Judith L. Trudel

The purpose of this study was to determine the reliability and validity of the scores from "key feature" cases in the self-assessment of colon and rectal surgeons. Key feature (KF) cases specifically focus on the assessment of the unique challenges, critical decisions, and difficult aspects of the identification and management of clinical problems in practice. KF cases have been used to assess medical students and residents but rarely for specialists. Responses from all 256 participants taking the American Society of Colon and Rectal Surgeons (ASCRS) Colon and Rectal Surgery Educational Program (CARSEP) V Self-assessment Examination (SAE) from 1997 to 2002 were scored and analyzed, including score reliability, item analysis for the factual (50 multiple-choice questions (MCQ)) and applied (9 KF cases) knowledge portions of the SAE, and the effect of examination preparation, examination setting, specialization, Board certification, and clinical experience on scores. The reliability (Cronbach alpha) of the scores for the MCQ and KF components was 0.97 and 0.95, respectively. The applied KF component of the SAE was more difficult than the factual MCQ component (0.52 versus 0.80, P < 0.001). Mean item discrimination (upper-lower groups) was 0.59 and 0.66 for the MCQ and KF components, respectively. Taking the test at the annual meeting was harder than at home (0.41 versus 0.81, P < 0.001). Content-related validity evidence for the KF cases was supported by mapping KF cases onto the examination blueprint and by judgments from expert colorectal surgeons about the challenging and critical nature of the KFs used. Construct validity of the KF cases was supported by incremental performance related to types of practice (general, anorectal, and colorectal), levels and types of Board certification, and years of clinical experience. The self-assessment of surgical specialists, in this case colorectal surgeons, using KF cases is possible and yielded reliable and valid scores.

Clostridium difficile enterocolitis is endemic in most modern hospitals. The spectrum of clinical presentation varies from the asymptomatic carrier state to fulminant colitis with toxic megacolon and perforation. Highly toxigenic and lethal strains of C. difficile have emerged worldwide. Medical treatment consists of discontinuing the precipitating antibiotic, supportive measures and bowel rest, and antibiotic treatment with metronidazole or vancomycin. Surgical treatment may be necessary in cases of fulminant disease. Subtotal colectomy with end ileostomy is the operation of choice.

The term “colitis” broadly refers to inflammation and infection of the colon and rectum. Although the use of this term is most often associated with nonspecific inflammatory bowel disease such as Crohn's disease and ulcerative colitis, many specific agents, bacteria, parasites, viruses, and insults result in a specific and characteristic type of colitis. This issue of Clinics in Colon and Rectal Surgery is devoted to these miscellaneous colitides. The purpose of this issue is to review current knowledge about the etiology, clinical manifestations, and treatment of the most common specific colitides encountered by colon and rectal surgeons worldwide. For the longest time, several of these colitides were considered medical and surgical curiosities, to be learned about for certifying examinations and forgotten as soon as the examination was over. Because of the changes in our world and practice environment, most are now seen regularly in the United States. Increased immigration and worldwide travel, increases in the number of immunosuppressed patients (whether the immunosuppression is medically induced after transplantation, used in multimodal treatment of cancer or inflammation, or secondary to diseases such as AIDS), and the emergence of multiresistant and hypervirulent pathogens all have contributed to an explosion in the number and severity of cases of specific colitides with which surgeons are confronted. We hope that this issue will raise surgeons' awareness of the variety and variability of clinical presentations of these entities and fill a gap by providing a concise, up-to-date resource on specific colitides. The nine articles in this issue cover the breadth and the width of specific colitides. I am grateful to all the authors for their excellent and exhaustive reviews of the topics they were assigned. Drs. Justin A. Maykel and Mark Y. Sun, from the University Massachusetts Medical School reviewed ischemic colitis. I reviewed Clostridium difficile-associated colitis. Bacterial colitides are covered in the article by Drs. Harry T. Papaconstantinou and J. Scott Thomas from Texas A&M University System Health Science Center. Dr. Matthew R. Dixon, from the University of Minnesota, presents viral and fungal colitides. Dr. Karim A. Alavi, also from the University of Minnesota, discusses amebiasis. Dr. Joel E. Goldberg, from Harvard University, presents a review of other nonamebic parasitic colitides. Dr. Amy J. Thorsen, from the University of Minnesota, covers the spectrum of noninfectious colitides. Sexually transmitted proctitides are reviewed by Drs. Matthew L. Voth and Robert P. Akbari, from Temple University School of Medicine. Finally, Drs. Gregory D. Kennedy and Charles P. Heise, from the University of Wisconsin, Madison, cover radiation colitis and proctitis. It was an honor and a pleasure for me to be guest editor of this issue of Clinics in Colon and Rectal Surgery.

The past 25 years have seen a revolution in the way surgery is learned, taught, and practiced. This revolution has increased the need for surgical educators to adapt surgical educational strategies to the modern practice environment. The purposes of this article are (1) to describe the impact of recent and upcoming changes in surgical education, (2) to explore the benefits of participating in surgical education activities both for academic surgeons and for surgeons in private practice, and (3) to review some of the avenues available to surgeons wishing to become involved or build a career in surgical education.