was 70.5 hours (range 0-93, 1st quartile 63, 3rd quartile 77). Themedian work day was 12 hours (range 0-24, 1st quartile 0, 3rd

quartile 14). Detailed work analysis is presented in table 1. 18.9hours (1134.9 minutes) of videotaped data were collected. Thetotal time spent directly related to patient care was 656 minutes(57.8%). 175 minutes (15.4%) were spent on education, both di-dactic and teaching on the wards. The resident spent 139.8 min-utes traveling within the hospital, covering 15742 feet (13.87feet/minute worked). 132.7 minutes (11.7%) were categorized ascommunication. Only1.5 percent of time was deemed pure waste.A total of 344.75 hours (20685 minutes) were self-reported andcategorized for the month in which the videotaping occurred.Categories were different than those chosen by the independentobservation team. Didactic education comprised 6.7% of total timewhile less formal teaching is embedded in the clinical activities ofconsultation, rounds and clinic. More waste was reported, mainlywaiting for test results at night or for trauma patients.

TABLE 1

Category TravelPt

exam ORClinical

data Education Communication Waste

Videotape 12.3% 12.3% 38.2% 6.8% 15.4% 11.7% 1.5%Travel* Rounds

andclinic

OR Clinicaldata

Education Consultation Waste

Self-Reported

3.9% 29.7 31% 6.2% 6.7% 8.6% 8.1%

* To and from home, no in hospital travel

Conclusions: The subject performed very efficiently, with only aminute amount of wasted or idle time during daytime work periods.The largest percentage of time was spent in the operating room,where efficiency improvements would yield the largest gains in time.A 10% improvement in OR efficiency combined with a workflowredesign which decreased walking and minutes on the phone by 50%would increase the time available for education and patient care byover 10 hours per week.

QS46. WHAT SURGERY STUDENTS REMEMBER: THE RE-LATIONSHIPS BETWEEN FACULTY GOALS, LEC-TURE CHARACTERISTICS, AND STUDENT LEARN-ING. Mohammed J. Shaikh, Susan S. Hagen, MarcyRosenbaum, Kimberly S. Ephgrave; U. Iowa Carver Collegeof Medicine, Iowa City, IA

Background: Surgery faculty members rarely receive educationaltraining prior to lecturing medical students. We sought to determinewhether the key points that students retain following surgical lec-tures overlap with faculty goals, and whether the degree of congru-ence between student’s perception of key points and the faculty goalscorrelates with student ratings of the effectiveness of the lecture.Methods: Prior to surgical lectures, 10 faculty members supplied 3-6key concepts they hoped students would retain. Each faculty memberwas rated on their lecture effectiveness (Leamon MH, Fields L.Teaching and Learning in Medicine 2005:17:199-29) by 16-79 surgi-cal clerks, who also supplied a listing of 3-6 concepts they gleanedfrom the lecture. The open-ended student responses were analyzedwith QSR’s NVivo 7 qualitative analysis software. Themes werecounted if identified in � 5 student responses, and grouped intoFaculty Key Concepts versus Other Themes versus Miscellaneouscomments. Results: On a 7 point Likert-type scale, the mean teach-ing effectiveness score varied from 4.9 to 6.1, with a median of 5.3.For each lecture, faculty identified 3-6 key points with a median of4.5, while the number of themes identified in open-ended studentcomments ranged from 4 to 10 with a median and mode of 7. Most ofthe key faculty-identified points did emerge in student comments(50-100%/lecture, median 78%). The percentage of student comments

fitting into a faculty key concept ranged from 17% to 53%, with amedian of 38%. The lecture with the highest proportion (53%) ofstudent comments on faculty-identified key themes was ranked 7/10at 5.20, while the lecture with the lowest (17%) proportion of studentcomments on key themes was ranked similarly (8/10) at 5.19. Thus,no strong relationship emerged between ratings of teaching effec-tiveness and percentage of on-topic student comments, other themes,or percentage of miscellaneous comments. However, the top twostudent-rated lectures had zero or one key point that failed to emerge(25% and 0%, respectively), while the bottom two lectures each hadtwo key points that failed to emerge (50% and 40%, respectively).Conclusions: Many factors contribute to students’ perceptions ofthe effectiveness of surgical lectures. Most surgical lectures wererated highly, and nearly 80% of faculty-identified key conceptsemerge in qualitative analysis of the themes expressed in students’recollections of the key concepts from the lectures. Our lowest ratedlectures (bottom 20%) had a higher than the median percentage ofkey concepts that failed to emerge from student comments, while thereverse was true for the lectures ranked most effective (top 20%).However, over 50% of student post-lecture comments on what theylearned did not reflect faculty-identified key concepts, and the degreeto which students’ comments fell into faculty-identified key conceptswas not related to the student ratings of teaching effectiveness.

QS47. PROVING THE FEASIBILITY AND COST-EFFECTIVENESS OF A PROFICIENCY-BASED BASICLAPAROSCOPIC SKILLS CURRICULUM FOR A VIR-TUAL REALITY SIMULATOR. Kenneth C. Walters, B.Todd Heniford, Dimitrios Stefanidis; Carolinas Medical Cen-ter, Charlotte, NC

Background: Acquisition of surgical skill on simulators is gainingwide acceptance in surgery programs and a number of laparoscopicsimulators have been validated for resident training. Our purpose wasto establish a proficiency-based basic laparoscopic skills curriculum ona validated virtual reality simulator. Methods: Novices (n�6, collegestudents) were enrolled in an IRB-approved protocol for proficiency-based training on the Lap Mentor simulator. Proficiency levels wereestablished for the 9 basic laparoscopic tasks offered by the simulator(camera navigation 0°, camera navigation 30°, hand-eye coordination,clip application, grasp and clip, ball drop, cutting, cautery applicationand object translocation) based on expert performance. The metrics oftime, accuracy, and efficiency were used for performance assessment.Over an 8-week period, participants were asked to practice on thesimulator during one-hour training sessions until proficiency levelswere achieved in all metrics and tasks on two consecutive attempts.Instruction was given during the first training session only and trainingwas self directed. Training time and number of repetitions to proficiencywere recorded and curriculum effectiveness was measured by perfor-mance improvement between baseline and training completion. Resultsare reported as means � s.d.. The paired t-test was used for perfor-mance comparisons. A p-value �0.05 was considered significant. Re-sults: Participant age was 20�1 years, 83% were women, 83% wereright hand dominant and no one had prior simulator or surgical expe-rience. Compared to baseline all trainees improved their performanceby 0.8-6.3 times at the end of the study period (p�0.001) validating skillacquisition. While no participant was able to achieve the proficiencylevels at baseline all except one were able to achieve them duringtraining. After a mean of 31�5 minutes and 22�11 repetitions partic-ipants had achieved the proficiency levels on two consecutive attemptsin 78% of the tasks. Cautery application for lysis of adhesions provedthe most difficult task to achieve proficiency. Besides the capital cost forthe acquisition of the simulator there was no training cost associatedwith this curriculum. Instructor involvement was limited to the intro-ductory session. Conclusions: This study provides evidence for thefeasibility and effectiveness of a proficiency-based basic laparoscopicskills curriculum for novices on a virtual reality simulator. Such a skillscurriculum is very appealing as it can be achieved with minimal cost

288 ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS

and instructor involvement. The adoption of similar standardized, val-idated skills curricula is justified by surgical residency programs.

QS48. CORRELATION BETWEEN PERFORMANCE ONTESTS OF MANUAL DEXTERITY AND USMLEBOARD SCORES AND MEDICAL SCHOOL CLASSRANK. Stephanie R. Goldberg, Aaron E. Goldberg, James P.Neifeld; VCUHS, Richmond, VA

Introduction: Surgical programs often rely on objective measures ofmedical school cognitive performance, including USMLE Board scoresand class rank, to predict success of the resident in their trainingprogram. However, potential surgical resident applicants are not typi-cally subjected to standardized dexterity testing which is used in non-medical, but highly technical fields. Prospective residents may performwell on board exams and have high class ranks yet lack the necessarymanual dexterity to become competent surgeons. Successful identifica-tion of applicants likely to succeed in surgery remains elusive. Giventhis difficulty, we wondered if performance on standardized tests ofmanual dexterity would correlate with medical student USMLE boardexam scores and/or class rank. Methods: After informed consent wasobtained, fourth year medical students underwent dexterity testingusing the Stromberg dexterity test (gross motor function) and theO’Conner Tweezer test (fine motor function) and were evaluated on theAcquirePlace task (easy mode) of the MIST VR computerized surgicalsimulator (Mentice Corporation, Gothenburg, Sweden). Performancetimes in seconds for each of these tests were compared with USMLEStep I and Step II board scores and class rank using a Spearmancorrelation coefficient, with significance defined as p�0.05. Results:113 medical students underwent dexterity testing. Median perfor-mance times on the Stromberg test, O’Conner Tweezer test, and surgi-cal simulator were 149.0 seconds, 349.0 seconds, and 46.7 seconds,respectively. Median USMLE Step 1 score, USMLE Step 2 score, andclass rank were 221, 234 and 79th percentile, respectively. Analysisrevealed that gross motor dexterity (Stromberg dexterity test) wassignificantly correlated with both class rank (p�0.04) and USMLE StepI score (p�0.04) and approached significance when correlated with theUSMLE Step II score (p�0.058). Performance on both the computerizedsurgical simulator and the test of fine motor dexterity (O’Conner Twee-zer test) were not correlated with either class rank or USMLE scores.Conclusions: Gross motor skill is associated with objective measuresof medical school cognitive performance such as class rank and USMLEscores. Neither fine motor skill nor performance using computerizedsurgical simulators are associated with such objective measures. Thesedata suggest that those who have greater gross motor dexterity are ableto perform better in medical school. Further research is necessary todetermine if such dexterity testing could be helpful in identifying ap-plicants who possess the ability to develop into competent surgeons.

QS49. DEVELOPING GUIDELINES FOR IDENTIFYING PA-TIENTS WHO WOULD BENEFIT FROM PALLIATIVECARE SERVICES IN THE SURGICAL INTENSIVECARE UNIT. Ciaran T. Bradley, Karen J. Brasel; MedicalCollege of Wisconsin, Milwaukee, WI

Background: The convergence of end-of-life care and surgical practiceoften occurs in the surgical intensive care unit, although many of thesepatients do not receive palliative care services. There is a need forguidelines that educate surgeons how to identify patients in the SICUwho could benefit from these services. Methods: A group of 29 nationaland local experts were identified based on qualifications as surgicalintensivists, palliative care specialists, or members of the AmericanCollege of Surgeons Task Force on Surgical Palliative Care. A smallerrepresentative group initially identified as many responses as possibleto the question, “Which patients in the SICU should receive a palliativecare consult?” Utilizing a modified Delphi technique, the results weredistributed electronically to the larger group who were asked to rankeach criterion in order of preference or perceived utility. Each criterion

was given a score corresponding to its rank and proportionate to thetotal number of choices in that round. Through three rounds, the list ofcriteria was culled from 33 to 10. At each stage, respondents wereencouraged to add criteria or to add numeric qualifiers to make a givencriterion more specific. These were reflected in the following round.When a variety of qualifiers were returned, the mode was taken as therepresentative opinion. Respondents who missed a round remained inthe pool for subsequent stages. Results: 13 participants responded tothe first round, 12 to the second round. In the third round the entiregroup was given the ten criteria for final approval. There were nodissenting opinions offered. Approximately half of the respondentswere national authorities. The other half were local experts. The 10criteria identified as “triggers” for a palliative care consult are listedin rank order:

Criteria to Identify Patients in the SICU for Palliative CareConsult

1. Family request2. Futility considered or declared by medical team3. Family disagreement with team, advance directive, or each

other �7 days4. Death expected during same SICU stay5. SICU stay �1 month6. A diagnosis with median survival �6 months7. �3 SICU admissions during same hospitalization8. Glasgow coma score �8 for �1 week in a patient �75 years

old9. Glasgow outcome score �3 (i.e. persistent vegetative state)10. Multi-system organ failure �3 systems

Conclusion: We offer a set of consensus guidelines derived fromnational and local expert opinion that can help identify critically illsurgical patients who would benefit from palliative care services. Wesuggest that these could be used to educate surgeons at large on thevariety of clinical scenarios in which palliative care specialists can offersupport. Further research into the implementation of such guidelines iswarranted.

QS50. MEDICAL STUDENTS HAVE EMOTIONAL INTELLI-GENCE SIMILAR TO GENERAL POPULATION. StevenB. Goldin, Michael T. Brannick, Monika M. Wahi, CharlesPaidas, Melissa Arce, Maria L. Cannarozzi, Hazel-AnneJohnson, Stanley J. Nazian; University of South Florida,Tampa, FL

Introduction: Medical students are selected in part on the basis ofrigorous testing of knowledge and cognitive ability, both of which arerelated to performance during the first two years of medical school.Ability to cope with personal emotions and social interactions appropri-ately has not been rigorously tested and may not be emphasized in theeducation of medical students. However, such attributes may becomeimportant during the third and fourth years of medical school. There-fore, it seems prudent to investigate individual differences in emotionalintelligence in medical students. As an initial step, we compared med-ical students to the general public on two tests of emotional intelligence.We reasoned that compared to the general population, medical studentswould show higher emotional intelligence. This is because medicalstudents represent a relatively high-achieving group, and because mostphysicians have daily patient contact. Methods: In Fall of 2006, first-and second-year medical students were invited to take two assess-ments: The Mayer, Salovey, Caruso Emotional Intelligence Test (MS-CEIT) and the Wong and Law Emotional Intelligence Scale (WLEIS),both of which claim to measure emotional intelligence. In addition tooverall scores, both the MSCEIT and the WLEIS provide four subscalescores, although these differ somewhat across the two tests. The MS-CEIT subscales are perceiving emotions, facilitating thought, under-

289ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS