2019 musculoskeletal radiology fellowship match process: initial experiences and lessons learned

OBJECTIVE

To present the 2019 Musculoskeletal (MSK) fellowship Match information most useful to MSK fellowship programs and sections in hopes of optimizing the fellowship application and selection process for MSK fellowship applicants and training programs.

MATERIALS/METHODS

We performed a mixed method analysis to gain a better understanding of the 2019 MSK Fellowship Match process. First, we distributed a ten-question survey to the fellowship leadership from the 78 US fellowship programs registered with the Society of Skeletal Radiology. Second, we collected and reviewed NRMP Match data that were distributed on Match Day.

RESULTS

We received completed surveys from 37 (45.7%) programs. Thirty-three (89.2%) of the responding programs identified themselves as academic, 3 (8.1%) as hybrid, and 1 (2.7%) as private practice. On average, programs interviewed 15.4 applicants over the interview session, with a range between 2 and 40. There was an average of 2.7 (range 1-8) open positions per fellowship and 1.2 (range 0-4) internal candidates per program. Each program interviewed 5.8 applicants per open position (range 1-24). There were a total of 81 certified MSK fellowship programs and 204 available positions in these programs. Twenty-four programs (29.6%) did not fill all positions resulting in a total of 36 unfilled positions (17.6%). The percentage of MSK unfilled programs, unfilled positions, and unmatched applicants were comparable to the Breast Imaging and Neuroradiology subspecialty matches.

CONCLUSION

The MSK Fellowship Match was a success with high match rates for applicants and programs. Most importantly, the Match allowed programs to make more informed decisions on their fellowship training opportunities.

Factors influencing treatment recommendations for base of 5th metatarsal fractures in orthopaedic residency programs

BACKGROUND

Management of proximal 5th metatarsal fractures remains a controversial topic in orthopaedic surgery. Both operative and non-operative approaches have been described in the clinical setting. This confusion has led to non-standardized treatment recommendations for proximal 5th metatarsal fractures. This study was designed to analyze concordance rate of treatment recommendations between orthopaedic trainees and orthopaedic foot and ankle experts.

METHODS

An online survey containing 14 cases of proximal 5th metatarsal fractures were distributed to 92 orthopaedic residents in two ACGME-accredited programs. Relevant weight-bearing radiographs, patient's age and gender were provided, and two questions regarding treatment recommendations were surveyed. Resident's recommended treatment was then matched against ultimate treatment by orthopaedic foot and ankle experts. ANOVA and T-test are used for associations between the rate of concordant treatment with PGY and trainee foot and ankle experience. Fleiss' kappa was used to assess the inter-observer agreement.

RESULTS

Seventy-two residents returned the survey. The overall concordance rate was 43.98% with no correlation between agreement rate and PGY-years. No difference in agreement rate was observed between residents who had completed their foot and ankle rotation versus those who had not. There was a slight inter-observer agreement in recommending treatment among all residents (κ=0.117, 95% CI: 0.071-0.184).

CONCLUSIONS

Our data demonstrated no significant concordance between resident level in training regarding proximal 5th metatarsal fracture treatment decisions, nor between residents and subspecialty-trained foot and ankle surgeons. Increased rotations with foot and ankle fellowship-trained surgeons throughout residency may be desirable to improve the quality of residency training.

LEVEL OF EVIDENCE

III.

Trauma Teams That Train as One Work as One: Invasive Procedure Training in Residency Education

BACKGROUND

Invasive surgical procedures occur infrequently in an emergency department setting; however, procedural competence is expected from trauma residents. Emergent procedures are challenging to train in a formal manner because of the urgent nature when they present. To supplement education, new and creative teaching tools such as simulation and multidisciplinary training are being used. Our study organized a multidisciplinary simulated learning workshop with surgery and emergency medicine residents for invasive, emergent procedures.

MATERIALS AND METHODS

In total, 14 surgical and 36 emergency medicine residents at our institution participated in a simulated learning experience. Ten workshops were organized, with six to seven residents participating in each session. Using a human cadaveric model, all residents were taught by senior-level residents and attendings from both specialties on how to perform uncommonly or anatomically challenging emergent invasive procedures. A pre- and post-laboratory survey was completed by all the residents to assess confidence in performing each of the 13 procedures.

RESULTS

All residents (N = 50), who participated in the study, completed pre- and post-laboratory surveys. Comparison of the pre- and post-laboratory confidence levels indicated significant increases in confidence in performing all procedures. Residents stated that this multidisciplinary approach to education in a controlled setting was helpful and fostered a collaborative relationship between both specialties.

CONCLUSIONS

Although some surgical procedures remain uncommon in the emergency department, competency is nevertheless expected for appropriate patient care. Using a collaborative simulation-based cadaver laboratory to teach emergent procedures significantly improved residents' confidence while concurrently fostering professional relationships.

Sustaining a national surgical training programme during the COVID-19 pandemic

The COVID-19 pandemic has disrupted all segments of daily life, with the healthcare sector being at the forefront of this upheaval. Unprecedented efforts have been taken worldwide to curb this ongoing global catastrophe that has already resulted in many fatalities. One of the areas that has received little attention amid this turmoil is the disruption to trainee education, particularly in specialties that involve acquisition of procedural skills. Hand surgery in Singapore is a standalone combined programme that relies heavily on dedicated cross-hospital rotations, an extensive didactic curriculum and supervised hands-on training of increasing complexity. All aspects of this training programme have been affected because of the cancellation of elective surgical procedures, suspension of cross-hospital rotations, redeployment of residents, and an unsustainable duty roster. There is a real concern that trainees will not be able to meet their training requirements and suffer serious issues like burnout and depression. The long-term impact of suspending training indefinitely is a severe disruption of essential medical services. This article examines the impact of a global pandemic on trainee education in a demanding surgical speciality. We have outlined strategies to maintain trainee competencies based on the following considerations: 1) the safety and wellbeing of trainees is paramount; 2) resource utilization must be thoroughly rationalized; 3) technology and innovative learning methods must supplant traditional teaching methods; and 4) the changes implemented must be sustainable. We hope that these lessons will be valuable to other training programs struggling to deliver quality education to their trainees, even as we work together to battle this global catastrophe.

Expanding the Orthopaedic Pipeline: The B.O.N.E.S. Initiative

OBJECTIVE

Although the number of female medical school graduates has dramatically increased over the last decades, Orthopaedic surgery continues to struggle in attracting women and under-represented minorities to the field. Potential barriers include limited exposure during medical school and the scarcity of female mentors. We hypothesized that a structured, low-cost, workshop for medical students allowing exposure to orthopaedic surgery would increase students' interest in the field. Our primary outcome was the perceived satisfaction with the program and the number of students who subsequently expressed an interest in pursuing a career in orthopaedic surgery. Our secondary outcome was the number of student participants who subsequently matched in orthopaedic surgery.

DESIGN

Combining female faculty from surrounding hospitals, we developed a free half-day program including skills workshops and panel discussions for women medical students in the region. Participants were asked to complete an anonymous survey grading their satisfaction with the utility of the information presented, the comfort level in interacting with faculty and how the experience may have impacted their potential interest in orthopaedic surgery. Eligible participants were contacted by email to determine their ultimate career choices and match results. Furthermore, participants were followed over time to determine how many chose and matched into an orthopaedic surgery residency.

SETTING

The workshop took place in Boston at the Harvard Medical School affiliated hospitals.

PARTICIPANTS

Student participants were invited from all New England allopathic and osteopathic medical schools. Faculty participants included staff, residents and fellows from the Harvard Combined Orthopaedic Residency Program.

RESULTS

Over 3 years, 155 female medical students participated in the program and 97% found it useful. Among 59 students who have since become eligible for the match, 22 matched into an orthopaedic surgery residency. Eight of 36 (22%) match eligible first and second year participants matched in orthopaedic surgery while 14 of 23 (61%) match eligible third and fourth year student attendees successfully matched in orthopaedic surgery programs.

CONCLUSIONS

Taking advantage of local resources, we demonstrated that outreach is effective in enhancing students' interest in the field. We encourage as many programs as possible to consider similar initiatives.

Improving plastic surgery resident education and quality of care with outcomes feedback using the surgery report card: An initial experience

BACKGROUND

The practice of tracking and analyzing surgical outcomes is essential to becoming better surgeons. However, this feedback system is largely absent in residency training programs. Thus, we developed a Surgery Report Card (SRC) for residents performing tissue expander (TE)-based breast reconstruction and report our initial experience with its implementation.

METHODS

We performed a systematic review and meta-analysis for TE-based breast reconstructions and compared outcomes to our retrospective cohort. The primary outcome was overall complications. The SRC compares patient and complication statistics for resident-led teams to the meta-analysis.

RESULTS

The meta-analysis included 12 studies, with 2093 patients (2982 breasts) that underwent TE-based reconstruction. The pooled complication rate was 26.9%; infection was most common (8.3%); failure rate was 5.9%. Our cohort included 144 patients (245 breasts) among 13 resident-led teams. Overall complication rate was 31.8%; infections were most frequent (17.6%) and failure rate was 7.3%. Our cohort had significantly higher BMIs (29.7 vs 25.4, p<0.0001) more diabetics (6.9% vs. 3.2%, p = 0.02), and more patients receiving adjuvant radiation therapy (41.4 vs 26.3%, p<0.0001). Every 3 months, residents receive a customized SRC of their cases, with the meta-analysis used as a benchmark. A survey demonstrated the SRC made residents reconsider surgical technique and more conscientious surgeons, and would like it implemented for other procedures during residency.

CONCLUSIONS

The implementation of our SRC for TE-based breast reconstruction establishes a baseline for surgical performance comparison for residents, demonstrates that residents can safely perform the procedure, and allows for critiquing of surgical techniques to improve patient care.

Establishing validity of the fundamentals of spinal surgery (FOSS) simulator as a teaching tool for orthopedic and neurosurgical trainees

BACKGROUND CONTEXT

Pedicle screw placement is a demanding surgical skill as a spine surgeon can face challenges including variations in pedicle morphology and spinal deformities. Available CT simulators for spine pedicle placement can be very costly and hands-on cadaver courses are limited by specimen availability and are not readily accessible.

PURPOSE

To conduct validation of a simulated training device for essential spine surgery skills.

DESIGN

Cross-sectional, empirical study of physician performance on a surgical simulator model.

SAMPLE

Spine attending physicians and residents from four different academic institutions across the United States.

OUTCOME MEASURES

Performance metrics on two surgical simulator tasks.

METHODS

After IRB approval, an inexpensive ($30) simulator was developed to test two main psychomotor tasks (1) creation of the pedicle screw path with a standard gearshift probe without cortical breaks and (2) the ability to palpate for the presence or absence of cortical breaches as well as determine the location of wall defects. Orthopedic and neurosurgery residents (N=72) as well as spine attending surgeons (N=26) participated from four different institutions. To test construct validity, performance metrics were compared between participants of different training status through one-way analysis of variance and linear regression analysis, with significance set at p<.05.

RESULTS

Spine attending surgeons consistently scored higher than the residents, in the screw trajectory task with triangular base (p=.0027) and defect probing task (p=.0035). In defect probing, performance improved with linear trend by number of residency training years with approaching significance (p=.0721). In that task, independent of institutional affiliation, PGY-2 residents correctly identified an average of 1.25±0.43 fewer locations compared with attending physicians (p=.0049). More than 80% of the spine attendings reported they would use the simulator for training purposes.

CONCLUSIONS

This low-cost fundamentals of spine surgery simulator detected differences in performances between spine attending surgeons and surgical residents. Programs should consider implementing a simulator such as fundamentals of spine surgery to assess and develop pedicle screw placement ability outside of the operating room.

Radiology Resident Journal Club: Enhancements Add Educational Value

RATIONALE AND OBJECTIVES

Resident journal clubs are essential to develop skills to critically appraise existing literature. However, most reports of journal clubs focus on logistics of the activity and less on established roles of those involved. Our objective is to report on an innovative journal club from the perspective of key participants.

MATERIALS AND METHODS

Journal club schedule, assignments, evaluations, and analysis are proffered from our institution. The journal club goals were formulated as: (1) improving resident understanding of research (biostatistical and epidemiologic) methods and statistical concepts, (2) teaching critical appraisal skills, and (3) promoting the use of evidence-based medicine. Each session's format is interactive, consisting of a 10 minute lecture with radiology examples of a research or statistical concept, followed by a journal club style discussion. Crucial to the success of this curriculum has been input and engagement of multiple parties: radiology residents, epidemiologist directors, and subspecialist clinician educator faculty members.

CONCLUSION

A well-thought out and well-run resident journal club offers numerous solutions to radiology residencies. To residency program leadership and to each individual resident annually, resident journal club offers cutting edge medical knowledge, interactive conferences in the formal didactic curriculum, resident training in critical thinking skills and research design, resident training in interpersonal and communication skills, opportunity for residents to be teachers, and expanded resident interprofessional education. It meets Accreditation Council for Graduate Medical Education common program, Residency Review Committee diagnostic radiology program, and American Board of Radiology Milestones requirements.

Building an adaptable resident curriculum for acute pediatric sexual abuse evaluations: A qualitative needs assessment

BACKGROUND

Residents are undertrained to perform acute pediatric sexual abuse evaluations. The American Academy of Pediatrics has proposed development of an adaptable child abuse curriculum, though no such curriculum exists.

OBJECTIVES

Our goal was to perform a needs assessment for pediatric residents performing acute sexual abuse evaluations in an emergency department setting, thus laying groundwork for an adaptable curriculum. The objective was to explore pediatric resident training, knowledge, confidence, expectations, learning needs, and educational goals.

PARTICIPANTS AND SETTING

We conducted a qualitative exploratory study of pediatric residents, faculty, and program directors at two academic health centers in New York City.

METHODS

Using purposive and convenience sampling, we conducted focus groups and semi-structured interviews until saturation of ideas was achieved. Through an iterative process using constructivist grounded theory, themes were organized into a curricular model.

RESULTS

We conducted 3 resident focus groups (n = 21) and 7 interviews with emergency medicine, pediatric, and child abuse faculty. Themes emerged in three categories: barriers (e.g., knowledge deficits), facilitators (e.g., pre-learning), and educational goals. Despite recognizing the importance and increased availability of subspecialists, participants supported gradual autonomy for pediatric residents in the evaluation of suspected sexual abuse, with a goal of independent competency in history and examination skills, and supervised competency of forensic evidence collection.

CONCLUSIONS

Our data support a multimodal, blended curriculum for the acute sexual abuse evaluation, including: (1) asynchronous pre-learning; (2) live workshops; (3) reference tools; and (4) modeled clinical experiences. Our proposed curricular model may be utilized by a variety of frontline clinicians.

A Standardized Robotic Training Curriculum in a General Surgery Program

Background and Objectives:

The general surgery residency at the University of Illinois College of Medicine at Peoria has a long tradition of integrating robotic surgery into training since 2002. The purpose of this paper is to investigate our curriculum and evaluation system, which was designed to achieve a standardized format for education in general robotic surgery.

Methods:

The curriculum consists of two phases: phase 1 (PGY 1–2): Complete 4 robotic surgery training modules; read two assigned robotic surgery articles; and practice simulation modules on the robot. phase 2 (PGY 3–5): Refresh training modules, score >90% on the simulator modules every 6 months; bedside assist minimum of 4 robotic procedures; and act as console surgeon for a minimum of 10 procedures with 2 separate attending surgeons. The required simulator modules were specially selected to incorporate all of the skills categories documented in the simulator. The faculty evaluate the resident's operative performance using the Global Evaluative Assessment of Robotic Skills validated rubric.

Results:

Since the curriculum was instituted in June 2017, 73 evaluations from 8 surgeons have been collected. We examined data from 6 residents who had at least 5 Global Evaluative Assessment of Robotic Skills assessments completed. Correlation coefficient scores showed a positive correlation ranging from 0.476 to 0.862 for average skills and 0.334 to 0.866 for overall performance scores.

Discussion:

The preliminary results suggest an improvement of resident robotic surgical skills through tailored education. This curriculum is designed to enhance robotic general surgery education that could potentially produce general surgeons able to operate robotically without needing a robotic/MIS (Minimally Invasive Surgery) fellowship.

Developing a Novel Scoring System to Objectively Track Orthopaedic Resident Educational Performance and Progression

OBJECTIVE

Objectively determining orthopedic resident competence remains difficult and lacks standardization across residency programs. We sought to develop a scoring system to measure resident educational activity to stratify participation and performance in particular aspects of training and the effect of these measures on board certification.

DESIGN

A weighted scoring system (Average Resident Score, ARS) was developed using the number of logged cases, clinic notes dictated, OITE PGY percentile, case minimums met, and scholarly activity completed each academic year (AY), with clinical activity being more heavily weighted. The Resident Effectiveness Score (RES), a z-score showing the number of standard deviations from the mean, was determined using the ARS. The RES effect on the Accreditation Council for Graduate Medical Education (ACGME) Milestones and American Board of Orthopedic Surgery (ABOS) Part 1 percentile score was determined using a Spearman correlation.

SETTING

Large academic orthopedic residency.

PARTICIPANTS

Thirty one orthopedic residents graduating between 2011 and 2016 were included.

RESULTS

The RES did not differ between classes in the same AY, nor change significantly for individual residents during their training. Milestone z-scores increased as residents progressed in their education. The RES correlated with each Milestone competency subscore. The PGY5 OITE score and achieving ACGME minimums correlated with passing ABOS Part 1 (28/31 1st time pass), but the RES did not predict passing the board examination.

CONCLUSIONS

This study demonstrates a scoring system encompassing multiple facets of resident education to track resident activity and progress. The RES can be tailored to an individual program's goals and aims and help program directors identify residents not maximizing educational opportunities compared to their peers. Monitoring this score may allow tailoring of educational efforts to individual resident needs. This RES may also allow residents to measure their performance and educational accomplishments and adjust their focus to obtain competence and board certification.

Incorporating Healthcare Risk Management into Podiatric Surgical Residency Training

In an effort to emphasize the practical importance of patient safety to the next generation of podiatric surgeons, a short healthcare risk management seminar was implemented. The purpose of this course is to demonstrate how safer and more quality oriented practices such as better provider-patientcommunication can help reduce the risk of medical malpractice cases.

Senior surgical resident autonomy and teaching assistant cases: A prospective observational study

INTRODUCTION

Teaching assistant (TA) cases allow senior residents (SR) to gain autonomy. We compared the safety profiles of TA cases performed under direct vs. indirect staff supervision.

METHODS

Prospective observational study of operative cases where a SR served as the TA between 7/2014-6/2017 (n = 161). Patient/operative characteristics, 30-day outcomes, and SR survey data were compared by level of supervision.

RESULTS

Case mix included 68 laparoscopic appendectomies (42%), 49 laparoscopic cholecystectomies (30%), 10 I&Ds (6%), 10 umbilical hernia repairs (6%), 4 port placements (3%), and 11 others. Indirectly supervised cases were shorter (61 vs. 76 min, p < 0.01), with less blood loss (11 vs. 24 ml, p < 0.05), and lower conversion rates (0% vs. 5.7%, p < 0.05). Perceived difficulty was high in 20% of cases with indirect vs. 49% with direct supervision (p < 0.01). Mean SR comfort was high (4.4 vs. 4.6 out of 5) regardless of level of staff supervision. 30-day complications did not differ for indirect vs. direct supervision (all p = NS).

DISCUSSION

Carefully selected TA cases offer SRs opportunities to practice autonomy without sacrificing operative time or patient safety.

The perceived efficacy and utility of spine bioskills curricula for resident and fellow education

The purpose of this study is to assess the role of bioskills in orthopaedic and neurosurgical resident education. A survey of the utilization and perceived efficacy of bioskills was submitted to Lumbar Spine Research Society (LSRS) members. 36/104 surgeons responded, including 25 orthopaedic, 7 neurosurgical, and 4 integrated respondents. 63% of orthopaedic and 83% of neurosurgery faculty, reported using bioskills. When asked if completion of bioskills modules would encourage advancing trainees' participation (1-10 scale, 10 greatly increase), neurosurgical faculty reported 4.00 versus orthopaedics 6.43. Although orthopaedic faculty perceive greater efficacy of bioskills, the clinical impact of this difference remains uncertain.

Survey of Global Health Education and Training in Pathology Residency Programs in the United States

OBJECTIVES

This study assessed the prevalence, general interest, and barriers to implementing global health curricula in pathology residency programs.

METHODS

We conducted a survey of 166 US pathology residency programs.

RESULTS

Thirty-two (195) of 166 programs responded. Of these, 13% have a formalized global health program (n = 4), and the majority indicated at least some general interest in global health among trainees (88%, n = 28) and faculty (94%, n = 30), albeit at a low to moderate level. Funding limitations, regulatory constraints, and insufficient knowledge of global health were frequently cited barriers to developing a global health program.

CONCLUSIONS

Few US pathology departments incorporate global health education into postgraduate training. The importance of pathology in global health has been underappreciated, despite its critical role in the delivery of health care in resource-limited settings. One solution is for pathology departments to expand global health educational opportunities for trainees.

Pediatric flexible laryngoscopy: Trends in diagnostic abilities throughout training

OBJECTIVES

Our objectives were to evaluate the ability of residents to diagnose pathology of the pediatric larynx on laryngoscopy, to trend this ability throughout training, to compare their skills to pediatric otolaryngologists, and to determine whether reviewing digitally captured videos in slow motion, as opposed to a live exam, enhanced diagnostic abilities. In addition, we identified pathologies and anatomical sub-sites that posed diagnostic challenges.

METHODS

Qualtrics was used to design and distribute an online test, which included 15 pediatric laryngoscopy videos. Participants selected a diagnosis for each video after (1) watching it once at full speed and (2) watching the video multiple times in slow motion. Anonymous responses were exported into excel for statistical analysis, including T-test, ANOVA, and descriptive statistics.

RESULTS

There were 21 total participants. Median scores for full speed versus slow motion video review were 47% and 60% respectively. When analyzed by training level, there was no significant difference in scores for full speed videos, but there was a significant difference across groups for slow motion review (p = 0.04). Post Graduate Year (PGY) 4 residents and pediatric otolaryngologists performed best with an average of 69% and 77% respectively. Base of tongue, subglottic, and laryngeal cleft lesions were the most difficult to diagnose. Motor, laryngeal, and vallecular pathologies were more accurately identified.

CONCLUSIONS

The ability to diagnose pathology on pediatric laryngoscopy tends to improve throughout residency training. Slow motion review enhances diagnostic skills. Laryngeal and vallecular pathologies are more easily diagnosed than base of tongue and subglottic lesions.

Resident Education in Laryngeal Stroboscopy: Part II-Evaluation of a Multimedia Training Module

OBJECTIVE

To evaluate the efficacy of a web-based training module for teaching interpretation of laryngeal stroboscopy in a cohort of otolaryngology residents.

STUDY DESIGN

Randomized controlled trial.

SETTING

Academic tertiary center.

SUBJECTS AND METHODS

Residents from three training programs were invited to complete an assessment consisting of a survey and five stroboscopic exams. Subsequently, participants were randomized to receive teaching materials in the form of (1) a handout (HO) or (2) a multimedia module (MM) and asked to complete a post-training assessment. Responses were compared to responses provided by three fellowship-trained laryngologists.

RESULTS

Thirty-five of 47 invited residents (74.4%) completed both assessments. Overall mean postassessment scores were 64.3% ± 7.0, with the MM group (67.0% ± 7.6, n = 17) scoring higher (P = 0.03) than the HO (61.6% ± 5.4, n = 18) cohort. Postassessment scores did not differ by postgraduate year (P = 0.75) or institution (P = 0.17). Paired analysis demonstrated an overall mean improvement of 7.4% in the handout (HO) cohort (P = 0.03) and 10.3% in the MM cohort (P = 0.0006). Subset analysis demonstrated higher scores for the MM cohort for perceptual voice evaluation (HO = 68.8% ± 11.0; MM = 77.3% ± 10.6, P = 0.03) and stroboscopy-specific items (HO = 55.5% ± 8.2; MM = 61.9% ± 10.8, P = 0.06). On a five-point Likert scale, residents reported improved confidence in stroboscopy interpretation (P < 0.0001), irrespective of cohort (P = 0.62). Residents rated the MM (median = 5) more favorably as a teaching tool compared to the HO (median = 4, P = 0.001).

CONCLUSION

Use of both the written HO and MM module improved scores and confidence in interpreting laryngeal stroboscopy. The MM was more effective in perceptual voice evaluation and stroboscopy-specific items. The MM was also rated more favorably by residents and may be an ideal adjunct modality for teaching stroboscopy.

The College of Surgeons of East, Central, and Southern Africa: Successes and Challenges in Standardizing Neurosurgical Training

BACKGROUND

The College of Surgeons of East, Central, and Southern Africa (COSECSA) is a regional accrediting body for general and specialty surgical training programs that has recently expanded to include neurosurgery. As neurosurgical services expand in sub-Saharan Africa, the structure of training and accreditation has become a vital issue.

METHODS

We review the founding and current structures of COSECSA neurosurgical training, identifying accomplishments and challenges facing the expansion of neurosurgical training in this region.

RESULTS

The COSECSA model has succeeded in several countries to graduate qualified neurosurgeons, but challenges remain. Programs must balance the long duration of training required to promote surgical excellence against an overwhelming clinical need that seeks immediate solutions.

CONCLUSION

Harnessing global collaboration, rapidly expanding local infrastructure, and a robust multinational training curriculum, COSECSA has emerged as a leader in the effort to train neurosurgeons and is anticipated to dramatically improve on the markedly unmet need for neurosurgical care in sub-Saharan Africa.

Impact of Resident and Fellow Participation on Surgical Outcomes in Breast Conserving Surgery for Invasive Breast Cancer

OBJECTIVE

Few studies examine the impact of surgical trainee involvement on tumor-free margins in breast conserving surgery (BCS). Our objective was to investigate the impact of resident and fellow involvement on positive margins rates following BCS for invasive breast cancer (BC).

DESIGN

We identified female patients who had BCS for BC between January 2005 to December 2015.

SETTING

Tertiary care hospital.

PARTICIPANTS

Around 1089 patients were identified from a prospectively maintained database.

RESULTS

Of 1089 patients, mean age was 63 (range 43-99) years. Around 768 patients (70.1%) required preoperative localization, and 328 patients (29.9%) had a palpable cancer. Nonpalpable cancers had a smaller volume of specimen tissue excised (p = 0.0005) compared to palpable cancers, and no significant difference was observed in the positive margin rate between the nonpalpable group compared to the palpable group (24.7% nonpalpable vs. 25.3% palpable, p = 0.88). Nonpalpable cancer positive margin rates were 23.9% (n = 102/427) for cases performed by an attending surgeon, 25.0% (n = 15/60) with a junior resident (PGY 2-3), 28.6% (n = 8/28) with a senior resident (PGY 4-5), and 25.7% (n = 65/253) with a fellow, which were not statistically significant (p = 0.89). Palpable cancer positive margin rates were 27.6% (n = 47/170) for cases performed by an attending, 13.9% (n = 5/36) with an intern (PGY-1), 40.9% (n = 9/22) with a junior resident, 0% (n = 0/8) with a senior resident, and 23.9% (n = 22/92) with a fellow, which were also not significantly different (p = 0.07).

CONCLUSION

Resident and fellow participation in BCS for BC does not appear to impact the rate of positive margins.

Orthopaedic residents demonstrate retention of point of care ultrasound knowledge after a brief educational session: a quasi experimental study

BACKGROUND

Musculoskeletal point of care ultrasound (MSK POCUS) has many uses for orthopaedic surgeons, but orthopaedic trainees are rarely exposed to this modality. The purpose of this project was to assess the usefulness in clinical education of a newly implemented MSK POCUS course in an orthopaedic surgery program.

METHODS

An MSK POCUS course for orthopaedic surgery residents was developed by an interdisciplinary team. Online videos were created to be viewed by residents prior to a half-day long practical course. An online survey covering the level of training of the resident and their previous use of ultrasound (total hours) was completed by the participants prior to the course. Resident's knowledge acquisition was measured with written pre-course, same-day post-course and six-month follow-up tests. Residents were also scored on a practical shoulder examination immediately after the course and at six-month follow-up. Changes in test scores between time points were evaluated using Wilcoxon signed-rank tests.

RESULTS

Ten orthopaedic surgery residents underwent the MSK POCUS curriculum. Pre-course interest in MSK-POCUS was moderate (65%) and prior exposure was low (1.5 h mean total experience). Written test scores improved significantly from 50.7 ± 17.0% before to 84.0 ± 10.7% immediately after the course (p < 0.001) and suffered no significant drop at 6 months (score 75.0 ± 8.7%; p = 0.303). Average post-course practical exam score was 78.8 ± 3.1% and decreased to 66.2 ± 11.3% at 6 months (p = 0.012). Residents significantly improved their subjective comfort level with all aspects of ultrasound use at 6 months (p = 0.007-0.018) but did not significantly increase clinical usage frequency.

CONCLUSION

An MSK POCUS curriculum was successfully developed and implemented using an interdisciplinary approach. The course succeeded in improving the residents' knowledge, skills, and comfort with MSK POCUS. This improvement was maintained at 6 months on the written test but did not result in higher frequency of use by the residents.

Developing an Education Budget for Radiology Vice Chairs and Leaders: An ADVICER Template

RATIONALE AND OBJECTIVES

The Alliance of Directors and Vice Chairs in Education group identified the need to develop an education budget template as resource for our community. Having a framework and working knowledge of budgetary considerations is crucial to those with general oversight and executive managerial responsibility for departmental educational programs.

METHODS

An online survey was sent to all the Alliance of Directors and Vice Chairs in Education members. Survey questions included education funding sources, presence of vice chair of finance, expectation of revenue generation, existing education budget, funding decision-makers, education budget formulation and approval, vice chair of education's role in budget, education budget line items, and income statement review.

RESULTS

The survey response rate was 41/81 (51%). A majority 26/41 (63%) of respondents had an education budget that typically included funding for all medical students, residents, and fellows but only a minority of respondents report they developed 10/22 (45%), approved 6/22 (27%), or regularly reviewed 6/21 (29%) this budget. In sharp contrast was the role of department chairs and administrators, who presumably all participated in this process. To assist in education budget development and review, as well as meet the need to improve participants' financial accounting knowledge as a key tenet of faculty professional development, the authors developed sample budget templates and an income statement primer.

CONCLUSION

Our survey results suggested the need for an educational budget framework and financial accounting resources for those in radiology education posts, and resources have been provided.

Urology Milestones 2.0: The Future Looks Bright

PURPOSE OF REVIEW

One of the major functions of the Accreditation Council for Graduate Medical Education (ACGME) is to accredit all approved residency programs. This accreditation system is based on both common and program-specific requirements that form the foundation of all ACGME-accredited training programs. Embedded within the program requirements are the essential elements of the Competencies and Milestones. In this review article, we hope to provide the reader with an overview of the current Milestones and a preview of what lies ahead.

RECENT FINDINGS

Milestones for resident education were implemented approximately 7 years ago. The milestones were intended to create a logical trajectory of professional growth which could be measured and tracked for each sub-specialty. However, substantial variability in both content and developmental progression was seen in many specialties. The ACGME has been actively reviewing the Milestones to insure that there exists harmony across all specialties. Much has been learned about the milestones since their implementation. As educators, we need to provide a robust and reproducible system for all to use. The future of resident education, Milestones 2.0, will provide the necessary groundwork for a more user friendly system that will allow adequate evaluation of our trainees.

Simulator training and residents' first laparoscopic hysterectomy: a randomized controlled trial

BACKGROUND

Hysterectomy rates are decreasing in many countries, and virtual reality simulators bring new opportunities into residents' surgical education. The objective of this study was to evaluate the effect of training in laparoscopic hysterectomy module with virtual reality simulator on surgical outcomes among residents performing their first laparoscopic hysterectomy.

METHODS

This randomized study was carried out at the Department of Obstetrics and Gynecology in Helsinki University Hospital and Hyvinkää Hospital. We recruited twenty residents and randomly signed half of them to train ten times with the laparoscopic hysterectomy module on a virtual reality simulator, while the rest represented the control group. Their first laparoscopic hysterectomy was video recorded and assessed later by using the Objective Structured Assessment of Technical Skills (OSATS) forms and Visual Analog Scale (VAS). The scores and surgical outcomes were compared between the groups.

RESULTS

The mean OSATS score for the Global Rating Scale (GRS) was 17.0 (SD 3.1) in the intervention group and 11.2 (SD 2.4) in the control group (p = 0.002). The mean procedure-specific OSATS score was 20.0 (SD 3.3) and 16.0 (SD 2.8) (p = 0.012), and the mean VAS score was 55.0 (SD 14.8) and 29.9 (SD 14.9) (p = 0.001). Operative time was 144 min in the intervention group and 165 min in the control group, but the difference did not reach statistical significance (p = 0.205). There were no differences between the groups in blood loss or direct complications.

CONCLUSION

Residents training with a virtual reality simulator prior to the first laparoscopic hysterectomy seem to perform better in the actual live operation. Thus, a virtual reality simulator hysterectomy module could be considered as a part of laparoscopic training curriculum.