Formative evaluation on clinical rotations

Each resident is evaluated by all attendings with which he or she has had contact at the end of every rotation. The evaluation includes criteria based on the General Competencies, as well as rotation-specific objectives. The resident is allowed and encouraged to view these reports. In addition, evaluations are completed by nurses, midlevels, administrative staff and patients. These evaluations are reviewed by the Program Director. If there are significant deficiencies, a conference is arranged with the Program Director. These evaluations are also monitored at the monthly Resident Evaluation Committee meeting.

In-Training Exam

A standardized method of evaluating basic fund of knowledge is the American Board of Surgery In-service Exam (ABSITE). This exam is administered the last Saturday in January each year.  Residents are expected to perform at least above the 30th percentile on this exam. If the resident does not meet this requirement but is performing well in the clinical arena and has otherwise demonstrated a high degree of commitment, he/she will undergo remediation. This may include assignment of a tutor from our surgical faculty who will set up a study program for the resident. An additional practice exam may be administered mid-cycle to assess progress in this area. If on the subsequent exam the resident again fails to achieve a score above the 30th percentile, the Residency Evaluation Committee may recommend that he/she be placed on probation. Continued failure to demonstrate an adequate fund of knowledge on the exam and in the clinical setting may lead to dismissal from the program. Overall clinical performance is taken into consideration when taking action.

Mock Oral Exam

Annually the program faculty and PGY 4 and PGY 5 residents participate with Creighton University in mock oral examinations. These are conducted in a format similar to the certifying exam and written evaluations are provided to the resident and program.

Mock Written Exam

Quarterly PGY 4 and PGY 5 residents participate in mock written examinations. These are conducted in a format similar to the qualifying exam. Areas of weakness are identified and residents are provided resources to improve deficiencies.

Conference attendance and participation

Attendance is taken at all mandatory conferences and reviewed by the Program Director every quarter or earlier as determined by the Program Coordinator. Evaluation of the resident presenting conferences is completed by the appropriate faculty and performance is reviewed with the resident.

Operative experience

Operative experience must be tracked on a continuous basis for all house officers in the program. This information is necessary for following the trainee’s progress, meeting the RRC requirements, and allowing the individual to qualify for the American Board of Surgery application. The program utilizes the ACGME’s online Resident Case Log system to report accumulated resident case information. All case information must be entered on a weekly basis starting with Monday and ending with Sunday.

Each applicant must submit a tabulation of the operative procedures performed as a Chief Resident, Junior Resident, First Assistant or Teaching Assistant. Credit may be claimed as "Surgeon" when the resident has actively participated in the patient's care; has made or confirmed the diagnosis; participated in selection of the appropriate operative procedure; has either performed or been responsibly involved in performing the critical portions of the operative procedure; and has been a responsible participant in both pre- and post-operative care. Only residents in their final year of training enter data as a senior resident. If you are in a junior year (HO I – HO IV), you are to indicate that you were the junior resident on the case. When previous personal operative experience justifies a teaching role, residents may act as teaching assistants and list such cases for the fourth and fifth year only. You may claim credit as a teaching assistant when you have actually been present and scrubbed and acted as an assistant to guide a more junior trainee through the procedure. All this must be accomplished under the supervision of the responsible member of the senior staff. An individual cannot claim credit as both responsible surgeon and teaching assistant.

The number of patients with multiple organ traumas for whom an operation was not required and the number of patients with critical surgical problems for whom they had primary responsibility must also be listed. Applicants for American Board of Surgery certification examination must meet the guidelines recommended by the Residency Review Committee, i.e. a minimum of 750 procedures in five years and a minimum of 150 procedures in the Chief Year. This must include operative experience in each of the areas of primary responsibility.

Semi-Annual Evaluation

The program teaching faculty meets every six months to review the performance of all residents. Each of these meetings is followed up by a conference with the Program Director to communicate the results of this evaluation as they pertain to the individual resident and is documented. This assessment will include a review of case volume, complexity, and will ensure that residents are entering cases concurrently. This evaluation will specifically monitor the resident's knowledge by use of the American Board of Surgery In-Training Examination (ABSITE) or other cognitive exams. Test results will not be the sole criterion of resident's knowledge, and will not be used as the sole criterion for promotion to a subsequent PGY level. Attendance and participation at conferences, skills training and administrative functions are also reviewed.

Summative Evaluation

The Program Director will provide a summative evaluation for each resident upon completion of the program. This evaluation will be come part of the resident's permanent record maintained by the institution, and will be accessible for review by the resident in accordance with institutional policy. The evaluation will document the resident's performance during the final period of education and verify that the resident has demonstrated sufficient competence to enter practice without direct supervision. 

Faculty Evaluation

At least annually, the program will evaluate faculty performance as it relates to the educational program. These evaluations will include a review of the faculty's clinical teaching abilities, commitment to the educational program, clinical knowledge, professionalism, and scholarly activities. Faculty development is also reviewed. This evaluation will include written confidential evaluations by the resident. The results of this faculty evaluation are shared with the individual faculty, section chief, and chairman. 

Program Evaluation and Improvement

The program will document formal, systematic evaluation of the curriculum at least annually and will monitor and track resident performance on the in-training examination, faculty development, graduate performance, including performance of program graduates on the qualifying and certification examination and program quality. Specifically; residents and faculty will have the opportunity to evaluate the program confidentially and in writing at least annually, and the program will use the results of residents' assessments of the program together with other program evaluation results to improve the program.

If deficiencies are found, the program will prepare a written plan of action to document initiatives to improve performance in the areas above. The action plan will be reviewed and approved by the teaching faculty and documented in meeting minutes.

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