruction • Wound Management • Traumatic Stab Wounds • Burns • Decubiti • Patient & Workplace Safety

7. Assess Patient

8. Item Assessment

9. Initial Impressions

10. Physical Exam

11. Order Tests

12. Diagnoses

13. Interventions

14. Performance Summary

15. Methods

16. Participants • 20 interns • 6 categorical general surgery • 1 categorical CT I-6 • 3 designated prelim urology • 10 non-designated prelim general surgery

17. Condition Assignment • Interns randomly assigned to: • Experimental Condition: Received FSC accounts prior to reporting for intern orientation (June 1). Asked to complete all 96 cases before June 27. • Control Condition: Did not receive FSC accounts prior to orientation

18. Exam • 30-item MCQ exam • Questions based on common clinical scenarios that interns will face • From 10 topics covered in FSC, but not explicitly taught in FSC • All interns took the exam

19. Questionnaire • Perceived usefulness of FSC • “Not at all helpful” to “Extremely helpful” • “N/A” for interns who were not assigned FSC. • Level of comfort with 10 topic areas • “Very uncomfortable” to “Extremely comfortable” • All interns completed the questionnaire

20. Results

21. Cases Completed Prior to Exam

22. Usefulness of FSC • How helpful were the Fundamentals of Surgery cases in terms of preparing you for internship? Not at All Moderately Extremely Helpful I only did a few of the cases and can’t provide a good assessment (n=3) Standard deviation = .5

23. Exam Scores Mann-Whitney U: p < .011

24. Level of Comfort

25. Cases Completed Prior to ABSITE Mann-Whitney U: p < .001

26. ABSITE Percentile Mann-Whitney U: NS

27. ABSITE Section Scores Mann-Whitney U: BS = NS CM = NS

28. Conclusions • Welcome addition to existing curricula • Implement FSC prior to internship • Higher scores on in-house exam • No differences in ABSITE scores • ABSITE assesses broader array of knowledge • Interns had time to “catch-up” • Rated cases as “Extremely Helpful” • Continue using FSC in future

29. Acknowledgements • Richard Peterson, MD • Daniel Dent, MD