Ann Thorac Surg 2003;75:1131
© 2003 The Society of Thoracic Surgeons
Invited commentary
Gordon N. Olinger, MD
Division of Cardiothoracic Surgery, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226, USA
e-mail: golinger{at}mcw.edu
These educators from the cardiothoracic surgery residency program at Washington University observed that performance historically on the Thoracic Surgery In-Training Examination (TSITE) of the American Board of Thoracic Surgery by residents tracked in cardiac surgery was poorer than that of residents tracked in general thoracic surgery. They hypothesized that the cognitive knowledge requisite to better performance could be achieved through a yearly series of cardiac specific lectures given by faculty and patterned on the requisite curriculum outline of the Thoracic Surgery Directors Association (TSDA). Nine cardiac residents were exposed to the lectures and were evaluated with TSITEs. The didactic program did not improve performance on either the overall TSITE or cardiac subtest of TSITE. The authors conclude and concur with other educators that independent self-study is better suited than didactic presentation to build a foundation of factual knowledge, as tested for on the TSITE.
I agree emphatically with the authors’ conclusion. The recently introduced Prerequisite Thoracic Surgery Curriculum of the TSDA, now in randomized, controlled trial for 128 cardiothoracic residents who matriculated in July 2002, is an example of new computerized methodology which might enhance learning with self-study through case-oriented problem solving. The fundamental premise to this type of learning is that students best remember answers to questions posed by the students themselves. Preliminary results show positive correlation of TSITE performance with the number of study sessions spent by residents in the self-study program.
Although most educators would probably agree with the conclusions of Dr Moon and colleagues, I would caution against application of the TSITE as an historical metric to assess the body of knowledge outlined in the TSDA requisite curriculum. Only over the last 4 to 5 years has the composition of this exam begun to reflect in any meaningful way the broad context of that curriculum, and has the construction of questions approached the rigor that can meet psychometric validity. I do believe that the TSITE in its current form can be utilized as a surrogate to reflect on the cumulative body of the knowledge expected of maturing cardiothoracic residents. It can also be a positive stimulus employed by program directors to motivate residents to self-study. The TSITE now includes a self-evaluation and learning syllabus for residents to engage at the completion of the exam.
The authors’ commendable effort in an already excellent program to improve learning by systematic assessment of educational methods and results should encourage each of us involved in surgical education to examine the old ways, "tried" but not necessarily "true."
