By:  Jessica R


Jessica R:  Hello. I'm Jessica, the content editor for @daily.absite.fact.  Please follow us on Facebook and Insta.  I'm here with the creator of the ABSITE test study guide ABSITE: Smackdown. That's the only review book with accompanying video lectures included. Please welcome Dr. David Kashmer.

David Kashmer, MD:  Hi Jessica. Thanks for having me on the program today as a guest.  This is much easier than hosting!

Jessica R:  Oh, you're welcome. Thanks for taking time out to get with us. I know things are a little crazy right now and I really, really want to get into why and how you created this book. But before we do that, I want to talk about the current events and the news.

I know what's going on in the world and what we're seeing on the news can be a little bit scary and there's a lot of uncertainty. We're getting conflicting reports. Everyone has a different opinion. It feels like the world is almost at a standstill. I'm lucky enough that I don't know anyone personally that has gotten sick, but the social distancing has a really affect all of us, I believe.

For example, my daughter's school has been closed for the rest of this year and they have even canceled the SATs.  What do you think?  What are your thoughts or what's your opinion on this virus & this pandemic and how it's affecting us?

David Kashmer, MD:  Jessica, whether we look at this from a healthcare point of view or a non-healthcare point of view, one thing we can't do is deny that this has really changed our lives lately. You know, the economic implications alone are serious.

On a healthcare note there's a real worry that hospitals won't be able to deal with a surge of potential patients. So again, whether we look at this from a healthcare perspective and how it affects human lives, whether it's the elderly or immunosuppressed patients, or whether we think of how it affects us economically, there's really just no denying this has been a tough time lately and very serious.


Jessica R:  I've noticed that they've had to put in a lot of new medical protocols for safety, not just for the patients but also for the caregivers. It's trickling down and affecting everything, from the doctors, nurses, even to the students and how they're going to finish up their residency program.


David Kashmer, MD:  Sure has, in fact, as we were discussing earlier before we started recording, the American Board of Surgery (ABS) released some guidelines and I think you were running through them with me.  They're really profound and they change requirements for what residents will need to complete their year successfully. So, you know, I was really amazed as we were going through those earlier. For me as a program director, they really represent a significant change and a timely one. This year has already been an interesting one and it's gonna keep on being interesting.

Jessica R:  All right, well for those of you who are listening and didn't get to read the article, if you want to look on the ABS website, you'll find the article here.

It was published on March 26, 2020 and it's the modifications for training requirements and this is going to apply to our residents as they're going through. So, they issued the statement, and I'll paraphrase:  the ABS and all our specialty boards recognize that these are extraordinary times.

Our health system, surgeons, patients and the public are under a kind of strain we have never experienced. We also know that this impacts the ability of trainees to meet our traditional requirements. In recognition of this ABS is making global recommendations and changes across specialties. Number one, they're saying non-voluntary offsite time that is used for clinical or educational purposes can be counted as clinical time. So what does that mean?

David Kashmer, MD:  So that means for those times that the residents are offsite, we can kind of count times when they're doing things that wouldn't traditionally be countable as time toward residency training completion. This represents a significant change for us. Usually we're really strict with what we consider clinical time and non-countable time. This really a frees that up and rightfully so. Just a really great choice by them to do that.

Jessica R:  They also said that they will accept 44 weeks of training time for the 2020 academic year.

David Kashmer, MD:  That's a big change. Also. Usually it's about 48 weeks or so that are required for a year. And this cuts that back to recognize what's going on.  This makes that, requirement somewhat more flexible in light of how things have been this year. And of course there's a possibility that could change if the things persist for a long period of time, et cetera. This shows a willingness of the board to make reasonable accommodations. Hopefully that will be all the downregulation that's needed on that, but you never know and it's really good to how there's a sensitivity to what interesting times these are.

Jessica R:  Yeah. That's wonderful. And I think that you'll definitely be able to understand this one because being a program director yourself, it says that the program directors are empowered, as they usually are, to make a decision about the readiness of the resident for independent practice.

David Kashmer, MD:  Yeah. For independent practice. Really the goal of what we do in our residency program is to train colleagues. People are going to finish and they're going to become surgeons who could operate on us or our families. And, to that end, the program director has to sign off and attest to the fact that they're ready to go at the end of their residency. These guys and girls are ready to go. And, this keeps the onus on us appropriately to make sure that the staff we train are ready to go and for us to sign off when and if they are. So again, very reasonable.

And it just says, once again, that program directors are going to determine when these guys and girls are ready to go and they need to sign off and we'll keep doing that.

All these recommendations in total really make a lot of sense.  And I shouldn't even say recommendations, I should say. This is the way it is now as the American Board of Surgery is telling us.  It really shows that they are willing to make changes at an appropriate time to an appropriate degree in a difficult situation.

Jessica R:  I think that we're all just grateful that we can come together and get this done right now. I do think that the situation means that you have to be accountable.  That all the students, they have to study on their own time, do what's right. You know, just take the time to be prepared.  Coming back to that now that they're working from home doing these things offsite, you know, it's going to be even more important on how they're focusing their time and what they're using for that.

So that leads us back around to you and why I have you here. So, can we get into a little bit about your book and why you wrote it and what actually gave you the idea to do this.

David Kashmer, MD:  Sure. Happy to do it. First I'll just pick up on what you said.  The resident staff--they're still coming to the hospital. There are changes of course, to their schedule and times where they may not be.

For example, if they catch this particular virus, they may not be in for awhile. So there's just an increased chance that they won't have the same amount of clinical time. We really try to train them as future colleagues. We try to train them as adult learners who are going to be prepared.

The reason I wanted to do a work like this is I didn't see much like it. The review books for the ABSITE that are out there are already really good.

In fact, they're really good. They really do have a lot of overlap in the content that they put out there because there are only so many factoids.  So most of the review books out there have really the facts that you need and share those facts in common with the other books.

But what I didn't see was one that had some course or some way to get those facts across for people who weren't just visual or reading learners--the ones who were either auditory learners.

Or the ones who didn't even have as much time to sit and read a book because their commute was long and through a city or they're on-call just so much or something similar.

So I thought it would be great to take a lot of those standard ABSITE facts and to put them together in a way that was easily accessible from any device, anytime, anywhere, on any of the commonly used devices.

And I thought that, as a program director who was starting a residency program, this'll be really useful because it would give our residents a complete course, a complete preparatory course, to get ready for their American Board of Surgery In Training exam, that ABSITE.

That's a lot of why I did it, to make sure that the staff I was going to have definitely had the educational core.  The core of education they would need. But there are other things.

When I looked around at other options, like ABSITE courses, they were sometimes $1,000 and you have to fly there and really nobody has time for that or at least very few, and not often. And also the expense is pretty significant.

So it's just not something I saw out there. It's something I thought that, you know, I'd be able to accomplish and it's just been really fulfilling to see it grow to the level that it has.

Jessica R:  Well, with you saying that, you know, it's on most devices, I feel like you're really catering to the way that students learn now. we do have a lot of auditory learners just with the time constraints that everyone has. I mean, how many phone calls do you take in your car, on your Bluetooth?  How many times are you listening to tapes?  So this really can help maximize your time to get the most out of the program rather than just picking up a book.

David Kashmer, MD:  Well, I, I agree with you of course. I can't encourage anybody to watch the videos in their car, but you can listen to them. And it sounds pretty good through the Bluetooth on the car. because gosh knows before I sent it over to the publisher, I listened to it a bunch! 

My compliments to the team, to you and everybody else for getting it set up on a platform that let it do just that because the vision was to get it out on every commonly used device platform. Really that's a tech accomplishment. You guys did nice work with that to get it out on all of the standard platforms. That was really good to see.

Jessica R:  Well, earlier you mentioned that you had this idea years ago.  With when we released the book, does that mean you've been working on this for years?

David Kashmer, MD:  In the back of my head, yes. You know, I always had notes for everything. They kind of got digitized progressively with things like Evernote and some colleagues gave me their notes with the understanding that I may use them one day in some way, you know, for some project like this.

And you know, I wanted to write a review book because once upon a time the authors of one of the other review books was an upper year resident when I was visiting a program doing an away rotation.

And I was just thinking, boy, you know, there's no good book for this ABSITE test and there should be.  Well, sure enough, he put one out not long after! It was great.

Then, years later, when I was rounding as a fellow in an ICU, I said to one of attendings:  "You know, I've really always wanted to do one of these review books and I think you could do this and you could change it like this..."

Well, sure enough, that guy put a review book out too while I was there!  So I've had these brushes with each of the authors of the really popular review books and I knew I wanted to do something like that for years.  In at least one case, I may have given them the idea to do it and told them how!  But I'm not complaining...and idea only takes you so far and any success from their book is owing to their hard work!

What I wanted to do differently is get it out there in a different way, in a different format.  I wanted a book that can easily fit in your pocket and something that's super convenient and lets you work it into your everyday routine because I thought that would be so much more valuable. So that's really what we tried to do with this.

Jessica R:  Yeah. We have to admit that if it's not convenient, we don't do it. Like that's just who we are nowadays. So by doing this, putting all the work into it, what was your main goal?  What did you want to accomplish with this book?

David Kashmer, MD:  It's education. It's setting something up that I wish I had when I was resident staff. I would've loved something like this. I mean, we didn't have all the devices that would've made it as easy, but I really would've just loved something as accessible like this with the lectures right there that I can go back to.

They follow the book & the book fits right in my pocket. I have a full course and what is going to be on the ABSITE in my pocket, that would have been so valuable. So that's exactly what I wanted to do with this, for the residents everywhere and more especially for the ones who are coming to our program.

So I'm just really fortunate that the publisher picked it up and said, yeah, we'd love to do this. Let's get it done.

We ran it by residents from across the country too and got their input.  So we validated the idea before we put it out.  They really liked it.

Jessica R:  Right. Well, cause I mean, your job is training those residents and if they come in prepared because they've done this work, it makes your job so much easier. That's for sure.

All right. So what do you think is going to be your next step with this?

David Kashmer, MD:  I'd love to see it grow. I really hope that the publishers, you know, bring us more versions or let us make more versions. I'd also like to tune up the version that we have. There's some editing things I think that could have been done better. So I'd like to see it cleaned up.

I hope that the publisher will let me start to build a community of learners kind of around this work like a Project ABSITE Smackdown where people can share their issues with the test, and share their thoughts on it, and just get better together. Because when you're trying to learn to do something, it's really hard when you're trying to coach yourself through things.

So a community of people helping each other, mentoring each other, as sort of this "Project ABSITE Smackdown" that would just be really fulfilling to help everybody do better on this test together. Because really the whole point is to just learn more together.

Jessica R:  It takes a village.

All right. Well, thank you so much for doing this interview with me today. I am just so excited with the feedback that I've received about how much help ABSITE Smackdown has provided to this next generation of surgeons. I'm very much looking forward to this next step and version.  So thanks for being here today.

David Kashmer, MD:  Well, thanks for having me.

Jessica R:  All right. Everybody have a good night and #ABSITE Smackdown!

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