Setting standards of performance expected in neurosurgery residency: A study on entrustable professional activities in competency-based medical education

BackgroundCompetency-based medical education requires evaluations of residents’ performances of tasks of the discipline (ie. entrustable professional activities (EPAs)). Using neurosurgical Faculty perspectives, this study investigated whether a sample of neurosurgical EPAs accurately reflected the expectations of general neurosurgical practice.MethodA questionnaire was sent to all Canadian neurosurgery Faculty using a SurveyMonkey® platform.ResultsThe proportion of respondents who believed the EPAs were representative of general neurosurgery competences varied significantly across all EPAs [47%–100%] (p < 0.0001). For 9/15 proposed EPAs, ≥75% agreed they were appropriate for general neurosurgery training and expected residents to attain the highest standard of performance. However, a range of 27–53% of the respondents felt the other six EPAs would be more appropriate for fellowship training and thus, require a lower standard of performance from graduating residents.ConclusionThe shift towards subspecialization in neurosurgery has implications for curriculum design, delivery and certification of graduating residents.     

Advanced age and decisional capacity: The effect of age on the ability to make health care decisions

ObjectiveCognitive disorders, including dementia, have been shown to be predictors of decisional incapacity, even more than psychotic or substance use disorders. Nonetheless, the impact of advanced age on decisional capacity remains understudied.MethodOut of more than 2500 consecutive psychiatric consultations performed by the Consultation-Liaison service at Bellevue Hospital Center in New York City, 266 completed decisional capacity assessments were identified and analyzed with respect to the indications for referral and the impact of age and other sociodemographic, medical and psychiatric variables on decisional capacity.ResultsBy itself, in this sample advanced age was not associated with impaired medical decision-making. In individuals ≥65 years old, among whom only 27% were deemed to have decisional incapacity, cognitive disorders including dementia remained the strongest association with this incapacity; meanwhile, in patients <65, decisional impairment was evident in 62%, and delirium, psychosis and neurological disorders caused more decisional impairment. The main indications for referral were placement refusals in those ≥65, while young patients were largely seen due to their desire to leave the hospital against medical advice.ConclusionAdvanced age by itself failed to be associated with decisional incapacity in this sample. In those ≥65, cognitive disorders remained the main association with such incapacity, versus psychosis, substance use and neurological disorders in younger patients.     

Inserción de la simulación clínica en el currículum de Anestesiología en un hospital universitario. Evaluación de la aceptabilidad de los participantes

IntroductionClinical simulation is currently an integral part of the curriculum of the Anesthesiology residency programs in other countries. We aimed to describe and evaluate the insertion of simulation in an anesthesia residency training program.MethodsActivities feasible to be used for training in a simulated environment were classified into 2 modules: workshops for technical skills conducted with first year residents, and high fidelity simulation scenarios performed with second and third year residents. After each activity, and using an anonymous questionnaire, residents assessed their satisfaction and objectives accomplished.ResultsA total of 18 activities: 6 skills workshops and 12 high fidelity scenarios were assessed. A total of 206 questionnaires were analyzed, corresponding to 41 residents. Almost all (96%) of respondents agreed or strongly agreed that workshops met the objectives and should be mandatory in the anesthesia curriculum; however, 11% agreed that the activity caused anxiety and/or nervousness. The high fidelity scenarios were considered realistic and consistent with the objectives by 97% of residents, and 42% felt that workshops caused anxiety and/or nervousness.ConclusionsThe inclusion of simulation has been well accepted by the residents. The activities have been described as realistic, and limited to the objectives, essential points in adult education, as according to Kolb's learning model this is associated with profound, useful and long lasting knowledge.     

Anxiety and performance

In the world of sport, athletes and their trainers see competitive emotions and, in particular, performance anxiety as one of the most important factors likely to influence the outcome of a sports competition. These emotions attract such vast interest because even today they continue to raise many questions. While positive emotions are generally considered to be largely facilitative to an athlete's performance, the link between negative emotions, and particularly competitive anxiety, and performance seems less unanimous. Some view anxiety as a phenomenon which hampers performance; for them, an anxious athlete is a fragile one. Others view anxiety as a driver and give as examples those athletes who only perform well under the pressure of competition and the anxious state it elicits. There is currently no single model for the relationship between anxiety (or emotions) and performance on which everybody agrees, in spite of the fact that the scientific community has been striving for some time to better understand the links between them. Research carried out to confirm these links has produced inconsistent results which are difficult to interpret as the variables measured (anxiety, emotional states, performance) and the framework of the studies (characteristics of the participants, importance of the sports event) most often differ.     

Surgical training technology for cerebrovascular anastomosis

Cerebrovascular anastomosis (for example in the management of Moyamoya disease or complex aneurysms) is a rarely performed but essential procedure in neurosurgery. Because of the complexity of this technique and the infrequent clinical opportunities to maintain skills relevant to this surgery, laboratory training is important to develop a consistent and competent performance of cerebrovascular anastomosis. We reviewed the literature pertaining to the training practices surrounding cerebrovascular anastomosis in order to understand the ways in which trainees should best develop these skills. A wide variety of training methods have been described. These may be classified into five general categories, according to training materials used, being synthetic material, living animal, animal carcass, human cadaver, and computer simulation. Ideally, a novice begins training with non-biological material. After gaining sufficient dexterity, the trainee will be able to practice using biological materials followed by high fidelity models prior to actual surgery. Unfortunately, the effectiveness of each model has generally, to our knowledge, only been judged subjectively. Objective quantification methods are necessary to accelerate the acquisition of competence.     

A Korean Survey on Qualities and Definition of a Good Psychiatrist

The definition of a "good" psychiatrist has varied over the past decades due to changing roles of psychiatrists. Studies on the qualities of "good" psychiatrists have been completed in many countries. However, no such study has been undertaken in Korea. In Korea, recent growing interest in psychiatry demands the identification of qualities for a good psychiatrist. The purpose of this study was to define the qualities of a good psychiatrist in Korea, subsequently facilitating the improvement of psychiatric training programs. The questionnaire was based on a Singaporean survey with the permission from the original authors. Respondents were divided into patient group and psychiatrist group. The 40-item questionnaire contained items grouped into four themes: Professional, Personal Values, Academic Executive and Relationship. Of the four themes, both patient and psychiatrist groups considered Professional as the most important, whereas Academic Executive as the least important. The mean scores for all items of each theme in the patient group were higher than those in the psychiatrist group, reflecting higher expectations for good psychiatrist in the patient group. Patients emphasized Relationship more than psychiatrists did. It is concluded that a good psychiatrist in Korea can be defined as "a good communicator and listener with a professional manner, who respects confidentiality and has good doctor-patient relationships."

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