choosing our residents michael j. ruckenstein m.d. otorhinolaryngology: head and neck surgery at...
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Choosing our Residents
Michael J. Ruckenstein M.D.
Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient Care, Education and Research
since 1870
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Residency Selection2 Anecdotes
The ‘Superstar’The ‘Sub’
David Kennedy quoting ?Mike Johns“If you are picking 4 residents, 1 will be a
superstar, 2 will be average, and 1 will be an underperformer”
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Shouldn’t we be doing better?Entering medical school is a highly selective
process
Otolaryngology – HNS is a highly competitive match
Penn is highly coveted, ‘top 10’ residency
Shouldn’t we be able to select 4 ‘superstars’?
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How we are choosing - all
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How we are choosing - OTO
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Cognitive AbilitiesUSMLEs
Clerkship grades
AOA status
Correlate with performance on inservice scores
Do not correlate with resident performance during residency
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Letters of RecNot standardized
Written in ‘code’ that isn’t always shared
Recapitulate ‘cognitive’ skills
May or may not correlate on all relevant factors
Vary according to who is writing them
Vary on who is reading them!
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Dean’s Letter (MSPE)Include the positive, not the negative
Fantasyland – ‘Jewish Day School phenomenon’
90% of the applicants are above average!
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The InterviewUnstructured
Individual
No set criteria to evaluate
Designed to ‘get the candidate talking’
The unstructured, casual conversation interview is the MOST invalid method of accessing candidates!
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Most valid interviewIndividual or group
Should assess a specific area
Structured
Situational > Job-Related> Psychological
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How can we improve?Define characteristics (Dimensions) of an ideal
resident
Evaluate for factors that may predict for these qualities
DimensionsCognitive AbilitiesPersonalityTechnical AbilitiesResearch Abilities
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Cognitive AbilitiesThese can be readily assessed using existing
dataUSMLEsClerkship grades (highly variable between
institutions)AOA
What do they mean in terms of performance?We may wish to look for a ‘minimum’ as opposed
to selecting for the highest scores
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PersonalityConscientiousness
DependabilityAttention to detailFollow through
Collegiality/agreeablenessAbility to work well with othersAbility to take directionBeing nice
EmpathyAbility to read in emotions and take their
perspectives
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Personality - 2Communication Skills
Ability to communicate with colleaguesAbility to communicate with patients
GRITPerseverance and passion for long term goals
ClutchAbility to function and act under pressure
Moral and Ethical Standards
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Personality - 3Some data to indicate this Dimension may be
the most predictive of success
How do you assess for all these FacetsSelf reporting – prone to confabulationScalesCan be included in standardized LOR Interview – structured to assess one or more of
these facets
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ResearchResearch productivity prior to entering residency
not correlated with performance during residency
May be desirable for a program to include research skills in their residency ‘mix’
Some evidence that research may be misrepresented in application
Likely good topic for structured interviewAssess performed researchPresentation of a ‘research problem’
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Technical SkillsInnate ability to perform surgical tasks
Age, sex, gender, grades, manual dexterity do not correlate with operative competence
Visual spatial abilities – the skill of mentally manipulating an object in 3-D correlates with initial acquisition of a surgical skillKnot tyingZ-plasty
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Mental Rotation Test
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Surgical AbilitiesTechnical ability not the sole factor in making a
‘good surgeon’
Surgical decision makingPreoperative determination of indications for
surgery Intraoperative decisionsPost-operative management
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Multicenter Studies Retrospective
GraduatesProspective
Incoming residents/applicants
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ProtocolCognitive Assessment
USMLE Part 1Clerkship marksAOA
ResearchNumeric Scale
Graduate degreePublicationsOTO-HNS relatedIndependent research (creativity)
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Protocol 2Personality
NEO PI-RBest test of 5 Factor Model of Personality
MSCEITEmotional Intelligence
TechnicalMental Rotation TestSIM (e.g. M&T)
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Protocol 3For prospective study, a standardized letter of
recommendation would be very advantageous
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Conclusions
Most of the criteria we currently rely on to select resident candidates are not valid
We are proposing retrospective and prospective studies to quantify factors that may predict an applicant’s future success as a resident