Do as I say and not as I do: Surgical critical care program directors and diplomates shape the future

In 1987, the Trauma, Burn, Surgical Critical Care Specialty Board of the American Board of Surgery began offering certification in surgical critical care (SCC). The blueprint for the certifying examination (CE) has changed little since then. The Trauma, Burn, Surgical Critical Care Specialty Board sought to modernize the content of the CE. A draft blueprint was vetted with SCC program directors (PDs) and diplomates to determine how frequently the proposed topics should be tested and how frequently these topics were encountered in clinical practice. The purpose of the study was to evaluate the importance placed on blueprint topics by SCC educators and practitioners, and their relevance to clinical practice.

Surgical critical care PDs and diplomates separately reviewed the blueprint and assessed the frequency topics should appear on the CE (4, annually; 3, biennially; 2, every few years; 1, never). Diplomates were also asked how frequently they encountered each topic in practice (4, daily; 3, weekly to monthly; 2, a few times/year; 1, never). Results were compared with t tests, and Cohen's d was calculated. A p value of <0.001 and a moderate effect size ( d > 0.50) were used for significance.

Response rates were 42% (n = 70) for PDs and 30% (n = 1307) for diplomates. A total of 188 topics were evaluated. Program directors requested more frequent assessment than diplomates in 28 categories ( d 's ranged from -0.51 to -0.87) with obstetrical emergencies and intensive care unit billing and coding being the most discordant. For 17 topics, diplomates expressed high discordance between the importance for testing and their current practice.

Surgical critical care practice has evolved significantly over the past 35 years. Modernization of the assessments used to measure knowledge should be aligned with practice but requires a balance of topics that are infrequently encountered but are exquisitely time-sensitive and life-threatening.

Prognostic and Epidemiologic; Level IV.