Papers by Margaret Boehler
Surgery, Oct 1, 2005
Resident evaluation traditionally involves global assessments including clinical performance, pro... more Resident evaluation traditionally involves global assessments including clinical performance, professional behavior, technical skill, and number of procedures performed. These evaluations lack objective assessment of operative skills. We describe an operative performance rating system (OPRS) designed to provide objective operative performance ratings using a sentinel procedure format. Ten-item procedure-specific rating instruments were developed. Items included technical skills, operative decision making, and general items. A 1 to 5 (5 = excellent) scale was used for evaluation. Six procedures had sufficient forms returned to allow evaluation. Inter-rater reliability was determined by having faculty evaluators view 2 videotaped operations. Return rates for the Internet-based form were full-time faculty (92%), volunteer faculty (27%), and overall (67%). Reliability, (average interitem correlation), and total procedures evaluated were excisional biopsy, 0.90, (0.48), 77; open inguinal herniorraphy, 0.94, (0.62), 51; laparoscopic cholecystectomy, 0.95, (0.64), 75; small-bowel and colon resection, 0.92, (0.58), 30; parathyroidectomy, 0.70, (0.19), 30; and lumpectomy, 0.92, (0.51), 38. Years of training accounted for 25% to 57% of the variation in scores. Inter-rater variability was observed; however, the average rater agreement was reliable. Internet-based management made obtaining the data feasible. The OPRS complements traditional evaluations by providing objective assessment of operative decision-making and technical skills. Interitem correlations indicate the average rating of items provides a reliable indicator of resident performance. The OPRS is useful in tracking resident development throughout postgraduate training and offers a structured means of certifying operative skills.
American Journal of Surgery, Jul 1, 2012
Journal of Surgical Education, Mar 1, 2009
American Journal of Surgery, Feb 1, 2021
INTRODUCTION Surgical educators' professional behavior constitutes a hidden curriculum and im... more INTRODUCTION Surgical educators' professional behavior constitutes a hidden curriculum and impacts trainee's professional identity formation. This study explores the nuances of professional behaviors as observed in varying surgical settings. METHODS 411 Transcripts originated from essays written by MS3 students during their surgical clerkship from 2010 to 2016 were collated. Employing a qualitative research methodology, we conducted a thematic analysis to uncover specific meaning emerging from medical student reflections' on surgical professionalism. RESULTS In clinics, taking time and protecting patient privacy; in the OR, control over emotion during difficult situations and attention to learners; and in the inpatient setting, showing accountability above normal expected behavior were noted as professional. Similarly, unprofessional behaviors in these contexts paralleled lack of these attributes. CONCLUSIONS Behaviors observed and the attributes of professionalism in the surgical learning environment have contextual nuances. These variations in professionalism can be utilized in deliberate development of professionalism in surgery.
Background: This study was developed to assess study habits of medical students in a third-year s... more Background: This study was developed to assess study habits of medical students in a third-year surgical clerkship and to determine the relationship of these study habits to performance outcomes. Methods: A questionnaire designed to assess medical student study habits was administered at the end of five consecutive 10-week multidisciplinary surgical clerkships. The results of questionnaires from 81 students were analyzed in respect to results on the National Board of Medical Education (NBME) surgical subtest and the multiple stations clinical examination (MSCE) given at the end of each clerkship. Results: Although only 18 of the total 81 students reported studying in formal but self-directed groups, students who reported studying in a group on average scored 4 points higher on the MSCE than those who did not study in a group (P ϭ 0.001). However, no significant differences or correlations were discovered between any of the study habits and the individual results on the NBME. Conclusion: Students may benefit from collaborative studying when it comes to clinical experience as demonstrated by improved performance on the MSCE.
Journal of the American College of Surgeons, 2017
INTRODUCTION: Microinvasive breast carcinoma is defined by the presence of one or more foci of in... more INTRODUCTION: Microinvasive breast carcinoma is defined by the presence of one or more foci of invasion with a length equal to or less than 1 mm. Given the heterogeneity of this entity is not yet established if its biological profile is close to in situ carcinoma or if it should be considered an invasive lesion. In this case series we intend to analyze its clinical-pathological characteristics through the review of consecutive cases treated in our institution. METHODS: Retrospective review of 142 patients with definitive histological diagnosis of microinvasive carcinoma treated between 2008 and 2015. RESULTS: A median age of 57 years and changes in the physical exam were present in 36 cases (25.3%), and the foci of invasion were mostly single (54.2%). Positivity was identified for estrogen and progesterone receptors in 66 , 2%, and 51.4%, respectively. Conservative surgery was the initial surgical procedure in 62% of the cases and the sentinel lymph node was biopsied in 140 patients, with metastasis in only 4 (2,9%). 79.6% of patients were submitted to adjuvant treatment. Four cases of locoregional and distant recurrences were observed and overall survival was 97.8% at 5 years. CONCLUSIONS: Mircoinvasive carcinoma is usually associated with extensive ductal carcinoma in situ and does not appear to have specific biological or pathological characteristics. It presents a low potential for metastasis and overall has a good prognosis. The data suggests that sentinel node biopsy requires an individualized therapeutic decision.
Journal of Surgical Education, 2021
OBJECTIVE The authors aimed to investigate faculty evaluation criteria for an effective oral surg... more OBJECTIVE The authors aimed to investigate faculty evaluation criteria for an effective oral surgical presentation in actual patient care contexts. DESIGN We conducted a 2-step observation-based qualitative study. Residents audiotaped oral presentations of a surgical consult to an attending. Evaluation panels listened to the recordings and discussed to develop joint feedback for the resident. The panel discussions were recorded and served as the data source for this study. We analyzed the data following the grounded theory approach using open coding and axial coding. SETTING The study setting was at Southern Illinois University School of Medicine, a 5-year general surgery residency program in Springfield, Illinois. PARTICIPANTS Thirteen residents out of 19 in the program participated by virtue of having submitted recordings of a patient care consult presentation via phone. Evaluation panels consisted of general surgery academic and community faculty, as well as senior residents. RESULTS Several criteria for effective oral presentations emerged that have rarely been discussed in prior literature. Themes included: (1) The strategic opening is critical as it "sets the stage" and frames how the attending will listen. Situational factors, such as consideration of time of the day and urgency, should be accounted for in the opening. (2) A deductive structure defines the relevance of the presented information. Clinical judgement should precede supporting evidence. Attending physicians perceive important information as unnecessary if provided outside of this framework. (3) Established trust between a resident and a surgeon determines the level of detail expected of the presenting resident. With increasing trust, surgeons expect residents to present fewer details; if too much detail is included, the presentation may be assessed as ineffective. (4) Surgical descriptions are appreciated for their value in promoting the attending's visualization or mental picture of the patient condition. (5) Oral emphasis using voice tone and pace can be helpful for capturing attending attention. CONCLUSIONS These findings can be utilized to improve the current training program and assessment rubrics toward contextualized work-based assessment practices in surgery. Oral patient presentation skills are neither static nor universal, but fluid and reflexive, based on trust, and situational factors.
The American Journal of Surgery, 2020
INTRODUCTION Surgical educators' professional behavior constitutes a hidden curriculum and im... more INTRODUCTION Surgical educators' professional behavior constitutes a hidden curriculum and impacts trainee's professional identity formation. This study explores the nuances of professional behaviors as observed in varying surgical settings. METHODS 411 Transcripts originated from essays written by MS3 students during their surgical clerkship from 2010 to 2016 were collated. Employing a qualitative research methodology, we conducted a thematic analysis to uncover specific meaning emerging from medical student reflections' on surgical professionalism. RESULTS In clinics, taking time and protecting patient privacy; in the OR, control over emotion during difficult situations and attention to learners; and in the inpatient setting, showing accountability above normal expected behavior were noted as professional. Similarly, unprofessional behaviors in these contexts paralleled lack of these attributes. CONCLUSIONS Behaviors observed and the attributes of professionalism in the surgical learning environment have contextual nuances. These variations in professionalism can be utilized in deliberate development of professionalism in surgery.
The American Journal of Surgery, 2003
Background: The surgery clerkship director is a key individual in the surgery department's educat... more Background: The surgery clerkship director is a key individual in the surgery department's educational mission and yet there has been no prior effort to describe this group or identify their learning needs. The purpose of this study was to develop a demographic profile and an educational needs assessment for surgery clerkship directors. Methods: A survey instrument was designed based on existing literature and distributed to surgery clerkship directors in the United States and Canada. Results: Surveys were returned from 108 subjects (77%). The majority of clerkship directors strongly agree that directing is a positive experience but express concern that the job demands may impede their professional careers. The perceived educational needs identified related primarily to the development and management of the student education curriculum. Conclusions: Surgery clerkship directors are experienced academic surgeons who report high levels of satisfaction. They identify a number of important educational needs of the position and express concern about the requirements of the position on their academic careers.
The American Journal of Surgery, 2004
Background: The transition from medical student to surgery internship can be stressful. The goal ... more Background: The transition from medical student to surgery internship can be stressful. The goal of this project was to design, implement, and evaluate a 1-month long elective course that would meet the majority of the American College of Surgeons Graduate Medical Education Committee prerequisites for graduate surgical education Methods: The major elements of the curriculum included faculty-and resident-facilitated case-based sessions and cadaver dissections. In addition, the students participated in skills laboratory experiences, Intensive Care Unit rounds, and mock interviews and clinical pages. The students took a knowledge pretest and post-test that was compared with the performance of 8 surgical interns on the same examination. Results: The highest rated elements of the course were those that provided hands-on experience or practical knowledge. The post-test knowledge examination scores were significantly higher than pretest scores and surgical intern scores. Conclusions: It was possible to develop a 1-month senior medical student elective course that provided students with the essential prerequisites believed to be essential for all surgical interns.
The American Journal of Surgery, 2010
BACKGROUND: The aim of this study was to compare the laboratory teaching of a basic technical ski... more BACKGROUND: The aim of this study was to compare the laboratory teaching of a basic technical skill by a nonphysician skills coach and a faculty surgeon. METHODS: Medical students were randomized to instruction of skin suturing in the skills laboratory by a faculty surgeon or by a nonphysician skills coach. Testing of performance occurred at 3 time points. Other faculty surgeons, blinded to identities and training groups, rated performance. RESULTS: Forty-nine students participated. Baseline fourth-year student mean scores showed no significant difference between training groups. Third-year and fourth-year student performance showed no difference between training groups on postintervention testing. Delayed testing also showed no difference in third-year student scores. CONCLUSIONS: Training by either a nonsurgeon skills coach or a faculty surgeon resulted in no difference in performance on a basic surgical skill. This was true for students with and without prior experience and was also true after subsequent clinical experiences. Nonphysician coaches may ease the teaching burden of surgical faculty members while providing similar quality of instruction for trainees.
The American Journal of Surgery, 2004
Background: The operating room (OR) is an important venue where surgeons do much of medical stude... more Background: The operating room (OR) is an important venue where surgeons do much of medical student teaching and yet there has been little work evaluating variables that influence learning in this unique environment. We designed this study to identify variables that affected medical student learning in the OR. Methods: We developed a questionnaire based on surgery faculty observations of learning in the OR. The medical students completed the questionnaire on 114 learning episodes in the OR. Pearson correlation coefficient was used to establish the strength of association between various variables and the student's overall perception of learning. Results: The students evaluated 27 variables that might impact their learning in the OR. Strong correlations were identified between the attending physician's attitude, interactions and teaching ability in the OR and the environment being conducive to learning. Conclusions: Surgical faculty behavior is a powerful determinant of student perceptions of what provides for a favorable learning environment in the OR.
The American Journal of Surgery, 2010
BACKGROUND: Health-related information can help patients understand their disease process and mak... more BACKGROUND: Health-related information can help patients understand their disease process and make informed decisions. We hypothesize that with the increased availability of Web-based resources, sociodemographic factors no longer impact Internet use among patients. METHODS: Study-specific surveys were administered to a convenience cohort of patients seen in the breast and colorectal specialty clinics at a single academic institution between August 2008 and February 2009. RESULTS: One hundred ninety-four surveys were returned (response rate 80%). Median age was 53 years (range 19-88) with 131 (75%) females. Twenty-six percent of patients were college graduates and 59% reported an annual income greater than $50,000. There was no association between Internet use and age, gender, income, or educational level. CONCLUSION: Web-based information is being increasingly used by patients irrespective of their demographic characteristics. These resources can therefore be used to educate patients about their disease, treatment options, and health maintenance.
Teaching and Learning in Medicine, 2005
Background: Prior investigations suggest that resident progress decisions by committee provide a ... more Background: Prior investigations suggest that resident progress decisions by committee provide a broader perspective on performance and result in less grade inflation. There is countervailing concern that group dynamics may compromise quality of progress decisions. Purpose: To determine whether and how group dynamics compromise decision making about resident progress. Methods: Researchers recorded and analyzed participant comments during a resident progress committee meeting. End-of-rotation (EOR) evaluations were analyzed and compared to progress committee meeting results. Results: EOR and progress committee comments were similar in content. The ratio of specific to general comments was higher for EOR evaluations (5:1) than for progress committee meetings (2:1). EOR evaluation comments provided more supporting evidence for assertions. Individual progress committee participants did not dominate discussion or sway decision making. Participant progress committee meeting comments were consistent with their EOR comments failing to support the presence of progress committee meeting "feeding frenzies." Conclusions: Results suggest that progress committee meeting group dynamics do not seriously compromise the validity of resident progress decisions.
Surgery, 2005
Resident evaluation traditionally involves global assessments including clinical performance, pro... more Resident evaluation traditionally involves global assessments including clinical performance, professional behavior, technical skill, and number of procedures performed. These evaluations lack objective assessment of operative skills. We describe an operative performance rating system (OPRS) designed to provide objective operative performance ratings using a sentinel procedure format. Ten-item procedure-specific rating instruments were developed. Items included technical skills, operative decision making, and general items. A 1 to 5 (5 = excellent) scale was used for evaluation. Six procedures had sufficient forms returned to allow evaluation. Inter-rater reliability was determined by having faculty evaluators view 2 videotaped operations. Return rates for the Internet-based form were full-time faculty (92%), volunteer faculty (27%), and overall (67%). Reliability, (average interitem correlation), and total procedures evaluated were excisional biopsy, 0.90, (0.48), 77; open inguinal herniorraphy, 0.94, (0.62), 51; laparoscopic cholecystectomy, 0.95, (0.64), 75; small-bowel and colon resection, 0.92, (0.58), 30; parathyroidectomy, 0.70, (0.19), 30; and lumpectomy, 0.92, (0.51), 38. Years of training accounted for 25% to 57% of the variation in scores. Inter-rater variability was observed; however, the average rater agreement was reliable. Internet-based management made obtaining the data feasible. The OPRS complements traditional evaluations by providing objective assessment of operative decision-making and technical skills. Interitem correlations indicate the average rating of items provides a reliable indicator of resident performance. The OPRS is useful in tracking resident development throughout postgraduate training and offers a structured means of certifying operative skills.
Medical Education, 2006
BACKGROUND Medical educators have indicated that feedback is one of the main catalysts required f... more BACKGROUND Medical educators have indicated that feedback is one of the main catalysts required for performance improvement. However, medical students appear to be persistently dissatisfied with the feedback that they receive. The purpose of this study was to evaluate learning outcomes and perceptions in students who received feedback compared to those who received general compliments. METHODS All subjects received identical instruction on two-handed surgical knot-tying. Group 1 received specific, constructive feedback on how to improve their knot-tying skill. Group 2 received only general compliments. Performance was videotaped before and after instruction and after feedback. Subjects completed the study by indicating their global level of satisfaction. Three faculty evaluators observed and scored blinded videotapes of each performance. Intra-observer agreement among expert ratings of performance was calculated using 2-way random effects intraclass correlation (ICC) methods. Satisfaction scores and performance scores were compared using paired samples t-tests and independent samples t-tests. RESULTS Performance data from 33 subjects were analysed. Inter-rater reliability exceeded 0.8 for ratings of pre-test, pre-intervention and post-intervention performances. The average performance of students who received specific feedback improved (21.98 versus 15.87, P < 0.001), whereas there was no significant change in the performance score in the group who received only compliments (17.00 versus 15.39, P ¼ 0.181) The average satisfaction rating in the group that received compliments was significantly higher than the group that received feedback (6.00 versus 5.00, P ¼ 0.005). DISCUSSION Student satisfaction is not an accurate measure of the quality of feedback. It appears that satisfaction ratings respond to praise more than feedback, while learning is more a function of feedback.
Journal of the American College of Surgeons, 2007
Curricula for surgical technical skills laboratories have traditionally been designed to accommod... more Curricula for surgical technical skills laboratories have traditionally been designed to accommodate the clinical activities of residents, so they typically consist of individual, episodic training sessions. We believe that the skills laboratory offers an opportunity to design a surgical skills curriculum based on the fundamental elements known to be important for motor skill instruction. We hypothesized that training novices with such a curriculum for a 1-month period would yield skills performance levels equivalent to those of second year surgery residents who had trained in a traditional program. Fourth-year medical students served as study subjects (novice group) during a 4-week senior elective. They were taught each skill during a 1-week period. Subjects received instruction by a content expert followed by a 1-week period of deliberate practice with feedback. The novice performances were videotaped both before and after the intervention, and each videotape was evaluated in a blinded fashion by experts using a validated evaluation instrument. These results were compared with skill performance ratings of first- and second-year surgery residents that had been accumulated over the previous 3 years. Average performance ratings for the novices substantially improved for all four skills after training. There was no marked difference between average performance ratings of postintervention novice scores when compared with the average scores in the resident group. Inter-rater agreement in scoring for the videotaped novice performances exceeded 0.87 (intraclass correlation) for all ratings of pre- and posttraining. These results demonstrate the effectiveness of a laboratory-based training program that includes fundamentals of motor skills acquisition.
Journal of Surgical Education, 2012
To identify the career development needs Vice Chair for Education in Surgery Departments (VCESDs)... more To identify the career development needs Vice Chair for Education in Surgery Departments (VCESDs). METHODS: In all, 33 VCESDs were invited to complete an online survey to identify the scope of duties, scholarly activity, job satisfaction, and career development needs. RESULTS: A total of 29/33 (88%) VCESDs responded. Time constraints were the most frequent impediment for MDs vs. PhDs (p Ͻ 0.05). Dominant faculty development needs were conducting educational research (2.0 Ϯ 0.78 for MDs, 1.33 Ϯ 0.76 for PhDs), developing resident selection systems (1.68 Ϯ 0.73), and mentorship programs (1.95 Ϯ 0.77) for MDs, and developing teach the teacher programs (1 Ϯ 0), and program performance evaluation systems (1.33 Ϯ 0.76) for PhDs. The skills deemed to be of greatest importance were ability to communicate effectively (1.27 Ϯ 0.55), resolve personnel conflicts (1.32 Ϯ 0.57), and introduce change (1.41 Ϯ 0.59). PhDs revealed a greater need to learn strategies for dealing with disruptive faculty (1.0 Ϯ 0 vs 2.15 Ϯ 0.87). CONCLUSIONS: This information will inform the future career development of VCESDs and will assist Department Chairs who wish to recruit and retain VCESDs.
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Papers by Margaret Boehler