shane mcnevin md fascrs spokane, wa. none except i took the abcrs qualifying/certifying exam before...
TRANSCRIPT
FORMATTING THE STEM – HOW TO WRITE
A GOOD QUESTION
Shane McNevin MD FASCRSSpokane, WA
Disclosures
None except I took the ABCRS qualifying/certifying exam before the emphasis on good question writing
Objectives
Why write test questions for ABCRS Goals for good question writing Inspiration for questions Techniques for writing a good stem
What’s in it for me?
Disadvantages Hard work After hours No recognition
Advantages Deeper clinical knowledge Participation in education Route to leadership position
Goals of questions
Clinical knowledge Does examinee have the requisite knowledge
to practice colorectal surgery Education
Imparting clinical knowledge to next generation of surgeons
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
situations
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 concept
Techniques for a good stemKey concept
Bad key concept Management of anal fissures
Good key concept Chronic anal fissure failing medical
management can be treated with lateral internal sphincterotomy
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:
Techniques for a good stem
Concise Non-ambiguous Testing clinical knowledge not English
comprehension Controversial/Judgement
consistent with ASCRS textbook
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:
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:
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?
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:
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 approach
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 ileostomy
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 colostomy
Techniques for a good stem
A good question answers itself! 1 + 2 = ?
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:
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:
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
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:
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:
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:
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:
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