S. Liu1, J. Unkart1, D. Hemming1, G. R. Jacobsen1, J. Baumgartner1, B. J. Sandler1 1University Of California – San Diego,Surgery,San Diego, CA, USA
Introduction:
In the era of work hour restrictions and increased patient hand offs, one of the cornerstones of surgery resident education is being able to effectively communicate high yield clinical information during signout. This study uses a novel method to evaluate the residents’ ability to communicate high yield clinical information during signout and compares their clinical judgment to the collective experience of their attendings. The scores of all the residents are then compared across years of training.
Methods:
From May to July of 2016, residents and 4th year medical students applying to surgery residency were asked to take a test titled “Sign out Scenarios” during education conference. The test gives 5 hypothetical patient vignettes, each with 10 pieces of underlined clinical information. The resident is asked to assume the role of the resident giving signout, and is asked to select 3 of the most important pieces of information in each vignette to emphasize to the on call resident. Three general surgery attendings were also asked to complete the same test. A grading rubric is created by assigning points to each piece of information in the vignette based on how many times an attending selects it, thus giving each piece of information a point between 0-3. The resident tests are then scored based on this rubric and compared between Post Graduate Years (PGY).
Results:
A total of 37 residents and 8 medical students took the test. There was a clear step-wise improvement in score (see graph below) with increasing PGY year. Statistically significant changes are observed between PGY1 to PGY3 year with an increase of score from 28.6 to 31.25 (P=0.039). Residents also had significantly higher scores when compared to the medical student at PGY 2 (P=0.026), PGY 3 (P=0.02) and PGY 4/5 (P=0.028).
Conclusion:
Giving effective signout is a skill that surgery residents are expected to master. Our test is unique because it uses the collective experience of attendings to weigh the test answers in order to evaluate how closely a resident is able to think like an attending. We show a stepwise increase in signout competency across PGY levels with the most improvement at PGY3 year. This makes sense in our institution because nightfloat rotations are completed at the end of PGY2, giving these residents practice in identifying high yield signout information. This assessment tool can be very valuable for evaluating resident progress because we would expect incremental improvement in score until PGY3. Additionally, this tool may be effective in identifying residents with deficiencies if they are below the expected for their PGY.
