ABCRS Question Writing Workshop Key Concepts Explained. Najjia N. Mahmoud, MD Division of Colon and Rectal Surgery University of Pennsylvania Definitions Key Concept: Websters Dictionary: A general notion or idea; conception An idea of
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Presentation Transcript
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ABCRS Question Writing Workshop Key Concepts Explained…. Najjia N. Mahmoud, MD
Division of Colon and Rectal Surgery
University of Pennsylvania<br>
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Definitions Key Concept:
Webster’s Dictionary:
A general notion or idea; conception
An idea of something formed by mentally combining all its characteristics or particulars; a construct
ABCRS:
Describes the phenomenon or “idea” the question is designed to test.<br>
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Why are key concepts important? They provide an “organizing principle” around which a question(s) can be constructed.
They are consistent between tests and through time.
Aging concepts can be discarded and replaced as evidence accumulates
Multiple testing/educational providers can use them.
They should test knowledge that we believe is absolutely essential, but not necessarily exclusive to colorectal surgery.<br>
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What are key concepts NOT? Statements of fact
“the rectum is in the pelvis”
“the arterial supply to the right colon is the ileocolic artery”
Minutiae, trivia, non-core information
“aspiration pneumonia is most likely to be right-sided”
“the waveform of an arterial line is influenced by position”<br>
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How are key concepts used? The use of key concepts is evolving:
In past, we used them to define ABCRS written board questions only
Going forward, we will use them for:
ABCRS written board questions
ABCRS oral board questions
CARSEP
CARSITE
CREST
PDA curriculum
Key concepts will be:
Open access
We want the trainee/test-taker to understand what ABCRS/ASCRS defines as “key knowledge.”
ABCRS written and oral board questions will remain secure<br>
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Communication concerns Problems with communication in 2015
Texting/email
General degradation of clear communication
Testing is different than texting
High stakes situation
Shorthand is NOT universally understood (except for )
Ambiguity is unacceptable
Key Concept format is important
Must be grammatically correct
Periods, capital letters, agreement!
Brevity
One concept at a time!
Active vs passive voice
The question must fit the concept and vice versa
IS THE CONCEPT REALLY KEY?<br>
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Top 5 list of most common problems! Too long and wordy (passive voice issues)
Compound sentences with multiple concepts embedded
Poor grammar, spelling, punctuation
Non-core or key knowledge—minutia
KEY CONCEPT does not relate to the question written!<br>
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Active vs passive voice Passive voice:
“The exam was failed by one third of the applicants.”
“The brakes were slammed on by her as the car sped downhill.”
The action is performed upon the sentence subject
Active voice:
“One-third of the applicants failed the exam.”
“She slammed on the brakes as the car sped downhill.”
The sentence subject performs the action
What happens when the voice changes from passive to active????
Brevity
Clarity<br>
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Active vs passive voice “Leak testing should be performed when creating a left sided anastomosis.” “ A left sided anastomosis should be leak tested.” The active voice is shorter and more succinct!<br>
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Example: “active” vs “passive” voice A patient with resected Stage III colon cancer should undergo adjuvant chemotherapy.
VERSUS
Adjuvant chemotherapy is recommended in Stage III colon cancer.<br>
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Examples Oophorectomy is advised for grossly abnormal ovaries or contiguous extension of the colonic cancer but routine prophylactic oophorectomy is not necessary.
What is the problem?
The key concept should test only ONE concept.
Resist the urge to combine concepts.
Make two questions!
How do we fix it?
Invasion from a contiguous colon cancer mandates en bloc oophorectomy.
Routine oophorectomy in post-menopausal patients is not indicated.<br>
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Examples The half-life of argatroban is 50 minutes.
What’s the problem?
Not conceptual—statement of fact
Not key knowledge
Important, BUT—not something that could differentiate a board certified colon and rectal surgeon from a general surgeon or internist.<br>
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Examples biopsy suspicious anal lesions—rule out cancer/Crohn’s dz
What’s the problem?
Poor grammar.
The intent of biopsy is implied. The question can be shortened by not stating the obvious.
What’s the fix?
Suspicious anal lesions should be biopsied.<br>
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Examples Severe anal pain that cannot be diagnosed in a bedside exam requires an exam under anesthesia to allow for proper diagnosis and treatment.
Good concept—too long!
Active vs passive voice
Severe anal pain requires exam under anesthesia.<br>
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Examples Management of anorectal disease often involves an algorithm that starts with conservative measures and progress to more aggressive ones as more conservative measures fail.
What’s the problem?
Nonspecific
Long
Repetitive
Can it be fixed?
Unsalvageable because it does not include a specific key concept.<br>
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Examples For patients that require surgical resection for CUC, segmental colectomy should typically be avoided
What’s the problem?
“CUC” (abbreviations/acronyms should be avoided)
Tangential to the point of the concept
Declarative voice better
What’s the fix?
Surgical management of ulcerative colitis is total proctocolectomy.<br>
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Examples CUC patients may have an acute flare-up of C. diff colitis and CMV and this should be ruled out.
What’s the problem?
Abbreviations!
The aim of the concept is unclear—cause and effect are uncertain.
Is the “flare-up” from infection or from UC?
What’s the fix?
C. difficile and cytomegalovirus infection should be ruled out in a patient with inflammatory bowel disease and acute inflammation.<br>
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Examples Functional problems, especially FI, constipation, and evacuation disturbance, frequently persist despite correction of the prolapse.
What’s the problem?
Long compound sentence
Not concise
Prolapse of what? Not specific!
What’s the fix?
Surgical repair of rectal prolapse may not improve functional outcomes.<br>
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Examples A biopsy should be performed on any suspicious anorectal lesion that fails to heal after treatment to rule out unsuspected Crohn’s disease or malignancy.
What’s the problem?
Long and wordy
Passive
Not specific (anal, rectal)
What’s the fix?
Nonhealing anal lesions should be biopsied.<br>
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We are here to help! Confusion about assignment
Lack of clarity on our part
Questions about the process…..
CALL or email:
Najjia.mahmoud@uphs.upenn.edu
215.219.7880
