Shane McNevin MD FASCRS Spokane WA Disclosures None except I took the ABCRS qualifyingcertifying exam before the emphasis on good question writing Objectives Why write test questions for ABCRS ID: 704312
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Slide1
Formatting the STEM – How to write a good question
Shane McNevin MD FASCRS
Spokane, WASlide2
Disclosures
None except I took the ABCRS qualifying/certifying exam before the emphasis on good question writing Slide3
Objectives
Why write test questions for ABCRS
Goals for good question writing
Inspiration for questions
Techniques for writing a good stemSlide4
What’s in it for me?
Disadvantages
Hard work
After hours
No recognition
Advantages
Deeper clinical knowledge
Participation in education
Route to leadership positionSlide5
Goals of questions
Clinical knowledge
Does examinee have the requisite knowledge to practice colorectal surgery
Education
Imparting clinical knowledge to next generation of surgeonsSlide6
Inspiration for questions
We take the written and oral boards everyday!
Derive questions from your own clinical practice
Take pictures of interesting clinical phenomena
Save radiographs from exemplary clinical situationsSlide7
Techniques for a good stem
ABCRS Manual for Question Writers
Read it
Know it
Live it
A good question writes itself from a good key conceptSlide8
Techniques for a good stem
Key concept
Bad key concept
Management of anal fissures
Good key concept
Chronic anal fissure failing medical management can be treated with lateral internal
sphincterotomySlide9
STEM
A 35 year old man presents with a 6 month history of severe anal pain and bleeding during defecation. He has a posterior fissure on examination. He has been treated with topical
diltiazem
ointment without improvement. The most appropriate treatment is:Slide10
Techniques for a good stem
Concise
Non-ambiguous
Testing clinical knowledge not English comprehension
Controversial/
Judgement
consistent with ASCRS textbookSlide11
Concise question
A 35 year old man presents with a 6 month history of severe anal pain and bleeding during defecation. He has a family history of colorectal cancer. He occasionally has fecal urgency with liquid stool. His vital signs show a heart rate of 65 and blood pressure of 130/80. He has a posterior fissure, grade II internal hemorrhoids and several small anal tags on examination. He has been treated with topical
diltiazem
ointment without improvement. He is also taking
docusate
sodium,
hydrocodone
and ibuprofen. The most appropriate treatment is:Slide12
English Comprehension
A 35 year old man presents with a 6 month history of severe anal pain and bleeding during defecation. He has a posterior fissure on examination. He has been treated with topical
diltiazem
ointment without improvement. The least appropriate treatment is:Slide13
English comprehension
A 50 year old man is diagnosed with a
cecal
cancer. Computed tomography of the abdomen shows no evidence of metastatic disease. His preoperative CEA is 25. Which of the following is true regarding the CEA?Slide14
English comprehension
A 50 year old man is diagnosed with a
cecal
cancer. Computed tomography of the abdomen shows no evidence of metastatic disease. His preoperative CEA is 25. All of the following are true regarding the CEA except:Slide15
Controversial topics
Surgeons taking this exam are newly out of fellowship
We want people to hit singles not swing for the fence
Usually direct people to the safest and most conservative approachSlide16
Controversial topics
A 25 year old man with genetically proven familial
polyposis
presents for discussion of prophylactic
colectomy
. His rectum is carpeted with polyps and he would prefer a sphincter preserving option. The most appropriate management is:
Total
colectomy
with
ileorectal
anastomosis
One stage restorative
proctocolectomy
Two stage restorative
proctocolectomy
Proctocolectomy
with
ileostomySlide17
Controversial topics
A 45 year old healthy woman is taken to surgery urgently for class III sigmoid
diverticulitis
. Intra-operatively her vital signs are normal, she has limited purulent peritonitis and a short segment of inflamed sigmoid colon. The most appropriate management is:
Resection, primary
anastomosis
Resection, protected
anastomosis
Hartmann’s resection
Loop transverse colostomySlide18
Techniques for a good stem
A good question answers itself!
1 + 2 = ?Slide19
Techniques for a good stem
A 35 year old man presents with a 6 month history of severe anal pain and bleeding during defecation. He has a posterior fissure on examination. He has been treated with topical
diltiazem
ointment without improvement. The most appropriate treatment is:Slide20
Techniques for a good stem
A 50 year old man is diagnosed with a
cecal
cancer. Computed tomography of the abdomen shows no evidence of metastatic disease. His preoperative CEA is 25. The clinical impact of the elevated preoperative CEA is:Slide21
Techniques for a good stemSecond order questions
Clinical practice in reality
Synthesize clinical information
Make a diagnosis
Develop a plan
First order questions
Simply making diagnosis
“simple recall”
Second order questions
Develop plan based on scenario
Preferred Slide22
First order question
A 42 year old woman presents with a newly diagnosed
mucinous
adenocarcinoma
of the
cecum
. Her family history is significant for her mother having endometrial cancer at age 52 and maternal grandmother having colon cancer at age 48. The most likely diagnosis is: Slide23
Second order question
A 42 year old woman presents with a newly diagnosed
mucinous
adenocarcinoma
of the
cecum
. Her family history is significant for her mother having endometrial cancer at age 52 and maternal grandmother having colon cancer at age 48. The most appropriate next step is: Slide24
How to use radiographs and photographs
A 52 year old woman is diagnosed with a
cecal
cancer. Staging computed tomography is shown. The most appropriate treatment is:Slide25
How to use radiographs and photographs
A 30 year old woman presents with a history of recurrent
perineal
and
perianal
infections. Physical examination findings are shown. The
pathophysiology
of this disorder is:Slide26
Conclusions
Use the ABCRS Manual for Question Writers
Keep questions concise, non-
ambigous
and appropriately formatted
Avoid controversial topics and answers
Write questions that don’t
require the answers
to complete
Write second order questions when possible
HAVE FUN