When to cut? Using an objective structured clinical examination to evaluate surgical decision-making

Area of Science:

• Medical Education
• Surgical Training
• Clinical Assessment

Background:

• Objective Structured Clinical Examinations (OSCEs) are valuable tools for assessing clinical skills.
• Surgical residency programs require robust evaluation methods for decision-making competency.
• Assessing the ability of residents to determine surgical indications and proceed with operations is crucial.

Purpose of the Study:

• To develop and evaluate an OSCE tailored for surgical residents.
• To assess residents' understanding of surgical indications and their decision-making process.
• To differentiate between junior and senior surgical residents' abilities in surgical case management.

Main Methods:

• Developed a two-tiered OSCE with junior (PGY 2-3) and senior (PGY 4-5) level surgical case scenarios.
• Included otolaryngology residents (4 junior, 4 senior) in the study.
• Faculty reviewed recorded resident encounters to assess elicitation of surgical indications, recognition of findings, diagnosis, and surgical decision-making.

Main Results:

• Senior residents (100%) outperformed junior residents (25%) in obtaining surgical information and indications.
• Seniors were more decisive in proceeding with surgery (100%) than juniors (0%).
• All seniors recommended appropriate surgery, while 75% correctly identified emergent needs; juniors struggled with surety and indication elicitation.

Conclusions:

• The surgical OSCE effectively evaluated resident surgical decision-making.
• Junior residents require further training in surgical history-taking and decision-making.
• The OSCE identified senior residents' ability to recognize emergency surgical situations.