ABCRS Question Writing Workshop
Key Concepts Explained….
Najjia N. Mahmoud, MDDivision of Colon and Rectal SurgeryUniversity of Pennsylvania
Key Concept:Webster’s Dictionary:A general notion or idea; conceptionAn idea of something formed by mentally combining all its characteristics or particulars; a constructABCRS:Describes the phenomenon or “idea” the question is designed to test.
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 accumulatesMultiple testing/educational providers can use them.They should test knowledge that we believe isabsolutely essential, but not necessarily exclusiveto colorectal surgery.
What are key concepts NOT?
Statements of fact“the rectum is in the pelvis”“the arterial supply to the right colon is theileocolicartery”Minutiae, trivia, non-core information“aspiration pneumonia is most likely to be right-sided”“the waveform of an arterial line is influenced by position”
How are key concepts used?
The use of key concepts is evolving:In past, we used them to define ABCRS written board questionsonlyGoing forward, we will use them for:ABCRS written board questionsABCRS oral board questionsCARSEPCARSITECRESTPDA curriculumKey concepts will be:Open accessWe want the trainee/test-taker to understand what ABCRS/ASCRS defines as “key knowledge.”ABCRS written and oral board questions will remain secure
Problems with communication in 2015Texting/emailGeneral degradation of clear communicationTestingis different thantextingHigh stakes situationShorthand is NOT universally understood (except for)Ambiguity is unacceptableKey Concept format is importantMust be grammatically correctPeriods, capital letters, agreement!BrevityOne concept at a time!Activevspassive voiceThe question must fit the concept and vice versaIS THE CONCEPT REALLY KEY?
Top 5 list of most common problems!
Too long and wordy (passive voice issues)Compound sentences with multiple concepts embeddedPoor grammar, spelling, punctuationNon-core or key knowledge—minutiaKEY CONCEPT does not relate to the question written!
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 subjectActive voice:“One-third of the applicants failed the exam.”“She slammed on the brakes as the car sped downhill.”The sentence subject performs the actionWhat happens when the voice changes from passive to active????BrevityClarity
“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!
Example: “active”vs“passive” voice
A patientwith resectedStage III colon cancer should undergo adjuvant chemotherapy.VERSUSAdjuvant chemotherapy is recommended in Stage III colon cancer.
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?Thekey 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.
The half-life ofargatrobanis 50 minutes.What’s the problem?Not conceptual—statement of factNot key knowledgeImportant, BUT—not something that could differentiate a board certified colon and rectal surgeon from a general surgeon or internist.
biopsy suspicious anal lesions—rule out cancer/Crohn’sdzWhat’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.
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!Activevspassive voiceSevere anal pain requires exam under anesthesia.
Management ofanorectaldisease often involves an algorithm that starts with conservative measures and progress to more aggressive ones as more conservative measures fail.What’s the problem?NonspecificLongRepetitiveCan it be fixed?Unsalvageable because it does not include a specific key concept.
For patients that require surgical resection for CUC, segmental colectomy should typically be avoidedWhat’s the problem?“CUC” (abbreviations/acronyms should be avoided)Tangential to the point of the conceptDeclarative voice betterWhat’s the fix?Surgical management of ulcerative colitis is totalproctocolectomy.
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.difficileand cytomegalovirus infection should be ruled out in a patient with inflammatory bowel disease and acute inflammation.
Functional problems, especially FI, constipation, and evacuation disturbance, frequently persist despite correction of the prolapse.What’s the problem?Long compound sentenceNot conciseProlapse of what? Not specific!What’s the fix?Surgical repair of rectal prolapse may not improve functional outcomes.
A biopsy should be performed on any suspiciousanorectallesion that fails to heal after treatment to rule out unsuspectedCrohn’sdisease or malignancy.What’s the problem?Long and wordyPassiveNot specific (anal, rectal)What’s the fix?Nonhealinganal lesions should be biopsied.
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