Transcript Formatting the STEM - American Board of Colon and Rectal Surgery

Shane McNevin MD FASCRS
Spokane, WA

None except I took the ABCRS
qualifying/certifying exam before the
emphasis on good question writing




Why write test questions for ABCRS
Goals for good question writing
Inspiration for questions
Techniques for writing a good stem

Disadvantages




Hard work
After hours
No recognition
Advantages
Deeper clinical knowledge
 Participation in education
 Route to leadership position


Clinical knowledge


Does examinee have the requisite knowledge to
practice colorectal surgery
Education

Imparting clinical knowledge to next generation of
surgeons


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


ABCRS Manual for Question Writers




Read it
Know it
Live it
A good question writes itself from a good key
concept

Bad key concept


Management of anal fissures
Good key concept

Chronic anal fissure failing medical management can
be treated with lateral internal sphincterotomy

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:




Concise
Non-ambiguous
Testing clinical knowledge not English
comprehension
Controversial/Judgement

consistent with ASCRS textbook

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:

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:

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?

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:



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

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

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


A good question answers itself!
1+2=?

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:

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:

Clinical practice in reality




First order questions



Synthesize clinical information
Make a diagnosis
Develop a plan
Simply making diagnosis
“simple recall”
Second order questions


Develop plan based on scenario
Preferred

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:

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:

A 52 year old woman
is diagnosed with a
cecal cancer. Staging
computed
tomography is shown.
The most appropriate
treatment is:

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:






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