Lessons learnt from evaluation of the orientation program for new surgical residents using objective structured clinical examination-Based assessmentJS Pandya, SM Bhagwat, SL Kini
Department of General Surgery, T N Medical College and B Y L Nair Ch. Hospital, Mumbai, India
Correspondence Address: Source of Support: None, Conflict of Interest: None DOI: 10.4103/0022-3859.93263
Source of Support: None, Conflict of Interest: None
We designed and conducted an orientation program in surgery for new surgical residents in May 2008. Pre- and post-program performance was assessed by Objective Structured Clinical Examination (OSCE). It was found that provision of basic clinical and practical instruction at the beginning of a surgical residency resulted in an immediate improvement in performance.  Till date (2011), four batches of junior residents have participated in this program. In response to analysis of test scores and feedback received, constant evaluation and modification of the program has taken place. We wish to share the lessons learnt over these four years.
The results of the subsequent two batches were grouped and analyzed [Table 1].
This showed that more emphasis on teaching specific psychomotor skills was required. Of note it was found that the affective domain (which deals with moral values, professionalism and communication) was consistently an area of difficulty. Recognizing this, Bernstein et al., have suggested a separate test to assess this domain. 
Feedback from participants and faculty indicated a need to expand the program, while case-based scenarios and small-group teaching were found to be the most popular and most effective formats.
The current orientation program, along with the pre- and post-program OSCE has undergone some modifications as follows:
It has been divided into two broad parts: One deals with essential administrative knowledge and the other with practical "must-know" topics.
The affective domain now receives more attention and includes topics like breaking bad news, dealing with the terminally ill patient, taking consent and talking to relatives about organ donation. These were taught using role-plays demonstrating incorrect and correct approaches.
Also added was a brief introduction to research methods and how to get started with the postgraduate dissertation.
An extra day was added to the week-long program.
What emerges clearly is an urgent need to provide more structured and supervised practical training with assessment during internship in India. The Medical Council of India, in its Vision 2015 document, has stated that "the importance of the internship year must be restored".  Various studies support the provision of such training, both during internship and at the beginning of residency.  At our institution, the existing interns' orientation program is being converted into a more detailed teaching program. Our future orientation program for new residents will include more practical training using low-cost simulators, with more opportunities for deliberate practice of skills.
We, as surgeons, have been given a unique opportunity to be continuous learners and teachers. The success of this small effort has strengthened our commitment to this cause.