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Millar JK, Matusko N, Evans J, Sandhu G. Faculty perception of resident promotion and prevention associated behaviors in the operating room to facilitate intra-operative learning. Am J Surg 2024; 234:3-8. [PMID: 38182458 DOI: 10.1016/j.amjsurg.2023.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/05/2023] [Accepted: 12/28/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Previous work has demonstrated that residents are able to accurately perceive the intraoperative motivational style of faculty. Additionally, alignment of motivational style between residents and faculty has been demonstrated to enhance resident intraoperative autonomy. This study evaluated if faculty perception of resident behaviors aligned with resident self-perception in order to identify ways of enhancing intraoperative learning. METHODS General surgery residents were asked to complete a self-assessment evaluating their own intraoperative behaviors. Conversely, faculty rated how strongly the residents exhibited these behaviors in the operating room. RESULTS Of the 10 intraoperative behaviors that were evaluated, eight demonstrated no correlation between resident self-perception and faculty perception of resident behavior. Similarly, inconsistent correlations emerged when behaviors were assessed according to the self-reported gender and race of the resident. CONCLUSION Faculty are not able to accurately perceive the motivational style of residents. Strategies to improve faculty perception of resident motivational style may enhance intraoperative learning.
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Affiliation(s)
- Jessica K Millar
- Department of Surgery, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, United States; Department of Cardiac Surgery, University of Michigan, 1425 E. Ann St, Ann Arbor, MI, 48109, United States.
| | - Niki Matusko
- Department of Surgery, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, United States.
| | - Julie Evans
- Department of Surgery, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, United States.
| | - Gurjit Sandhu
- Department of Surgery, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, United States.
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Lau JN. We don't really know our residents as well as we think. Trait characteristic recognition by faculty in autonomy needs more attention. But does it matter? Am J Surg 2024; 234:1-2. [PMID: 38378350 DOI: 10.1016/j.amjsurg.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/22/2024]
Affiliation(s)
- James N Lau
- Surgery and Medical Education, Loyola University Chicago Stritch School of Medicine, USA.
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Montgomery KB, Mellinger JD, Lindeman B. Entrustable Professional Activities in Surgery: A Review. JAMA Surg 2024; 159:571-577. [PMID: 38477902 PMCID: PMC11260519 DOI: 10.1001/jamasurg.2023.8107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
Importance Entrustable professional activities (EPAs) compose a competency-based education (CBE) assessment framework that has been increasingly adopted across medical specialties as a workplace-based assessment tool. EPAs focus on directly observed behaviors to determine the level of entrustment a trainee has for a given activity of that specialty. In this narrative review, we highlight the rationale for EPAs in general surgery, describe current evidence supporting their use, and outline some of the practical considerations for EPAs among residency programs, faculty, and trainees. Observations An expanding evidence base for EPAs in general surgery has provided moderate validity evidence for their use as well as practical recommendations for implementation across residency programs. Challenges to EPA use include garnering buy-in from individual faculty and residents to complete EPA microassessments and engage in timely, specific feedback after a case or clinical encounter. When successfully integrated into a program's workflow, EPAs can provide a more accurate picture of residents' competence for a fundamental surgical task or activity compared with other assessment methods. Conclusions and Relevance EPAs represent the next significant shift in the evaluation of general surgery residents as part of the overarching progression toward CBE among all US residency programs. While pragmatic challenges to the implementation of EPAs remain, the best practices from EPA and other CBE assessment literature summarized in this review may assist individuals and programs in implementing EPAs. As EPAs become more widely used in general surgery resident training, further analysis of barriers and facilitators to successful and sustainable EPA implementation will be needed to continue to optimize and advance this new assessment framework.
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Montgomery KB, Mellinger JD, Jones A, McLeod MC, Zmijewski P, Sarosi GA, Brasel KJ, Klingensmith ME, Minter RM, Buyske J, Lindeman B. Validity of Entrustable Professional Activities in a National Sample of General Surgery Residency Programs. J Am Coll Surg 2024; 238:376-384. [PMID: 38224150 PMCID: PMC10942265 DOI: 10.1097/xcs.0000000000000967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
BACKGROUND The American Board of Surgery has endorsed competency-based education as vital to the assessment of surgical training. From 2018 to 2020, a national pilot study was conducted at 28 general surgery programs to evaluate feasibility of implementing entrustable professional activities (EPAs) for 5 common general surgical conditions. ACGME core competency Milestones were also rated for each resident by program clinical competency committees. This study aimed to evaluate the validity of general surgery EPAs compared with Milestones. STUDY DESIGN Prospectively collected, de-identified EPA Pilot Study data were analyzed. EPAs studied were EPA-1 (gallbladder), EPA-2 (inguinal hernia), EPA-3 (right lower quadrant pain), EPA-4 (trauma), and EPA-5 (consult). Variables abstracted included levels of EPA entrustment (1 to 5) and corresponding ACGME Milestone subcompetency ratings (1 to 5) for the same study cycle. Spearman's correlations were used to evaluate the relationship between summative EPA scores and corresponding Milestone ratings. RESULTS A total of 493 unique residents received a summative entrustment decision. EPA summative entrustment scores had moderate-to-strong positive correlation with mapped Milestone subcompetencies, with median rho value of 0.703. Among operation-focused EPAs, median rho values were similar between EPA-1 (0.688) and EPA-2 (0.661), but higher for EPA-3 (0.833). EPA-4 showed a strong positive correlation with diagnosis and communication competencies (0.724), whereas EPA-5, mapped to the most Milestone subcompetencies, had the lowest median rho value (0.455). CONCLUSIONS Moderate-to-strong positive correlation was noted between EPAs and patient care, medical knowledge, and communication Milestones. These findings support the validity of EPAs in general surgery and suggest that EPA assessments can be used to inform Milestone ratings by clinical competency committees.
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Affiliation(s)
| | - John D Mellinger
- American Board of Surgery, Philadelphia, PA
- Department of Surgery, Southern Illinois University, Springfield, IL
| | | | - M Chandler McLeod
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Polina Zmijewski
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - George A Sarosi
- Department of Surgery, University of Florida, Gainesville, FL
| | - Karen J Brasel
- Department of Surgery, Oregon Health & Science University, Portland, OR
| | - Mary E Klingensmith
- Accreditation Council for Graduate Medical Education, Chicago, IL
- Department of Surgery, Washington University in St. Louis, St. Louis, MO
| | | | - Jo Buyske
- American Board of Surgery, Philadelphia, PA
- Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Brenessa Lindeman
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
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Ojute F, Gonzales PA, Ghadimi TR, Edwards A, van der Schaaf M, Lebares C. Investigating First Year Surgery Residents' Expectations of Demand, Control, and Support During Training. JOURNAL OF SURGICAL EDUCATION 2024; 81:474-485. [PMID: 38388312 DOI: 10.1016/j.jsurg.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/09/2023] [Accepted: 12/28/2023] [Indexed: 02/24/2024]
Abstract
OBJECTIVE To provide a more granular understanding of the expectations of general surgery interns regarding workplace demand, control, and support prior to starting training. SUMMARY/BACKGROUND DATA General surgery (GS) interns are at highest risk for burnout and attrition. Maslach frames burnout as resulting from a mismatch between workplace expectations and reality. Occupational science demonstrates workplace demand, control, and support (DCS) as strong influencers of job strain. GS interns' realistic expectations of demands are associated with decreased likelihood of attrition, but their expectations regarding this factor are poorly understood. METHODS Semi-structured interviews were conducted with 14 incoming surgical residents at UCSF: University of California, San Francisco (57% women, 71% non-White), exploring expectations regarding workplace DCS. Transcripts were uploaded to analytic software and coded in dyads using an iterative approach to consensus. Transcripts were thematically analyzed using inductive and deductive reasoning, applying job-demand-resource theory frameworks, and following a published 6-step approach. RESULTS Four main themes emerged: past experiences, expected rewards, anticipated challenges, and the desire to belong. Past experiences describes the expectation to successfully cope with future stressors via self-reliance. Rewards such as professional mastery, personal growth, and sense of meaning were expected outcomes seen as balancing anticipated challenges. Anticipated challenges included low control, toxic cultural elements, and discrimination. Desire to belong (i.e., earned recognition as a peer, inclusion in an elite culture) emerged as a powerful motivator, with survival connotations for women and non-Whites. CONCLUSION Our results suggest incoming interns overestimate the efficacy of self-reliance for coping; count on specific rewards; express realistic expectations regarding challenges; and see inclusion among surgeons as an aspiration that off-sets prolonged effort. Further study is warranted to understand expectation-reality mismatch and potential interventions to target dissonance. MINI-ABSTRACT In this institutional study of general surgery interns, we provide a more granular understanding of the expectations of general surgery interns regarding workplace demand, control, and support prior to starting training, and how we might target "expectations-reality" mismatch and the "desire to belong" as a means of mitigating burnout and minimizing attrition from training.
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Affiliation(s)
- Feyisayo Ojute
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Paul Adam Gonzales
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - T Roxana Ghadimi
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Anya Edwards
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Marieke van der Schaaf
- Utrecht Center for Research and Development of Health Professions Education, Department of Education, Utrecht University, Utrecht, Utrecht, Netherlands
| | - Carter Lebares
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, California.
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Millar JK, Matusko N, Evans J, Baker SJ, Lindeman B, Jung S, Minter RM, Weinstein E, Goodstein F, Cook MR, Brasel KJ, Sandhu G. Faculty Entrustment and Resident Entrustability. JAMA Surg 2024; 159:277-285. [PMID: 38198146 PMCID: PMC10782383 DOI: 10.1001/jamasurg.2023.6915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/17/2023] [Indexed: 01/11/2024]
Abstract
Importance As the surgical education paradigm transitions to entrustable professional activities, a better understanding of the factors associated with resident entrustability are needed. Previous work has demonstrated intraoperative faculty entrustment to be associated with resident entrustability. However, larger studies are needed to understand if this association is present across various surgical training programs. Objective To assess intraoperative faculty-resident behaviors and determine if faculty entrustment is associated with resident entrustability across 4 university-based surgical training programs. Design, Setting, and Participants This cross-sectional study was conducted at 4 university-based surgical training programs from October 2018 to May 2022. OpTrust, a validated tool designed to assess both intraoperative faculty entrustment and resident entrustability behaviors independently, was used to assess faculty-resident interactions. A total of 94 faculty and 129 residents were observed. Purposeful sampling was used to create variation in type of operation performed, case difficulty, faculty-resident pairings, faculty experience, and resident training level. Main Outcomes and Measures Observed resident entrustability scores (scale 1-4, with 4 indicating full entrustability) were compared with reported measures (faculty level, case difficulty, resident postgraduate year [PGY], resident gender, observation month) and observed faculty entrustment scores (scale 1-4, with 4 indicating full entrustment). Path analysis was used to explore direct and indirect effects of the predictors. Associations between resident entrustability and faculty entrustment scores were assessed by pairwise Pearson correlation coefficients. Results A total of 338 cases were observed. Cases observed were evenly distributed by faculty experience (1-5 years' experience: 67 [20.9%]; 6-14 years' experience: 186 [58%]; ≥15 years' experience: 67 [20.9%]), resident PGY (PGY 1: 28 [8%]; PGY 2: 74 [22%]; PGY 3: 64 [19%]; PGY 4: 40 [12%]; PGY 5: 97 [29%]; ≥PGY 6: 36 [11%]), and resident gender (female: 183 [54%]; male: 154 [46%]). At the univariate level, PGY (mean [SD] resident entrustability score range, 1.44 [0.46] for PGY 1 to 3.24 [0.65] for PGY 6; F = 38.92; P < .001) and faculty entrustment (2.55 [0.86]; R2 = 0.94; P < .001) were significantly associated with resident entrustablity. Path analysis demonstrated that faculty entrustment was associated with resident entrustability and that the association of PGY with resident entrustability was mediated by faculty entrustment at all 4 institutions. Conclusions and Relevance Faculty entrustment remained associated with resident entrustability across various surgical training programs. These findings suggest that efforts to develop faculty entrustment behaviors may enhance intraoperative teaching and resident progression by promoting resident entrustability.
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Affiliation(s)
- Jessica K. Millar
- Department of Surgery, University of Michigan, Ann Arbor
- Department of Cardiac Surgery, University of Michigan, Ann Arbor
| | - Niki Matusko
- Department of Surgery, University of Michigan, Ann Arbor
| | - Julie Evans
- Department of Surgery, University of Michigan, Ann Arbor
| | | | - Brenessa Lindeman
- Department of Surgery, University of Alabama at Birmingham, Birmingham
| | - Sarah Jung
- Department of Surgery, University of Wisconsin-Madison
| | | | - Emily Weinstein
- Department of Surgery, Oregon Health and Science University, Portland
| | | | - Mackenzie R. Cook
- Department of Surgery, Oregon Health and Science University, Portland
| | - Karen J. Brasel
- Department of Surgery, Oregon Health and Science University, Portland
| | - Gurjit Sandhu
- Department of Surgery, University of Michigan, Ann Arbor
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Pernar LI. Familiarity, Communication, and Entrustment in the Operating Room. JAMA Surg 2024; 159:285-286. [PMID: 38198180 DOI: 10.1001/jamasurg.2023.6923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Affiliation(s)
- Luise I Pernar
- Department of Surgery, Boston Medical Center, Boston, Massachusetts
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
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Choinski KN, Vouyouka AG. Understanding and addressing varying perceptions of autonomy. J Vasc Surg Venous Lymphat Disord 2024; 12:101691. [PMID: 37783286 DOI: 10.1016/j.jvsv.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 09/04/2023] [Accepted: 09/25/2023] [Indexed: 10/04/2023]
Abstract
Recently, there has been a major shift in the concept of resident autonomy in the operating room. As a result, surgical residents' independence has decreased during their training years. This change has been secondary to multiple factors, including fragmented attending resident interactions, hospital demands for productivity, operating room efficiency, and the public's perception of resident participation in surgery. Multiple gender, personality, and racial biases have also influenced the autonomy of surgical residents. In this paper, we have analyzed the impact of all these factors on the current state of resident autonomy after reviewing relevant literature. We have proposed a strategy to increase resident autonomy via increased resident and faculty interactions, case planning, and encouraged recruitment of diverse vascular surgery trainees and faculty.
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Affiliation(s)
- Krystina N Choinski
- Division of Vascular Surgery, Department of Surgery, Mount Sinai Hospital, New York, NY
| | - Ageliki G Vouyouka
- Division of Vascular Surgery, Department of Surgery, Mount Sinai Hospital, New York, NY.
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Sevestre A, Dochez V, Souron R, Deschamps T, Winer N, Thubert T. Evaluation Tools for Assessing Autonomy of Surgical Residents in the Operating Room and Factors Influencing Access to Autonomy: A Systematic Literature Review. JOURNAL OF SURGICAL EDUCATION 2024; 81:182-192. [PMID: 38160113 DOI: 10.1016/j.jsurg.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/16/2023] [Accepted: 11/01/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Surgical residents in France lack a clear pedagogical framework for achieving autonomy in the operating room. The progressive acquisition of surgical autonomy is a determining factor in the confidence of operators for their future independent practice. Currently, there is no autonomy scale commonly used in Europe. The objective of this study is to identify existing tools for quantifying the autonomy of residents and the factors that influence it. MATERIALS AND METHODS We conducted a qualitative systematic review following the recommendations of the Systematic Review Without Meta-Analysis (SWiM) guidelines. Publications were extracted from the MEDLINE (PubMed), EMBASE, and PSYCINFO databases. All publications without date restrictions up to July 2022 were identified. RESULTS Among the 231 identified publications, 21 met the inclusion criteria. Seventeen publications used a graded autonomy assessment tool by the student and/or the teacher, while 4 used evaluations by an observing third party. We found 8 different autonomy scales, with the Zwisch Scale representing 57.1% of the cases. Factors influencing autonomy were diverse, including the work context, experience, and gender of the resident and their teacher. DISCUSSION We found heterogeneity in the tools used to "measure" the autonomy of a resident in the operating room. The SIMPL tool or the Zwisch Scale appear to be the most frequently used tools. The relationship between autonomy, performance, confidence, and knowledge may require multidimensional tools that encompass various areas of competence, but this could make their daily application more challenging. The factors influencing autonomy are numerous; and understanding them would improve teaching in the operating room. There is a significant lack of data on surgical autonomy in France, as well as a lack of evaluation in the field of gynecology-obstetrics worldwide.
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Affiliation(s)
- Anaïs Sevestre
- Nantes Université, CHU Nantes, Service de Gynécologie-Obstétrique, Nantes, France; Nantes Université, CHU Nantes, Movement - Interactions - Performance, Nantes, France
| | - Vincent Dochez
- Nantes Université, CHU Nantes, Service de Gynécologie-Obstétrique, Nantes, France; Nantes Université, CHU Nantes, Movement - Interactions - Performance, Nantes, France.
| | - Robin Souron
- Nantes Université, CHU Nantes, Movement - Interactions - Performance, Nantes, France
| | - Thibault Deschamps
- Nantes Université, CHU Nantes, Movement - Interactions - Performance, Nantes, France
| | - Norbert Winer
- Nantes Université, CHU Nantes, Service de Gynécologie-Obstétrique, Nantes, France; Nantes Université, CHU Nantes, INRAE, Nantes, France
| | - Thibault Thubert
- Nantes Université, CHU Nantes, Service de Gynécologie-Obstétrique, Nantes, France; Nantes Université, CHU Nantes, Movement - Interactions - Performance, Nantes, France
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Eruchalu CN, Etheridge JC, Hammaker AC, Kader S, Abelson JS, Harvey J, Farr D, Stopenski SJ, Nahmias JT, Elsaadi A, Campbell SJ, Foote DC, Ivascu FA, Montgomery KB, Zmijewski P, Byrd SE, Kimbrough MK, Smith S, Postlewait LM, Dodwad SJM, Adams SD, Markesbery KC, Meister KM, Woeste MR, Martin RCG, Callahan ZM, Marks JA, Patel P, Anstadt MJ, Nasim BW, Willis RE, Patel JA, Newcomb MR, Stahl CC, Yafi MA, Sutton JM, George BC, Quillin RC, Cho NL, Cortez AR. Racial and Ethnic Disparities in Operative Experience Among General Surgery Residents: A Multi-Institutional Study from the US ROPE Consortium. Ann Surg 2024; 279:172-179. [PMID: 36928294 PMCID: PMC11104265 DOI: 10.1097/sla.0000000000005848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE To determine the relationship between race/ethnicity and case volume among graduating surgical residents. BACKGROUND Racial/ethnic minority individuals face barriers to entry and advancement in surgery; however, no large-scale investigations of the operative experience of racial/ethnic minority residents have been performed. METHODS A multi-institutional retrospective analysis of the Accreditation Council for Graduate Medical Education case logs of categorical general surgery residents at 20 programs in the US Resident OPerative Experience Consortium database was performed. All residents graduating between 2010 and 2020 were included. The total, surgeon chief, surgeon junior, and teaching assistant case volumes were compared between racial/ethnic groups. RESULTS The cohort included 1343 residents. There were 211 (15.7%) Asian, 65 (4.8%) Black, 73 (5.4%) Hispanic, 71 (5.3%) "Other" (Native American or Multiple Race), and 923 (68.7%) White residents. On adjusted analysis, Black residents performed 76 fewer total cases (95% CI, -109 to -43, P <0.001) and 69 fewer surgeon junior cases (-98 to -40, P <0.001) than White residents. Comparing adjusted total case volume by graduation year, both Black residents and White residents performed more cases over time; however, there was no difference in the rates of annual increase (10 versus 12 cases per year increase, respectively, P =0.769). Thus, differences in total case volume persisted over the study period. CONCLUSIONS In this multi-institutional study, Black residents graduated with lower case volume than non-minority residents throughout the previous decade. Reduced operative learning opportunities may negatively impact professional advancement. Systemic interventions are needed to promote equitable operative experience and positive culture change.
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Affiliation(s)
- Chukwuma N Eruchalu
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - James C Etheridge
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Ariadne Labs, Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital, Boston, MA
| | - Austin C Hammaker
- Department of Surgery, Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Cincinnati, OH
| | - Sarah Kader
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA
| | - Jonathan S Abelson
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA
| | - Jalen Harvey
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Deborah Farr
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Jeffry T Nahmias
- Department of Surgery, University of California Irvine, Orange, CA
| | - Ali Elsaadi
- Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX
| | - Samuel J Campbell
- Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX
| | - Darci C Foote
- Department of Surgery, Beaumont Health, Royal Oak, MI
| | | | | | - Polina Zmijewski
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Samuel E Byrd
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Mary K Kimbrough
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | | | | | | | - Sasha D Adams
- Department of Surgery, McGovern Medical School at UTHealth, Houston, TX
| | | | | | | | | | | | - Joshua A Marks
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Purvi Patel
- Department of Surgery, Loyola University, Maywood, IL
| | | | - Bilal Waqar Nasim
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Ross E Willis
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Jitesh A Patel
- Department of Surgery, University of Kentucky, Lexington, KY
| | | | | | - Motaz Al Yafi
- Department of Surgery, University of Toledo, Toledo, OH
| | - Jeffrey M Sutton
- Department of Surgery, Medical University of South Carolina, Division of Oncologic and Endocrine Surgery, Charleston, SC
| | - Brian C George
- Department of Surgery, Center for Surgical Training and Research (CSTAR), University of Michigan, Ann Arbor, MI
| | - Ralph C Quillin
- Department of Surgery, Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Cincinnati, OH
| | - Nancy L Cho
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Alexander R Cortez
- Department of Surgery, Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Cincinnati, OH
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Thelen AE, Marcotte KM, Diaz S, Gates R, Chen X, George BC, Krumm AE. Variation in Competence of Graduating General Surgery Trainees. JOURNAL OF SURGICAL EDUCATION 2024; 81:17-24. [PMID: 38036389 DOI: 10.1016/j.jsurg.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 07/22/2023] [Accepted: 11/03/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE To examine the readiness of general surgery residents in their final year of training to perform 5 common surgical procedures based on their documented performance during training. DESIGN Intraoperative performance ratings were analyzed using a Bayesian mixed effects approach, adjusting for rater, trainee, procedure, case complexity, and postgraduate year (PGY) as random effects as well as month in academic year and cumulative, procedure-specific performance per trainee as fixed effects. This model was then used to estimate each PGY 5 trainee's final probability of being able to independently perform each procedure. The actual, documented competency rates for individual trainees were then identified across each of the 5 most common general surgery procedures: appendectomy, cholecystectomy, ventral hernia repair, groin hernia repair, and partial colectomy. SETTING This study was conducted using data from members of the SIMPL collaborative. PARTICIPANTS A total of 17,248 evaluations of 927 PGY5 general surgery residents were analyzed from 2015 to 2021. RESULTS The percentage of residents who requested a SIMPL rating during their PGY5 year and achieved a ≥90% probability of being rated as independent, or "Practice-Ready," was 97.4% for appendectomy, 82.4% for cholecystectomy, 43.5% for ventral hernia repair, 24% for groin hernia repair, and 5.3% for partial colectomy. CONCLUSIONS There is substantial variation in the demonstrated competency of general surgery residents to perform several common surgical procedures at the end of their training. This variation in readiness calls for careful study of how surgical residents can become more adequately prepared to enter independent practice.
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Affiliation(s)
- Angela E Thelen
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan; MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
| | - Kayla M Marcotte
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan; University of Michigan Medical School, Ann Arbor, Michigan; Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan
| | - Sarah Diaz
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan; University of Michigan Medical School, Ann Arbor, Michigan
| | - Rebecca Gates
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Xilin Chen
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Brian C George
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Andrew E Krumm
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan
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Poeppelman RS, Moore-Clingenpeel M, Siems A, Mitchell DL, Jani P, Stewart C. Faculty Decision Making in Ad Hoc Entrustment of Pediatric Critical Care Fellows: A National Case-Based Survey. TEACHING AND LEARNING IN MEDICINE 2023:1-8. [PMID: 37933862 DOI: 10.1080/10401334.2023.2269402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/02/2023] [Indexed: 11/08/2023]
Abstract
Phenomenon: Ad hoc entrustment decisions reflect a clinical supervisor's estimation of the amount of supervision a trainee needs to successfully complete a task in the moment. These decisions have important consequences for patient safety, trainee learning, and preparation for independent practice. Determinants of these decisions have previously been described but have not been well described for acute care contexts such as critical care and emergency medicine. The ad hoc entrustment of trainees caring for vulnerable patient populations is a high-stakes decision that may differ from other contexts. Critically ill patients and children are vulnerable patient populations, making the ad hoc entrustment of a pediatric critical care medicine (PCCM) fellow a particularly high-stakes decision. This study sought to characterize how ad hoc entrustment decisions are made for PCCM fellows through faculty ratings of vignettes. The authors investigated how acuity, relationship, training level, and task interact to influence ad hoc entrustment decisions. Approach: A survey containing 16 vignettes that varied by four traits (acuity, relationship, training level, and task) was distributed to U.S. faculty of pediatric critical care fellowships in 2020. Respondents determined an entrustment level for each case and provided demographic data. Entrustment ratings were dichotomized by "high entrustment" versus "low entrustment" (direct supervision or observation only). The authors used logistic regression to evaluate the individual and interactive effects of the four traits on dichotomized entrustment ratings. Findings: One hundred seventy-eight respondents from 30 institutions completed the survey (44% institutional response rate). Acuity, relationship, and task all significantly influenced the entrustment level selected but did not interact. Faculty most frequently selected "direct supervision" as the entrustment level for vignettes, including for 24% of vignettes describing fellows in their final year of training. Faculty rated the majority of vignettes (61%) as "low entrustment." There was no relationship between faculty or institutional demographics and the entrustment level selected. Insights: As has been found in summative entrustment for pediatrics, internal medicine, and surgery trainees, PCCM fellows often rated at or below the "direct supervision" level of ad hoc entrustment. This may relate to declining opportunities to practice procedures, a culture of low trust propensity among the specialty, and/or variation in interpretation of entrustment scales.
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Affiliation(s)
- Rachel Stork Poeppelman
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | - Melissa Moore-Clingenpeel
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | - Ashley Siems
- Department of Pediatrics, Children's National, Washington, DC, USA
| | - Diana L Mitchell
- Department of Pediatrics, Advocate Children's Hospital Park Ridge, Park Ridge, Illinois, USA
- Department of Pediatrics, University of Chicago, Chicago, Illinois, USA
| | - Priti Jani
- Department of Pediatrics, University of Chicago, Chicago, Illinois, USA
| | - Claire Stewart
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
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Biller J, Simunich T, Morrissey S, Dumire R. Evaluation of Gender Bias Through Autonomy During Laparoscopic Cholecystectomy at a Rural Community General Surgery Residency Program. JOURNAL OF SURGICAL EDUCATION 2023; 80:1508-1515. [PMID: 37353421 DOI: 10.1016/j.jsurg.2023.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/10/2023] [Accepted: 05/21/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE Gender bias not only continues to exist in surgical specialties, but in the medical field overall. Despite females graduating from medical schools at the same rate as men, a discrepancy still exists in the number of females pursuing surgical specialties compared to their male counterparts. We hypothesized that surgical training occurring in smaller institutions with close-knit relationships between faculty and residents should decrease the likelihood of gender bias towards females, as measured by perceived autonomy during laparoscopic cholecystectomy. DESIGN All 17 surgery residents at a community surgery residency program were asked to voluntarily and anonymously complete an investigator-created questionnaire after every laparoscopic cholecystectomy from October 2020 to May 2022. The questionnaire included details regarding overall resident operative experience, case complexity, patient diagnosis, resident autonomy throughout the case, and perceived autonomy compared to their peers. Each respondent estimated their percent autonomy from 0% to 100% during 5 distinct portions of the case, from which, a mean overall percent autonomy was calculated. RESULTS A total of 233 questionnaires (98 female, 135 male) were completed during the study period, with 8 females and 9 males in the first study year and 7 females and 10 males in the second. Mean overall autonomy was statistically similar between males and females, 71% and 72% respectively (p = 0.967). Case difficulty was not statistically different between males and females (p = 0.445). There was a significant difference in autonomy of all residents with male and female attendings, 67.5% and 80.3%, respectively (p = 0.001), however this did not differ between male and female residents. Eighty-three percent of respondents felt that their level of autonomy was acceptable for their postgraduate year (PGY) level. Over 90 percent of respondents felt their autonomy was not affected by their gender. CONCLUSIONS There was no significant difference in perceived autonomy between male and female residents during laparoscopic cholecystectomy at our small general surgery residency program. Gender bias did not appear to be a prohibiting factor in the amount of autonomy given to male and female residents.
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Affiliation(s)
- Jessica Biller
- Department of Surgery, Conemaugh Memorial Medical Center, Johnstown, Pennsylvania.
| | - Thomas Simunich
- Department of Research, Duke LifePoint Conemaugh Memorial Medical Center, Johnstown, Pennsylvania
| | - Shawna Morrissey
- Department of Surgery, Conemaugh Memorial Medical Center, Johnstown, Pennsylvania
| | - Russell Dumire
- Department of Surgery, Conemaugh Memorial Medical Center, Johnstown, Pennsylvania
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Heidt N, Whiting J, Falank C, Olsen B, Miller H, Sawhney J. Educational Value of Surgical Residents Operating as Teaching Assistant. JOURNAL OF SURGICAL EDUCATION 2023; 80:1522-1528. [PMID: 37423803 DOI: 10.1016/j.jsurg.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/03/2023] [Accepted: 06/07/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE To assess the educational of value of teaching assistant (TA) cases from the perspectives of attending, chief resident, and junior resident. We hypothesized the greatest educational value of TA cases would be for chief residents more so than other team members. DESIGN A prospective survey was designed and collected for TA cases separately from attendings, chief residents, and junior residents to assess operative details and educational value. The study period ran from August 2021 through December 2022. Qualitative and quantitative analysis was undertaken to compare answers and discover themes in the free-text responses of attendings and residents. SETTING Single center, tertiary care institution, Maine Medical Center, Department of Surgery, Portland, ME PARTICIPANTS: Sixty-nine teaching assistant cases were captured from a total of 117 completed surveys that were completed by 44 chief residents, 49 junior residents, 22 attendings (n = 22) and 2 APPs. RESULTS A wide variety of TA cases were included in the study with the most common reason for performing a TA case being resident request 68%. Operative complexity was most commonly rated easiest third (50%) and middle third (41%) of overall cases. Both junior and chief residents felt that compared to working with an attending alone, TA cases contributed more or much more to their procedural independence >80% of the time. Attendings reported learning something about the resident's skills that they were not expecting in 59% of the cases. Thematic analysis: attendings focused on the steps of the procedure, including the technical aspects, particularly regarding opening while residents largely focused on communication and preparation. CONCLUSIONS Teaching assistant cases seem to have more educational value for chief and junior residents than attendings. Both junior and chief residents felt that compared to working with an attending alone, TA cases contributed more or much more to their procedural independence >80% of the time.
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Affiliation(s)
- Nicole Heidt
- Department of Surgery, Maine Medical Center, Portland, Maine
| | - James Whiting
- Department of Surgery, Maine Medical Center, Portland, Maine
| | - Carolyne Falank
- Department of Surgery, Maine Medical Center, Portland, Maine
| | - Bridget Olsen
- Department of Surgery, Maine Medical Center, Portland, Maine
| | - Heidi Miller
- Department of Surgery, Maine Medical Center, Portland, Maine
| | - Jaswin Sawhney
- Department of Surgery, Maine Medical Center, Portland, Maine.
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15
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Liu S, Ji Y, Li J, Peng Y, Li Z, Lai W, Feng T. Analysis of students' positive emotions around the green space in the university campus during the COVID-19 pandemic in China. Front Public Health 2022; 10:888295. [PMID: 36016888 PMCID: PMC9395969 DOI: 10.3389/fpubh.2022.888295] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 07/08/2022] [Indexed: 01/21/2023] Open
Abstract
Green space around the university campus is of paramount importance for emotional and psychological restorations in students. Positive emotions in students can be aroused when immersed in green space and naturalness. However, to what extent can perceived naturalness influence students' positive emotion remains unclear, especially in the context of COVID-19 countermeasures. This study, therefore, attempts to investigate in-depth the nature and strength of the relationships between students' positive emotion and their perceived naturalness, place attachment, and landscape preference, which are potentially varying across universities in different social and environmental contexts and different restrictions policies regarding the COVID-19 pandemic. A course of questionnaire-based surveys was administered on two university campuses in Heilongjiang and Hunan Provinces, China, resulting in 474 effective samples. Structural equation modeling was used to explore the hypothetical conceptual framework of latent variables and the indicators. The findings indicate that the higher students' perceived naturalness results in greater positive emotion. Students' perceived naturalness in green spaces of campus has a positive effect on their place attachment and landscape preference. Moreover, the difference between mediate effects of place attachment and landscape preference were addressed, which verifies the contextual influences.
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Affiliation(s)
- Shaobo Liu
- The Department of Environmental Design, School of Architecture and Art, Central South University, Changsha, China
| | - Yifeng Ji
- The Department of Environmental Design, School of Architecture and Art, Central South University, Changsha, China
| | - Jiang Li
- The Department of Environmental Design, School of Architecture and Art, Central South University, Changsha, China
| | - You Peng
- Urban Planning and Transportation Research Group, Department of the Built Environment, Eindhoven University of Technology, Eindhoven, Netherlands,*Correspondence: You Peng
| | - Zhitao Li
- Smart Transport Key Laboratory of Hunan Province, School of Traffic and Transportation Engineering, Central South University, Changsha, China
| | - Wenbo Lai
- Department of Landscape Architecture, School of Architecture, South China University of Technology, Guangzhou, China
| | - Tao Feng
- Urban and Data Science Lab, Graduate School of Advanced Science and Engineering, Hiroshima University, Higashi Hiroshima, Japan
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16
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Miles VP, Schroll RW, Beaty JS. Empowering the Resident Learner. JOURNAL OF SURGICAL EDUCATION 2022; 79:909-917. [PMID: 35490137 DOI: 10.1016/j.jsurg.2022.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/07/2022] [Accepted: 03/22/2022] [Indexed: 06/14/2023]
Abstract
Surgical resident autonomy is an essential element of the transition from supervised training to independent practice. However, in an age of duty hour restrictions, legislative constraints, increased litigation, and heightened societal expectations, training an autonomous resident proves increasingly difficult. To tackle these barriers to training successful surgeons, the American College of Surgeons Committee on Resident Education initiated the Resident Mentored Autonomy Project. As a subdivision of this project, the Empowered Learner research team here presents a framework for training the self-directed and empowered surgical resident learner. There are many strategies by which surgical faculty, program directors and chairs, and residents themselves may engage to improve resident operative autonomy.
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Affiliation(s)
- Victoria P Miles
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee.
| | - Rebecca W Schroll
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
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Chang YC, Chuang RS, Hsiao CT, Khwepeya M, Nkambule NS. Bridging the Gap: Using Consensus to Explore Entrustment Decisions and Feedback Receptivity in Competency-Based Emergency Medicine Residency Programs Through the Construction of a Q-Sample Incorporating a Delphi Technique. Front Med (Lausanne) 2022; 9:879271. [PMID: 35721074 PMCID: PMC9201255 DOI: 10.3389/fmed.2022.879271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 05/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Recent changes in medical education calls for a shift toward student-centered learning. Therefore, it is imperative that clinical educators transparently assess the work-readiness of their medical residents through entrustment-based supervision decisions toward independent practice. Similarly, it is critical that medical residents are vocal about the quality of supervision and feedback they receive. This study aimed to explore the factors that influence entrustment-based supervision decisions and feedback receptivity by establishing a general consensus among Taiwanese clinical educators and medical residents regarding entrustment decisions and feedback uptake, respectively. Methods In Q-methodology studies, a set of opinion statement (i.e., the Q-sample) is generated to represent the phenomenon of interest. To explore the factors that influence entrustment-based supervision decisions and feedback receptivity, a Q-sample was developed using a four-step approach: (1) literature search using electronic databases, such as PubMed and Google Scholar, and interviews with emergency clinical educators and medical residents to generate opinion statements, (2) thematic analysis and grouping using The Model of Trust, the Ready, Wiling, and Able model, and the theory of self-regulated learning, (3) translation, and (4) application of a Delphi technique, including two expert panels comprised of clinical educators and medical residents, to establish a consensus of the statements and validation for a subsequent Q-study. Results A total of 585 and 1,039 statements from the literature search and interviews were extracted to populate the sample of statements (i.e., the concourse) regarding entrustment-based supervision decisions for clinical educators and feedback receptivity emergency medicine residents, respectively. Two expert panels were invited to participate in a Delphi Technique, comprised of 11 clinical educators and 13 medical residents. After two-rounds of a Delphi technique, the panel of clinical educators agreed on 54 statements on factors that influence entrustment-based supervision decisions and were categorized into five themes defined by the Model of Trust. Similarly, a total of 60 statements on the factors that influence feedback receptivity were retained by the panel of medical residents and were categorized into five themes defined by the Ready, Willing, and Able model and the theory of self-regulated learning. Conclusion Though not exhaustive, the key factors agreed upon by clinical educators and medical residents reflect the characteristics of entrustment-based supervision decisions and feedback receptivity across specialties. This study provides insight on an often overlooked issue of the paths to teaching and learning in competency-based residency training programs. Additionally, incorporation of the Delphi technique further adds to the existing literature and puts emphasis as an important tool that can be used in medical education to rigorously validate Q-statements and develop Q-samples in various specialties.
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Affiliation(s)
- Yu-Che Chang
- Chang Gung Medical Education Research Centre (CG-MERC), Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Renee S. Chuang
- Chang Gung Medical Education Research Centre (CG-MERC), Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Cheng-Ting Hsiao
- Chang Gung Medical Education Research Centre (CG-MERC), Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Madalitso Khwepeya
- Chang Gung Medical Education Research Centre (CG-MERC), Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Nothando S. Nkambule
- International Graduate Program of Education and Human Development (IGPEHD), College of Social Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
- *Correspondence: Nothando S. Nkambule
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18
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Jeyalingam T, Brydges R, Ginsburg S, McCreath GA, Walsh CM. How Clinical Supervisors Conceptualize Procedural Entrustment: An Interview-Based Study of Entrustment Decision Making in Endoscopic Training. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:586-592. [PMID: 34935727 DOI: 10.1097/acm.0000000000004566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Entrustment is central to assessment in competency-based medical education (CBME). To date, little research has addressed how clinical supervisors conceptualize entrustment, including factors they consider in making entrustment decisions. The aim of this study was to characterize supervisors' decision making related to procedural entrustment, using gastrointestinal endoscopy as a test case. METHOD Using methods from constructivist grounded theory, the authors interviewed 29 endoscopy supervisors in the United States and Canada across multiple specialties (adult and pediatric gastroenterology, surgery, and family medicine). Semistructured interviews, conducted between April and November 2019, focused on how supervisors conceptualize procedural entrustment, how they make entrustment decisions, and what factors they consider. Transcripts were analyzed using constant comparison to generate an explanatory framework and themes. RESULTS Three themes were identified from the analysis of interview transcripts: (1) entrustment occurs in varying degrees and fluctuates over time; (2) entrustment decisions can transfer within and across procedural and nonprocedural contexts; (3a) persistent static factors (e.g., supervisor competence, institutional culture, legal considerations) influence entrustment decisions, as do (3b) fluctuating, situated dynamic factors (e.g., trainee skills, patient acuity, time constraints), which tend to change from one training encounter to the next. CONCLUSIONS In the process of making procedural entrustment decisions, clinical supervisors appear to synthesize multiple dynamic factors against a background of static factors, culminating in a decision of whether to entrust. Entrustment decisions appear to fluctuate over time, and assessors may transfer decisions about specific trainees across settings. Understanding which factors supervisors perceive as influencing their decision making has the potential to inform faculty development, as well as competency committees seeking to aggregate faculty judgments about trainee unsupervised practice. Those leading CBME programs may wish to invest in optimizing the observed static factors, such that these foundational factors are tuned to facilitate trainee learning and achievement of entrustment.
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Affiliation(s)
- Thurarshen Jeyalingam
- T. Jeyalingam is an advanced fellow in luminal therapeutic endoscopy, University of Calgary, Calgary, Alberta, Canada; ORCID: http://orcid.org/0000-0002-7254-9639
| | - Ryan Brydges
- R. Brydges is a scientist and holds the Professorship in Technology-Enabled Education, St. Michael's Hospital, Unity Health Toronto, and is associate professor, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shiphra Ginsburg
- S. Ginsburg is professor of medicine, Department of Medicine, Sinai Health System and Faculty of Medicine, a scientist, Wilson Centre for Research in Education, and Canada Research Chair in Health Professions Education, University of Toronto, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0002-4595-6650
| | - Graham A McCreath
- G.A. McCreath is clinical research project coordinator, SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0002-9312-8665
| | - Catharine M Walsh
- C.M. Walsh is staff gastroenterologist, Division of Gastroenterology, Hepatology, and Nutrition, educational researcher, SickKids Learning Institute, scientist, Child Health Evaluative Sciences, SickKids Research Institute, Hospital for Sick Children, scientist, Wilson Centre for Research in Education, and associate professor of paediatrics, University of Toronto, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0003-3928-703X
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19
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Rivard SJ, Kemp MT, Evans J, Sandhu G. Resident Perceptions of Faculty Behaviors Promoting Learner Operative Skills and Autonomy. JOURNAL OF SURGICAL EDUCATION 2022; 79:431-440. [PMID: 34758932 DOI: 10.1016/j.jsurg.2021.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 09/17/2021] [Accepted: 09/17/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To better understand the resident perceived faculty factors associated with the promotion of resident operative skill and autonomy DESIGN: Qualitative retrospective analysis utilizing anonymous open-ended comments from residents on department of surgery faculty teaching evaluations and cross references them to observed faculty entrustment scores SETTING: Single tertiary midwestern allopathic academic medical center using data obtained between January 2016-August 2019 PARTICIPANTS: Forty-six resident and fourteen faculty surgeons from general, plastic, thoracic, and vascular surgery sections. RESULTS Themes of personal traits, the working environment created, and teaching techniques employed were identified across resident promoting attendings and resident limiting attendings. Promoting attendings employed preoperative goal setting, increased operative autonomy, and postoperative feedback while creating environments conducive to learning by promoting teamwork and collaboration. Alternatively, limiting attendings used more ineffective teaching techniques including micromanaging, lack of delegation, and treating residents as observers. Additionally, trainees described these operating room environments as stressful and strained. CONCLUSIONS Qualitative analysis of resident teaching evaluations of attending surgeons highlights the importance of relationships between learner and teacher, the learning environment, and teaching techniques. Continuous professional development programs centered on entrustment and promoting behaviors have the potential to disseminate strategies to enhance educator skills among surgeons.
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Affiliation(s)
| | - Michael T Kemp
- University of Michigan, Department of Surgery, Ann Arbor, Michigan
| | - Julie Evans
- University of Michigan, Department of Surgery, Ann Arbor, Michigan
| | - Gurjit Sandhu
- University of Michigan, Department of Surgery, Ann Arbor, Michigan
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20
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Williams AM, Karmakar M, Thompson-Burdine J, Matusko N, Ji S, Kamdar N, Seiler K, Minter RM, Sandhu G. Increased Intraoperative Faculty Entrustment and Resident Entrustability Does Not Compromise Patient Outcomes After General Surgery Procedures. Ann Surg 2022; 275:e366-e374. [PMID: 32541221 DOI: 10.1097/sla.0000000000004052] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Intraoperative resident autonomy has been compromised secondary to expectations for increased supervision without defined parameters for safe progressive independence, diffusion of training experience, and more to learn with less time. Surgical residents who are insufficiently entrusted during training attain less autonomy, confidence, and even clinical competency, potentially affecting future patient outcomes. OBJECTIVE To determine if OpTrust, an educational intervention for increasing intraoperative faculty entrustment and resident entrustability, negatively impacts patient outcomes after general surgery procedures. METHODS Surgical faculty and residents received OpTrust training and instruction to promote intraoperative faculty entrustment and resident entrustability. A post-intervention OpTrust cohort was compared to historical and pre-intervention OpTrust cohorts. Multivariable logistic and negative binomial regression was used to evaluate the impact of the OpTrust intervention and time on patient outcomes. SETTING Single tertiary academic center. PARTICIPANTS General surgery faculty and residents. MAIN OUTCOMES AND MEASURES Thirty-day postoperative outcomes, including mortality, any complication, reoperation, readmission, and length of stay. RESULTS A total of 8890 surgical procedures were included. After risk adjustment, overall patient outcomes were similar. Multivariable regression estimating the effect of the OpTrust intervention and time revealed similar patient outcomes with no increased risk (P > 0.05) of mortality {odds ratio (OR), 2.23 [95% confidence interval (CI), 0.87-5.6]}, any complication [OR, 0.98 (95% CI, 0.76-1.3)], reoperation [OR, 0.65 (95% CI, 0.42-1.0)], readmission [OR, 0.82 (95% CI, 0.57-1.2)], and length of stay [OR, 0.99 (95% CI, 0.86-1.1)] compared to the historic and pre-intervention OpTrust cohorts. CONCLUSIONS OpTrust, an educational intervention to increase faculty entrustment and resident entrustability, does not compromise postoperative patient outcomes. Integrating faculty and resident development to further enhance entrustment and entrustability through OpTrust may help facilitate increased resident autonomy within the safety net of surgical training without negatively impacting clinical outcomes.
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Affiliation(s)
| | - Monita Karmakar
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
| | | | - Niki Matusko
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Sunjong Ji
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Neil Kamdar
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, Michigan Medicine, Ann Arbor, MI
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, MI
- Department of Emergency Medicine, Michigan Medicine, Ann Arbor, MI
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI
| | - Kristian Seiler
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
- Department of Emergency Medicine, Michigan Medicine, Ann Arbor, MI
| | - Rebecca M Minter
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Gurjit Sandhu
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, MI
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21
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Schultz K, Howard S, Moreno K, Siegel T, Zonies D, Brasel K, Cook M. Teaching primary palliative care to general surgical residents: A novel pedagogical approach drawn from multi-disciplinary focus group data. Am J Surg 2022; 224:396-399. [DOI: 10.1016/j.amjsurg.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/23/2022] [Accepted: 02/03/2022] [Indexed: 01/23/2023]
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22
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Geary AD, Sanfey H, Glynn L, Pernar LI. Teaching assistant cases in general surgery training - A literature review. Am J Surg 2021; 223:1088-1093. [PMID: 34819229 DOI: 10.1016/j.amjsurg.2021.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/10/2021] [Accepted: 11/14/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND There is a lack of understanding of the scope and purpose of teaching assistant cases, impact on patients and safety, as well as the facilitators or barriers to resident participation in these cases. METHODS Four databases (PubMed, Embase, Web of Science, and the Education Resources Information Center), were searched. The references of identified resources were additionally hand-searched. 10 articles were identified and considered in the literature review. RESULTS The TA case literature focuses on case numbers and safety. The discussions of papers allude to perceived benefits of TA cases. The literature review reveals that residents are more likely to be granted TA opportunities if they show themselves worthy of entrustment. CONCLUSIONS The work elucidates aspects of TA cases that have not previously been emphasized or highlighted. The literature review can serve to inform attending surgeons and trainees how to optimize the opportunities teaching assistant cases can afford.
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Affiliation(s)
- Alaina D Geary
- Boston University School of Medicine, United States; Department of Surgery, Boston Medical Center, United States
| | - Hilary Sanfey
- Department of Surgery, Southern Illinois University, United States
| | - Loretto Glynn
- Department of Surgery, NYU Long Island School of Medicine, United States
| | - Luise I Pernar
- Boston University School of Medicine, United States; Department of Surgery, Boston Medical Center, United States.
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23
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Transition from trainee to educator in the operating room: A needs assessment and framework to support junior faculty. Am J Surg 2021; 223:1112-1119. [PMID: 34799075 DOI: 10.1016/j.amjsurg.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/26/2021] [Accepted: 11/03/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Transitioning from trainee to attending surgeon requires learners to become educators. The purpose of this study is to evaluate educational strategies utilized by surgeons, define gaps in preparation for operative teaching, and identify opportunities to support this transition. METHODS A web-based, Association of Surgical Education approved survey was distributed to attending surgeons. RESULTS There were 153 respondents. Narrating actions was the most frequently reported educational model, utilized by 74% of junior faculty [JF] (0-5yrs) and 63% of senior faculty [SF] (>6yrs). Other models used included educational time-outs (29% JF, 27% SF), BID teaching model (36% JF, 51% SF), and Zwisch model (13% JF, 25% SF). Compared with 91% JF, 65% SF reported struggling with instruction (p < 0.001). Five themes emerged as presenting difficulty during the resident to attending transition: lack of relationships, ongoing learning, systems-based, cognitive load, impression management. CONCLUSIONS Our results represent a needs assessment in the transition from learner to educator in the OR.
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Wojcik BM, McKinley SK, Fong ZV, Mansur A, Bloom JP, Amari N, Hamdi I, Chang DC, Petrusa E, Mullen JT, Phitayakorn R. The Resident-Run Minor Surgery Clinic: A Four-Year Analysis of Patient Outcomes, Satisfaction, and Resident Education. JOURNAL OF SURGICAL EDUCATION 2021; 78:1838-1850. [PMID: 34092535 DOI: 10.1016/j.jsurg.2021.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/04/2021] [Accepted: 04/01/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE A resident-run minor surgery clinic was developed to increase resident procedural autonomy. We evaluated whether 1) there was a significant difference between complications and patient satisfaction when procedures were independently performed by surgical residents vs. a surgical attending and 2) if participation was associated with an increase in resident procedural confidence. DESIGN Third year general surgery residents participated in a weekly procedure clinic from 2014-2018. Post-procedure complications and patient satisfaction were compared between patients operated on by residents vs. the staff surgeon. Residents were surveyed regarding their confidence in independently performing a variety of clinic-based patient care tasks. SETTING Massachusetts General Hospital General in Boston, MA; an academic tertiary care general surgery residency program. PARTICIPANTS Post-graduate year three general surgery residents that ran the clinic as part of a general surgery rotation. RESULTS 1230 patients underwent 1592 procedures (612 in resident clinic, 980 in attending clinic). There was no significant difference in the 30-day complication rate between patients operated on by the resident vs. attending (2.5% vs. 1.9%, p = 0.49). 459 patient satisfaction surveys were administered with a 79.1% response rate. There was no significant difference in the overall quality of care rating between residents and the attending surgeon (87.5% top-box rating vs. 93.1%, p = 0.15). Twenty-one residents completed both a pre- and post-rotation survey (77.8% response rate). The proportion of residents indicating that they could independently perform a variety of patient care tasks significantly increased across the rotation (all p < 0.05). CONCLUSION Mid-level general surgery residents can independently perform office-based procedures without detriment to safety or patient satisfaction. The resident-run procedure clinic serves as an environment for residents to grow in confidence in both technical and non-technical skills. Given the high rate at which patients provide resident feedback, future work may investigate how to best incorporate patient derived evaluations into resident assessment.
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Affiliation(s)
- Brandon M Wojcik
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Sophia K McKinley
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Zhi Ven Fong
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Arian Mansur
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Jordan P Bloom
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Noor Amari
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Isra Hamdi
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - David C Chang
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - John T Mullen
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Roy Phitayakorn
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
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Booth KK, Stewart KE, Lewis SL, Garwe T, Kempenich JW, Lees JS. Correlation of Supervised Independence and Performance with Procedure Difficulty amongst Surgical Residents Stratified by Post Graduate Year. JOURNAL OF SURGICAL EDUCATION 2021; 78:e47-e55. [PMID: 34526256 DOI: 10.1016/j.jsurg.2021.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/01/2021] [Accepted: 08/03/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE This study investigates the role of procedure difficulty on attending ratings of supervised levels of independence and procedural performance amongst general surgery residents, while accounting for case complexity. METHODS Attending ratings for residents were obtained from System for Improving and Measuring Procedural Learning (SIMPL) database. Current procedural terminology (CPT) codes were used to match procedures to a corresponding work relative value unit (wRVU) as a surrogate for procedure difficulty. Three categories of wRVU (<13.07, 13.07-22, >22) were identified using recursive partitioning. Procedures were also divided into 'Core' or 'Advanced' as defined by the American Board of Surgery Surgical Council on Resident Education (SCORE). Temporal advancement in resident skill was accounted for through academic quarterly analysis. A generalized estimating equations (GEE) approach was used to form separate multivariable logistic regression models for meaningful autonomy (MA) and satisfactory performance (SP) adjusted for potential clustering by program, subject, and rater. Models were further adjusted for core/advanced procedures, attending rated complexity, and academic quarter. RESULTS A total of 33,281 ratings were analyzed. Overall, 51.6% were rated as MA and 44.4% as SP. For core procedures, surgical residents rated as MA (53.5%) and SP (45.7%), which was twice as high as those for advance procedures (MA-29.2%, SP-29.0%). MA and SP both decreased with increasing wRVU (Figure 2 &3). Using a wRVU<13.07 as a reference, the adjusted odds ratios of MA and SP were significantly lower with increasing procedure difficulty, 0.44 for wRVU 13.07-22.0 and 0.24 for wRVU >22.00 (Table 3). Post graduate year (PGY) 5 residents in the final quarter of training obtain MA in 95.5% and SP 92.9% for core procedures with wRVU <13.07 (Table 4). CONCLUSION Increasing procedural difficulty is independently associated with decreases in meaningful autonomy and satisfactory performance. As residents approach graduation the level of meaningful autonomy and satisfactory performance both reach high levels for common core procedures but decrease as procedural difficulty increases.
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Affiliation(s)
- Kristina K Booth
- Department of Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
| | - Kenneth E Stewart
- Department of Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Samara L Lewis
- Department of Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Tabitha Garwe
- Department of Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Jason W Kempenich
- Department of Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Jason S Lees
- Department of Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Kearse LE, Schmiederer IS, Anderson TN, Dent DL, Payne DH, Korndorffer JR. American Board of Surgery Entrustable Professional Activities (EPAs): Assessing Graduating Residents' Perception of Preoperative Entrustment. JOURNAL OF SURGICAL EDUCATION 2021; 78:e183-e188. [PMID: 34602378 DOI: 10.1016/j.jsurg.2021.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/21/2021] [Accepted: 09/09/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To determine if graduating surgical residents are achieving entrustment of surgical entrustable professional activities (EPAs). We hypothesize that postgraduate year 5 (PGY5) residents are achieving evaluation and management entrustment in the selected EPAs. DESIGN In January 2020, surgical residents completed a survey following the American Board of Surgery In-Training Examination (ABSITE) to measure their levels of entrustment in 4 of the 5 ABS-selected EPAs. A Resident Entrustability Index (REI) score was developed to ascertain PGY5 residents' levels of entrustment (range 1-5). Residents indicated how often their assessments and operative plans were modified in the prior 6 months for each EPA (1=Always, 2=Frequently, 3=Occasionally, 4=Rarely, 5=Never). An independent clinical decision-making score (ICDM) was developed with subsequent evaluation of its relationships to intrinsic, resident-related and extrinsic, program-dependent factors. SETTING A national post-ABSITE survey. PARTICIPANTS All general surgery residents participating in ABSITE were invited to participate. Of the 1367 PGY5 residents that completed the survey, 1049 residents (76.7%) responded to the surgical EPA items. RESULTS Residents achieved an average REI of 4, indicating rare modification of assessments and operative plans for the 4 EPAs assessed. Complete entrustment was reported for inguinal hernias and penetrating abdominal trauma (Median REI = 5, IQR 4, 5) indicating assessments and operative plans were never modified. Lack of entrustment (REI ≤3) was reported by a minority of residents (ranging from 8.6% for operative plan of right lower quadrant pathology to 12.8% for operative plan of blunt abdominal trauma). Significant resident-related and program-dependent factors associated with achievement of expected ICDM was socializing with a co-resident (p = 0.001), while training in one's hometown (p < 0.001) and policies that mandate attendings be scrubbed in (p = 0.022) were associated with decreased achievement of expected ICDM. Overall, 89.2% and 90.3% of PGY5 residents are attaining appropriate levels of entrustment and ICDM abilities, respectively, within 6 months of graduating. CONCLUSIONS Of the EPAs evaluated, PGY5 residents are achieving appropriate levels of entrustment in evaluation and management. Although this is the case for a vast majority of PGY5 residents, there is still work to be done to ensure that all PGY5 residents are attaining entrustment prior to graduation. Our study also provides content validity for the surgical EPAs in assessing levels of entrustment in PGY5 residents.
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Affiliation(s)
- LaDonna E Kearse
- Department of Surgery, Stanford University, Stanford, California
| | | | | | - Daniel L Dent
- Department of Surgery, University of Texas Health at San Antonio, San Antonio, Texas
| | - Davis H Payne
- Department of Surgery, University of Texas Health at San Antonio, San Antonio, Texas
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Forte M, Morson N, Mirchandani N, Grundland B, Fernando O, Rubenstein W. How Teachers Adapt Their Cognitive Strategies When Using Entrustment Scales. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:S87-S92. [PMID: 34348370 DOI: 10.1097/acm.0000000000004287] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Rater cognition is a field of study focused on individual cognitive processes used by medical teachers when completing assessments. Much has been written about the role of rater cognition in the use of traditional assessment scales. Entrustment scales (ES) are becoming the tool of choice for workplace-based assessments. It is not known how moving to an entrustment framework may cause teachers to adapt their cognitive rating strategies. This study aimed to explore this gap by asking teachers to describe their thinking when making rating decisions using a validated ES. METHOD Using purposive sampling, family medicine teachers supervising obstetrical care were invited to participate in cognitive interviews. Teachers were interviewed between December 2018 and March 2019 using retrospective verbal protocol analysis. They were asked to describe their experiences of rating residents in the last 6 months using new ES. Constructivist grounded theory guided data collection and analysis. Interviews were recorded, transcribed, and analyzed iteratively. A constant comparative approach was used to code and analyze the data until consensus was reached regarding emerging themes. RESULTS There was variability in how teachers used the ES. Faculty describe several ways in which they ultimately navigated the tool to say what they wanted to say. Four key themes emerged: (1) teachers interpreted the anchors differently based on their cognitive framework, (2) teachers differed in how they were able to cognitively shift away from traditional rating scales, (3) teachers struggled to limit assessments to a report on observed behavior, and (4) teachers contextualized their ratings. CONCLUSIONS Variability in teachers' interpretation of learner performance persists in entrustment frameworks. Rater's individual cognitive strategies and how they observe, process, and integrate their thoughts into assessments form part of a rich picture of learner progress. These insights can be harnessed to contribute to decisions regarding readiness for unsupervised practice.
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Affiliation(s)
- Milena Forte
- M. Forte is assistant professor, Postgraduate lead, Office of Education Scholarship, Maternity Care lead, Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0001-9387-0184
| | - Natalie Morson
- N. Morson is lecturer, Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Natasha Mirchandani
- N. Mirchandani is assistant professor, Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Batya Grundland
- B. Grundland is assistant professor and associate postgraduate program director, Curriculum & Remediation, Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Oshan Fernando
- O. Fernando is research associate, Office of Education Scholarship, Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0002-4600-9399
| | - Warren Rubenstein
- W. Rubenstein is associate professor, Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Senders ZJ, Brady JT, Ladhani HA, Marks J, Ammori JB. Factors Influencing the Entrustment of Resident Operative Autonomy: Comparing Perceptions of General Surgery Residents and Attending Surgeons. J Grad Med Educ 2021; 13:675-681. [PMID: 34721797 PMCID: PMC8527956 DOI: 10.4300/jgme-d-20-01259.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 03/02/2021] [Accepted: 07/12/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND General surgery residents may be underprepared for practice, due in part to declining operative autonomy during training. The factors that influence entrustment of autonomy in the operating room are unclear. OBJECTIVE To identify and compare the factors that residents and faculty consider influential in entrustment of operative autonomy. METHODS An anonymous survey of 29-item Likert-type scale (1-7, 1 = strongly disagree, 7 = strongly agree), 9 multiple-choice, and 4 open-ended questions was sent to 70 faculty and 45 residents in a large ACGME-approved general surgery residency program comprised of university, county, and VA hospitals in 2018. RESULTS Sixty (86%) faculty and 38 (84%) residents responded. Faculty were more likely to identify resident-specific factors such as better resident reputation and higher skill level as important in fostering entrustment. Residents were more likely to identify environmental factors such as a focus on efficiency and a litigious malpractice environment as impeding entrustment. Both groups agreed that work hour restrictions do not decrease autonomy and entrustment does not increase risk to patients. More residents considered low faculty confidence level as a barrier to operative autonomy, while more faculty considered lower resident clinical skill as a barrier. Improvement in resident preparation for cases was cited as an important intervention that could enhance entrustment. CONCLUSIONS Differences in perspectives exist between general surgery residents and faculty regarding entrustment of autonomy. Residents cite environmental and attending-related factors, while faculty cite resident-specific factors as most influential. Residents and faculty both agree that entrustment is integral to surgical training.
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Affiliation(s)
- Zachary J. Senders
- Zachary J. Senders, MD, is a General Surgery Resident, Department of Surgery, University Hospitals (UH) Cleveland Medical Center
| | - Justin T. Brady
- Justin T. Brady, MD, is a General Surgery Resident, Department of Surgery, UH Cleveland Medical Center
| | - Husayn A. Ladhani
- Husayn A. Ladhani, MD, is a General Surgery Resident, Department of Surgery, UH Cleveland Medical Center
| | - Jeffrey Marks
- Jeffrey Marks, MD, FACS, is Professor of Surgery and Associate Program Director, General Surgery Residency, UH Cleveland Medical Center, Case Western Reserve University School of Medicine
| | - John B. Ammori
- John B. Ammori, MD, FACS, is Associate Professor of Surgery and Program Director, General Surgery Residency, UH Cleveland Medical Center, Case Western Reserve University School of Medicine
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Smith CB, Saillant NN, Mendoza AE. Perceptions of differences in graduated autonomy between male and female surgical residents. Surgery 2021; 170:1281-1284. [PMID: 33775394 DOI: 10.1016/j.surg.2021.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Charlotte B Smith
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC. https://twitter.com/cblythesmith
| | | | - April E Mendoza
- Department of Surgery, Massachusetts General Hospital, Boston, MA.
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OpTrust: An Effective Educational Bundle for Enhancing Faculty-resident Intraoperative Entrustment. Ann Surg 2021; 273:e255-e261. [PMID: 33979313 DOI: 10.1097/sla.0000000000003436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to measure the efficacy of a novel faculty and resident educational bundle focused on development of faculty-resident behaviors and entrustment in the operating room. SUMMARY BACKGROUND DATA As surgical training environments are orienting to entrustable professional activities (EPAs), successful transitions to this model will require significant faculty and resident development. Identifying an effective educational initiative which prepares faculty and residents for optimizing assessment, teaching, learning, and interacting in this model is critical. METHODS From September 2015 to June 2017, an experimental study was conducted in the Department of Surgery at the University of Michigan Health System (UMHS). Case observations took place across general, plastic, thoracic, and vascular surgical specialties. A total of 117 operating room observations were conducted during Phase I of the study and 108 operating room observations were conducted during Phase II following the educational intervention. Entrustment behaviors were rated for 56 faculty and 73 resident participants using OpTrust, a validated intraoperative entrustment instrument. RESULTS Multiple regression analysis showed a significant increase in faculty entrustment (Phase I = 2.32 vs Phase II = 2.56, P < 0.027) and resident entrustability (Phase I = 2.16 vs Phase II = 2.40, P < 0.029) scores following exposure to the educational intervention. CONCLUSIONS Our study shows improved intraoperative entrustment following implementation of faculty and resident development, indicating the efficacy of this innovative educational bundle. This represents a crucial component in the implementation of a competency-based assessment framework like EPAs.
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Beucler N, Sellier A, Desse N, Joubert C, Dagain A. Letter to the Editor. Rethinking the mentorship system in neurosurgery. J Neurosurg 2021; 135:659-660. [PMID: 33578382 DOI: 10.3171/2020.11.jns204050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Nathan Beucler
- 1Sainte-Anne Military Teaching Hospital, Toulon, France
- 2Ecole du Val-de-Grâce, French Military Health Service Academy, Paris, France; and
| | | | - Nicolas Desse
- 1Sainte-Anne Military Teaching Hospital, Toulon, France
| | | | - Arnaud Dagain
- 1Sainte-Anne Military Teaching Hospital, Toulon, France
- 3Val-de-Grâce Military Academy, Paris, France
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Woodworth GE, Marty AP, Tanaka PP, Ambardekar AP, Chen F, Duncan MJ, Fromer IR, Hallman MR, Klesius LL, Ladlie BL, Mitchell SA, Miller Juve AK, McGrath BJ, Shepler JA, Sims C, Spofford CM, Van Cleve W, Maniker RB. Development and Pilot Testing of Entrustable Professional Activities for US Anesthesiology Residency Training. Anesth Analg 2021; 132:1579-1591. [PMID: 33661789 DOI: 10.1213/ane.0000000000005434] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Modern medical education requires frequent competency assessment. The Accreditation Council for Graduate Medical Education (ACGME) provides a descriptive framework of competencies and milestones but does not provide standardized instruments to assess and track trainee competency over time. Entrustable professional activities (EPAs) represent a workplace-based method to assess the achievement of competency milestones at the point-of-care that can be applied to anesthesiology training in the United States. METHODS Experts in education and competency assessment were recruited to participate in a 6-step process using a modified Delphi method with iterative rounds to reach consensus on an entrustment scale, a list of EPAs and procedural skills, detailed definitions for each EPA, a mapping of the EPAs to the ACGME milestones, and a target level of entrustment for graduating US anesthesiology residents for each EPA and procedural skill. The defined EPAs and procedural skills were implemented using a website and mobile app. The assessment system was piloted at 7 anesthesiology residency programs. After 2 months, faculty were surveyed on their attitudes on usability and utility of the assessment system. The number of evaluations submitted per month was collected for 1 year. RESULTS Participants in EPA development included 18 education experts from 11 different programs. The Delphi rounds produced a final list of 20 EPAs, each differentiated as simple or complex, a defined entrustment scale, mapping of the EPAs to milestones, and graduation entrustment targets. A list of 159 procedural skills was similarly developed. Results of the faculty survey demonstrated favorable ratings on all questions regarding app usability as well as the utility of the app and EPA assessments. Over the 2-month pilot period, 1636 EPA and 1427 procedure assessments were submitted. All programs continued to use the app for the remainder of the academic year resulting in 12,641 submitted assessments. CONCLUSIONS A list of 20 anesthesiology EPAs and 159 procedural skills assessments were developed using a rigorous methodology to reach consensus among education experts. The assessments were pilot tested at 7 US anesthesiology residency programs demonstrating the feasibility of implementation using a mobile app and the ability to collect assessment data. Adoption at the pilot sites was variable; however, the use of the system was not mandatory for faculty or trainees at any site.
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Affiliation(s)
- Glenn E Woodworth
- From the Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, Oregon
| | - Adrian P Marty
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Pedro P Tanaka
- Department of Anesthesiology, Stanford University, Stanford, California
| | - Aditee P Ambardekar
- Department of Anesthesiology, University of Texas, Southwestern Medical Center, Dallas, Texas
| | - Fei Chen
- Department of Anesthesiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Michael J Duncan
- Department of Anesthesiology, University of Missouri-Kansas City, Kansas City, Missouri
| | - Ilana R Fromer
- Department of Anesthesiology, University of Minnesota, Minneapolis, Minnesota
| | - Matthew R Hallman
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Lisa L Klesius
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Beth L Ladlie
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota
| | | | - Amy K Miller Juve
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, Oregon
| | - Brian J McGrath
- Department of Anesthesiology, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida
| | - John A Shepler
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Charles Sims
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota
| | - Christina M Spofford
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Wil Van Cleve
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Robert B Maniker
- Department of Anesthesiology, Columbia University, New York, New York
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Chen XP, Cochran A, Harzman AE, Ellison EC. A Novel Operative Coaching Program for General Surgery Chief Residents Improves Operative Efficiency. JOURNAL OF SURGICAL EDUCATION 2021; 78:1097-1102. [PMID: 33358340 PMCID: PMC8217072 DOI: 10.1016/j.jsurg.2020.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/29/2020] [Accepted: 12/05/2020] [Indexed: 06/01/2023]
Abstract
INTRODUCTION We evaluated the effect of an operative coaching (OC) model on general surgery chief residents' operative efficiency (OE) measured by operative times. We hypothesized that higher levels of entrustment surgeons intend to offer resident in future similar cases are associated with improved OE. MATERIALS AND METHODS From July 2018 to June 2019, we used a validated instrument to score prospective resident entrustment in 228 evaluations of 6 chief residents during 12 OC sessions each (3 lap colectomy, 3 lap cholecystectomy, 3 ventral hernia, 3 inguinal hernia). Operative times of matched case CPT codes performed by coached chiefs (N = 500) were matched via CPT code to the cases of uncoached chiefs in the academic year 2016-2017 (N = 478). Statistical analysis was performed using Pearson correlation and one-way ANOVA. RESULTS Prospective entrustment scores from coached chief residents were associated with significantly shorter operative times in matched complex cases (CC) (r = -0.58, p = 0.0047). A similar trend was observed in noncomplex cases (NCC) (r = -0.29, p = 0.18). Compared to the historical cohort, coached chief residents showed a decrease in mean operative time during complex cases (p = 0.0008, d = 0.44), but an increase in mean operative times for noncomplex cases (p < 0.0001, d = 0.33). CONCLUSIONS An OC model improves chief residents' prospective entrustment leading to increased OE in cases with greater levels of operative complexity, showing a decrease in mean operative time compared to uncoached residents in certain procedures. This is the first report showing formal coaching may be a method to enhance chief resident OE.
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Affiliation(s)
| | - Amalia Cochran
- Department of Surgery, The Ohio State University, Columbus Ohio
| | - Alan E Harzman
- Department of Surgery, The Ohio State University, Columbus Ohio
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Kinnear B, Warm EJ, Caretta-Weyer H, Holmboe ES, Turner DA, van der Vleuten C, Schumacher DJ. Entrustment Unpacked: Aligning Purposes, Stakes, and Processes to Enhance Learner Assessment. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:S56-S63. [PMID: 34183603 DOI: 10.1097/acm.0000000000004108] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Educators use entrustment, a common framework in competency-based medical education, in multiple ways, including frontline assessment instruments, learner feedback tools, and group decision making within promotions or competence committees. Within these multiple contexts, entrustment decisions can vary in purpose (i.e., intended use), stakes (i.e., perceived risk or consequences), and process (i.e., how entrustment is rendered). Each of these characteristics can be conceptualized as having 2 distinct poles: (1) purpose has formative and summative, (2) stakes has low and high, and (3) process has ad hoc and structured. For each characteristic, entrustment decisions often do not fall squarely at one pole or the other, but rather lie somewhere along a spectrum. While distinct, these continua can, and sometimes should, influence one another, and can be manipulated to optimally integrate entrustment within a program of assessment. In this article, the authors describe each of these continua and depict how key alignments between them can help optimize value when using entrustment in programmatic assessment within competency-based medical education. As they think through these continua, the authors will begin and end with a case study to demonstrate the practical application as it might occur in the clinical learning environment.
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Affiliation(s)
- Benjamin Kinnear
- B. Kinnear is associate professor of internal medicine and pediatrics, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0003-0052-4130
| | - Eric J Warm
- E.J. Warm is professor of internal medicine and program director, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0002-6088-2434
| | - Holly Caretta-Weyer
- H. Caretta-Weyer is assistant professor of emergency medicine, Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California; ORCID: https://orcid.org/0000-0002-9783-5797
| | - Eric S Holmboe
- E.S. Holmboe is chief, research, milestones development and evaluation officer, Accreditation Council for Graduate Medical Education, Chicago, Illinois; ORCID: https://orcid.org/0000-0003-0108-6021
| | - David A Turner
- D.A. Turner is vice president, Competency-Based Medical Education, American Board of Pediatrics, Chapel Hill, North Carolina
| | - Cees van der Vleuten
- C. van der Vleuten is professor of education, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; ORCID: https://orcid.org/0000-0001-6802-3119
| | - Daniel J Schumacher
- D.J. Schumacher is associate professor of pediatrics, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0001-5507-8452
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Eskander MF, Woelfel I, Harzman A, Cochran AL, Ellison EC, Phoenix Chen X. Education Morbidity and Mortality: Reviving Intraoperative Teaching and Learning. J Surg Res 2021; 264:462-468. [PMID: 33848846 DOI: 10.1016/j.jss.2021.02.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/08/2021] [Accepted: 02/27/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Using the platform of morbidity and mortality conference, we developed and executed a combined faculty-resident intervention called "Education M&M" to discuss challenges faced by both parties in the operating room (OR), identify realistic solutions, and implement action plans. This study aimed to investigate the impact of this intervention on resident OR training. MATERIALS AND METHODS Two resident case presentations were followed by audience discussion and recommendations regarding actionable solutions aimed at improving resident OR training from an expert faculty panel. Postintervention surveys were completed by participants immediately and 2 mo later to assess perceived short and long-term impact on OR teaching and/or learning and the execution of two recommended solutions. Descriptive statistical analysis was applied. RESULTS Immediate post-intervention surveys (n = 44) indicated that 81.8% of participants enjoyed the M&M "a lot"; 90.1% said they would use some or a lot of the ideas presented. Awareness of OR teaching/learning challenges before and after the M&M improved from 3.0 to 3.7 (P = 0.00001) for faculty and 3.0 to 3.9 for trainees (P = 0.00004). Understanding of OR teaching and/or learning approaches improved from 3.1 to 3.7 for faculty (P = 0.00004) and 2.7 to 3.9 for trainees (P = 0.00001). In 2-mo post-intervention surveys, most residents had experienced two recommended solutions (71% and 88%) in the OR, but self-reported changes to faculty behavior did not reach statistical significance. CONCLUSIONS A department-wide education M&M could be an effective approach to enhance mutual communication between faculty members and residents around OR teaching/learning by identifying program-specific challenges and potential actionable solutions.
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Affiliation(s)
| | - Ingrid Woelfel
- Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Alan Harzman
- Ohio State University Wexner Medical Center, Columbus, Ohio
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Foster MJ, O'Hara NN, Weir TB, Aneizi A, Henn RF, Packer JD, Hasan SA, Slobogean GP, Gilotra MN. Difference in Resident Versus Attending Perspective of Competency and Autonomy During Arthroscopic Rotator Cuff Repairs. JB JS Open Access 2021; 6:JBJSOA-D-20-00014. [PMID: 33748637 PMCID: PMC7963494 DOI: 10.2106/jbjs.oa.20.00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A noted deficiency in orthopaedic resident education is a lack of intraoperative autonomy; however, no studies exist evaluating this issue. The purpose of this study was to determine whether there is a difference between resident and attending perception of resident competency and autonomy during arthroscopic rotator cuff repairs and whether increased perceived competency leads to more autonomy.
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Affiliation(s)
- Michael J Foster
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Nathan N O'Hara
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Tristan B Weir
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Ali Aneizi
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jonathan D Packer
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - S Ashfaq Hasan
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Gerard P Slobogean
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Mohit N Gilotra
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
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Joh DB, van der Werf B, Watson BJ, French R, Bann S, Dennet E, Loveday BPT. Assessment of Autonomy in Operative Procedures Among Female and Male New Zealand General Surgery Trainees. JAMA Surg 2021; 155:1019-1026. [PMID: 32857160 DOI: 10.1001/jamasurg.2020.3021] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Importance The need for trainee sex equality within surgical training has resulted in an appraisal of the training experience in the New Zealand general surgery training program. Objective To investigate the association between trainee sex and surgical autonomy in the operating room in the New Zealand general surgery training program. Design, Setting, and Participants Retrospective cohort study conducted from December 10, 2012, to December 10, 2017, examining all endoscopic, major, and minor procedures performed by all New Zealand general surgery trainees in every training hospital in New Zealand. Main Outcomes and Measures The primary outcome was the level of meaningful autonomy by each New Zealand general surgery trainee (ie, trainee as primary operator without the surgeon mentor scrubbed for the case). Outcomes were compared using multivariable analysis. Results This study included 120 New Zealand general surgery trainees (42 women [35%] and 78 men [65%]) who were analyzed over 279.5 trainee-years (88.5 trainee-years for women and 191.0 trainee-years for men). Included were 119 380 general surgery procedures (17 465 endoscopic, 56 964 major, and 44 951 minor) in 18 hospitals. By the end of the 5-year training program, female trainees had a lower cumulative mean autonomous caseload than male trainees for endoscopic (284.0 [95% CI, 207.0-361.0] vs 352.2 [95% CI, 282.9-421.6], P = .03), major (139.9 [95% CI, 76.7-203.2] vs 198.1 [95% CI, 142.3-254.0], P = .02), and minor (456.3 [95% CI, 394.8-517.9] vs 519.9 [95% CI, 465.6-574.2], P = .007) procedures. Conclusions and Relevance After accounting for differences among trainees, hospital type, number of female and male surgeon mentors at each hospital, and trainee seniority, female trainees performed fewer cases with meaningful autonomy compared with male trainees. These findings support the need for pragmatic solutions to address this bias and further investigations on mechanisms contributing to discrepancies.
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Affiliation(s)
- Daniel B Joh
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Bert van der Werf
- Department of Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand
| | - Bridget J Watson
- Department of Surgery, Auckland District Health Board, Auckland, New Zealand
| | - Rowan French
- Department of Surgery, Waikato District Health Board, Hamilton, New Zealand
| | - Simon Bann
- Department of Surgery, Capital and Coast District Health Board, Wellington, New Zealand
| | - Elizabeth Dennet
- Department of Surgery, Capital and Coast District Health Board, Wellington, New Zealand.,Department of Surgery and Anaesthesia, University of Otago, Wellington, New Zealand
| | - Benjamin P T Loveday
- Department of Surgery, The University of Auckland, Auckland, New Zealand.,Department of Surgery, Royal Melbourne Hospital, Victoria, Australia
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Chen XP, Cochran A, Harzman AE, Eskander MF, Ellison EC. Efficiency of Increasing Prospective Resident Entrustment in the Operating Room. J Surg Res 2021; 261:236-241. [PMID: 33460968 DOI: 10.1016/j.jss.2020.12.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 12/09/2020] [Accepted: 12/16/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prospective resident entrustment (i.e., trust an attending surgeon intends to give to a resident in the near future) in the operating room (OR) closely associates with granted future autonomy. However, the process of determining resident entrustment takes time and effort. Thus, this study aimed to assess the efficiency of granting incremental resident entrustment for upcoming surgical cases. METHODS We analyzed prospective resident entrustment of 6 chief residents in 76 cases of laparoscopic cholecystectomy, laparoscopic colectomy, ventral hernia, and inguinal hernia scored by attending surgeon, resident, and a surgeon observer. Matched direct costs and operative time were extracted from hospital billing. We assessed the efficiency of granting incremental prospective resident entrustment with direct cost per minute incurred in the evaluated case. Effect size was computed to assess the differences between groups. RESULTS Sixty-three cases (82.9%) were matched; 47.6% (30/63) of matched cases received prospective resident entrustment score ≥ 4. The direct cost per minute increased in three procedures (laparoscopic cholecystectomy, laparoscopic colectomy, and ventral hernia) with increased intention of granting incremental resident entrustment. Inguinal hernia was the only procedure in which chiefs were entrusted with future independence while the direct cost per minute decreased. CONCLUSIONS Our findings demonstrate more time and effort are required (except for inguinal hernia) for residents to be entrusted with increased independence in the future. Faculty and resident development programs are recommended to improve the efficiency of the process of granting incremental operative entrustment to optimize resident training quality and cost of care delivery.
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Affiliation(s)
| | - Amalia Cochran
- Department of Surgery, The Ohio State University, Columbus, Ohio
| | - Alan E Harzman
- Department of Surgery, The Ohio State University, Columbus, Ohio
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Nishii A, Burdine J, Matusko N, Wang T, De Roo A, Lussiez A, Sutzko DC, Minter R, Sandhu G. Identification of promotion and prevention associated surgeon behaviors in the operating room to facilitate resident self-regulated learning. Am J Surg 2020; 221:331-335. [PMID: 33729917 DOI: 10.1016/j.amjsurg.2020.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/24/2020] [Accepted: 10/18/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND The regulatory focus theory (RFT) posits that people can pursue goals with a promotion or prevention focus. Greater alignment of RFT motivational styles between faculty and residents may enhance resident operative autonomy. This study establishes a set of faculty behaviors residents can identify to infer faculty motivational styles. METHODS 10 behaviors associated with promotion and prevention motivational styles were identified. General surgery residents rated faculty on how strongly they exhibit these behaviors. Faculty conducted a self-assessment of how strongly they exhibit these behaviors. RESULTS There is a positive correlation between resident and faculty ratings for the promotion-associated behaviors of "works quickly," "high energy," and "mostly provides broad oversight," and for the prevention-associated behaviors of "works slowly and deliberately," "quiet and calm," and "preference for vigilant strategies." CONCLUSION Residents can observe faculty operative behaviors to infer faculty motivational styles. Residents may use this knowledge to adjust to faculty motivational styles and enhance operative interactions.
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Affiliation(s)
- Akira Nishii
- University of Michigan, 500 S State St, Ann Arbor, MI, 48109, United States.
| | - Julie Burdine
- Department of Surgery, Michigan Medicine, 1500, E. Medical Center Dr, Ann Arbor, MI, United States.
| | - Niki Matusko
- Department of Surgery, Michigan Medicine, 1500, E. Medical Center Dr, Ann Arbor, MI, United States.
| | - Ton Wang
- Department of Surgery, Michigan Medicine, 1500, E. Medical Center Dr, Ann Arbor, MI, United States.
| | - Ana De Roo
- Department of Surgery, Michigan Medicine, 1500, E. Medical Center Dr, Ann Arbor, MI, United States.
| | - Alisha Lussiez
- Department of Surgery, Michigan Medicine, 1500, E. Medical Center Dr, Ann Arbor, MI, United States.
| | - Danielle C Sutzko
- Department of Surgery, University of Alabama at Birmingham School of Medicine, 1808 7th Avenue South, BDB 652, Birmingham, AL, 35294, United States.
| | - Rebecca Minter
- Department of Surgery, University of Wisconsin School of Medicine & Public Health, H4/710D Clinical Science Center, 600 Highland Avenue, Madison, WI, United States.
| | - Gurjit Sandhu
- Department of Surgery, Michigan Medicine, 1500, E. Medical Center Dr, Ann Arbor, MI, United States.
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Skelly K, Kim P, Rosenbaum M, Wilbur J. Goldilocks and Entrustment: Finding the Amount of Learner Autonomy That's Just Right. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10987. [PMID: 33094155 PMCID: PMC7566225 DOI: 10.15766/mep_2374-8265.10987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 05/01/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Faculty and residents strive for appropriate autonomy and entrustment. Initial direct supervision of clinical care gradually shifts to increasing levels of resident independence over time. Faculty members are inconsistent in resident supervision leading to missed opportunities for resident independence. METHODS Family medicine faculty workshop participants completed teaching style self-evaluations prior to discussion of clinical examples with excessive or insufficient autonomy. Participants reviewed real resident feedback examples to increase insight into teaching styles. Participants were presented with cases to discuss varying degrees of resident autonomy and entrustment. Learners committed to one specific behavior to calibrate the degree of autonomy they provide. RESULTS Of the faculty, 113 members participated in the workshop with the majority (98%) finding the workshop relevant in helping them to identify strategies for reflecting on their degree of autonomy allowed and to look for appropriate situations for enhancing their resident entrustment. DISCUSSION This interactive workshop provided clear ways for addressing the issue of independence versus control in supervision of patient care. It provided a feedback mechanism for educators who provide too much or too little autonomy for the best resident learning. Additionally, this conversation encouraged participants to engage in self-reflection on the autonomy given to their resident.
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Affiliation(s)
- Kelly Skelly
- Associate Professor, Department of Family Medicine, University of Iowa Carver College of Medicine
| | - Parang Kim
- Research Assistant, Department of Family Medicine, University of Iowa Carver College of Medicine
| | - Marcy Rosenbaum
- Professor, Department of Family Medicine, University of Iowa Carver College of Medicine
| | - Jason Wilbur
- Professor, Department of Family Medicine, University of Iowa Carver College of Medicine
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Quality of dictated feedback associated with SIMPL operative assessments of pediatric surgical trainees. Am J Surg 2020; 221:303-308. [PMID: 33051067 DOI: 10.1016/j.amjsurg.2020.10.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/23/2020] [Accepted: 10/04/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND SIMPL is a workplace-based operative performance assessment tool which allows for dictated feedback (DF). To better understand the value of DF, we sought to characterize the type and quality of DF generated during SIMPL evaluations. METHODS Thematic analysis of DF from SIMPL assessments between June 2017 and December 2018 at a single pediatric surgery fellowship program was performed. Comments were categorized as specific, encouraging or corrective. Categories were combined to determine DF quality as effective, mediocre or ineffective. RESULTS Of 781 SIMPL assessments (21 faculty, 5 trainees), 451 (57%) had DF. Most comments were encouraging (93%) and specific (65%). Only 21% were corrective, 17% had entrustment features, and 8% had an explicit learning plan. Feedback quality was deemed mediocre (45%), ineffective (33%) and effective (21%). CONCLUSION SIMPL dictated feedback was mostly encouraging and specific. To improve quality, feedback should incorporate learning plans as well as corrective and entrustment features.
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Dickinson KJ, Bass BL, Nguyen DT, Graviss EA, Pei KY. Public Perception of General Surgery Resident Autonomy and Supervision. J Am Coll Surg 2020; 232:8-15.e1. [PMID: 33022397 DOI: 10.1016/j.jamcollsurg.2020.08.764] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/03/2020] [Accepted: 08/31/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite patients being important stakeholders in surgical training, little is known about the public's perception of trainee participation in surgical care. This study evaluates the public's perception of surgical resident autonomy and supervision. STUDY DESIGN An anonymous electronic survey was sent to adult panelists older than 18 years in the US using SurveyGizmo. The design of the survey used Dillman's Tailored Design Method to optimize response rate. Participants completed surveys including demographic characteristics and perceptions toward general surgery resident autonomy. Univariable and multivariable analyses were used as appropriate. RESULTS Survey response rate was 93% (2,005 of 2,148). Demographic characteristics including age, gender, race or ethnicity, and highest level of education were nationally representative. Most respondents (87%) had health insurance. On multivariable logistic regression analysis, factors associated with participants who would never allow a resident to perform any portion of the operation include: female gender (odds ratio [OR] 1.58; 95% CI, 1.28 to 1.95), no health insurance (OR 1.38; 95% CI, 1.03 to 1.84), Black race (OR 1.82; 95% CI, 1.38 to 2.41), and Hispanic ethnicity (OR 1.49; 95% CI, 1.03 to 2.15). Participants who were younger than 50 years (OR 1.57; 95% CI, 1.24 to 1.98), male (OR 1.90; 95% CI, 1.56 to 2.32), of Black race (OR 1.45; 95% CI, 0.10 to 1.91), Hispanic ethnicity (OR 1.49; 95% CI, 1.05 to 2.11), working in healthcare (OR 2.18; 95% CI, 1.67 to 2.86), or insured (OR 1.46; 95% CI, 1.07 to 1.99) were more likely to believe that resident involvement increases complications. CONCLUSIONS Among survey participants broadly representing the US population, resident participation in operations is not universally accepted. Public perception of surgical resident autonomy and supervision is important, as GME continues to evolve to address readiness for independent practice.
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Affiliation(s)
| | - Barbara L Bass
- George Washington University School of Medicine and Health Services, Washington, DC
| | - Duc T Nguyen
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, TX
| | - Edward A Graviss
- Department of Surgery, Houston Methodist Hospital, Houston, TX; Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, TX
| | - Kevin Y Pei
- Department of Graduate Medical Education, Parkview Health, Fort Wayne, IN
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Nguyen C, Thompson-Burdine J, Kemp MT, Williams AM, Rivard S, Sandhu G. High vs. low entrustment behaviors in the operating room. Am J Surg 2020; 221:973-979. [PMID: 33019972 DOI: 10.1016/j.amjsurg.2020.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/05/2020] [Accepted: 09/11/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Operative experience with an appropriate degree of supervised autonomy is critical to resident training. Progressively greater intraoperative entrustment has been associated with gradually higher levels of resident autonomy. This study attempts to identify consistently observed intraoperative behaviors that are linked with higher resident entrustment. METHODS This qualitative study analyzed observational notes recorded by trained raters who provided entrustment scores for 204 surgical cases at Michigan Medicine from 2015 to 2017. Notes were coded in NVivo12. Thematic analysis was used to identify themes and patterns within the data. RESULTS The analysis generated 144 codes. Codes were clustered into 10 themes. These themes manifested differently in intraoperative behaviors strongly associated with high entrustment versus low entrustment. CONCLUSION This study demonstrates key differences in intraoperative behaviors exhibited by residents and faculty in high and low entrustment interactions. Awareness of behaviors that enhance entrustment can help faculty augment resident learning and enable higher resident operative autonomy.
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Affiliation(s)
- Christine Nguyen
- University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | | | - Michael T Kemp
- Department of Surgery, Michigan Medicine, Ann Arbor, MI, 48109, USA
| | - Aaron M Williams
- Department of Surgery, Michigan Medicine, Ann Arbor, MI, 48109, USA
| | - Samantha Rivard
- Department of Surgery, Michigan Medicine, Ann Arbor, MI, 48109, USA
| | - Gurjit Sandhu
- Department of Surgery, Michigan Medicine, Ann Arbor, MI, 48109, USA.
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Williams AM, Chang EL, Boothman R, Thompson-Burdine JA, Minter RM, Sandhu G. The "Key" or "Critical" Portions of an Operation: Understanding Attending Supervision and Resident Autonomy From a Legal Perspective. JOURNAL OF SURGICAL EDUCATION 2020; 77:931-938. [PMID: 32173294 DOI: 10.1016/j.jsurg.2020.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 02/17/2020] [Accepted: 02/21/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To obtain a legal understanding of the "key" or "critical" portions of an operation, pertaining to attending supervision, resident autonomy, and patient safety. DESIGN Snowball sampling, a subset of purposive sampling, was used to develop a population of 47 risk managers and legal counsel, who were given an online, qualitative questionnaire. Interpretive description was used to analyze qualitative data. Individual responses were coded with simultaneous categorization and assessment of underlying relationships. SETTING Online, qualitative questionnaire. PARTICIPANTS Hospital risk managers and legal counsel from across the United States. RESULTS Overall, 25 of 47 (53%) risk managers completed the survey. Qualitative responses could be organized into 3 major themes (1) variation in the definition of "key" or "critical" portions of an operation, (2) differing expectations of attending supervision and resident autonomy, and (3) the need for clear communication and trust among attendings, residents, and patients. CONCLUSIONS Among risk managers, the primary liaisons between surgeons and patients in malpractice litigation, there is widespread variation in understanding the "key" and "critical" portions of an operation and the dynamic between appropriate attending supervision and resident autonomy. Better collaboration and transparency between surgeons and legal experts are required to facilitate a shared mental model regarding attending supervision and resident autonomy.
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Affiliation(s)
- Aaron M Williams
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Emma L Chang
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Richard Boothman
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; Risk Management and Clinical Affairs, University of Michigan, Ann Arbor, Michigan
| | | | - Rebecca M Minter
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Gurjit Sandhu
- Department of Surgery, University of Michigan, Ann Arbor, Michigan.
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Groot F, Jonker G, Rinia M, Ten Cate O, Hoff RG. Simulation at the Frontier of the Zone of Proximal Development: A Test in Acute Care for Inexperienced Learners. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1098-1105. [PMID: 32134783 DOI: 10.1097/acm.0000000000003265] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
PURPOSE Vygotsky's zone of proximal development (ZPD) refers to the space between what learners have mastered and what they should master in the next developmental stage. Physicians' tasks are ZPD activities for medical students, with high-acuity tasks such as resuscitation representing activities at the ZPD's frontier. This type of task can be taught and assessed with simulation but may be demanding and stressful for students. Highly challenging simulation may lead to a negative simulated patient outcome and can affect the participant's emotional state, learning, and motivation. This study aimed to increase understanding of the psychosocial and educational impact of simulation at the frontier of the ZPD. METHOD The authors conducted 11 phenomenological interviews between September 2016 and May 2017, to describe medical students' experiences with a challenging residency-level simulation test of acute care competence at the start of the final undergraduate year at University Medical Center Utrecht. Interviews took place within 2 weeks after the participants' simulation experience. The authors analyzed transcripts using a modified Van Kaam method. RESULTS Students experienced a significant amount of stress fueled by uncertainty about medical management, deterioration of critically ill simulated patients, and disappointment about their performance. Stress manifested mainly mentally, impeding cognitive function. Students reported that awareness of the practice setting, anticipation of poor performance, the debriefing, a safe environment, and the prospect of training opportunities regulated their emotional responses to stress. These stress-regulating factors turned stressful simulation into a motivating educational experience. CONCLUSIONS Simulation at the ZPD's frontier evoked stress and generated negative emotions. However, stress-regulating factors transformed this activity into a positive and motivating experience.
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Affiliation(s)
- Fedde Groot
- F. Groot is a resident in anesthesiology, Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. G. Jonker is anesthesiologist and a PhD candidate in medical education, Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; ORCID: https://orcid.org/0000-0001-6819-9990. M. Rinia is anesthesiologist, intensivist, and simulation instructor, Department of Anesthesiology, Rijnstate Hospital, Arnhem, the Netherlands. O. ten Cate is professor of medical education, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; ORCID: https://orcid.org/0000-0002-6379-8780. R.G. Hoff is professor of education and training in perioperative, intensive and emergency care, Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; ORCID: https://orcid.org/0000-0002-7432-7087
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Sandhu G, Thompson J, Matusko N, Sutzko DC, Nikolian VC, Boniakowski AE, Georgoff PE, Prabhu KA, Minter RM. Greater faculty familiarity with residents improves intraoperative entrustment. Am J Surg 2020; 219:608-612. [DOI: 10.1016/j.amjsurg.2019.06.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/31/2019] [Accepted: 06/07/2019] [Indexed: 10/26/2022]
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Logishetty K, Gofton WT, Rudran B, Beaulé PE, Cobb JP. Fully Immersive Virtual Reality for Total Hip Arthroplasty: Objective Measurement of Skills and Transfer of Visuospatial Performance After a Competency-Based Simulation Curriculum. J Bone Joint Surg Am 2020; 102:e27. [PMID: 31929324 DOI: 10.2106/jbjs.19.00629] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Fully immersive virtual reality (VR) uses headsets to situate a surgeon in a virtual operating room to perform open surgical procedures. The aims of this study were to determine (1) if a VR curriculum for training residents to perform anterior approach total hip replacement (AA-THR) was feasible, (2) if VR enabled residents' performance to be measured objectively, and (3) if cognitive and motor skills that were learned with use of VR were transferred to the physical world. METHODS The performance of 32 orthopaedic residents (surgical postgraduate years [PGY]-1 through 4) with no prior experience with AA-THR was measured during 5 consecutive VR training and assessment sessions. Outcome measures were related to procedural sequence, efficiency of movement, duration of surgery, and visuospatial precision in acetabular component positioning and femoral neck osteotomy, and were compared with the performance of 4 expert hip surgeons to establish competency-based criteria. Pretraining and post-training assessments on dry bone models were used to assess the transfer of visuospatial skills from VR to the physical world. RESULTS Residents progressively developed surgical skills in VR on a learning curve through repeated practice, plateauing, on average, after 4 sessions (4.1 ± 0.6 hours); they reached expert VR levels for 9 of 10 metrics (except femoral osteotomy angle). Procedural errors were reduced by 79%, assistive prompts were reduced by 70%, and procedural duration was reduced by 28%. Dominant and nondominant hand movements were reduced by 35% and 36%, respectively, and head movement was reduced by 44%. Femoral osteotomy was performed more accurately, and acetabular implant orientation improved in VR assessments. In the physical world assessments, experts were more accurate than residents prior to simulation, but were matched by residents after simulation for all of the metrics except femoral osteotomy angle. The residents who performed best in VR were the most accurate in the physical world, while 2 residents were unable to achieve competence despite sustained practice. CONCLUSIONS For novice surgeons learning AA-THR skills, fully immersive VR technology can objectively measure progress in the acquisition of surgical skills as measured by procedural sequence, efficiency of movement, and visuospatial accuracy. Skills learned in this environment are transferred to the physical environment.
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Affiliation(s)
- Kartik Logishetty
- The MSk Lab, Department of Surgery and Cancer, Imperial College, London, United Kingdom
| | - Wade T Gofton
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Branavan Rudran
- The MSk Lab, Department of Surgery and Cancer, Imperial College, London, United Kingdom
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Justin P Cobb
- The MSk Lab, Department of Surgery and Cancer, Imperial College, London, United Kingdom
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Surgical Training Throughout Africa: A Review of Operative Case Volumes at Multiple Training Centers. World J Surg 2020; 44:2100-2107. [DOI: 10.1007/s00268-020-05463-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Zhao B, Hollandsworth HM, Lee AM, Lam J, Lopez NE, Abbadessa B, Eisenstein S, Cosman BC, Ramamoorthy SL, Parry LA. Making the Jump: A Qualitative Analysis on the Transition From Bedside Assistant to Console Surgeon in Robotic Surgery Training. JOURNAL OF SURGICAL EDUCATION 2020; 77:461-471. [PMID: 31558428 PMCID: PMC7036000 DOI: 10.1016/j.jsurg.2019.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 08/21/2019] [Accepted: 09/15/2019] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To determine barriers associated with the transition from bedside assistant to console surgeon for general surgery residents in the era of robotic surgery in general surgery training. DESIGN Qualitative thematic analysis using one-on-one interviews of general surgery residents and attendings conducted between June 2018 and February 2019. SETTING An urban, academic, multihospital general surgery residency program with a robust robotic surgery program. PARTICIPANTS Convenient and purposeful sampling was performed to ensure a variety of resident graduate-years and attending subspecialties were represented. Sample size was determined by data saturation, which occurred after 20 resident and 7 attending interviews. RESULTS Residents identified the low volume of general surgery robotic cases, the infrequency of exposure to robotic surgery, and attending comfort with robotic surgery (and with teaching on the robot) as potential barriers in the transition from bedside assistant to console surgeon. Residents had to find a replacement bedside assistant in order to be the console surgeon, which was challenging. In addition, residents felt that the current culture surrounding robotic surgery is very hierarchal, limiting their exposure. Attendings' trust in the residents' console skills was a major determining factor in allowing residents on the console. CONCLUSIONS Most robotic surgery education curricula are sequential, requiring the resident to progress from bedside assistant to console surgeon. Unfortunately, there are many potential barriers for residents in the transition from bedside assistant to console surgeon. Some barriers apply to general surgery training overall, but are amplified in robotic surgery, while others are unique to robotic surgery education. Recognition of, and rectifying, these barriers may increase resident participation as the console surgeon.
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Affiliation(s)
- Beiqun Zhao
- Department of Surgery, University of California San Diego, La Jolla, California.
| | | | - Arielle M Lee
- Department of Surgery, University of California San Diego, La Jolla, California
| | - Jenny Lam
- Department of Surgery, University of California San Diego, La Jolla, California
| | - Nicole E Lopez
- Department of Surgery, University of California San Diego, La Jolla, California
| | - Benjamin Abbadessa
- Department of Surgery, University of California San Diego, La Jolla, California
| | - Samuel Eisenstein
- Department of Surgery, University of California San Diego, La Jolla, California
| | - Bard C Cosman
- Department of Surgery, University of California San Diego, La Jolla, California; Department of Surgery, VA San Diego Healthcare System, La Jolla, California
| | - Sonia L Ramamoorthy
- Department of Surgery, University of California San Diego, La Jolla, California
| | - Lisa A Parry
- Department of Surgery, University of California San Diego, La Jolla, California; Department of Surgery, VA San Diego Healthcare System, La Jolla, California
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Foote DC, Reddy RM, Matusko N, Sandhu G. Surgery clerkship offers greater entrustment of medical students with supervised procedures than other clerkships. Am J Surg 2020; 220:537-542. [PMID: 32139105 DOI: 10.1016/j.amjsurg.2020.02.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 01/09/2020] [Accepted: 02/25/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Medical student procedural participation is increasingly limited, creating concerns over poor preparation for internship. Inadequate experiences may also compromise patient safety. This study explores variances in procedural entrustment of medical students between core clerkships during the first clinical year. METHODS Students completing their first clinical year were surveyed on procedure participation. Holistic entrustment decisions are complex, thus participation was used as an objective proxy for entrustment. RESULTS 138 students responded (66% response rate); 89% (123/138) wished they had performed more procedures. Students had higher participation rates during procedural clerkships (surgery, obstetrics/gynecology). Entrustment was highest during surgery, and lowest during pediatrics. Surgery gave statistically significantly higher entrustment for subcuticular suturing (compared to obstetrics/gynecology) and nasogastric tube removal (compared to internal medicine). Entrustment was generally inversely proportional to procedure complexity within each specialty. CONCLUSIONS Students encounter higher entrustment during procedural clerkships, especially surgery. Targeted areas for increased procedural involvement can be identified in all specialties.
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Affiliation(s)
- Darci C Foote
- University of Michigan Medical School, 1305 Catherine St., Ann Arbor, MI, 48109, USA.
| | - Rishindra M Reddy
- Department of Surgery, University of Michigan Health System, 1500 E. Medical Center Dr., 2120 Taubman Center, Ann Arbor, MI, 48109, USA
| | - Niki Matusko
- Department of Surgery, University of Michigan Health System, 1500 E. Medical Center Dr., 2120 Taubman Center, Ann Arbor, MI, 48109, USA
| | - Gurjit Sandhu
- Department of Surgery, University of Michigan Health System, 1500 E. Medical Center Dr., 2120 Taubman Center, Ann Arbor, MI, 48109, USA.
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