Differences in echocardiography interpretation techniques among trainees and expert readers

Background

Trainees learn transthoracic echocardiogram (TTE) interpretation through independently completing and reviewing selected portions of the study with experts. The diagnostic accuracy of novice TTE interpretation is known to be low and schema for reading TTEs systematically are lacking. The purpose of our study is to identify techniques experts use while reading TTEs which could be used to more effectively teach novice readers.

Methods

We performed a prospective qualitative case study to observe how experts and trainees interpret TTEs in an academic institution using a concurrent think aloud (CTA) method. Three TTEs of intermediate complexity were given to 3 advanced imaging fellows, 3 first year fellows and 3 expert TTE readers Participants filled out a report while reading and described aloud their thought processes. Sessions were video and audiotaped for analysis.

Results

Experts and advanced fellows used specific techniques that novices did not including: previewing studies, reviewing multiple images simultaneously, having flexibility in image review order and disease coding, and saving hardest elements to code for the end. Direct observation of TTE reading informed trainee inefficiencies and was a well-received educational tool.

Conclusions

In this single centered study we identified several unique approaches experts use to interpret TTEs which may be teachable to novices. Although limited in generalizability the findings of this study suggests that a more systematic approach to TTE interpretation, using techniques found in experts, might be of significant value for trainees. Further study is needed to evaluate teaching practices at other institutions and to assess whether implementation of these techniques by novices improves can improve their diagnostic accuracy and efficiency of reading at an earlier stage in their training.

Variable Learning Curve of Basic Rigid Bronchoscopy in Trainees

BACKGROUND

Despite increased use of rigid bronchoscopy (RB) for therapeutic indications and recommendations from professional societies to use performance-based competency, an assessment tool has not been utilized to measure the competency of trainees to perform RB in clinical settings.

OBJECTIVES

The aim of the study was to evaluate a previously developed assessment tool - Rigid Bronchoscopy Tool for Assessment of Skills and Competence (RIGID-TASC) - for determining the RB learning curve of interventional pulmonary (IP) trainees in the clinical setting and explore the variability of learning curve of trainees.

METHODS

IP fellows at 4 institutions were enrolled. After preclinical simulation training, all RBs performed in patients were scored by faculty using RIGID-TASC until competency threshold was achieved. Competency threshold was defined as unassisted RB intubation and navigation through the central airways on 3 consecutive patients at the first attempt with a minimum score of 89. A regression-based model was devised to construct and compare the learning curves.

RESULTS

Twelve IP fellows performed 178 RBs. Trainees reached the competency threshold between 5 and 24 RBs, with a median of 15 RBs (95% CI, 6-21). There were differences among trainees in learning curve parameters including starting point, slope, and inflection point, as demonstrated by the curve-fitting model. Subtasks that required the highest number of procedures (median = 10) to gain competency included ability to intubate at the first attempt and intubation time of <60 s.

CONCLUSIONS

Trainees acquire RB skills at a variable pace, and RIGID-TASC can be used to assess learning curve of IP trainees in clinical settings.

Assessing Interdisciplinary Trainees' Objective and Self-Reported Knowledge of Autism Spectrum Disorder and Confidence in Providing Services

The importance of accurate identification and high-quality intervention for individuals with autism spectrum disorder (ASD) is indisputable. Clinicians from multiple professions need adequate knowledge of ASD to make appropriate referrals to specialists, conduct thorough evaluations, and provide effective interventions. ASD knowledge development for many professionals may start at the pre-service training level. An interdisciplinary sample consisting of trainees from Leadership Education in Neurodevelopmental and Related Disabilities (LEND) programs and University Centers for Excellence in Developmental Disabilities (UCEDDs) across the country (N = 155) was evaluated on their objectively measured ASD knowledge using the ASKSP-R. Self-reported knowledge of ASD and self-reported confidence in providing services to individuals who have ASD was evaluated using a 0-100 scale. Results from an ANOVA demonstrated a significant difference in objectively measured knowledge across disciplines, F(7, 146) = 4.68, p < .001. Specifically, trainees in psychology had significantly higher levels of objectively measured ASD knowledge than trainees in physical/occupational therapy, social work, and non-clinical disciplines. Pre-service and professional development experiences predicted trainees' objectively measured ASD knowledge, self-reported ASD knowledge, and self-reported confidence. Implications and recommendations regarding interdisciplinary training to improve outcomes for individuals with ASD are discussed.

Patient Perceptions of Trust in Trainees During Delivery of Surgical Care: A Thematic Analysis

OBJECTIVE

Trust is an essential element of an effective physician-patient relationship. There is limited literature examining trust between trainees and patients in the surgical setting. The goal of this study was to investigate how otolaryngology patients perceive trust in trainees during delivery of surgical care.

DESIGN

We extracted trainee-specific data from a larger, qualitative interview study examining trust in the surgeon-patient relationship. We then used realist thematic analysis to explore preoperative otolaryngology patients' perceptions of trust in trainees during delivery of surgical care.

SETTING

Department of Otolaryngology-Head and Neck Surgery at Michigan Medicine in Ann Arbor, MI, a tertiary academic medical center.

PARTICIPANTS

Using convenience sampling, adults 18 years or older scheduled to undergo elective otolaryngologic surgery between February and June 2019 were invited, and 12 agreed to participate in the study.

RESULTS

All participants (n = 12) self-identified as White/Caucasian with a mean age of 60 years (range, 28-82). Participants were 50% (n = 6) female and 50% (n = 6) male. Thematic analysis of participants' perspectives about trust in trainees during delivery of surgical care revealed 3 themes. Trust in trainees is conditional based on (i) level of trainee involvement; (ii) trust in the attending surgeon; and, (iii) trust in the institution.

CONCLUSION

Trust in trainees during delivery of surgical care is conditional on types of tasks trainees perform, bounded by trust in their attending surgeon, and positively influenced by institutional trust. Trainees and surgical educators must look to innovative methods to engender trust more efficiently in the clinic and immediate pre-operative setting. Such approaches can have a positive impact on patient outcomes, facilitate stronger trainee-attending interpersonal relationships, and empower surgeons to practice the professional values integral to surgical care.

Surgical training tools for dermatology trainees: porcine vs. synthetic skin for excision and repair

Since dermatologists routinely perform surgery in an outpatient setting, ensuring that dermatology trainees are provided with opportunities to develop sufficient proficiency in excisional surgery and suture technique is paramount. The objectives of this study are to assess trainee preference for silicone-based synthetic skin compared with porcine skin as a surgical training medium and to assess the ability of trainees to successfully demonstrate basic surgical skills using the simulated skin model. Participants were a convenience sample of dermatology residents from the greater Chicago area, who were asked to perform an elliptical excision and bilayered repair on a silicone-based synthetic skin model. Residents were then surveyed regarding their satisfaction with the model. Four blinded dermatologist raters evaluated digital photographs obtained during the performance of the procedures and graded the execution of each maneuver using a surgical task checklist. Nineteen residents were enrolled. Residents were more likely to prefer pig skin to simulated skin for overall use (p = 0.040) and tissue repair (p = 0.018), but the nominal preference for tissue handling was nonsignificant (p = 0.086). There was no significant difference between satisfaction with pig skin versus synthetic skin with regard to excision experience (p = 0.82). The majority of residents (10/19) performed all surgical checklist tasks correctly. Of those residents who did not perform all steps correctly, many had difficulty obtaining adequate dermal eversion and wound approximation. Synthetic skin may be conveniently and safely utilized for hands-on surgical practice. Further refinement may be necessary to make synthetic skin comparable in feel and use to animal skin.

Advanced Anesthesiology and Perioperative Medicine (AAPM) Fellowship Program in Hamad Medical Corporation during COVID-19 Pandemic: Adapting and Redesigning the Fellowship Program

This article was migrated. The article was marked as recommended. Health care systems, as well as graduate medical education and training, have experienced unprecedented disruption due to the COVID-19 pandemic. Many academic medical institutions have adopted innovative strategies, technology, and dramatic transformation to continuously provide education and training to physicians in training while providing utmost and urgent care to the growing number of COVID-19 patients. Furthermore, medical societies have prioritized personal well-being, flexibility, and support for the trainees. Herein, we share the experience, lesson learned, practical guidance, and highlight the challenges faced by the program director and fellows of the advanced anesthesiology fellowship program at Hamad Medical Corporation.

Motivation: how to create a cohort of engaged, energized, and happy radiology trainees

Burnout among physicians continues to be a "hot topic" as medical culture struggles to adapt to the changing marketplace, where clinical demands are ever increasing but healthcare systems are pivoting to prefer value and cost-savings. To date, many attempts to understand and battle burnout center around the individual physician, rather than the system, limiting the medical community's ability to counter it successfully. The training environment is a common nidus for burnout. By promoting an understanding of motivation, happiness, and engagement in the workplace, we suggest several changes that training programs can make to minimize burnout and promote resident wellness. Creating a culture of support, promoting a positive work environment, building a cohesive team, and encouraging wellness both inside and outside the workplace stands to create engaged, happy, and motivated trainees who will hopefully continue to promote those strategies as they advance their careers.

Laparoscopic appendectomy as an index procedure for surgical trainees: clinical outcomes and learning curve

Surgical training is essential to maintain safety standards in healthcare. The aim of this study is to evaluate learning curves and short-term postoperative outcomes of laparoscopic appendectomy (LA) performed by trainees (TRN) and attendings (ATT). The present study included the medical records of patients with acute appendicitis who underwent a fully LA in our department between January 2013 and December 2018. Cases were divided into trainees (TRN and ATT groups based on the experience of the operating surgeon. The primary outcome measures were 30-day morbidity and mortality. Preoperative patients' clinical characteristics, intraoperative findings, operative times, and postoperative hospitalization were compared. Operative times were used to extrapolate learning curves and evaluate the effects of changes in faculty using CUSUM charts. A propensity score matching analysis was performed to reduce differences between cohorts regarding both preoperative characteristics and intraoperative findings. A total of 1173 patients undergoing LA for acute appendicitis were included, of whom 521 (45%) in the TRN group and 652 (55%) in the ATT group. No significant differences were found between the two groups in terms of complication rates, operative times and length of hospital stay. However, CUSUM chart analysis showed decreased operating times in the TRN group. Operative times improved more quickly for advanced cases. The results of this study indicate that LA can be performed by trainees without detrimental effects on clinical outcomes, procedural safety, and operative times. However, the learning curve is longer than previously acknowledged.

Performance of overnight on-call radiology residents in interpreting unenhanced abdominopelvic magnetic resonance imaging studies performed for pediatric right lower quadrant abdominal pain

BACKGROUND

Abdominopelvic magnetic resonance imaging (MRI) is increasingly being used to evaluate children with abdominal pain suspected of having acute appendicitis. At our institution, these examinations are preliminarily interpreted by radiology residents, especially when performed after hours.

OBJECTIVE

To determine the accuracy of preliminary reports rendered by radiology residents in this setting.

MATERIALS AND METHODS

Three hundred seventy-seven pediatric abdominopelvic MRI examinations were included. The preliminary (resident) and final (attending) radiology reports were coded as diagnosing acute appendicitis or no acute appendicitis. The concordance between resident and attending radiologist interpretations was calculated. Additionally, both resident and attending reports were compared to available surgical pathology or clinical follow-up data.

RESULTS

Overall concordance rate for the diagnosis of acute appendicitis was 97.1%. Concordance for verified cases of acute appendicitis was 93.4%. Concordance rates did not differ by residents' postgraduate year levels. When compared against surgical pathology or clinical follow-up data, residents demonstrated 91.2% sensitivity and 97.6% specificity. There was no statistically significant difference in the sensitivity or specificity of resident or attending radiologist interpretations.

CONCLUSION

Radiology residents demonstrate high concordance with attending pediatric radiologists in their interpretations of pediatric abdominopelvic MRI for acute appendicitis. The diagnostic performances of residents and attendings were comparable.

Emotional intelligence in palliative medical education

The death of a patient is one of the most stressful situations a healthcare professional can face for the first time at work or during training. Palliative and end of life care education aims to impart appropriate awareness and understanding of key issues arising at the end of life, but also to develop learners' interpersonal skills in leadership, communication and management of their own emotional load. There is a pressing need to be explicit around death, dying and care at the end of life and to equip clinical staff with the ability to manage the emotions that are experienced by their patients, their teams and themselves. Emotional intelligence is considered as a framework for medical educators to use in this setting with presentation of a simulated patient vignette to contextualise this.

Neurosurgical Interactive Teaching Series: Multidisciplinary Educational Approach

OBJECTIVE

The goal of this manuscript is to investigate the effects of a multidisciplinary multinational web-based teaching conference on trainee education, research, and patient care.

METHODS

We present the structure, case selection, and presentation of our educational lectures. We retrospectively reviewed our database to gather data on the number of presentations, type of presentation, and the pathology diagnosis from November 11, 2016 until February 28, 2020. To investigate attendee satisfaction, we analyzed our yearly continuing medical education evaluation survey results to report the impact that this series may have had on our attendees. We assigned a numeric value to the answers, and the mean overall scores were compared through an analysis of variance. Further analysis on specific questions was performed with a Fisher exact test.

RESULTS

We have hosted 150 lectures, in which we have presented 208 neurosurgical cases corresponding to 133 general session, 59 pituitary, and 16 spine cases, as well as 28 distinct lectures by guest speakers from institutions across the globe. We received 61 responses to our yearly continuing medical education evaluations over the course of 3 years. On these evaluations, we have maintained an excellent overall rating from 2017-2019 (two-sided P > 0.05) and received significantly less suggestions to improve the series comparing 2017 with 2019 (two-sided, P= 0.04).

CONCLUSIONS

As the world of medicine is constantly changing, we are in need of developing new tools to enhance our ability to relay knowledge through accredited and validated methods onto physicians in training, such as the implementation of structured, multidisciplinary, case-based lectures as presented in this manuscript.

Wellness Services: A Need Assessment Survey for Post Graduate Medical Education Trainees at Aga Khan University Hospital, Pakistan

OBJECTIVE

The study aimed to assess the need of mental wellbeing services for post graduate medical (PGME) trainees working at the Aga Khan University Hospital in Karachi, Pakistan.

METHODS

A cross-sectional study was conducted among all PGME trainees working at Aga Khan University Hospital in Karachi, Pakistan. The study questionnaire was developed by the team of investigators. The data collection was done through online survey from April 2019 to May 2019 and it was analyzed using descriptive and inferential analyses.

RESULTS

Out of total 623 PGME trainees, 334 trainees completed the online survey (response rate of 53.61%). A total of 292 participants (87.4%) perceived a need for mental health services. The major stressors identified were increase work hours (77.8%), excessive workload (75.1%), and difficulty balancing between work and personal life (72.8%). The perceived obstacles of utilizing mental services included lack of protected time (69.8%), fear of consequences (36.8%), lack of confidentiality (36.5%), and stigma (32.9%). The study participants indicated various suggestions to reduce their stressors such as separate relaxation space in hospital (91.3%), appreciation gestures like encouraging emails (65%), mentoring programs (43.4%), and regular surveys about resident needs (39.8%).

CONCLUSION

It is evident that innovative strategies to address trainees' mental health needs, looking at limitations of developing countries like Pakistan with large population and limited resources, need to be explored.

Rate of anastomotic leak following right hemicolectomy by general surgical trainees

PURPOSE

Performing a right hemicolectomy (RH) is a core technical competency for general surgical trainees. There is a concern that anastomotic leaks occur more frequently when patients are operated on by trainees rather than by surgeons. This study aims to analyse the quality of care outcomes after RH, stratified by the experience level of the operator.

METHODS

Patients were retrospectively recruited from the Bi-National Colorectal Cancer Audit (BCCA) Registry, from 2007 to 2018. All patients who underwent a RH for colorectal cancer were eligible. The primary outcome measure was anastomotic leak rate.

RESULTS

A total of 6548 eligible right hemicolectomies were identified, with 74% being performed by consultants, 12% by fellows, and 14% by surgical trainees. The overall incidence of an anastomotic leak was 2.1%, with the highest rate of 3.7% noted among supervised registrars. Positive resection margin rate was the highest among unsupervised trainees at 10.5%, as compared with 4.3% among consultants. Anastomotic leak, anastomotic bleeding, prolonged ileus, and pneumonia occurred significantly less frequently with consultant surgeons, as compared with trainees. Independent risk factors for anastomotic leak were urgent surgery, extended right hemicolectomy, conversion to open surgery, and a lower level of operator seniority. Two independent risk factors were identified for inpatient mortality-a high ASA score (III and above) and urgent surgery.

CONCLUSION

RH is a common operative procedure in general surgical training. Data from this study may assist with the structuring of surgical training programmes, aimed at maximising both patient safety and trainee professional development and education.

The Trainee's Role in Patient Safety: Training Residents and Medical Students in Surgical Patient Safety

"The focus on patient safety offers a new framework not only for delivering health care but also for training physicians. Medical school and surgical graduate medical education must transition to a more holistic approach by teaching technical and nontechnical skills. Formalized safety curricula can be developed by adopting recommended guidelines and content from national and international organizations, existing validated practices of training programs, frequent simulation exercises, and objective evaluation tools."

[A microsurgical wet lab for medical students increases interest in ophthalmology]

Hintergrund

Praktischen Inhalten wird in den Curricula der Humanmedizin zunehmend Platz eingeräumt. Bei verbreitetem Bewerbermangel trägt dies zu einem vermehrten Interesse seitens der Studierenden an den jeweiligen Fachbereichen bei. Einen praktischen Reiz der Augenheilkunde stellt die mikrochirurgische Arbeitsweise dar. Eine Einführung kann beispielsweise mit einem mikrochirurgischen Nahtkurs geleistet werden.

Ziel der Arbeit

Erfassung des Zugewinns des Interesses an der Augenheilkunde mittels Evaluation eines Nahtkurs-Wetlabs inklusive Nähen unter dem Mikroskop.

Material und Methoden

Die Daten wurden im Blockpraktikum Augenheilkunde des 6. Semesters an der Universitätsmedizin Mainz im April 2019 erhoben. In einem Fragebogen wurden verschiedene Aussagen auf Ordinalskalen gemeinsam mit dem Zentrum für Qualitätssicherung und -entwicklung der Johannes-Gutenberg-Universität Mainz bewertet und ausgewertet.

Ergebnisse

Es wurden 64 Evaluationsbögen von 8 Gruppen unterschiedlicher Dozenten zu je 8 Teilnehmern ausgewertet. Das Wetlab wurde im Mittel mit einer Schulnote von 1,24 ± 0,5 (MW±SD) bewertet. Es bestand Zustimmung (1 = stimme völlig zu, 7 = stimme gar nicht zu) zum Wunsch nach weiteren Wetlabs unter dem Mikroskop (1,86 ± 1,28) sowie nach dem Erlernen von mehr augenchirurgischen Techniken (2,02 ± 1,13). Das Interesse an der Augenheilkunde (1 = sehr groß, 7 = sehr gering) nahm von 3,66 ± 1,55 zu Beginn des Kurses auf 2,52 ± 1,00 zu.

Diskussion

Das Interesse an der Augenheilkunde lässt sich mittels eines mikrochirurgischen Wetlabs steigern. Bei Studierenden kann so das Interesse an der Augenheilkunde geweckt werden, was sich vorteilhaft auf Bewerbersituation und Forschungsarbeiten auswirken kann. So können sich bereits im Studium Erfahrungen und praktische Techniken der Augenheilkunde angeeignet werden.

A Continental Survey on the Impact of COVID-19 on Neurosurgical Training in Africa

Background

Containment measures for COVID-19 have affected surgical training globally. We sought to assess how neurosurgical training has been affected across Africa in April 2020.

Methods

A cross-sectional survey was distributed to African Neurosurgical trainees seeking to review demographics and effects of COVID on training.

Results

A total of 123 neurosurgery trainees responded from 23 African countries and a further 6 were abroad. A total of 91.80% were men, and 96.70% were training in public institutions. Only 41% had received training in COVID-19 with 61.79% worried that they would contract COVID-19 while performing their clinical duties. There was a marked reduction in clinical activities including a median reduction of elective surgery (−80%), clinics (−83%), and emergency surgery (−38.50%). A total of 23.58% of residents did not receive a formal salary, with 50% on less than $1000 USD gross per month.

Conclusions

This is the first continental survey of neurosurgery trainees in Africa. COVID-19 has significantly affected clinical and learning opportunities. There are concerns of the long-term effects on their training activities for an uncertain period of time during this pandemic. Although there has been a global increase in e-learning, there is need to evaluate if this is accessible to all trainees.

University Teaching Trauma Centers: Decreased Mortality but Increased Complications

BACKGROUND

Teaching hospitals are often regarded as excellent institutions with significant resources and prominent academic faculty. However, the involvement of trainees may contribute to higher rates of complications. Conflicting reports exist regarding outcomes between teaching and nonteaching hospitals, and the difference among trauma centers is unknown. We hypothesized that university teaching trauma centers (UTTCs) and nonteaching trauma centers (NTTCs) would have a similar risk of complications and mortality.

METHODS

We queried the Trauma Quality Improvement Program (2010-2016) for adults treated at UTTCs or NTTCs. A multivariable logistic regression analysis was performed to evaluate the risk of mortality and in-hospital complications, such as respiratory complications (RCs), venous thromboembolisms (VTEs), and infectious complications (ICs).

RESULTS

From 895,896 patients, 765,802 (85%) were treated at UTTCs and 130,094 (15%) at NTTCs. After adjusting for covariates, UTTCs were associated with an increased risk of RCs (odds ratio (OR) 1.33, confidence interval (CI) 1.28-1.37, P < 0.001), VTEs (OR 1.17, CI 1.12-1.23, P < 0.001), and ICs (OR 1.56, CI 1.49-1.64, P < 0.001). However, UTTCs were associated with decreased mortality (OR 0.96, CI 0.93-0.99, P = 0.008) compared with NTTCs.

CONCLUSIONS

Our study demonstrates increased associated risks of RCs, VTEs, and ICs, yet a decreased associated risk of in-hospital mortality for UTTCs when compared with NTTCs. Future studies are needed to identify the underlying causative factors behind these differences.

Medical Education During the Coronavirus Disease-2019 Pandemic: Learning From a Distance

As paradigms of clinical care delivery have been significantly impacted by the novel coronavirus disease-2019 pandemic, so has the structure, delivery, and future of medical education. Both undergraduate and graduate medical education have seen disruptions ranging from fully virtual delivery of educational content and limited clinical care for medical students to increased clinical demands with redeployment for residents and fellows. Adherence to social distancing has led to the adoption and implementation of already available technologies in medical education, including video conferencing softwares and social media platforms. Efficient and effective use of these technologies requires an understanding not only of these platforms and their features but also of their inherent limitations. During a time of uncertainty and increased clinical demands, the approach to medical education must be thoughtful with attention to wellness of both the educator and learner. In this review, we discuss the influence of the pandemic on the existing medical education landscape, outline existing and proposed adaptations to social distancing, and describe challenges that lie ahead.

Improving trainee engagement in science: Lessons from a virtual seminar series

To be a successful researcher, you are expected to have important skills beyond the bench such as being able to ask questions, talk about science with your peers, and organize scientific events. However, there is frequently little to no training or emphasis on these skills at the student and postdoc level. The virtual Aging Science Talks seminar series and Slack group have benefitted the scientific community in many ways amidst the chaos of coronavirus quarantines and lab shutdowns, but as a 2^nd year PhD student, I was particularly excited about how this format was able to engage trainees. We should end the era of trainees sitting at the back of the room while PIs dominate discussions and Q&A sessions with speakers. Reflecting on the advantages of Aging Science Talks can show us how to make future scientific events more engaging and inclusive for everyone.

Effectiveness and safety of a laparoscopic training system combined with modified reconstruction techniques for total laparoscopic distal gastrectomy

BACKGROUND

Total laparoscopic distal gastrectomy (TLDG) is increasing due to some advantages over open surgery, which has generated interest in gastrointestinal surgeons. However, TLDG is technically demanding especially for lymphadenectomy and gastrointestinal reconstruction. During the course of training, trainee surgeons have less chances to perform open gastrectomy compared with that of senior surgeons.

AIM

To evaluate an appropriate, efficient and safe laparoscopic training procedures suitable for trainee surgeons.

METHODS

Ninety-two consecutive patients with gastric cancer who underwent TLDG plus Billroth I reconstruction using an augmented rectangle technique and involving trainees were reviewed. The trainees were taught a laparoscopic view of surgical anatomy, standard operative procedures and practiced essential laparoscopic skills. The TLDG procedure was divided into regional lymph node dissections and gastrointestinal reconstruction for analyzing trainee skills. Early surgical outcomes were compared between trainees and trainers to clarify the feasibility and safety of TLDG performed by trainees. Learning curves were used to assess the utility of our training system.

RESULTS

Five trainees performed a total of 52 TLDGs (56.5%), while 40 TLDGs were conducted by two trainers (43.5%). Except for depth of invasion and pathologic stage, there were no differences in clinicopathological characteristics. Trainers performed more D2 gastrectomies than trainees. The total operation time was significantly longer in the trainee group. The time spent during the lesser curvature lymph node dissection and the Billroth I reconstruction were similar between the two groups. No difference was found in postoperative complications between the two groups. The learning curve of the trainees plateaued after five TLDG cases.

CONCLUSION

Preparing trainees with a laparoscopic view of surgical anatomy, standard operative procedures and practice in essential laparoscopic skills enabled trainees to perform TLDG safely and feasibly.

Hopelessness, helplessness and resilience: The importance of safeguarding our trainees' mental wellbeing during the COVID-19 pandemic

•

The COVID-19 pandemic may put the mental wellbeing of trainees at risk.

•

Hopelessness, helplessness and burnout are important to be aware of.

•

We need to foster an open culture of trust and support.

•

We need to promote resilience in colleagues/trainees where possible.

Best Practices in Teaching Endoscopy Based on a Delphi Survey of Gastroenterology Program Directors and Experts in Endoscopy Education

BACKGROUND AND AIMS

Teaching endoscopy is a key objective of gastroenterology (GI) fellowship programs but the best approach is not known. We sought to characterize which teaching competencies experts considered most critical for endoscopy education.

METHODS

We developed and refined 18 endoscopy teaching competencies based on literature review, personal experience, and interviews with experts. We invited GI fellowship program directors and endoscopy education experts to participate in a Delphi process to rate each proposed competency as essential, important but not essential, or not important using a 70% agreement threshold for consensus. Thirty-four GI fellowship program directors and 2 experts in endoscopy education participated (n = 36).

RESULTS

Most survey participants were male (61.8%), associate professors (55.9%), and had performed at least a quarter of procedures with fellows (80.6%). Survey response rates were 94% (34 of 36) for round 1 and 91% (31 of 34) for round 2 (overall 31 of 36; 86.1%). After 2 rounds we achieved the predefined consensus level for most competencies. Fourteen of 18 competencies (77.8%) reached consensus after round 2: 10 (55.6%) were deemed essential and 4 (22.2%) were deemed important but not essential. Essential competencies included the following: discusses patient history and plans for procedure with trainee (100%), assumes control of procedure when trainee is unable to progress or if patient safety concerns arise (100%), maintains attention throughout the case (96.8%), and discusses the next steps in management for the patient (96.8%).

CONCLUSIONS

In a national Delphi survey of endoscopy education experts, we identified 10 essential endoscopy teaching competencies. These can be used to frame faculty development and standardize GI fellowship programs to promote high-quality endoscopy education.

Impact of an educational workshop on psychiatrists' attitude towards psychosomatic medicine

BACKGROUND

Although psychosomatic medicine is not recognised as a medical specialisation globally, it has proven useful for treating many disorders in Germany. This paper reports on the impact of an educational workshop as a tool for raising awareness about psychosomatic medicine among international psychiatrists.

METHODS

Psychiatrists from eight different countries were educated on psychosomatic medicine and psychotherapy during a 90-min workshop using a video, a slide presentation and an innovative teaching format called 'speed coaching'. Learning outcomes were assessed by analysing questionnaires completed by the participants before and after the workshop.

RESULTS

Half of the participants who initially rejected the notion that psychosomatic medicine should be a specialisation on its own changed their minds in favour for it to be a separate discipline (p = 0.125). Awareness about which diseases and patients psychosomatic doctors deal with was increased. The intent for treatment of patients with eating disorders by a psychosomatic physician quadrupled among the participants (p = 0.004).

CONCLUSIONS

A brief educational intervention can influence psychiatrists' decisions to opt for approaches by doctors specialized in psychosomatics for certain disorders. Further studies may explore why psychiatrists agree or disagree that psychosomatic medicine should be a separate specialisation on its own.