Abstract
Background: Otorhinolaryngology / Head and Neck Surgery residents in Israel face two certification exams during residency, the first (Step A), a theoretical exam, and the second (Step B), a clinical exam. The exams require different qualifications in order to succeed in each. Herein, we investigate the institutional “effect” on the theoretical and clinical certification exams.
Aims: The study Objectives are:
- To investigate the correlation between institutional workload and surgical training ("effect") and the perception of being prepared to the theoretical and clinical certification exams.
- To analyze residents’ comprehensive perception of competence according to their certification exams status.
Methods: An anonymous electronic questionnaire was emailed to all registered Israeli Otorhinolaryngology / Head and Neck Surgery residents. The questionnaire investigated the residents’ perception of their preparation for the certification exams with regard to their department’s workload, training, and competence in the five main sub-specialties: Otology, Head and Neck Surgery, Pediatric Ear-Nose and Throat, Rhinology and Laryngology.
Results: Overall, 92 (63.5%) residents responded to the questionnaire. Of these, 17 residents had successfully passed the theoretical, Step A, certification exam, and 14 passed the clinical, Step B, certification exam. We have demonstrated an institutional “effect” (workload and surgical training) in most sub-specialties in clinical Step B, which was less observed in theoretical Step A.
In addition, Otorhinolaryngology / Head and Neck Surgery residents' comprehensive perception (mainly clinical and surgical competence) was significantly higher following clinical Step B compared to their perception after theoretical Step A. These significant differences were found in all sub-specialties except Rhinology.
Conclusions: The clinical, Step B exam, is a highly important milestone in the residency program. The perception of being well prepared to clinical Step B is more affected by the workload and surgical training, varying between different institutions. We recommend having the clinical, Step B exam, earlier in the course of the residency program and suggesting the need for central training system and supervision (e.g. regional curriculum collaboration) for a better medical training.