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Ji L, Xiaowei Z, Ling K, Yao F, Qingkun S, Jun Z. Burnout level and job satisfaction in Chinese pediatrics residents: A web-based cross-sectional study. Medicine (Baltimore) 2020; 99:e19249. [PMID: 32080130 PMCID: PMC7034729 DOI: 10.1097/md.0000000000019249] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 01/06/2020] [Accepted: 01/20/2020] [Indexed: 11/26/2022] Open
Abstract
To study the prevalence of burnout and job satisfaction in Chinese pediatrics residents.Prospective participants were invited via a WeChat group to participate from October 1, 2018 to January 31, 2019. The Maslach Burnout Inventory-Human Services Survey was used to measure physician burnout, and the Minnesota Satisfaction Questionnaire was used to measure job satisfaction.A total of 380 residents (81.1% response rate) from 35 pediatric residency programs completed the cross-sectional web-based survey. Of the responders, 233 (61.3%) exhibited high levels of career burnout. Residents 24 to 29 years of age were less likely to report burnout than residents ≥30 years of age (50.9% vs74.7%; P < .05). In addition, residents with an annual income less than 80,000 RMB seem to have higher burnout levels (66.2%). Residents who reported that they felt sleep deprived had significantly higher rates of burnout than those who did not (P < .01). Logistic regression showed that age ≥30 years (odds ratio [OR] 3.74 [1.57-7.66], P < .01) and sleep deprivation (OR 4.11 [2.19-7.35], P < .01) were the 2 independent risk factors associated with burnout.Burnout is highly prevalent among Chinese pediatrics residents who also reported poor job satisfaction.
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Affiliation(s)
- Li Ji
- Department of Pediatrics, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences
| | - Zhang Xiaowei
- Department of Urology, Peking University People's Hospital, Beijing
| | - Kuang Ling
- Nephrology Division, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital; Chengdu, Sichuan Province
| | - Fu Yao
- Department of Education, Peking University People's Hospital
| | - Song Qingkun
- Department of Science and Technology, Beijing Shijitan Hospital, Capital Medical University
| | - Zhao Jun
- Department of Education, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences
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202
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Richards NQ, Osardu RK. The Ophthalmology Chief Resident: Does Surgical Volume Correlate With Likelihood of Selection? J Med Educ Curric Dev 2020; 7:2382120520930779. [PMID: 32637640 PMCID: PMC7322814 DOI: 10.1177/2382120520930779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/07/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Investigate whether number of logged Accreditation Council for Graduate Medical Education (ACGME) surgical cases correlates with likelihood of Virginia Commonwealth University Health System (VCUHS) ophthalmology residents being selected as the chief resident. DESIGN Retrospective study. PARTICIPANTS VCUHS ophthalmology residents from 2006 to 2016. METHODS Analyze association between chief resident selection and logged cases. MAIN OUTCOME MEASURES Review number of archived logged ACGME surgical cases of all residents between the years 2006 and 2017. Review chief resident selected each year 2006-2016. RESULTS Our analysis correctly predicted the chief resident in 2 of the 10 years analyzed. CONCLUSION Those residents performing the most surgical procedures in each respective class were not more likely to be selected as chief resident.
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Affiliation(s)
- Nikisha Q Richards
- Department of Ophthalmology, Virginia Commonwealth University Health System, Richmond, VA, USA
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Reginald K Osardu
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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203
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Butsch WS, Robison K, Sharma R, Knecht J, Smolarz BG. Medicine Residents are Unprepared to Effectively Treat Patients with Obesity: Results from a U.S. Internal Medicine Residency Survey. J Med Educ Curric Dev 2020; 7:2382120520973206. [PMID: 33283047 PMCID: PMC7691912 DOI: 10.1177/2382120520973206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/23/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND In an obesity epidemic, physicians are unprepared to treat patients with obesity. The objective of this study was to understand how obesity is currently addressed in United States (U.S.) Internal Medicine (IM) residency programs and benchmark the degree to which curricula incorporate topics pertaining to the recently developed Obesity Medicine Education Collaborative (OMEC) competencies. METHODS Invitations to complete an online survey were sent via postal mail to U.S IM residency programs in 2018. Descriptive analyzes were performed. RESULTS Directors/associate directors from 81 IM residencies completed the online survey out of 501 programs (16.2%). Although obesity was an intentional educational objective for most programs (66.7%), only 2.5% of respondents believed their residents are "very prepared" to manage obesity. Formal rotation opportunities in obesity are limited, and at best, only one-third (34.6%) of programs reported any one of the core obesity competencies are covered to "a great extent." Many programs reported psychosocial components of obesity (40.7%), weight stigma (44.4%), etiological aspects of obesity (64.2%) and pharmacological treatment of obesity (43.2%) were covered to "very little extent" or "not at all." Lack of room in the curriculum and lack of faculty expertise are the greatest barriers to integrating obesity education; only 39.5% of residency programs have discussed incorporating or expanding formal obesity education. CONCLUSIONS Our study found the current obesity curricula within U.S. IM residency programs do not adequately cover important aspects that address the growing obesity epidemic, suggesting that obesity education is not enough of a priority for IM residency programs to formalize and implement within their curricula.
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Affiliation(s)
- W Scott Butsch
- Bariatric and Metabolic Institute,
Cleveland Clinic, Cleveland, OH, USA
| | | | - Ranita Sharma
- Rutgers Robert Wood Johnson Medical
School, Department of Medicine, Brunswick, NJ, USA
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204
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Abstract
Objective Acute abdominal pain (AAP) of diverse etiology is a common chief complaint of patients who present to the emergency department (ED). AAP may pose a diagnostic challenge to physicians in training. We aimed to evaluate whether or not resident trainee doctors examine patients presenting with AAP in a Japanese acute-care hospital following Kendall's diagnostic algorithm. Methods We conducted a retrospective medical chart review from January 2015 to December 2016. Patients Patients ≥50 years old who presented to the ED within 7 days of the onset of AAP who were evaluated by residents at the ED of an acute care hospital were enrolled in this study. Patients transported by ambulance and referred from other hospitals and classified as level 1 or 2 according to the Japanese version of the Canadian Triage and Acuity Scale were excluded. Data, including the clinical history, location and character of pain, and age and gender of patients as well as the level of experience of residents, were abstracted from charts. We evaluated the concordance rate between the actual diagnostic process followed by residents and Kendall's diagnostic algorithm for AAP. Results We analyzed 466 patients (mean age 67.6 years) in the study who were evaluated and diagnosed by 123 residents. The concordance rate between the diagnostic procedures performed by residents and those suggested by Kendall's diagnostic algorithm was 61.2%. A low concordance rate was observed among patients with peritoneal signs, shock or toxic appearance (25.0%), suggested acute coronary syndromes (ACS) (55.1%), epigastric or right upper-quadrant pain (52.8%), and left upper-quadrant pain (55.6%). Abdominal ultrasonography is one of the recommended examinations for patients with signs of peritoneal irritation, shock or toxic appearance, right lower-quadrant pain, and left upper- or lower-quadrant pain, but the rates were relatively low at 25.0%, 34.4%, 31.8%, and 26.7%, respectively. Conclusion Abdominal ultrasonography required by Kendall's diagnostic algorithm was not performed appropriately in patients with symptoms and signs of peritonitis, shock or toxic appearance, right lower-quadrant pain, and left upper- or lower-quadrant pain or in female patients by resident trainees. Our findings underscore the importance of providing resident doctors with focused training concerning ultrasonography by attending physicians.
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Affiliation(s)
- Kaori Amari
- Department of Emergency Medicine, Saga-Ken Medical Center Koseikan, Japan
- Department of General Medicine, Saga University Hospital, Japan
| | - Norio Fukumori
- Education and Research Center for Community Medicine, Faculty of Medicine, Saga University, Japan
| | - Keizo Anzai
- Department of Hepatology, Diabetes, and Endocrinology, Faculty of Medicine, Saga University, Japan
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205
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Onat L, Hancı V, Özbilgin Ş, Boztaş N, Taşdöğen A, Yurtlu S, Kuvaki B, Arkan A. Anaesthesiology and Reanimation Education in Turkey: Residents' Views. Turk J Anaesthesiol Reanim 2019; 47:496-502. [PMID: 31828248 DOI: 10.5152/tjar.2018.34437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/01/2018] [Indexed: 11/22/2022] Open
Abstract
Objective This study aimed to determine opinions of medical residents undergoing anaesthesia and reanimation training about equipment, programmes, applications, study conditions and shift systems at training institutions in Turkey. Methods A web-based survey was sent by e-mail to residents in anaesthesiology and reanimation training programmes. The survey comprised 73 questions about demographic characteristics, satisfaction, basic specialisation knowledge, anxiety and motivation. Results The study included 270 individuals. Of the residents, 82.2% willingly chose their field, whereas 66.7% stated that specialisation was necessary because of incorrect application of first-stage and GP medical services. The mean of the weekly working hours was 91.69±36.69 hours; the mean number of monthly on-call shifts was 7.49±1.99. Of the participants, 61.9% found the predicted five-year training duration long. The intensive care training duration was sufficient for 71.1% and only 26.3% found the pain management training duration sufficient. Conclusion According to the results, the number of residents is insufficient, workload is heavy, working hours are long and large numbers of shifts are worked without leave afterwards. In spite of negatives and high dissatisfaction, most residents willingly chose their departments and would choose the same branches again. Participants stated that their institutions emphasised service rather than education and research, and educators were less accessible to residents due to increasing service loads.
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Affiliation(s)
- Levent Onat
- Department of Anaesthesiology and Reanimation, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Volkan Hancı
- Department of Anaesthesiology and Reanimation, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Şule Özbilgin
- Department of Anaesthesiology and Reanimation, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Nilay Boztaş
- Department of Anaesthesiology and Reanimation, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Aydın Taşdöğen
- Department of Anaesthesiology and Reanimation, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Serhan Yurtlu
- Department of Anaesthesiology and Reanimation, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Bahar Kuvaki
- Department of Anaesthesiology and Reanimation, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Atalay Arkan
- Department of Anaesthesiology and Reanimation, Dokuz Eylül University School of Medicine, İzmir, Turkey
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206
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Dennis M, Batalini F, Demers L, Upadhyay A. Overcoming barriers to resident scholarly productivity and research at a large academic institution. MedEdPublish (2016) 2019; 8:213. [PMID: 38089365 PMCID: PMC10712469 DOI: 10.15694/mep.2019.000213.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
This article was migrated. The article was marked as recommended. Background: Scholarship is an important component of resident education that can increase future opportunities in academic medicine. Each year the Accreditation Council for Graduate Medical Education surveys internal medicine (IM) residents for their satisfaction with scholarship opportunities. The IM residents at our large academic center have consistently reported scores that were lower than expected. We designed this study to identify barriers to resident scholarship and successful interventions. Objective: Identify barriers to resident scholarly productivity and report the results of several interventions aimed at improving resident scholarship. Methods: Leaders within the IM residency program were interviewed with a standardized questionnaire, and an online survey was distributed to IM residents. Comparisons were made between program leader interviews and resident survey responses. Results: Program leaders unanimously agreed there are abundant research opportunities, that resident research is prioritized, and that time is the major research barrier. Conversely, only 72% of residents reported satisfaction with research opportunities, 56% felt that the program prioritized research, and finding a mentor was the most frequently reported research barrier (60%). Residents considered early discussions about research the most successful intervention to improve scholarship. Conclusion: Finding a mentor was the most important barrier to resident scholarship and discussing research early in the intern year was the most successful intervention.
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Affiliation(s)
- Michael Dennis
- Boston Medical Center and Boston University School of Medicine
| | - Felipe Batalini
- Beth Israel Deaconess Medical Center and Harvard Medical School
| | - Lindsay Demers
- Boston Medical Center and Boston University School of Medicine
| | - Ashish Upadhyay
- Boston Medical Center and Boston University School of Medicine
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207
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Annam K, Chen AJ, Lee IM, Paul AA, Rivera JJ, Greenberg PB. Risk Factors for Early Intraocular Pressure Elevation After Cataract Surgery in a Cohort of United States Veterans. Mil Med 2019; 183:e427-e433. [PMID: 29425312 DOI: 10.1093/milmed/usx113] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 10/23/2017] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Cataract surgery is the most frequently performed surgery in the Veterans Health Administration (VHA). A well-known complication is a transient but potentially harmful elevation in intraocular pressure (IOP) within the 24-h postoperative period. The purpose of this study is to investigate the risk factors for IOP elevation 1 d after cataract surgery in a cohort of United States (US) veterans. MATERIALS AND METHODS The study included 784 patients who underwent cataract surgery between April 2013 and April 2016 at a single Veterans Affairs medical center in Providence, RI. One thousand one hundred thirty-seven cataract surgeries were considered in total. Institutional Review Board (IRB) approval was obtained through the Providence Veterans Affairs Medical Center (PVAMC). Logistic regression, adjusted for patients with bilateral surgeries, was used to evaluate risk factors for first postoperative day IOP elevation (≥28 mmHg). The main outcome measure was elevated IOP on postoperative day 1 (POD1) after cataract surgery. RESULTS The average patient age was 74 yr. Ninety-eight percent (1,110/1,137) of cases involved male patients; 75.3% (856/1,137) of the cataract surgeries were performed by resident surgeons. Type II diabetes mellitus (DM) was present in 41% (461/1,137), alpha-1 blocker use in 31% (358/1,137), ocular hypertension (ocular HTN) in 4% (44/1,137), and glaucoma in 11% (126/1,137) of cases. Twenty-two percent (232/1,137) of eyes had elevated IOP. Independent risk factors were a history of ocular HTN (OR: 8.74 [4.03-18.9]), glaucoma (OR: 3.54 [2.17-5.75]), a preoperative IOP ≥22 mmHg (OR: 2.51 [1.12-5.62]), and complicated cataract surgery (OR: 2.45 [1.18-5.08]), defined as vitreous loss, anterior capsular tear (ACT), posterior capsular tear (PCT), or presence of zonular lysis. CONCLUSION These findings suggest that cataract surgery patients with ocular HTN, glaucoma, a preoperative IOP ≥22 mmHg, or significant intraocular complications may benefit from prophylactic ocular anti-hypertensive medication.
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Affiliation(s)
- Kaushik Annam
- Section of Ophthalmology, VA Medical Center, 830 Chalkstone Ave, Providence, RI
- Division of Ophthalmology, Warren Alpert Medical School of Brown University, 222 Richmond St, Providence, RI
| | - Allison J Chen
- Section of Ophthalmology, VA Medical Center, 830 Chalkstone Ave, Providence, RI
- Division of Ophthalmology, Warren Alpert Medical School of Brown University, 222 Richmond St, Providence, RI
| | - Irene M Lee
- Department of Ophthalmology, Kaiser Permanente of Washington, 310 15th Ave E, Seattle, WA
| | - Alfred A Paul
- Section of Ophthalmology, VA Medical Center, 830 Chalkstone Ave, Providence, RI
- Division of Ophthalmology, Warren Alpert Medical School of Brown University, 222 Richmond St, Providence, RI
| | - Jorge J Rivera
- Section of Ophthalmology, VA Medical Center, 830 Chalkstone Ave, Providence, RI
- Division of Ophthalmology, Warren Alpert Medical School of Brown University, 222 Richmond St, Providence, RI
| | - Paul B Greenberg
- Section of Ophthalmology, VA Medical Center, 830 Chalkstone Ave, Providence, RI
- Division of Ophthalmology, Warren Alpert Medical School of Brown University, 222 Richmond St, Providence, RI
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Boniface MP, Helgeson SA, Cowdell JC, Simon LV, Hiroto BT, Werlang ME, Robison SW, Edwards GG, Lewis MD, Maniaci MJ. A Longitudinal Curriculum In Point-Of-Care Ultrasonography Improves Medical Knowledge And Psychomotor Skills Among Internal Medicine Residents. Adv Med Educ Pract 2019; 10:935-942. [PMID: 31807108 PMCID: PMC6839571 DOI: 10.2147/amep.s220153] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/23/2019] [Indexed: 05/29/2023]
Abstract
PURPOSE Despite its growing popularity and clinical utility among hospital-based physicians, there are no formal competency requirements nor training standards for United States based Internal Medicine Residencies for learning point-of-care ultrasonography (POCUS). The purpose of this investigation was to study the impact and effectiveness of a novel POCUS curriculum for an Internal Medicine (IM) residency program. PATIENTS AND METHODS This was a Single-Group Educational Quasi-Experiment involving Categorical and Preliminary Internal Medicine Residents in Post-Graduate Years 1 through 3 at a single United States academic tertiary center. The study period was from January 1, 2017, through June 30, 2017, during which time the residents participated in monthly modules including didactics and hands-on ultrasound scanning skills with live models. Participants completed a comprehensive knowledge examination at the beginning and end of the six-month period. Participants were also tested regarding hands-on image acquisition and interpretation immediately before and after the hands-on skills labs. The primary outcome measure was performance improvement in a comprehensive medical knowledge assessment. RESULTS In total, 42 residents consented for participation. The residents' monthly rotations were adjusted in order to accommodate the new educational process. Among 29 participants with complete data sets for analysis, the mean (SD) comprehensive knowledge examination score improved from 60.9% before curriculum to 70.2% after curriculum completion (P<0.001). Subgroup analysis determined that improvement in medical knowledge required attending at least 2 out of the 6 (33%) educational sessions. Attendance at hands-on skills labs correlated significantly with improvement; didactics alone did not. CONCLUSION A longitudinal POCUS curriculum consisting of both didactic sessions and hands-on skills labs improves knowledge, image acquisition, and interpretation skills of residents. Having this curriculum span at least 6 months provides learners the opportunity to attend multiple classes which strengthens learning through repetition while also providing learners flexibility in schedule.
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Affiliation(s)
| | - Scott A Helgeson
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Jed C Cowdell
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Leslie V Simon
- Department of Emergency Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Brett T Hiroto
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Monia E Werlang
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Sarah W Robison
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Grace G Edwards
- Department of Education, Mayo Clinic, Jacksonville, FL, USA
- The Mayo Clinic School of Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Michele D Lewis
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
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209
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Ashley CW, Donaldson K, Evans KM, Nielsen B, Everett EN. Surgical Cross-Training With Surgery Naive Learners: Implications for Resident Training. J Surg Educ 2019; 76:1469-1475. [PMID: 31303542 DOI: 10.1016/j.jsurg.2019.06.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/26/2019] [Accepted: 06/25/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE While current literature has explored the transferability of laparoscopic surgical skills to robotic surgery, this study looks to investigate the transferability of surgical skills between robotic surgical simulation and simulated traditional laparoscopy. DESIGN Participants completed a survey regarding prior surgery exposure and other confounding factors including previous video game experience and self-assessed hand-eye coordination. Following orientation to the laparoscopic simulator (LS) and robotic surgical simulator (RoSS), participants were timed performing the Balloon Grasp and Ball Drop tasks on the RoSS and the Peg Transfer and Ball Drop tasks on the LS. Participants were then randomized to either the laparoscopic or RoSS arm and timed performing the Ball Drop task 10 times and then reassessed performing the Ball Drop using the unpracticed modality. SETTING Clinical Simulation Laboratory at the University of Vermont PARTICIPANTS: A total of 31 medical students with limited experience in laparoscopic and robotic surgery. RESULTS There were no statistically significant differences in the demographics or prior surgical and videogame experience between the participants in the laparoscopic and robotic arms of the study (X2 = 0.72, p = 0.75). Timed initial assessment of the RoSS Balloon Grasp (p = 0.84) and Ball Drop (p = 0.79) tasks and the LS Peg Transfer (p = 0.14) and Ball Drop (p = 0.44) tasks were not statistically different between the 2 arms. The simulator modality which was practiced yielded the greatest improvement. The degree of improvement on the unpracticed modality was not statistically different between the groups (p = 0.57), and it was not significantly better than 2 rounds of sequential practice on the practiced modality (LS, p = 0.98 and RoSS, p = 0.55). CONCLUSIONS With practice, both groups increased surgical skill on the unpracticed modality. However, this degree of improvement was equal, suggesting there is no transferability of skills between laparoscopy and robotics.
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Affiliation(s)
- Charles W Ashley
- Department of Surgery, Gynecology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Katherine M Evans
- Department of Anesthesiology, University of Vermont College of Medicine, Burlington, Vermont
| | - Brian Nielsen
- Department of Obstetrics and Gynecology, Western Michigan University Homer Stryker M.D. College of Medicine, Kalamazoo, Michigan
| | - Elise N Everett
- Division of Gynecologic Oncology, University of Vermont College of Medicine, Burlington, Vermont.
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Dewar ZE, Yurkonis T, Attia M. Hand-off bundle implementation associated with decreased medical errors and preventable adverse events on an academic family medicine in-patient unit: A pre-post study. Medicine (Baltimore) 2019; 98:e17459. [PMID: 31577774 PMCID: PMC6783144 DOI: 10.1097/md.0000000000017459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To determine the impact of the implementation of a hand-off bundle on medical errors at an inpatient unit of an academic community teaching hospital. Our secondary objective was to determine the research utility of the use of an all-electronic data collection system for medical errors.A retrospective review was conducted of 1290 admissions 6 months before and after implementation of an improved computerized hand-off tool and training bundle. The study took place at an academic community teaching hospital on a Family Medicine inpatient service caring for patients of all ages. The comparison focused on preventable and non-preventable adverse events.A significant decrease in medical errors was noted. Medical error rate dropped from 6.0 (95% CI, 4.2-8.3) to 2.2 (95% CI, 1.2-3.7) per 100 admissions (P < .001). Preventable medical errors dropped from 0.65 (95% CI, 0.18-1.67) to 0.15 (95% CI, 0.03-0.82) per 100 admissions (P = .194). Non-intercepted potential adverse events dropped from 1.30 (95% CI, 0.56-2.57) to 0.44 (95% CI, 0.09-1.30) per 100 admissions (P = .131). Intercepted potential adverse events dropped from 0.98 (95% CI 0.36-2.13) to 0.74 (95% CI 0.24-1.7) per 100 admissions (P = .766) and errors with little potential for harm dropped from 2.77 (95% CI 1.61-4.43) to 0.74 (95% CI 0.24-1.7) per 100 admissions (P = .009).Implementation of a standardized hand-off bundle was associated with a reduction in medical errors despite a low overall event rate. Further studies are warranted to determine the generalizability of this finding, to examine the overall epidemiology of medical errors and the reporting of such events within general medical teaching units.
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211
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Kannampallil T, Jones S, Abraham J. 'This is our liver patient…': use of narratives during resident and nurse handoff conversations. BMJ Qual Saf 2019; 29:135-141. [PMID: 31270253 DOI: 10.1136/bmjqs-2018-009268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 05/17/2019] [Accepted: 06/14/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Handoffs are often framed as the co-construction of a shared understanding relying on narrative storytelling. We investigated how narratives are constructed and used during resident and nurse handoff conversations. METHOD We audio-recorded resident (n=149) and nurse (n=126) handoffs in an inpatient medicine unit. Qualitative analysis using grounded theory was conducted to identify and characterise the structure of resident and nursing handoff narratives. RESULTS Handoff conversations among both residents and nurses used three types of narratives: narratives on creating clinical imagery, narratives on coordinating care continuity and narratives on integrating contextual aspects of care. Clinical imagery narratives were common during patient introductions: residents used a top-down approach relying on overarching patient clinical situations (eg, 'a liver patient'), whereas nurses used a bottom-up approach using patient-specific identifying information. Narratives on the coordination of care continuity for residents focused on managing internal and external coordination activities, whereas nurse narratives focused on internal coordination, emphasising their role as an interface between patients and their physicians. Both resident and nurse narratives on the contextual aspects of care had considerable focus on highlighting 'heads up' anticipatory information and personal patient information; such information was often not present in patient charts, but was important for ensuring effective care management. DISCUSSION The presence of narrative structures highlights the need for new perspectives for the design of handoff tools that allow for both informational and cognitive support and shared awareness among conversational partners during handoff conversations. We discuss the implications of the use of narratives for patient safety and describe specific design considerations for supporting narrative interactions during handoffs.
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Affiliation(s)
- Thomas Kannampallil
- Department of Anesthesiology, Washington University in Saint Louis, Saint Louis, Missouri, USA
| | - Steve Jones
- Department of Communication, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Joanna Abraham
- Department of Anesthesiology, Washington University in Saint Louis, Saint Louis, Missouri, USA
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Mnatzaganian CL, Morello CM, Sarino L, Kuo GM. Development of a community-academic collaborative pharmacy residency program. Am J Health Syst Pharm 2019; 76:1079-1085. [PMID: 31415687 DOI: 10.1093/ajhp/zxz088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To describe the development of a collaborative community-academic postgraduate year 1 pharmacy residency program in San Diego that provides a hybrid experience of opportunities in community practice, ambulatory care, and teaching. SUMMARY Residency training programs are being developed to better match the evolving role of the community pharmacist. In 2016, the University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences partnered with Ralphs Pharmacy, a division of the Kroger Co., to launch a 1-year community residency to develop community-based pharmacists with diverse patient care, leadership, and education skills. Learning experiences include pharmacy operations, clinical services focusing on chronic disease management and education, teaching, and practice-based research. Training settings include community pharmacy, corporate pharmacy, ambulatory care, and academia. Graduates are prepared to work in these settings as well as capitalize on advanced training opportunities, including postgraduate year 2 residencies and professional certifications. The program has been successfully accredited, and graduates have completed the program: one completed a postgraduate year 2 residency, and both have obtained a management or clinical pharmacist position. CONCLUSION An innovative community-academic residency program preparing postgraduate year 1 learners for careers in community-based pharmacy, corporate, ambulatory care, and academic settings was developed, with positive preliminary outcomes.
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Affiliation(s)
- Christina L Mnatzaganian
- PGY1 Community Residency Program, University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA
| | - Candis M Morello
- University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA, and Veterans Affairs San Diego Healthcare System, La Jolla, CA
| | | | - Grace M Kuo
- University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences and School of Medicine, Department of Family Medicine and Public Health, La Jolla, CA
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213
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McGuire KJ, Sparks MB, Gitajn IL, Henderson ER, Jevsevar DS, Paddock NG, Coe MP. Selecting Residents for Predetermined Factors Identified and Thought to be Important for Work Performance and Satisfaction: A Methodology. J Surg Educ 2019; 76:949-961. [PMID: 30846348 DOI: 10.1016/j.jsurg.2019.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 12/29/2018] [Accepted: 02/03/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The medical profession seeks to hire and train individuals who consistently meet and/or exceed both job and cultural expectations. Resident selection is often not structured to meet this goal. The objective of this quality improvement project was to evaluate a classic unscripted interview process (OI) in conjunction with a structured, scripted interview process (SI) developed using an established hiring methodology from industry not yet utilized in health care. Qualitative questions we sought to answer: (1) Can SI be practically applied to the selection of residents? (2) Is there a significant difference in the relative position of applicants between the OI and SI rank lists? (3) Qualitatively, does SI help the evaluation/discussion of the affective domain? METHODS Design: Prospective qualitative comparison of OI versus SI. SETTING Dartmouth Hitchcock Medical Center, Lebanon, NH. PARTICIPANTS Applicants were assessed by OI and SI. SI factors were selected based on a job profile. Interview scripts were created from validated behavioral and attitudinal questions. Online assessments assessed 2 important attributes - adaptability and values. Rank lists were compared for relative rank position of applicants. Feedback from faculty was obtained. RESULTS Fifty-two applicants. Critical attributes were self-management, integrator-synthesizer, versatility, communication, and achievement. Absolute mean difference in rank/applicant was 9.8 (standard deviation 8.9, Range 0-36) positions. Comparing the top 20 candidates of each rank list, 40% of those applicants were only on one list. Faculty felt that applicants were given a greater opportunity to show "who they are." CONCLUSIONS In conjunction with OI, an industry proven methodology was practically applied to define and select for high performance for the authors' specific institution. Comparing OI and SI resulted in substantial differences in rank lists. This initiative seemed to provide a structure to evaluate values and motivations that are inherently difficult to assess. Faculty felt SI in conjunction with OI gave a greater chance for applicants to show "who they are."
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Affiliation(s)
- Kevin J McGuire
- Department of Orthopedics, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.
| | - Michael B Sparks
- Department of Orthopedics, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Ida L Gitajn
- Department of Orthopedics, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Eric R Henderson
- Department of Orthopedics, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - David S Jevsevar
- Department of Orthopedics, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Nicholas G Paddock
- Department of Orthopedics, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Marcus P Coe
- Department of Orthopedics, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
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214
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Klimstra MA, Beck NA, Forte ML, Van Heest AE. Did a Minimum Case Requirement Improve Resident Surgical Volume for Closed Wrist and Forearm Fracture Treatment in Orthopedic Surgery? J Surg Educ 2019; 76:1153-1160. [PMID: 30852184 DOI: 10.1016/j.jsurg.2019.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 01/23/2019] [Accepted: 02/04/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The purpose of this study is to determine whether the 2013 implementation of ACGME minimum case requirements was associated with increased documented case volume of closed manipulation of forearm and wrist fractures (CMFWF) for graduating orthopedic surgery residents. DESIGN We reviewed ACGME case log data for CMFWF among graduating orthopedic surgery residents from 2007 to 2016. Annual national mean, and median number of CMFWF performed by residents in the 10th, 30th, 50th, and 90th case volume percentile were evaluated. Preminimum (2007-2010) data was compared to postminimum (2013-2016) values to assess the impact of ACGME minimum requirements on resident case volume. SETTING Review of publically available ACMGE Orthopedic Surgery Residency Program case log data. PARTICIPANTS ACGME case log data for orthopedic surgery residents graduating between 2007 and 2016. RESULTS National mean number of CMFWF increased significantly pre- to postminimum requirement (30.0 ± 2.84 to 45.0 ± 3.36, p < 0.001). Between 2010 and 2016 there was a 1100%, 300%, 83%, and 9% increase in the median number of CMFWF within the 10th, 30th, 50th, and 90th percentiles, respectively. CONCLUSIONS ACGME's 2013 case minimum requirement corresponded to an increase in case counts for CMFWF; the greatest increase occurred in residents below the 50th percentile of case volume. Implementation of case minimum requirements may allow for more accurate depiction of resident experience and program strengths with regards to procedural exposure. However, the current case log system measures only case quantity, which may inaccurately depict mastery of given procedures. Future work should focus not only on improving case counts in underperforming residents and training sites, but also on refining metrics that ensure accurate assessment of resident skill for essential orthopedic procedures prior to graduation.
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Affiliation(s)
- Mikhail A Klimstra
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Nicholas A Beck
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Mary L Forte
- School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Ann E Van Heest
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota.
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215
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Essien UR, He W, Ray A, Chang Y, Abraham JR, Singer DE, Atlas SJ. Disparities in Quality of Primary Care by Resident and Staff Physicians: Is There a Conflict Between Training and Equity? J Gen Intern Med 2019; 34:1184-1191. [PMID: 30963439 PMCID: PMC6614525 DOI: 10.1007/s11606-019-04960-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 11/30/2018] [Accepted: 02/26/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Outpatient primary care experience is vital to internal medicine resident training but may impact quality and equity of care delivered in practices that include resident physicians. Understanding whether quality differences exist among resident and staff primary care physicians (PCPs) may present an opportunity to address health disparities within academic medical centers. OBJECTIVE To determine whether there are differences in the quality of primary care provided by resident PCPs compared to staff PCPs. DESIGN A retrospective cohort study with a propensity-matched analysis. PARTICIPANTS 143,274 patients, including 10,870 patients managed by resident PCPs, seen in 16 primary care practices affiliated with an academic medical center. MAIN MEASURES Guideline-concordant chronic disease management of diabetes (HbA1c, LDL) and coronary artery disease (LDL), preventive breast, cervical, and colorectal cancer screening, and resource utilization measures including emergency department (ED) visits, hospitalizations, high-cost imaging, and patient-reported health experience. KEY RESULTS At baseline, there were significant differences in sociodemographic and clinical characteristics between resident and staff physician patients. Resident patients were less likely to achieve chronic disease and preventive cancer screening outcome measures including LDL at goal (adjusted OR [aOR] 0.77 [95% CI 0.65, 0.92]) for patients with coronary artery disease; HbA1c at goal (aOR 0.73 [95% CI 0.62, 0.85]) for patients with diabetes; breast (aOR 0.56 [95% CI 0.49, 0.63]), cervical (aOR 0.66 [95% CI 0.60, 0.74]), and colorectal (aOR 0.72 [95% CI 0.65, 0.79] cancer screening. Additionally, resident patients had higher rates of ED visits and hospitalizations but lower rates of high-cost imaging. Resident patients reported lower rates of satisfaction with certain access to care and communication measures. Similar outcomes were noted in propensity-matched sensitivity analyses. CONCLUSION After controlling for differences in sociodemographic and clinical factors, resident patients were less likely to achieve chronic disease and preventive cancer screening outcomes compared to staff patients. Further efforts to address ambulatory trainee education and primary care quality along with novel approaches to the management of the disproportionately disadvantaged resident patient panels are needed.
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Affiliation(s)
- Utibe R Essien
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, 3609 Forbes Avenue, Suite 2, Pittsburgh, PA, USA. .,Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
| | - Wei He
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Alaka Ray
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Yuchiao Chang
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Jonathan R Abraham
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Daniel E Singer
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Steven J Atlas
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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216
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Ambardekar AP, Black S, Singh D, Lockman JL, Simpao AF, Schwartz AJ, Hales RL, Rodgers DL, Gurnaney HG. The impact of simulation-based medical education on resident management of emergencies in pediatric anesthesiology. Paediatr Anaesth 2019; 29:753-759. [PMID: 31034728 DOI: 10.1111/pan.13652] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 04/13/2019] [Accepted: 04/19/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Resident education in pediatric anesthesiology is challenging. Traditional curricula for anesthesiology residency programs have included a combination of didactic lectures and mentored clinical service, which can be variable. Limited pediatric medical knowledge, technical inexperience, and heightened resident anxiety further challenge patient care. We developed a pediatric anesthesia simulation-based curriculum to address crises related to hypoxemia and dysrhythmia management in the operating room as an adjunct to traditional didactic and clinical experiences. AIMS The primary objective of this trial was to evaluate the impact of a simulation curriculum designed for anesthesiology residents on their performance during the management of crises in the pediatric operating room. A secondary objective was to compare the retention of learned knowledge by assessment at the eight-week time point during the rotation. METHODS In this prospective, observational trial 30 residents were randomized to receive simulation-based education on four perioperative crises (Laryngospasm, Bronchospasm, Supraventricular Tachycardia (SVT), and Bradycardia) during the first week (Group A) or fifth week (Group B) of an eight-week rotation. Assessment sessions that included two scenarios (Laryngospasm, SVT) were performed in the first week, fifth week, and the eighth week of their rotation for all residents. The residents were assessed in real time and by video review using a 7-point checklist generated by a modified Delphi technique of senior pediatric anesthesiology faculty. RESULTS Residents in Group A showed improvement between the first week and fifth week assessment as well as between first week and eighth week assessments without decrement between the fifth week and eighth week assessments for both the laryngospasm and SVT scenarios. Residents in Group B showed improvement between the first week and eighth week assessments for both scenarios and between the fifth week and eighth week assessment for the SVT scenario. CONCLUSION This adjunctive simulation-based curriculum enhanced the learner's management of laryngospasm and SVT management and is a reasonable addition to didactic and clinical curricula for anesthesiology residents.
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Affiliation(s)
- Aditee P Ambardekar
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical School, Dallas, Texas
| | - Stephanie Black
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Devika Singh
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Justin L Lockman
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Allan F Simpao
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alan J Schwartz
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Roberta L Hales
- Center for Simulation, Advanced Education, and Innovation, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - David L Rodgers
- Clinical Simulation Center, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | - Harshad G Gurnaney
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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217
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Aldarweesh F, Rose WN. Transfusion Medicine Education for Anesthesiology Residents: A Novel Curriculum. Acad Pathol 2019; 6:2374289519855729. [PMID: 31236442 PMCID: PMC6572327 DOI: 10.1177/2374289519855729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/07/2019] [Accepted: 04/13/2019] [Indexed: 11/26/2022] Open
Abstract
Transfusion medicine education for anesthesiology residents was an unmet need at our institution. Our goal was to develop a detailed and organized curriculum to introduce the essentials of transfusion medicine to first-year anesthesiology residents during a 3-week shared rotation. Based on our observations and the residents’ feedback, the curriculum was modified after each year with the goal of creating a more resident-focused educational experience. Here, we report our 3-year experience of creating, teaching, and revising this curriculum to 35 residents, and we share our detailed curricula and learning aids (including over 100 directing questions for reading assignments) so that the interested reader can begin using them immediately.
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Affiliation(s)
- Fatima Aldarweesh
- Department of Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - William Nicholas Rose
- Department of Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
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218
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Amirhajlou L, Sohrabi Z, Alebouyeh MR, Tavakoli N, Haghighi RZ, Hashemi A, Asoodeh A. Application of data mining techniques for predicting residents' performance on pre-board examinations: A case study. J Educ Health Promot 2019; 8:108. [PMID: 31334260 PMCID: PMC6615122 DOI: 10.4103/jehp.jehp_394_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 02/01/2019] [Indexed: 05/24/2023]
Abstract
CONTEXT Predicting residents' academic performance is critical for medical educational institutions to plan strategies for improving their achievement. AIMS This study aimed to predict the performance of residents on preboard examinations based on the results of in-training examinations (ITE) using various educational data mining (DM) techniques. SETTINGS AND DESIGN This research was a descriptive cross-sectional pilot study conducted at Iran University of Medical Sciences, Iran. PARTICIPANTS AND METHODS A sample of 841 residents in six specialties participating in the ITEs between 2004 and 2014 was selected through convenience sampling. Data were collected from the residency training database using a researcher-made checklist. STATISTICAL ANALYSIS The analysis of variance was performed to compare mean scores between specialties, and multiple-regression was conducted to examine the relationship between the independent variables (ITEs scores in postgraduate 1st year [PGY1] to PG 3rd year [PGY3], sex, and type of specialty training) and the dependent variable (scores of postgraduate 4th year called preboard). Next, three DM algorithms, including multi-layer perceptron artificial neural network (MLP-ANN), support vector machine, and linear regression were utilized to build the prediction models of preboard examination scores. The performance of models was analyzed based on the root mean square error (RMSE) and mean absolute error (MAE). In the final step, the MLP-ANN was employed to find the association rules. Data analysis was performed in SPSS 22 and RapidMiner 7.1.001. RESULTS The ITE scores on the PGY-2 and PGY-3 and the type of specialty training were the predictors of scores on the preboard examination (R 2 = 0.129, P < 0.01). The algorithm with the overall best results in terms of measuring error values was MLP-ANN with the condition of ten-fold cross-validation (RMSE = 0.325, MAE = 0.212). Finally, MLP-ANN was utilized to find the efficient rules. CONCLUSIONS According to the results of the study, MLP-ANN was recognized to be useful in the evaluation of student performance on the ITEs. It is suggested that medical, educational databases be enhanced to benefit from the potential of DM approach in the identification of residents at risk, allowing instructors to offer constructive advice in a timely manner.
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Affiliation(s)
- Leila Amirhajlou
- Department of Medical Education, Iran University of Medical Sciences, Tehran, Iran
| | - Zohre Sohrabi
- Department of Medical Education, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Reza Alebouyeh
- Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Nader Tavakoli
- Department of Emergency Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Roghye Zare Haghighi
- Department of Deputy of Specialty and Subspecialty Education, Iran University of Medical Sciences, Tehran, Iran
| | - Akram Hashemi
- Department of Medical Ethics, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Asoodeh
- Health Laboratories Administration, Birjand University of Medical Sciences, Birjand, Iran
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219
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Giordano L, Oliviero A, Peretti GM, Maffulli N. The presence of residents during orthopedic operation exerts no negative influence on outcome. Br Med Bull 2019; 130:65-80. [PMID: 31049559 DOI: 10.1093/bmb/ldz009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 02/05/2019] [Accepted: 03/26/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Operative procedural training is a key component of orthopedic surgery residency. It is unclear how and whether residents participation in orthopedic surgical procedures impacts on post-operative outcomes. SOURCES OF DATA A systematic search was performed to identify articles in which the presence of a resident in the operating room was certified, and was compared with interventions without the presence of residents. AREAS OF AGREEMENT There is a likely beneficial role of residents in the operating room, and there is only a weak association between the presence of a resident and a worse outcome for orthopedic surgical patients. AREAS OF CONTROVERSY Most of the studies were undertaken in USA, and this represents a limit from the point of view of comparison with other academic and clinical realities. GROWING POINT The data provide support for continued and perhaps increased involvement of resident in orthopedic surgery. AREAS OF RESEARCH To clarify the role of residents on clinically relevant outcomes in orthopedic patients, appropriately powered randomized control trials should be planned.
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Affiliation(s)
- Lorenzo Giordano
- Department of Musculoskeletal Disorder, Faculty of Medicine and Surgery, University of Salerno, Salerno Italy
| | - Antonio Oliviero
- Department of Musculoskeletal Disorder, Faculty of Medicine and Surgery, University of Salerno, Salerno Italy
| | | | - Nicola Maffulli
- Department of Musculoskeletal Disorder, Faculty of Medicine and Surgery, University of Salerno, Salerno Italy.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK.,Institute of Science and Technology in Medicine, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, UK
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220
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Shim JY, Park S, Kim GE, Jeong YS, Kim JH, Lee E, Lee EJ, Kim TH, Park SY. Does Physician Leadership Influence Followers' Hand Hygiene Compliance? Open Forum Infect Dis 2019; 6:ofz236. [PMID: 31263732 PMCID: PMC6590979 DOI: 10.1093/ofid/ofz236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 05/16/2019] [Indexed: 11/15/2022] Open
Abstract
The aim of this study was to determine factors influencing the hand hygiene compliance of a physician. We found a strong correlation between a leader’s (staff member’s or fellow’s) and a follower’s (resident’s) hand hygiene compliance. Followers’ appropriate hand hygiene compliance was significantly associated with the compliance of the leader (P = .01).
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Affiliation(s)
- Jeong-Yun Shim
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Suyeon Park
- Department of Biostatics, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Gil Eun Kim
- Infection Control Team, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Yeon Su Jeong
- Infection Control Team, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Jin Hwa Kim
- Infection Control Team, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Eunyoung Lee
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Eun Jung Lee
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Tae Hyong Kim
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Se Yoon Park
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
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221
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Rogers TS, Wilcox R, Harm SK. Design and Implementation of a Pathology-Specific Handoff Tool for Residents. Acad Pathol 2019; 6:2374289519839186. [PMID: 31058216 PMCID: PMC6452587 DOI: 10.1177/2374289519839186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/18/2019] [Accepted: 02/27/2019] [Indexed: 11/15/2022] Open
Abstract
Miscommunication is a source of clinical errors. Tools to decrease the risk of miscommunication (ie, patient handoff tools) are routinely used in clinical specialties that see patients but not routinely used in pathology residency programs. Our primary goal was to develop a structured handoff tool for pathology residents useful for both patient-specific communication and information about general laboratory operation with a secondary goal to increase resident confidence in on-call situations. The CATCH tool was developed and implemented in a pathology residency program with a pre- and postimplementation survey given to residents. The structured handoff tool for pathology residents provided consistent and timely communication between residents and attending physicians. Resident confidence with pathology on-call issues was more likely related to progression through the residency training program rather than implementation of a structured handoff tool.
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Affiliation(s)
- Thomas S Rogers
- Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, VT, USA.,The Robert Larner MD College of Medicine at The University of Vermont, Burlington, VT, USA
| | - Rebecca Wilcox
- Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, VT, USA.,The Robert Larner MD College of Medicine at The University of Vermont, Burlington, VT, USA
| | - Sarah K Harm
- Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, VT, USA.,The Robert Larner MD College of Medicine at The University of Vermont, Burlington, VT, USA
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222
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Kaya R, Benli AR, Cebecik A, Sunay D. Self-assessment of residents in respect of attitudes to communication. Prim Health Care Res Dev 2019; 20:e32. [PMID: 32800016 DOI: 10.1017/S1463423618000920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aim As communication skills are essential for medical practice, many medical schools have added communication skills training to their curricula in recent years. The aim of this study was to determine and compare the attitudes to communication skills of family medicine, internal medicine and general surgery residents. Materials and methods Family medicine, internal medicine and general surgery residents of three training and research hospitals and one university hospital in Ankara were included in this cross-sectional study. A questionnaire was used for obtaining information about age, gender, marital status, graduation date and whether receiving any training for communication skills. The Turkish version of the Communication Skills Attitude Scale was used. Results In all, 58 (50%) family medicine, 30 (25.9%) internal medicine, and 28 (24.1%) general surgery residents were accepted to participate in the study. Of the 116 residents, 58 (50%) were female and 58 (50%) were male, with a mean age of 29.47±4.63 years, and 68 (58.6%) of them were married; 59.5% of the participants received training about communication skills and 56.5% of them received it at medical school. The mean positive attitude scale (PAS) score was 3.85±0.58, and the mean negative attitude scale (NAS) score was 2.42±0.52. The PAS scores of female residents were higher than those of males (P=0.01). The PAS scores of residents who received communication skills training were higher than the scores of those who had not (P=0.01). The PAS scores of family medicine residents were higher and the NAS scores were lower than those of internal medicine and general surgery residents. Conclusion The communication skill attitudes of family medicine residents were better than those of internal medicine and general surgery residents.
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223
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Kemper KJ, Wilson PM, Schwartz A, Mahan JD, Batra M, Staples BB, McClafferty H, Schubert CJ, Serwint JR. Burnout in Pediatric Residents: Comparing Brief Screening Questions to the Maslach Burnout Inventory. Acad Pediatr 2019; 19:251-255. [PMID: 30395934 DOI: 10.1016/j.acap.2018.11.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/24/2018] [Accepted: 11/02/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Measuring burnout symptoms is important, but the Maslach Burnout Inventory (MBI) has 22 items. This project compared 3 single-item measures with the MBI and other factors related to burnout. METHODS Data were analyzed from the 2016 and 2017 Pediatric Resident Burnout-Resilience Study Consortium surveys, which included standard measures of perceived stress, mindfulness, resilience, and self-compassion; the MBI; and the 1- and 2-item screening questions. RESULTS In 2016 and 2017, data were collected from 1785/2723 (65%) and 2148/3273 (66%) eligible pediatric residents, respectively. Burnout rates on the MBI were 56% in 2016 and 54% in 2017. The Physician Work Life Study item generated estimates of burnout prevalence of 43% to 49% and, compared with the MBI for 2016 and 2017, had sensitivities of 69% to 72%, specificities of 79% to 82%, positive likelihood ratios of 3.4 to 3.8, and negative likelihood ratios of 0.35 to 0.38. The combination of an emotional exhaustion item and a depersonalization item generated burnout estimates of 53% in both years and, compared with the full MBI, had sensitivities of 85% to 87%, specificities of 84% to 85%, positive likelihood ratios of 5.7 to 6.4, and negative likelihood ratios of 0.18 for both years. Both items were significantly correlated with their parent subscales. The single items were significantly correlated with stress, mindfulness, resilience, and self-compassion. CONCLUSIONS The 1- and 2-item screens generated prevalence estimates similar to the MBI and were correlated with variables associated with burnout. The 1- and 2-item screens may be useful for pediatric residency training programs tracking burnout symptoms and response to interventions.
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Affiliation(s)
- Kathi J Kemper
- College of Medicine, The Ohio State University (KJ Kemper).
| | - Paria M Wilson
- Nationwide Children's Hospital and the Department of Pediatrics, College of Medicine, The Ohio State University College of Medicine (JD Mahan), Columbus, Ohio
| | - Alan Schwartz
- Department of Pediatrics, University of Cincinnati and Cincinnati Children's Hospital Medical Center (CJ Schubert), Cincinnati, Ohio
| | - John D Mahan
- Department of Pediatrics, Division of Emergency Medicine (P Wilson), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa
| | - Maneesh Batra
- Department of Medical Education and Pediatrics (A Schwartz), University of Illinois College of Medicine, Chicago, Ill
| | - Betty B Staples
- Department of Pediatrics (M Batra), Seattle Children's Hospital, Seattle, Wash
| | - Hilary McClafferty
- Department of Pediatrics (B Staples), Duke University Medical Center, Durham, NC
| | - Charles J Schubert
- Department of Medicine (HMcClafferty), University of Arizona College of Medicine, Tucson, Ariz
| | - Janet R Serwint
- Department of Pediatrics (JR Serwint), The Johns Hopkins University, Baltimore, Md
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Kumar A, Chi J. CMS Billing Guidelines and Student Documentation: a New Era or New Burden? J Gen Intern Med 2019; 34:634-635. [PMID: 30756301 PMCID: PMC6446003 DOI: 10.1007/s11606-019-04853-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/20/2018] [Accepted: 01/22/2019] [Indexed: 11/29/2022]
Abstract
The Centers for Medicare and Medicaid Services (CMS) recently revised their Medicare Claims Processing Manual with the addition of CR 10412, a provision that permits teaching providers to fully bill for medical student notes. This change will have significant implications on the documentation duties of teaching physicians and trainees. Potential benefits of this provision include reduced documentation burden on house officers, improved medical student empowerment, and the infusion of more original content into the electronic medical record. However, these benefits may be offset by shifting the burden of documentation onto medical students, which may compromise their time spent with patients and overall wellness. In this perspective, we review the changes that occurred with CR 10412 and their potential impact on documentation across the medical education spectrum.
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Affiliation(s)
- Andre Kumar
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Dr. Stanford, Stanford, CA, 94305, USA.
| | - Jeffrey Chi
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Dr. Stanford, Stanford, CA, 94305, USA
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225
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Zafar S, Chen X, Sikder S, Srikumaran D, Woreta FA. Outcomes of resident-performed small incision cataract surgery in a university-based practice in the USA. Clin Ophthalmol 2019; 13:529-534. [PMID: 30962673 PMCID: PMC6433105 DOI: 10.2147/opth.s198870] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose To assess outcomes of resident-performed small incision cataract surgery (SICS) at a single academic institute and to determine the availability of SICS-oriented educational resources in residency programs across the USA. Patients and methods A retrospective chart review was conducted on all patients who underwent SICS performed by postgraduate year 4 residents between January 2014 and January 2018 at the Wilmer Eye Institute, Baltimore, MD, USA. Postoperative visual acuity, intraoperative complications, and postoperative complications were the main outcomes measured. In addition, a survey was administered to all ophthalmology residency program directors in the USA to assess the presence of SICS-related content in their surgical training curriculum. Results Twenty-two eyes of 17 patients underwent planned resident-performed SICS, mainly for white cataracts. Intraoperative complications occurred in two (9.1%) eyes. The most common postoperative complication was transient increased intraocular pressure (two eyes, 9.1%). Mean preoperative best-corrected visual acuity (BCVA) was approximately 20/4,000. The large majority (95.2%) of eyes experienced improved BCVA following SICS, with a mean postoperative BCVA of 20/138 over an average follow-up of 4.2 months. Forty-seven programs responded to the survey (40.1% response rate). Residents were trained in SICS in 66.7% of these programs. However, more than half of all the programs did not have SICS-oriented educational resources available for residents. Conclusion Resident-performed SICS was found to be a safe and effective technique for cataract management. Considering the limited surgical volume for SICS in the USA, training programs might instead consider implementing SICS-oriented content in their surgical curriculum, including wet labs.
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Affiliation(s)
- Sidra Zafar
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD, USA,
| | - Xinyi Chen
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD, USA,
| | - Shameema Sikder
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD, USA,
| | - Divya Srikumaran
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD, USA,
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD, USA,
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226
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Yamamoto R, Mokuno Y, Matsubara H, Kaneko H, Iyomasa S. Feasibility and Safety of Laparoscopic Appendectomy Performed by Residents with No Experience in Open Appendectomy. JMA J 2019; 2:54-59. [PMID: 33681513 PMCID: PMC7930708 DOI: 10.31662/jmaj.2018-0037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/12/2018] [Indexed: 01/07/2023] Open
Abstract
Introduction: Open appendectomy for acute appendicitis is a common procedure for surgical residents to perform at the beginning of their training. Recently, many programs have moved to laparoscopic appendectomy as the initial training procedure. However, the feasibility and safety of laparoscopic appendectomy for acute appendicitis performed by surgical residents without any experience of open appendectomy remains controversial. Methods: The records of patients who underwent laparoscopic appendectomy for acute appendicitis between August 2006 and March 2017 were retrospectively reviewed. Patients were assigned to two groups according to whether their procedure was performed by a surgical resident, with no experience of open appendectomy, or a surgical fellow, with adequate open appendectomy experience but no experience with laparoscopic appendectomy. Results: A total of 130 patients were included. Five residents performed 104 procedures, and three fellows performed 26 procedures. The baseline patient characteristics were comparable between groups. The median operative time was comparable (77.0 min vs. 65.5 min; p = 0.771). There were no significant differences in overall complications; with 14 patients (13%) in the resident group and five patients (19%) in the fellow group experienced complications (p = 0.535). No patient required reoperation, and there were no fatalities. The median length of stay was similar (5.0 days vs. 5.5 days; p = 0.430). Conclusions: Laparoscopic appendectomy for acute appendicitis is feasible and safe when performed by surgical residents with no prior open appendectomy experience. It may be performed as the first procedure during surgical training with no adverse effect on patients.
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Affiliation(s)
| | - Yasuji Mokuno
- Department of Surgery, Yachiyo Hospital, Anjo, Japan
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227
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Abstract
Migratory animals undergo seasonal and often spectacular movements and perform crucial ecosystem services. In response to anthropogenic changes, including food subsidies, some migratory animals are now migrating shorter distances or halting migration altogether and forming resident populations. Recent studies suggest that shifts in migratory behaviour can alter the risk of infection for wildlife. Although migration is commonly assumed to enhance pathogen spread, for many species, migration has the opposite effect of lowering infection risk, if animals escape from habitats where pathogen stages have accumulated or if strenuous journeys cull infected hosts. Here, we summarize responses of migratory species to supplemental feeding and review modelling and empirical work that provides support for mechanisms through which resource-induced changes in migration can alter pathogen transmission. In particular, we focus on the well-studied example of monarch butterflies and their protozoan parasites in North America. We also identify areas for future research, including combining new technologies for tracking animal movements with pathogen surveillance and exploring potential evolutionary responses of hosts and pathogens to changing movement patterns. Given that many migratory animals harbour pathogens of conservation concern and zoonotic potential, studies that document ongoing shifts in migratory behaviour and infection risk are vitally needed.This article is part of the theme issue 'Anthropogenic resource subsidies and host-parasite dynamics in wildlife'.
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Affiliation(s)
- Dara A Satterfield
- Migratory Bird Center, Smithsonian Conservation Biology Institute, National Zoological Park, Washington, DC, USA
| | - Peter P Marra
- Migratory Bird Center, Smithsonian Conservation Biology Institute, National Zoological Park, Washington, DC, USA
| | - T Scott Sillett
- Migratory Bird Center, Smithsonian Conservation Biology Institute, National Zoological Park, Washington, DC, USA
| | - Sonia Altizer
- Odum School of Ecology, University of Georgia, Athens, GA, USA
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228
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Huang L, Harsh J, Cui H, Wu J, Thai J, Zhang X, Cheng L, Wu W. A Randomized Controlled Trial of Balint Groups to Prevent Burnout Among Residents in China. Front Psychiatry 2019; 10:957. [PMID: 32116808 PMCID: PMC7026367 DOI: 10.3389/fpsyt.2019.00957] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 12/04/2019] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Burnout is highly prevalent among residents and is associated with negative outcomes for patients, organizations, and physicians. Balint groups have been shown to be an effective strategy to alleviate physicians' burnout. The purpose of this study was to examine the effectiveness and feasibility of Balint groups in preventing burnout among residents in training programs in China. METHODS 36 resident physicians in their first year of residency at a comprehensive hospital in China were randomly assigned to two groups. Physicians in the intervention group participated in 2 lectures and 10 Balint sessions for 6 months, while participants in the control group were placed on a waitlist for future Balint sessions. All 36 participants completed burnout and job satisfaction measures pre and post-intervention. RESULTS The mean burnout subscale scores for EE and DP decreased, and the scores for PA and job satisfaction increased after Balint group participation. However, paired t-test results revealed there were no statistically significant differences between pre and post-test scores for EE (t = -1.323, p = 0.203), DP (t = -0.727, p = 0.477), PA (t = 0.716, p = 0.484, and job satisfaction (t = 0.282, p = 0.781) for the intervention group. For the control group, the burnout subscale scores for EE (t = 2.312, p = 0.034) and DP (t = 2.898, p = 0.019) increased, and there were statistically significant differences between pre and post-test. PA (t = -0.717, p = 0.483) and job satisfaction (t = -0.241, p = 0.812) scores decreased although there were no significant differences seen between the pre and post-test. Independent t-test results demonstrated statistically significant differences in scores for EE (t = -2.662, p = 0.013) and DP (t = -2.433, p = 0.020) between intervention and control group. However, there were not statistically significant differences between groups for scores in PA (t = 1.013, p = 0.318) and job satisfaction (t = 0.367, p = 0.716). All 18 participants in the intervention group reported that Balint groups were helpful and that they would be willing to attend future sessions. Overall satisfaction with the Balint group program was over 80%. CONCLUSION Balint groups are an efficacious, feasible, standardized method of preventing resident burnout. Residents in China may benefit from Balint group implementation in residency training programs.
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Affiliation(s)
- Lei Huang
- Department of Psychiatry, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.,Medical Education Division, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jennifer Harsh
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Haisong Cui
- Department of Psychiatry, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jiaxin Wu
- Tongji University School of Medicine, Shanghai, China
| | - Jessica Thai
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Xu Zhang
- Department of Psychiatry, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Liming Cheng
- Department of Orthopedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wenyuan Wu
- Department of Psychiatry, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
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229
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Carender CN, Shamrock AG, An Q, Karam MD. Variability in Experience Performing Lower Extremity Amputations Between Surgical Residents: An Examination Of ACGME Case Logs. Iowa Orthop J 2019; 39:15-20. [PMID: 31413669 PMCID: PMC6604556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND There is a wide array of indications for lower extremity amputation (LEA) and inherent variability in operative experiences between surgical residents. Significant variation in resident surgical experience performing LEAs is possible. OBJECTIVE To identify inter- and intra-specialty trends and variability in LEA experience in graduating orthopedic surgery, general surgery, and vascular surgery residents from 2007-2017. METHODS Publicly available ACGME case log data for above knee amputation, below knee amputation, and transmetatarsal/ digital amputation procedures from accredited orthopaedic surgery, general surgery, traditional (5+2) vascular surgery and integrated (0+5) vascular surgery residencies was reviewed from 2007-2017. Linear regression analysis was used to identify temporal trends, with statistical significance set at p<0.05. RESULTS From 2007-2017, the mean number of total LEA, AKA, and BKA performed by graduating orthopaedic surgery residents did not change significantly. The mean number of total LEAs logged by graduating general surgery and integrated (0+5) vascular surgery residents did not change significantly over time (p=0.98, p=0.23, respectively). The mean number of total LEAs logged by traditional (5+2) vascular surgery residents increased from 16.0 to 32.6 (p<0.01). As study year increased, graduating integrated (0+5) and traditional (5+2) vascular surgery residents logged more LEAs relative to graduating orthopaedic surgery and general surgery residents (p<0.01). CONCLUSIONS There is significant variation in resident experience in LEAs between surgical specialties. Integrated vascular surgery residents logged the most LEAs, followed by traditional vascular surgery residents, orthopaedic surgery residents, and general surgery residents. Experience of orthopaedic surgery residents in LEAs has been relatively stable over time.Level of Evidence: IV.
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Affiliation(s)
- Christopher N Carender
- Department of Orthopedics and Rehabilitation University of Iowa Hospitals and ClinicsIowa City, IA
| | - Alan G Shamrock
- Department of Orthopedics and Rehabilitation University of Iowa Hospitals and ClinicsIowa City, IA
| | - Qiang An
- Department of Orthopedics and Rehabilitation University of Iowa Hospitals and ClinicsIowa City, IA
| | - Matthew D Karam
- Department of Orthopedics and Rehabilitation University of Iowa Hospitals and ClinicsIowa City, IA
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Abstract
Objective: To determine the burnout among postgraduate residents’ and junior consultants in a tertiary care hospital. Methods: This cross-sectional study was conducted among the postgraduate residents (PGR) and junior consultants (JC) working at The Children’s Hospital Lahore in 2018. Participants were asked to complete Copenhagen Burnout Inventory questionnaire about burnout on 5 point Likert scale. ‘100 (always), 75 (often), 50 (sometimes), 25 (seldom) and 0 (never/almost never or according to intensity ranging from ‘a very low degree’ to ‘to a very high degree’. Data was analyzed using SPSS version 22. Three questions were added related to hospital factors but scored separately. Students t-test and chi square test were used to compare the burnout. Results: A total of 227 participants including 177 PGR and 50 JC completed the questionnaire with a response rate of 84% and 86% respectively. There was a female predominance, 140 participants (61.7%) were female. Majority was from pediatric medicine 173 (76.2%). The mean personal and work related-burnout was high among PGRs as compared to JCs (18.68±5.01vs 16.62±4.57) (p=0.008) and (21.14±5.57 vs. 18.56±5.52) (p=0.004) respectively. Similarly, there was significantly more burnout among pediatric medicine study participants as compared to surgery and diagnostic in all domains (personal BO; p=0.030, work-related BO; p=0.021, patient related BO; 0.033 and hospital related BO; 0.001). No difference were noted based on gender and year of training. Conclusion: Tertiary care hospital postgraduate residents and junior consultants face moderate burnout. Postgraduate residents had significantly more burnout as compared to junior consultants and majority was from pediatric medicine.
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Affiliation(s)
- Attia Bari
- Attia Bari, MBBS, D.C.H, M.C.P.S, F.C.P.S., MHPE Associate Professor, Department of Paediatric Medicine, The Children's Hospital and The Institute of Child Health, Lahore, Pakistan
| | - Rizwan Kamran
- Rizwana Kamran, MBBS, MHPE. Assistant Professor, CMH Lahore Medical College & Institute of Dentistry (NUMS), Lahore, Pakistan
| | - Farah Haroon
- Farah Haroon, MBBS, FCPS (Paediatric Medicine), FCPS (Neonatology) Associate Professor Pediatric Neonatology, Department of Paediatric Medicine, The Children's Hospital and The Institute of Child Health, Lahore, Pakistan
| | - Iqbal Bano
- Iqbal Bano, MBBS, F.C.P.S. Associate Professor, Department of Paediatric Medicine, The Children's Hospital and The Institute of Child Health, Lahore, Pakistan
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231
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Laure Boillod A, Biard N. [A place for intimacy and sexuality in nursing homes]. Soins 2018; 63:48-51. [PMID: 30551755 DOI: 10.1016/j.soin.2018.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In nursing homes, intimacy is threatened by the increased dependence and lack of support. It is nevertheless possible to preserve it, meaning it is possible to ensure a continuity of existence for the elderly person in an institution.
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Affiliation(s)
| | - Nicolas Biard
- c/o Soins, Elsevier Masson SAS, 65, rue Camille-Desmoulins, 92442 Issy-les-Moulineaux, France.
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232
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Hédont S, Le Guillou A, Letty A, Denormandie P, Sanchez S. [Non-pharmacological therapies and neuropsychological disorders in institutions]. Soins Gerontol 2018; 23:32-35. [PMID: 30449368 DOI: 10.1016/j.sger.2018.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Non-pharmacological therapies are now used in many nursing homes often with residents presenting a risk of behavioural disorders. They include music therapy, animal-assisted therapy, physical activity as well as other approaches such as light therapy or aromatherapy. It requires rigorous assessment, the permanent involvement and engagement of residents as well as the staff as part of a compassionate and participative approach.
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Affiliation(s)
- Stéfane Hédont
- Fondation du Bien Vieillir, Korian, 21-25, rue Balzac, 75008 Paris, France
| | - Adrien Le Guillou
- Pôle information médicale évaluation performance, Centre hospitalier de Troyes, 101, avenue Anatole-France, 10000 Troyes, France
| | - Aude Letty
- Fondation du Bien Vieillir, Korian, 21-25, rue Balzac, 75008 Paris, France
| | | | - Stéphane Sanchez
- Fondation du Bien Vieillir, Korian, 21-25, rue Balzac, 75008 Paris, France; Pôle information médicale évaluation performance, Centre hospitalier de Troyes, 101, avenue Anatole-France, 10000 Troyes, France.
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233
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Javet F. [Restraint in nursing homes, the psychologist's point of view]. Rev Infirm 2018; 67:29-30. [PMID: 30415685 DOI: 10.1016/j.revinf.2018.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
With regard to restraint, the caregiving teams are confronted on a daily basis with various issues which reveal a clash between the respect of a person's rights and dignity and the need to protect and provide a safe environment. The triangular relationship between the resident, their family and the multidisciplinary caregiving team can result in the construction of a response to this dilemma between liberty and safety.
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Affiliation(s)
- Fanny Javet
- Hôpital de jour gériatrique, Évaluation du CHU Grenoble Alpes, CS 10217, 38043 Grenoble cedex 9, France.
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234
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Joshi ART, Klingensmith ME, Malangoni MA, Delman KA, Korndorffer JR, Smink DS, Barrett KB, Hickey M. Best Practice for Implementation of the SCORE Portal in General Surgery Residency Training Programs. J Surg Educ 2018; 75:e11-e16. [PMID: 29793808 DOI: 10.1016/j.jsurg.2018.04.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 04/19/2018] [Indexed: 05/26/2023]
Abstract
INTRODUCTION The Surgical Council on Resident Education (SCORE) has presented a workshop annually at the annual meeting of the Association of Program Directors (APDS) to discuss the evolution of the SCORE portal and best practices for implementation within residency training programs. METHODS/RESULTS A review of the literature was undertaken, along with a summation of discussion at these several workshops. A history of the SCORE project and a summary of its organizational framework and content are presented. In addition, best practices for use of SCORE within programs are described. CONCLUSIONS The SCORE portal is now a decade old, and is used ubiquitously in US surgical training programs. With this experience, there is data to show the utility of SCORE to support trainee learning and programmatic didactics.
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Affiliation(s)
- Amit R T Joshi
- Department of Surgery, Einstein Healthcare Network, Philadelphia, Pennsylvania.
| | | | | | - Keith A Delman
- Department of Surgery, Emory University-Winship Cancer Institute, Atlanta, Georgia
| | | | - Douglas S Smink
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kerry B Barrett
- Surgical Council on Resident Education, Philadelphia, Pennsylvania
| | - Mark Hickey
- Surgical Council on Resident Education, Philadelphia, Pennsylvania
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Yari SS, Jandhyala CK, Sharareh B, Athiviraham A, Shybut TB. Efficacy of a Virtual Arthroscopic Simulator for Orthopaedic Surgery Residents by Year in Training. Orthop J Sports Med 2018; 6:2325967118810176. [PMID: 30480024 PMCID: PMC6249662 DOI: 10.1177/2325967118810176] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Virtual reality arthroscopic simulators are an attractive option for resident training and are increasingly used across training programs. However, no study has analyzed the utility of simulators for trainees based on their level of training/postgraduate year (PGY). PURPOSE/HYPOTHESIS The primary aim of this study was to determine the utility of the ArthroS arthroscopic simulator for orthopaedic trainees based on their level of training. We hypothesized that residents at all levels would show similar improvements in performance after completion of the training modules. STUDY DESIGN Descriptive laboratory study. METHODS Eighteen orthopaedic surgery residents performed diagnostic knee and shoulder tasks on the ArthroS simulator. Participants completed a series of training modules and then repeated the diagnostic tasks. Correlation coefficients (r 2) were calculated for improvements in the mean composite score (based on the Imperial Global Arthroscopy Rating Scale [IGARS]) as a function of PGY. RESULTS The mean improvement in the composite score for participants as a whole was 11.2 ± 10.0 points (P = .0003) for the knee simulator and 14.9 ± 10.9 points (P = .0352) for the shoulder simulator. When broken down by PGY, all groups showed improvement, with greater improvements seen for junior-level residents in the knee simulator and greater improvements seen for senior-level residents in the shoulder simulator. Analysis of variance for the score improvement variable among the different PGY groups yielded an f value of 1.640 (P = .2258) for the knee simulator data and an f value of 0.2292 (P = .917) for the shoulder simulator data. The correlation coefficient (r 2) was -0.866 for the knee score improvement and 0.887 for the shoulder score improvement. CONCLUSION Residents training on a virtual arthroscopic simulator made significant improvements in both knee and shoulder arthroscopic surgery skills. CLINICAL RELEVANCE The current study adds to mounting evidence supporting virtual arthroscopic simulator-based training for orthopaedic residents. Most significantly, this study also provides a baseline for evidence-based targeted use of arthroscopic simulators based on resident training level.
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Affiliation(s)
- Shahram S. Yari
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas, USA
| | | | - Behnam Sharareh
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Aravind Athiviraham
- Department of Orthopaedic Surgery, University of Chicago, Chicago, Illinois, USA
| | - Theodore B. Shybut
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas, USA
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Acheampong DO, Paul P, Guerrier S, Boateng P, Leitman IM. Effect of Resident Involvement on Morbidity and Mortality Following Thoracic Endovascular Aortic Repair. J Surg Educ 2018; 75:1575-1582. [PMID: 29709469 DOI: 10.1016/j.jsurg.2018.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 03/27/2018] [Accepted: 04/08/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To evaluate the effect of resident involvement in thoracic endovascular aortic repair (TEVAR). SUMMARY OF BACKGROUND DATA Although the influence of resident intraoperative involvement in several types of surgical procedures has been reported, the effect of resident participation in TEVAR is unknown. We evaluated patient outcomes in resident-involved TEVAR procedures. METHODS The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was analyzed for TEVAR performed from 2010 to 2012. Current procedural terminology codes were used to identify adult patients (≥18 y) who underwent TEVAR. Patients were grouped into those with and without resident involvement. Descriptive and binomial logistic statistics were used to determine the effect of resident involvement on post-TEVAR outcomes. p values < 0.05 were considered statistically significant. RESULTS A total of 676 patients met inclusion criteria for this study. Of these, 517 (76.5%) had residents involved. Overall mortality was 9.8%, with no significant difference between the 2 groups (p = 0.88). Resident involvement was not a significant predictor of any post-TEVAR complication. Postoperative pneumonia (3.5% vs 6.9%, p = 0.06), prolonged mechanical ventilation (11.8% vs 11.9%, p = 0.96), stroke (2.7% vs 5.7%, p = 0.07), urinary tract infection (3.3% vs 4.4%, p = 0.50), progressive renal insufficiency (1.2% vs 2.5%, p = 0.22), acute renal failure (4.1% vs 5.0%, p = 0.60), cardiac arrest (2.9% vs 5.0%, p = 0.20), myocardial infarction (1.7% vs 1.9%, p = 0.91), deep venous thrombosis (1.7% vs 1.3%, p = 0.67), red blood cells transfusions (29.2% vs 36.5%, p = 0.08), sepsis (2.9% vs 4.4%, p = 0.35), septic shock (1.9% vs 3.8%, p = 0.18), and unplanned reintubation (8.7% vs 9.4%, p = 0.78) were not significantly affected. Additionally, resident involvement did not significantly affect operative time (176.1 ± 122.8 min vs 180.3 ± 119.1 min, p = 0.71) and anesthesia time (282.1 ± 146.6 min vs 278.3 ± 140.5 min, p = 0.78). CONCLUSIONS The participation of residents in TEVAR did not significantly affect all 30-day patient outcomes. Resident involvement in TEVAR is safe and should be encouraged. MINI ABSTRACT This study evaluated the effect of resident participation on postoperative outcomes of thoracic endovascular aortic repair (TEVAR) using the American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP) database. Results showed that resident involvement in TEVAR does not negatively affect patient outcomes.
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Affiliation(s)
- Derrick O Acheampong
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Philip Paul
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Shanice Guerrier
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Percy Boateng
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - I Michael Leitman
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
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Vaattovaara E, Nikki M, Nevalainen M, Ilmarinen M, Tervonen O. Discrepancies in interpretation of night-time emergency computed tomography scans by radiology residents. Acta Radiol Open 2018; 7:2058460118807234. [PMID: 30364822 PMCID: PMC6198399 DOI: 10.1177/2058460118807234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/16/2018] [Indexed: 11/24/2022] Open
Abstract
Background In many emergency radiology units, most of the night-time work is performed
by radiology residents. Residents’ preliminary reports are typically
reviewed by an attending radiologist. Accordingly, it is known that
discrepancies in these preliminary reports exist. Purpose To evaluate the quality of night-time computed tomography (CT)
interpretations made by radiology residents in the emergency department. Material and Methods Retrospectively, 1463 initial night-time CT interpretations given by a
radiology resident were compared to the subspecialist’s re-interpretation
given the following weekday. All discrepancies were recorded and classified
into different groups regarding their possible adverse effect for the
emergency treatment. The rate of discrepancies was compared between more and
less experienced residents and between different anatomical regions. Results The overall rate of misinterpretations was low. In 2.3% (33/1463) of all
night-time CT interpretations, an important and clinically relevant
diagnosis was missed. No fatalities occurred due to CT misinterpretations
during the study. The total rate of discrepancies including clinically
irrelevant findings such as anatomical variations was 12.2% (179/1463). Less
experienced residents were more likely to miss the correct diagnosis than
more experienced residents (18.3% vs. 10.9%, odds ratio [OR] = 1.82,
P = 0.001). Discrepancies were more common in body CT
interpretations than in neurological CTs (18.1% vs. 9.1%, OR = 2.30,
P < 0.0001). Conclusion The rate of clinically important misinterpretations in CT examinations by
radiology residents was found to be low. Experience helps in lowering the
rate of misinterpretations.
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Affiliation(s)
- Elias Vaattovaara
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.,Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - Marko Nikki
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Mika Nevalainen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.,Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - Mervi Ilmarinen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Osmo Tervonen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.,Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
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238
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Krowl L, Gudlavalleti A, Patel A, Panebianco L, Kosters M, Dhamoon AS. A pilot study to standardize and peer-review shift handoffs in an academic internal medicine residency program: The DOCFISH method. Medicine (Baltimore) 2018; 97:e12798. [PMID: 30313109 PMCID: PMC6203497 DOI: 10.1097/md.0000000000012798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
With increased oversight of residency work hours, there has been an increase in shift handoffs, which are prone to medical errors. To date, there are no evidence-based recommendations on essential elements of shift handoffs. We implemented a standardized shift-handoff rubric at an academic medicine residency program. Compliance, resident/faculty perceptions, and surrogate markers of patient safety were measured.Shift-handoff documents were collected January-February 2016 (control) April-June 2016 (intervention). Signouts were scored based on inclusion of seven elements: Daily events, Overnight events, Code status, Follow up tasks, If/then statements, 'sick or stable' and History present illness. The mnemonic 'DOCFISH' was taught in a grand-rounds forum then embedded into a shift-handoff tool within our electronic health record (EHR). Senior residents were assigned to supervise/provide feedback on shift handoffs from April-June 2016. Faculty and resident perceptions regarding quality of shift handoffs was measured by the annual ACGME (Accreditation Council Graduate Medical Education) program survey.Patient safety was measured by number of rapid-response teams (RRT) initiated for unstable vital signs. Handoffs were 74% complete in intervention group and 60% in control group (p < .0001). Median DOCFISH features present in patients that required RRT was 3 of 7 whereas, total post-intervention group had 5 of 7 (p < .001). 'Daily events' and 'follow -up tasks' were less frequent in patients that required RRT (20%, 67% respectively, p < .001).Academic medical centers can implement standardized shift handoffs by embedding high-yield information in an EHR with peer-review. Information during shift changes that may have significant improvement on patient safety includes: 'daily events' and 'follow -up tasks.'
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Affiliation(s)
- Lauren Krowl
- Chief Medicine Resident Quality and Patient Safety, State University of New York (SUNY) Upstate Medical University, Syracuse, New York
| | - Aashrai Gudlavalleti
- Chief Neurology Resident Quality and Patient Safety, State University of New York (SUNY) Upstate Medical University, Syracuse, New York
| | - Arpan Patel
- Hematology/Oncology Fellow, University of Florida, Gainesville, Florida
| | - Lauren Panebianco
- Hematology/Oncology Fellow, State University of New York (SUNY) Upstate Medical University, Syracuse, New York
| | - Michael Kosters
- Pulmonary/Critical Care Fellow, State University of New York (SUNY) Upstate Medical University, Syracuse, New York
| | - Amit S. Dhamoon
- Assistant Professor of Medicine, State University of New York (SUNY) Upstate Medical University, Syracuse, New York, USA
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239
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Abstract
Objectives Emergency medicine (EM) residents are required to perform a cricothyrotomy during training as per the Accreditation Council for Graduate Medical Education (ACGME) guidelines. Cricothyrotomy is a rare procedure, comprising 0.45% of emergency department airway management procedures. Procedural competence in utilizing a realistic trainer is of utmost importance. We have developed a cricothyrotomy trainer using a fused deposition modeling (FDM) three-dimensional (3D) printer and innovative bleeding tissue to enhance fidelity. We aim to evaluate the trainer’s realism. Methods Implementation occurred during a difficult airway educational lab for EM residents in April 2018. Participants completed anonymous written surveys after performing a cricothyrotomy on the trainer. The survey evaluated the realism of the trainer and compared it to other available models by utilizing five-point visual analog scales (VAS). The participants rated their comfort level in performing the procedure pre- and post-educational lab on a five-point VAS. Demographic data included postgraduate year, prior clinical cricothyrotomy experience as a primary operator versus as an assistant, and previous trainer experience. The survey included open-response suggestions for trainer improvement. Results Forty-three EM residents completed the survey (82.7%, 43/52). The mean realism rating of the trainer was 3.81 (95% CI = 3.54-4.1). The participants reported previous training on cadaver (62.8%, 27/43), porcine (46.5%, 20/43), and manikin (67.4%, 29/43) models prior to using this trainer. The bleeding cricothyrotomy trainer was rated higher than other models (4.45, 95% CI = 4.28-4.63). Participants noted improved comfort with performing the cricothyrotomy after the educational lab (average improvement of 1.23±0.75). Participants specifically commented on the realism of the bleeding and skin texture; however, they also recommended a reduction in the size of the cricothyroid membrane space. Conclusion The innovative bleeding cricothyrotomy trainer has greater fidelity and reported superiority when compared to other commonly used nonbleeding models. This trainer provides a more advanced platform to teach an infrequent yet critical procedural skill to emergency medicine residents.
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Affiliation(s)
- Kate E Hughes
- Emergency Medicine, University of Arizona, Tucson, USA
| | - David Biffar
- Health Sciences, University of Arizona, Tucson, USA
| | - Eze O Ahanonu
- Electrical and Computer Engineering, University of Arizona, Tucson, USA
| | | | | | - John C Sakles
- Emergency Medicine, University of Arizona, Tucson, USA
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240
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Karlen AI, Solberg EJ, Quanbeck DS, Van Heest AE. Orthopaedic Surgery Residency Rotations and Correlation With Orthopaedic In-Training Examination Performance. J Surg Educ 2018; 75:1325-1328. [PMID: 29449163 DOI: 10.1016/j.jsurg.2018.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 12/07/2017] [Accepted: 01/24/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The Orthopaedic In-Training Examination (OITE) is administered annually and is used to assess medical knowledge of orthopedic surgery residents. Beginning in the 2013 to 2014 academic year, the ACGME expanded the postgraduate year (PGY)-1 curriculum from 3 to 6 months of orthopedic surgery rotations. The purpose of this study is to evaluate the effect of increased PGY-1 orthopedic surgery exposure on medical knowledge as measured by the OITE. DESIGN From 2011 to 2013, 24 PGY-2 residents completed 3 months of PGY-1 orthopedic training (Group 1). From 2014 to 2016, 24 PGY-2 residents completed 6 months of PGY-1 orthopedic training (Group 2). The effect of an initial PGY-2 pediatrics rotation (Sub-group A), compared to a trauma rotation (Sub-group B) was also analyzed. The hypothesis of this study is that Group 2 scores higher on the OITE than Group 1. Raw percentage and overall percentile scores for all PGY-2 residents from 2011 to 2016 for the pediatrics subsection, the trauma subsection, and for the overall OITE test in our program were recorded. Group 1 versus Group 2, and Sub-group A versus Sub-group B were compared (Student's t-test). SETTING University of Minnesota (Institutional, Tertiary); Gillette Children's Hospital (Institutional, Tertiary); Regions Hospital (Institutional, Tertiary). PARTICIPANTS 48 PGY-2 residents from 2011 to 2016 were included in the study. RESULTS Group 2 achieved higher raw and percentile scores on the OITE during their PGY-2 year than Group 1. Sub-group B scored higher than Sub-group A on all OITE subsections and overall. CONCLUSIONS This study suggests that raw percentage and percentile OITE scores improve with an additional 3 months of orthopedic training in the PGY-1 year. Clinical exposure, specifically in orthopedic trauma, correlates with higher OITE performance in our residency program.
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Affiliation(s)
- Aaron I Karlen
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Erik J Solberg
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Deborah S Quanbeck
- Department of Pediatric Orthopedics, Gillette Children's Specialty Healthcare, St. Paul, Minnesota
| | - Ann E Van Heest
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota.
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241
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Mendoza D, Peterson R, Ho C, Harri P, Baumgarten D, Mullins ME. Cultivating Future Radiology Educators: Development and Implementation of a Clinician-Educator Track for Residents. Acad Radiol 2018; 25:1227-1231. [PMID: 29731418 DOI: 10.1016/j.acra.2018.03.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 03/24/2018] [Accepted: 03/28/2018] [Indexed: 11/28/2022]
Abstract
Effective and dedicated educators are critical to the preservation and advancement of the practice of radiology. The need for innovative and adaptable educators is increasingly being recognized, with several institutions granting academic promotions through clinician-educator tracks. The implementation of resident "clinician-educator tracks" or "teaching tracks" should better prepare residents aspiring to become academic radiologists focused on teaching. In this work, we describe our experience in the development and implementation of a clinician-educator track for diagnostic radiology residents at our institution.
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Affiliation(s)
- Dexter Mendoza
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd. NE, D125A, Atlanta, GA 30322.
| | - Ryan Peterson
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd. NE, D125A, Atlanta, GA 30322
| | - Christopher Ho
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd. NE, D125A, Atlanta, GA 30322
| | - Peter Harri
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd. NE, D125A, Atlanta, GA 30322
| | - Deborah Baumgarten
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd. NE, D125A, Atlanta, GA 30322
| | - Mark E Mullins
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd. NE, D125A, Atlanta, GA 30322
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242
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Arroyo-Berezowsky C. [Development for an arthroscopy simulation program for orthopedic residents]. Acta Ortop Mex 2018; 32:297-302. [PMID: 30726593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND There are less and fewer opportunities for residents to learn and develop surgical skills in the operating room. In some parts of the world, the development and adaptation of technology for the teaching of psychomotor skills in surgical specialties appears. Arthroscopy is a surgical technique that lends itself to simulation. So far there is no such thing as a structured and validated arthroscopy training program for orthopaedic residents in Mexico. OBJECTIVE To propose a structured arthroscopy training plan that incorporates the simulation for orthopaedic residents. METHOD A review of the literature on teaching with simulation in orthopaedics and arthroscopy was performed, a study was conducted to establish reference values for arthroscopy exercises in a virtual reality simulator and a training plan was developed with Arthroscopy simulation for orthopaedic residents. RESULTS A seven-stage program was developed with theoretical classes and simulation to improve motor skills. The complexity of the procedures increases through the practical modules. It is complemented by a semester evaluation. DISCUSSION Currently most of the efforts in teaching with simulators focus on medical students and first-and second-year residents. I believe that efforts should be focused to include residents of higher ranks and surgeons. This design will be proposed to the orthopaedic Unique Medical Education Program (PUEM in Spanish). It is important to develop validated curricula that incorporate the simulation for the development of motor skills in orthopaedic residents.
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243
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Putnam MD, Adams JE, Lender P, Van Heest AE, Shanedling JR, Nuckley DJ, Bechtold JE. Examination of Skill Acquisition and Grader Bias in a Distal Radius Fracture Fixation Model. J Surg Educ 2018; 75:1299-1308. [PMID: 29502990 DOI: 10.1016/j.jsurg.2018.01.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/07/2017] [Accepted: 01/24/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Primary: Assess the ability of faculty graders to predict the objectively measured strength of distal radius fracture fixation. Secondary: Compare resident skill variation and retention related to other knowable training data. DESIGN Residents were allowed 60 minutes to stabilize a standardized distal radius fracture using an assigned fixed-angle volar plate. Faculty observed and subjectively graded the residents without providing real-time feedback. Objective biomechanical evaluation (construct strength and stiffness) was compared to subjective grades. Resident-specific characteristics (sex, PGY, and ACGME case log) were also used to compare the objective data. SETTING A simulated operating room in our laboratory. PARTICIPANTS Post-graduate year 2, 3, 4, and 5 orthopedic residents. RESULTS Primary: Faculty were not successful at predicting objectively measured fixation, and their subjective scoring suggests confirmation bias as PGY increased. Secondary: Resident year-in-training alone did not predict objective measures (p = 0.53), but was predictive of subjective scores (p < 0.001). Skills learned were not always retained, as 29% of residents objectively failed subsequent to passing. Notably, resident-reported case-specific experience alone was inversely correlated with objective fixation strength. CONCLUSIONS This testing model enabled the collection of objective and subjective resident skill scores. Faculty graders did not routinely predict objective measures, and their subjective assessment appears biased related to PGY. Also, in vivo case volume alone does not predict objective results. Familiar faculty teaching consistency, and resident grading by external faculty unfamiliar with tested residents, might alter these results.
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Affiliation(s)
- Matthew D Putnam
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota.
| | | | - Paul Lender
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Ann E Van Heest
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Janet R Shanedling
- Clinical and Translational Science, University of Minnesota, Minneapolis, Minnesota
| | | | - Joan E Bechtold
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota; Minneapolis Medical Research Foundation and Excelen Center for Bone and Joint Education and Research, Minneapolis, Minnesota.
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244
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Ahmet A, Gamze K, Rustem M, Sezen KA. Is Video-Based Education an Effective Method in Surgical Education? A Systematic Review. J Surg Educ 2018; 75:1150-1158. [PMID: 29449162 DOI: 10.1016/j.jsurg.2018.01.014] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/21/2017] [Accepted: 01/16/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Visual signs draw more attention during the learning process. Video is one of the most effective tool including a lot of visual cues. This systematic review set out to explore the influence of video in surgical education. We reviewed the current evidence for the video-based surgical education methods, discuss the advantages and disadvantages on the teaching of technical and nontechnical surgical skills. METHODS This systematic review was conducted according to the guidelines defined in the preferred reporting items for systematic reviews and meta-analyses statement. The electronic databases: the Cochrane Library, Medline (PubMED), and ProQuest were searched from their inception to the 30 January 2016. The Medical Subject Headings (MeSH) terms and keywords used were "video," "education," and "surgery." We analyzed all full-texts, randomised and nonrandomised clinical trials and observational studies including video-based education methods about any surgery. "Education" means a medical resident's or student's training and teaching process; not patients' education. We did not impose restrictions about language or publication date. RESULTS A total of nine articles which met inclusion criteria were included. These trials enrolled 507 participants and the total number of participants per trial ranged from 10 to 172. Nearly all of the studies reviewed report significant knowledge gain from video-based education techniques. The findings of this systematic review provide fair to good quality studies to demonstrate significant gains in knowledge compared with traditional teaching. Additional video to simulator exercise or 3D animations has beneficial effects on training time, learning duration, acquisition of surgical skills, and trainee's satisfaction. CONCLUSION Video-based education has potential for use in surgical education as trainees face significant barriers in their practice. This method is effective according to the recent literature. Video should be used in addition to standard techniques in the surgical education.
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Affiliation(s)
- Akgul Ahmet
- Department of Gerontology, Faculty of Health Sciences, Istanbul University, Istanbul, Turkey.
| | - Kus Gamze
- Division of Physiotherapy and Rehabilitation, Institute of Health Science, Istanbul University, Istanbul, Turkey; Department of Physiotherapy and Rehabilitation, Mustafa Kemal University, Hatay, Turkey
| | - Mustafaoglu Rustem
- Department of Neurological Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University, Istanbul, Turkey
| | - Karaborklu Argut Sezen
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University, Istanbul, Turkey.
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245
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Kuperstock JE, Horný M, Platt MP. Mobile app technology is associated with improved otolaryngology resident in-service performance. Laryngoscope 2018; 129:E15-E20. [PMID: 30151970 DOI: 10.1002/lary.27299] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/19/2018] [Accepted: 05/01/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Otolaryngology residents face time-management challenges between clinical duties and self-directed learning. Mobile devices provide a new medium for education that could aid with educational efficiency. The objective of this study was to investigate whether spaced repetition mobile app use of an otolaryngology question bank was associated with improving factual knowledge as measured by in-service exam performance. METHODS For approximately 6 months prior to the 2016 in-service examination, 12 otolaryngology residents at a single institution were provided access to a spaced-repetition app with a preloaded licensed otolaryngology review question bank. The number of questions answered, as well as the time spent on the app, were electronically tracked. The associations of app usage on in-service results were analyzed using an autoregressive model adjusted for prior historical Otolaryngology Trainee Examination performance and postgraduate year. RESULTS Eleven residents used the mobile app and were included in the analysis for an average of 304 minutes (range: 3 to 1,020) and reviewed on average 679 questions (range: 6 to 1,934). Controlling for residency year and prior performance, app usage was associated with an improvement by 2.92 percentage points (pp) (95% confidence interval [CI]: 0.14, 5.70) on overall in-service score. Allergy and pediatric subsection scores improved by 11.3 pp (95% CI: 3.8, 18.8) and 15.2 pp. (95% CI: 8.9, 21.5), respectively. Increased app use was associated with a score improvement by 0.008 pp per minute of use (95% CI: 0.004, 0.012). CONCLUSION Use of mobile spaced-repetition technology can aid resident factual knowledge retention measured by improved in-service exam performance. LEVEL OF EVIDENCE 4 Laryngoscope, 129:E15-E20, 2019.
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Affiliation(s)
- Jacob E Kuperstock
- Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Michal Horný
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, U.S.A.,Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, U.S.A.,Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, Georgia, U.S.A
| | - Michael P Platt
- Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts, U.S.A
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246
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Wong A, Filimonov A, Lee YJ, Hsueh WD, Baredes S, Liu JK, Eloy JA. The Impact of Resident and Fellow Participation in Transsphenoidal Pituitary Surgery. Laryngoscope 2018; 128:2707-2713. [PMID: 30151897 DOI: 10.1002/lary.27349] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/10/2018] [Accepted: 05/22/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Postoperative complications is an important marker of healthcare quality. The aim of this study was to analyze the impact of resident and fellow participation on postoperative complications in transsphenoidal pituitary surgery in a multi-institutional setting. STUDY DESIGN Retrospective analysis of population-based surgical registry. SETTING Academic medical center. METHODS The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was utilized to generate transsphenoidal pituitary surgery patient cohorts. The attending with resident and/or fellow group was compared to the attending alone based on demographics and preoperative and postoperative variables. RESULTS A total of 469 cases were included in the analysis, with 315 performed with resident participation and 154 by attendings alone. The attending group had higher rates of diabetics (20.1% vs. 11.7%, P = 0.015) and patients with a history of previous percutaneous coronary intervention (6.0 vs. 1.6%, P = 0.009). Although the attending group demonstrated higher rates of surgical complications, and the resident/fellow group showed increased incidence in medical and overall complication rates, there was no statistical difference between the two groups. Multivariate analysis further demonstrated lack of significance in complication rates between attendings and residents/fellows. CONCLUSION Resident and fellow participation in transsphenoidal surgery is not associated with significant differences in surgical complications, medical complications, mortality, operating time, reoperation rates, or readmission rates when compared to attendings. LEVEL OF EVIDENCE 4 Laryngoscope, 128:2707-2713, 2018.
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Affiliation(s)
- Anni Wong
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Andrey Filimonov
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Yung-Jae Lee
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Wayne D Hsueh
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.,the Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey
| | - James K Liu
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.,the Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey.,the Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.,the Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey.,the Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.,the Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
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247
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Abstract
Objective: We aimed to clarify the safety of open surgical tracheotomy performed by supervised residents, and the impact of “reason for hospitalization” on complication rates in open surgical tracheotomy technique. Methods: In this retrospective cohort study, the medical files and documents of 277 patients who underwent open surgical tracheotomy (OST) over a period of 12 years from October 2005 to July 2017 were analyzed. Forty four patients were excluded due to emergent tracheotomy and presence of malignancy. Remaining 223 cases were divided into two groups as “OSTs done by supervised residents” and “OSTs done by attending surgeons”. Age, gender, reason for hospitalization, observation time and complications were noted. The overall minor and major complication rates and each complication rate were compared with regard to the operating surgeons. Results: No statistically significant difference between two groups was demonstrated in terms of observation time (p=0.127). Minor complication rate for residents and attending surgeons was 14.7% and 17.5%, whereas major complication rate was 6.3% and 5.0%, respectively. No significant difference was found between two groups both in terms of minor (p=0.58) and major (p=0.43) complication rates. No risk of “reason for hospitalization” on minor and major complications was found (p=0.06, p=0.15). Conclusion: Open surgical tracheotomy performed by supervised residents is as safer as the ones performed by the attending surgeons. The study also showed that “reason for hospitalization” does not potentiate the occurrence of tracheotomy related complications.
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Affiliation(s)
- Burak Ulkumen
- Burak Ulkumen, MD. Assistant Professor, Manisa Celal Bayar University, Department of Otorhinolaryngology-Head Neck Surgery, Manisa, Turkey
| | - Gorkem Eskiizmir
- Gorkem Eskiizmir Associate Professor, Manisa Celal Bayar University, Department of Otorhinolaryngology-Head Neck Surgery, Manisa, Turkey
| | - Onur Celik
- Prof. Onur Celik, Manisa Celal Bayar University, Department of Otorhinolaryngology-Head Neck Surgery, Manisa, Turkey
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248
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Mehta ST, Agarwal C, Siddiqi F, Rockwell WB, Gociman BR. The Benefit of a Formal Plastic Surgery In-Service Conference. J Surg Educ 2018; 75:1058-1061. [PMID: 29397356 DOI: 10.1016/j.jsurg.2017.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 11/07/2017] [Accepted: 12/06/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Annually, residents are expected to take an in-service examination to gauge their understanding of plastic surgery knowledge and prepare them for the American Board of Plastic Surgery written examination. In addition, in-service score are now being used as an assessment tool for fellowship applicants. Because of the breadth of Plastic Surgery material, it is difficult to prepare a resident for such a comprehensive examination. At the University of Utah, a weekly conference was instituted to help prepare residents for the in-service and board examination with the goal of improving scores. MATERIALS AND METHODS A weekly 90min review conference was initiated at the University of Utah in an effort to improve in-service scores. Residents along with a member of the faculty reviewed old in-service examination questions and discussed the selected topics in depth. The residents' examination score averages per PGY level were compared from years before and after initiation of the conference. In addition, examination scores for each individual were compared before and after initiation of the conference. Paired t-test comparisons were performed to analyze the results. RESULTS Statistically significant improvement in residents examination scores averages were observed from years before and after initiation of the conference after the second year of training (42% vs 62%, p = 0.03). Furthermore, examination scores for each individual obtained the years before and the year after initiation of the conference significantly improved (31% vs 71%, p = 0.01). When comparing individuals in years prior to implementation of the conference there was no statistically significant improvement from year to year. CONCLUSION Implementation of a formal weekly in-service conference significantly improved performance on the in-service examination. Improvement was found when comparing between PGY training level after the second year of training and individually for residents. These results advocate for a focused educational conference for preparation for the in-service examination.
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Affiliation(s)
- Sagar T Mehta
- University of Utah Hospitals and Affiliates, Salt Lake City, Utah.
| | - Cori Agarwal
- University of Utah Hospitals and Affiliates, Salt Lake City, Utah
| | - Faizi Siddiqi
- University of Utah Hospitals and Affiliates, Salt Lake City, Utah
| | | | - Barbu R Gociman
- University of Utah Hospitals and Affiliates, Salt Lake City, Utah
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Mehta P, Rand EB, Visco CJ, Wyss J. Resident Accuracy of Musculoskeletal Palpation With Ultrasound Verification. J Ultrasound Med 2018; 37:1719-1724. [PMID: 29280168 DOI: 10.1002/jum.14523] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 10/02/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The purpose of this observational study was to determine the accuracy of musculoskeletal palpation of the medial joint line of the knee, medial patellar tendon, and posterior tibialis tendon verified by ultrasound imaging among physical medicine and rehabilitation residents. METHODS Eighteen physical medicine and rehabilitation resident physicians at a single specialized institution were asked to identify the medial joint line of the knee, medial patellar tendon, and posterior tibialis tendon on 2 separate standardized patient models during a single data collection. They were asked to place a paper clip flat on the surface of the skin parallel to the specified anatomic structure. A high-frequency linear array transducer was used to identify whether the paper clip was correctly placed over the structures and to measure the distance from the intended structure. RESULTS The accuracy rates for palpation of the medial joint line, medial patellar tendon, and posterior tibialis tendon in both models were 14%, 36%, and 28%, respectively, for all levels of residents. Accuracy rates for all of the structures by level of education were 19%, 29%, and 31% for postgraduate years 2, 3, and 4. Median confidence scores were 3.75, 3.5, and 2 for the medial joint line, medial patellar tendon, and posterior tibialis tendon. CONCLUSIONS This study highlights the level of inaccuracy of musculoskeletal palpation skills and draws further attention to an area of much-needed improvement in our musculoskeletal residency training programs. Ultrasound imaging is an effective noninvasive method for providing swift feedback to medical students and residents and thereby reduce the instances of inaccurate musculoskeletal palpation.
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Affiliation(s)
- Priyesh Mehta
- Department of Physiatry, Hospital for Special Surgery, New York, New York, USA
| | - Ethan B Rand
- Department of Rehabilitation Medicine, Weill Cornell Medical Center, New York, New York, USA
| | - Christopher J Visco
- Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, New York, USA
| | - James Wyss
- Department of Physiatry, Hospital for Special Surgery, New York, New York, USA
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250
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Sarkany D, DeBenedectis CM, Brown SD. A Review of Resources and Methodologies Available for Teaching and Assessing Patient-Related Communication Skills in Radiology. Acad Radiol 2018; 25:955-961. [PMID: 29361417 DOI: 10.1016/j.acra.2017.11.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 11/21/2017] [Accepted: 11/22/2017] [Indexed: 11/29/2022]
Abstract
ACGME expectations for radiology trainees' proficiencies in communication skills pose a challenge to program directors who wish to develop curricula addressing these competencies. Numerous educational resources and pedagogical approaches have emerged to address such competencies specifically for radiology, but have yet to be systematically catalogued. In this paper, we review and compile these resources into a toolkit that will help residencies develop curricula around patient-centered communication. We describe numerous web-based resources and published models that have incorporated innovative, contemporary pedagogical techniques. In undertaking this compilation, our hope is to kindle discussion about the development of formalized or standardized communication curricula or guides for radiology residencies.
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Affiliation(s)
- David Sarkany
- Staten Island University Hospital Northwell Health, Department of Radiology, 475 Seaview Avenue, Staten Island, NY 10305.
| | - Carolynn M DeBenedectis
- Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Stephen D Brown
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Institute for Professionalism and Ethical Practice, Boston Children's Hospital, Boston, Massachusetts
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