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This study determined the construct validity, inter-rater reliability and internal consistency of a “Structured Assessment Format for Evaluating Operative Reports” (SAFE-OR) in general surgery. The assessment instrument was developed using consensus criteria set forth by the Canadian Association of General Surgeons. It includes a structured assessment and a global quality rating scale. Residents divided into novice and experienced groups viewed and dictated a video-taped laparoscopic sigmoid colectomy. Transcriptions were then graded by blinded, independent faculty evaluators using SAFE-OR. Twenty-one residents participated in the study. Mean structured assessment scores (out of 44) were significantly lower for novice versus experienced residents (23.3 ± 5.2 vs 34.1 ± 6.0, t=0.001). Mean global quality scores (out of 45) were similarly lower for novice residents (25.6 ± 4.7 vs 35.9 ± 7.6, t=0.006). Inter-class correlation coefficients were 0.98 (95% CI 0.96-0.99) for structured assessment and 0.93 (95% CI 0.83-0.97) for global quality scales. Cronbach’s alpha coefficients for internal consistency were 0.85 for structured assessment and 0.96 for global quality assessment scales. SAFE-OR demonstrates significant construct validity, excellent inter-rater reliability and high internal consistency. This tool will allow educators to objectively evaluate the quality of trainee operative reports and ultimately provide a mechanism for implementing, monitoring, and refining curriculum for operative dictation communication skills. Moore R. The dictated operative note: important but is it being taught? Journal of the American College of Surgeons 2000; 190(5):639-40. Novitsky Y, Sing R, et al. Prospective, blinded evaluation of accuracy of operative reports dictated by surgical residents. The American Surgeon 2005; 71(8):627-31. Wanzel K, Ward R, et al. Teaching the surgical craft: From selection to certification. Current Problems in Surgery 2002; 39(6):573-659.

Background: The past several years have witnessed unparalleled changes in treatment for patients with ALK-translocated NSCLC. The objective of this study was to evaluate oncologists' competence regarding the use of ALK tyrosine kinase inhibitors in the management of NSCLC and the impact of virtual patient simulation on narrowing gaps in clinical practices. Method: A CME certified virtual patient simulation (VPS) was made available via a website dedicated to continuous professional development. The VPS consisted of 2 cases presented in a platform that allows oncologists to assess the patients and make diagnostic and therapeutic decisions supported by an extensive database of diagnostic and treatment possibilities matching the scope and depth of actual practice. Clinical decisions were analyzed using a sophisticated decision engine, and instantaneous clinical guidance (CG) employing up-to-date evidence-base and faculty recommendations was provided after each decision. Oncologists were able to revise each decision post-CG, if desired. Rationales for clinical decisions were also collected in real time. Data were collected between 08/01/ 2017 and 10/31/2017. Result: At the time of assessment, 178 oncologists had fulfilled the participation criteria for completing the simulation. Assessment of their practice choices revealed: In a patient with newly diagnosed NSCLC, up to 30% of oncologists did not order testing for a tumor's ALK translocation status. Moreover, only 37% ordered the appropriate therapeutic regimen. CG led to a 9% improvement in testing and 20% increase in evidence-based treatment (P<.001) Crizotinib remained the initial systemic treatment of choice despite data from the ALEX trial. In a patient whose disease has progressed on crizotinib with significant disease burden, 24% of oncologists would not discontinue therapy. CG resulted in a 23% improvement in evidence-based treatment decisions (P¼0.003). The primary rationales for the selected treatment differed based on the chosen regimen, disease control (26%) for continued treatment with crizotinib, better efficacy profile for the patient (24%) with use of ceritinib, andrecommended by guidelines (25%) for alectinib. A majority of oncologists initially ordered side effect counseling in each case. CG resulted in a 18% (P¼0.014) increase in the case for progression on crizotinib. Conclusion: This study, using an immersive VPS, provided insights into oncologists' real world practices, and the rationales behind them, in an evolving treatment landscape and uncovered a lack of clarity about identification of the most appropriate regimen for patients with ALKtranslocated NSCLC. Our findings demonstrate a continued need to educate oncologists about how to select and prescribe treatment for these patients.Background: Given earlier diagnosis and personalized treatment, lung cancer (LC) survival rates are increasing. LC can be associated with significant emotional distress, which affects health-seeking behaviors and health care utilization. This study examines LC pati...