Interpersonal Skills

Question 1

You are the program director and wish to implement a structured surgical skill-building educational session for your new interns, which includes computer-generated simulation. When incorporated, which of the following has been shown to result in sustainable improvements in technical skill?

Answer 1

In two studies of educational interventions, only focused, in-person expert feedback has been shown to result in sustainable improvement in technical skills (Answer choice A). Computer-generated feedback has been shown to be inferior to expert feedback (Answer choices B and C). Peer-review (Answer choice D) and knowledge-based examinations (Answer choice E) have not been directly compared to expert feedback; however other studies have demonstrated questionable results in the sustainability of skills using these modalities alone.

Question 2

An apology includes what:

Answer 2

An apology includes the following components: acknowledgement of offense, explanation for the offense, expression of remorse, and offer of reparation. The first part of any apology is the acknowledgment of the offense, which includes the identity of the offender(s), appropriate details of the offense, and validation that the behavior was unacceptable. The second part of an apology is the explanation for committing the offense. Sometimes saying, “There is just no excuse for what happened” or “We are still trying to find out what happened” can be the most honest and dignified explanation. The third part of an apology is the expression of remorse, shame, forbearance, and humility. Remorse is a deep sense of regret. Shame is the emotion associated with failing to live up to one’s standards. Forbearance is a commitment not to repeat the offense. Humility is the state of being humble, not arrogant. Lack of remorse, shamelessness, unwillingness to address the future, and arrogance will undo most apologies. The fourth part of an apology is reparation, which can range from an early scheduling of the next appointment to canceling the bill to a financial settlement. All 4 parts are not necessarily present in every effective apology, but when an apology is ineffective, one can invariably locate the defect in 1 or more of these 4 parts.

Question 3

“never events” by the National Quality Forum

Answer 3

“never events” by the National Quality Forum:

Surgery or other invasive procedure performed on the wrong site.

Surgery or other invasive procedure performed on the wrong patient.

Wrong surgical or other invasive procedure performed on a patient.

Unintended retention of a foreign object in a patient after surgery or other invasive procedure.

Intraoperative or immediately postoperative/postprocedure death in an ASA Class 1 patient.

Question 4

IPASS

Answer 4

Illness severity, Patient summary, Action list, Situational awareness, Synthesis & questions

The IPASS mnemonic is gaining traction as a proven part of a systematic approach to training, conducting, and assessing safe and reliable handoff performance. In prospective evaluation, implementation of a handoff bundle was associated with a significant reduction in medical errors and preventable adverse events among hospitalized children. Improvements in verbal and written handoff processes occurred, and resident workflow did not change adversely.

Question 5

SBAR

Answer 5

Situation, Background, Assessment, Recommendation

A systematic method for summarizing past events, current state, and needed future actions, the SBAR mnemonic was developed as part of the MedTeams project and is now incorporated into TeamSTEPPS training.

Question 6

How to set goals?

Answer 6

While all of these goals might sound reasonable at first, they do not all follow the SMART rules for goal-setting. (SMART: Specific, Measurable, Attainable, Realistic, Timely). Learning how to be proactive and create achievable goals sets the stage for optimizing the educational value of feedback obtained during a rotation.

Question 7

How to give feedback?

Answer 7

There is no single correct model for delivering feedback; rather, there are general guiding principles that fit into models that may be best utilized in different learning situations.

According to the BID Model (Briefing, Intraoperative Teaching, Debrief), quick goals can be set before the case (at the scrub sink, for example), teaching can focus on these areas, and debriefing during opportune times at the end of the case (closing, waiting for extubation, etc.) can occur.