CRITICAL-ASSESSMENT OF THE HEAD AND NECK CLINICAL SKILLS OF GENERAL-SURGERY RESIDENTS

Head and neck surgery is an important part of general surgery. There i s, however, little information about the quality of residents' clinica l skills in this important field. In an Objective Structured Clinical Examination (OSCE), residents encounter multiple patients with various clinical problems and are rated by faculty members using objective cr iteria. This study was undertaken to assess the head and neck surgery skills of a group of general surgical residents. Fifty-one general sur gery residents examined the same nine patients with head and neck dise ase. Faculty members graded each clinical interaction according to pre set objective criteria. Both actual (e.g., thyroid nodule, oral cancer follow-up examination) and simulated (e.g., dysphagia) patients were used in the OSCE. The reliability of the examination was assessed by c oefficient (alpha. The construct validity was determined by a two-way analysis of variance with one repeated measure. The reliability was 0. 75 for the clinical examination. Performance varied by level of traini ng: Residents performed at a higher level than interns (p < 0.0001), b ut overall scores were poor (mean score 55%). Important deficits in sk ills were identified at all levels of training. It is concluded that m ore attention should be focused on specific outcome assessments of sur gical training programs and on strategies for upgrading the clinical s kills of surgical residents.