Miller, Barbra S.

ABSTRACT Introduction The American Association of Endocrine Surgeons (AAES) drafted Entrustable Professional Activities (EPAs) for Endocrine Surgery (ES) to assess general surgery residents and ES fellows in core topics. Here, we examine learner and teacher concordance of entrustability ratings. Methods Fourteen EPAs were defined (10 “core”–6 with pre‐, intra‐, and post‐operative phases, four single‐phase–and four elective EPAs). Ten institutions collected three‐item micro‐assessments (MAs) of learner EPA performance using a web‐based platform, where entrustment was assessed on observable behaviors using a five‐point scale. Learner provided self‐assessment ratings, while teachers separately assigned ratings for the same activities. Spearman rank correlation tests were applied to compare learner‐teacher ratings for EPAs. Results MAs ( n = 698) were submitted between 7/2022‐9/2023. Programs submitted between 3 and 468 MAs. Among 3‐phase core EPAs, the intraoperative phase was most assessed ( n = 496), followed by pre‐ and post‐operative phases ( n = 108 and 55, respectively). Thirty‐nine single‐phase EPAs were submitted. Learner self‐assessment and teacher ratings were equivalent for 32% of pre‐operative EPAs, 53% of intra‐operative EPAs, 29% of post‐operative EPAs, and 64% of single phase of care EPAs. Spearman rank correlation between teacher and learner ratings for all phases of care combined was 0.66. Correlation was highest for the intra‐operative phase (0.73), followed by single‐phase (0.65), pre‐operative phase (0.27), and post‐operative phase (0.20). Rating concordance did not differ when high and low scores were examined independently. Learners were more prone to underestimate performance than to overestimate it when ratings were discordant. Conclusions Learners' self‐assessment and teacher ratings of endocrine surgery EPAs are strongly concordant with operative technical skills. However, learners often underestimate their performance of pre‐ and post‐operative care compared to faculty ratings when using EPAs.

AbstractBackgroundPostoperative radioactive iodine (RAI) administration is widely utilized in patients with differentiated thyroid cancer. While beneficial in select patients, it is critical to recognize the potential negative sequelae of this treatment. The prevention, diagnosis, and management of the salivary and lacrimal complications of RAI exposure are addressed in this consensus statement.MethodsA multidisciplinary panel of experts was convened under the auspices of the American Head and Neck Society Endocrine Surgery and Salivary Gland Sections. Following a comprehensive literature review to assess the current best evidence, this group developed six relevant consensus recommendations.ResultsConsensus recommendations on RAI were made in the areas of patient assessment, optimal utilization, complication prevention, and complication management.ConclusionSalivary and lacrimal complications secondary to RAI exposure are common and need to be weighed when considering its use. The recommendations included in this statement provide direction for approaches to minimize and manage these complications.