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Brooks NE, French JC, Sancheti H, Lipman JM. American Board of Surgery In-Training Exam Performance Predicted by Question Bank Use While Unassociated With Other Learning Strategies. J Surg Res 2024; 300:191-197. [PMID: 38824849 DOI: 10.1016/j.jss.2024.05.002] [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: 08/26/2023] [Revised: 04/24/2024] [Accepted: 05/06/2024] [Indexed: 06/04/2024]
Abstract
INTRODUCTION There is no consensus regarding optimal curricula to teach cognitive elements of general surgery. The American Board of Surgery In-Training Exam (ABSITE) aims to measure trainees' progress in attaining this knowledge. Resources like question banks (QBs), Surgical Council on Resident Education (SCORE) curriculum, and didactic conferences have mixed findings related to ABSITE performance and are often evaluated in isolation. This study characterized relationships between multiple learning methods and ABSITE performance to elucidate the relative educational value of learning strategies. METHODS Use and score of QB, SCORE use, didactic conference attendance, and ABSITE percentile score were collected at an academic general surgery residency program from 2017 to 2022. QB data were available in the years 2017-2018 and 2021-2022 during institutional subscription to the same platform. Given differences in risk of qualifying exam failure, groups of ≤30th and >30th percentile were analyzed. Linear quantile mixed regressions and generalized linear mixed models determined factors associated with ABSITE performance. RESULTS Linear quantile mixed regressions revealed a relationship between ABSITE performance and QB questions completed (1.5 percentile per 100 questions, P < 0.001) and QB score (1.2 percentile per 1% score, P < 0.001), but not with SCORE use and didactic attendance. Performers >30th percentile had a significantly higher QB score. CONCLUSIONS Use and score of QB had a significant relationship with ABSITE performance, while SCORE use and didactic attendance did not. Performers >30th percentile completed a median 1094 QB questions annually with a score of 65%. Results emphasize success of QB use as an active learning strategy, while passive learning methods warrant further evaluation.
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Affiliation(s)
- Nicole E Brooks
- Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Judith C French
- Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Himani Sancheti
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Jeremy M Lipman
- Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
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Heskin L, Galvin R, Traynor O, Simms C. Simulation in Upper and Lower Limb Trauma Skill Acquisition: A Review. Simul Healthc 2022; 17:54-65. [PMID: 34009908 DOI: 10.1097/sih.0000000000000570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY STATEMENT This review aimed to explore the published evidence with regard to the types and composition of both full- and part-task trainers to teach surgeons extremity exploration procedures in limb trauma management. Studies were included if they reported the development and/or validation of synthetic or virtual task trainers. Studies were evaluated to determine their derivation, usability, and clinical utility.A total of 638 citations were identified and 63 satisfied the inclusion criteria. Twenty-five articles addressed simulator validation and 36 addressed level of learning achieved with simulator engagement. Two studies described a dedicated limb simulator. Simulators were developed to repair limb structures including skin (n = 15), tendon (n = 7), nerve (n = 1), fascia (n = 1), muscle (n = 1), vascular (n = 24), and bone (n = 11). Considerations such as material fidelity, learning outcomes, cost or reusability, validity, and effectiveness are inconsistently reported. Future studies should address design standards for the effective production of synthetic or virtual simulators for limb trauma management.
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Affiliation(s)
- Leonie Heskin
- From the Department of Surgical Affairs, Royal College of Surgeons in Ireland (L.H., O.T.); University of Limerick (R.G.); and Trinity College Dublin (C.S.), Dublin, Ireland
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Dadgar S, Mousavi Vahed S, Afiat M. Peppermint drop effect on ileus following cesarean section. J Family Med Prim Care 2022; 11:1435-1442. [PMID: 35516656 PMCID: PMC9067208 DOI: 10.4103/jfmpc.jfmpc_1366_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/14/2021] [Accepted: 12/09/2021] [Indexed: 11/05/2022] Open
Abstract
Objective: Intestine dysfunction and ileus are one of the cesarean section complications. medicinal herbs have been used to restore the postoperative intestinal function. Therefore, we decided to use a mint drop to improve bowel function after cesarean section. Methods and Materials: 102 women enrolled in the study. The patients were simply randomized and double blindly divided into two groups of 51 patients and giving them medication (mint drops) or placebo. Then, the initial evaluation included hearing the first bowel sound, having nausea and vomiting, the first gas passing feeling time, the first defecation feeling time, and duration of hospitalization was evaluated and compared between the two groups. Results: The mean time to hearing the first intestinal sounds was 9/05 ± 2/44 hours in the placebo group and 5/78 ± 1/25 hours in the treatment group. The interval between surgery and the first gas passing feeling time in the placebo group was 12/24 ± 3/91 hours and in the treatment group was 7/87 ± 2/02 hours. None of the patients had nausea and vomiting. Conclusion: Considering the significant difference between two groups in the meantime interval to hearing the first intestinal sound, the first gas passing feeling time, and the first defecation feeling time, we conclude that the peppermint drop is more effective than placebo in improving bowel function.
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Assessment of YouTube as an educational tool in teaching thyroidectomy and parathyroidectomy. The Journal of Laryngology & Otology 2021; 136:952-960. [PMID: 34895376 DOI: 10.1017/s0022215121004096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
Principles of surgical training have not changed, but methods of training are evolving very fast. Online tools are being adopted in both knowledge and skills training for surgical residents. As a result, to evaluate the outcome of these tools, online assessment is also developing. Knowledge resources are very diverse ranging from lectures, webinars, surgical videos to three-dimensional planning and printing. Skills resources include virtual reality simulators, remote skills training and interdisciplinary teamwork. Assessment of E-learning tools can be performed using online questions, task-based simulations, branching scenarios and online interviews/discussions. In thoracic surgery, video assisted thoracic surgery (VATS) lobectomy simulator has been developed and it appears to be an important tool for minimally invasive thoracic surgery education. Training programs incorporate e-Learning in their curriculum and online training and assessment will become an important part of thoracic surgical training as well.
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Affiliation(s)
| | - Jalal Assouad
- Sorbonne University, Tenon University Hospital, Department of Thoracic and Vascular Surgery, Paris, France
| | - Harry Etienne
- Sorbonne University, Tenon University Hospital, Department of Thoracic and Vascular Surgery, Paris, France
| | - Xavier Benoit D'Journo
- Aix-Marseille University, Thoracic surgery department, North Hospital, Marseille, France
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6
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Castillo-Segura P, Fernández-Panadero C, Alario-Hoyos C, Muñoz-Merino PJ, Delgado Kloos C. Objective and automated assessment of surgical technical skills with IoT systems: A systematic literature review. Artif Intell Med 2021; 112:102007. [PMID: 33581827 DOI: 10.1016/j.artmed.2020.102007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/25/2020] [Accepted: 12/28/2020] [Indexed: 11/18/2022]
Abstract
The assessment of surgical technical skills to be acquired by novice surgeons has been traditionally done by an expert surgeon and is therefore of a subjective nature. Nevertheless, the recent advances on IoT (Internet of Things), the possibility of incorporating sensors into objects and environments in order to collect large amounts of data, and the progress on machine learning are facilitating a more objective and automated assessment of surgical technical skills. This paper presents a systematic literature review of papers published after 2013 discussing the objective and automated assessment of surgical technical skills. 101 out of an initial list of 537 papers were analyzed to identify: 1) the sensors used; 2) the data collected by these sensors and the relationship between these data, surgical technical skills and surgeons' levels of expertise; 3) the statistical methods and algorithms used to process these data; and 4) the feedback provided based on the outputs of these statistical methods and algorithms. Particularly, 1) mechanical and electromagnetic sensors are widely used for tool tracking, while inertial measurement units are widely used for body tracking; 2) path length, number of sub-movements, smoothness, fixation, saccade and total time are the main indicators obtained from raw data and serve to assess surgical technical skills such as economy, efficiency, hand tremor, or mind control, and distinguish between two or three levels of expertise (novice/intermediate/advanced surgeons); 3) SVM (Support Vector Machines) and Neural Networks are the preferred statistical methods and algorithms for processing the data collected, while new opportunities are opened up to combine various algorithms and use deep learning; and 4) feedback is provided by matching performance indicators and a lexicon of words and visualizations, although there is considerable room for research in the context of feedback and visualizations, taking, for example, ideas from learning analytics.
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Affiliation(s)
- Pablo Castillo-Segura
- Universidad Carlos III de Madrid, Av. Universidad 30, 28911, Leganés, Madrid, Spain.
| | | | - Carlos Alario-Hoyos
- Universidad Carlos III de Madrid, Av. Universidad 30, 28911, Leganés, Madrid, Spain.
| | - Pedro J Muñoz-Merino
- Universidad Carlos III de Madrid, Av. Universidad 30, 28911, Leganés, Madrid, Spain.
| | - Carlos Delgado Kloos
- Universidad Carlos III de Madrid, Av. Universidad 30, 28911, Leganés, Madrid, Spain.
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7
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Cheun TJ, Davies MG. Improving ABSITE scores - A meta-analysis of reported remediation models. Am J Surg 2020; 220:1557-1565. [DOI: 10.1016/j.amjsurg.2020.04.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 10/24/2022]
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Ataee Dizaji P, Vasheghani Farahani M, Sheikhaliyan A, Biglarian A. Application of additive hazards models for analyzing survival of breast cancer patients. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2020; 25:99. [PMID: 33273944 PMCID: PMC7698387 DOI: 10.4103/jrms.jrms_701_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 01/28/2020] [Accepted: 06/29/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Survival rates for breast cancer (BC) are often based on the outcomes of this disease. The aim of this study was to compare the performance of three survival models, namely Cox regression, Aalen's, and Lin and Ying's additive hazards (AH) models for identifying the prognostic factors regarding the survival time of BC patients. MATERIALS AND METHODS This study was a historical cohort study which used 1025 females' medical records that underwent modified radical mastectomy or breast saving. These patients were admitted to Besat and Chamran Hospitals, Tehran, Iran, during 2010-2015 and followed until 2017. The Aalen's and Lin and Ying's AH models and also traditional Cox model were applied for analysis of time to death of BC patients using R 3.5.1 software. RESULTS In Aalen's and also Lin and Ying's AH models, age at diagnosis, history of disease, number of lymph nodes, metastasis, hormonal therapy, and evacuation lymph nodes were prognostic factors for the survival of BC patients (P < 0.05). In addition, in the Lin and Ying's AH model tumor size (P = 0.048) was also identified as a significant factor. According to Aalen's plot, metastasis, age at diagnosis, and number of lymph nodes had a time-varying effect on survival time. These variables had a different slope as the times go on. CONCLUSION AH model may yield new insights in prognostic studies of survival time of patients with BC over time. Because of the positive slope of estimated cumulative regression function in Aalen's plot, metastasis, higher age at diagnosis, and high number of lymph nodes are important factors in reducing the survival BC, and then based on these factors, the therapists should consider a special therapeutic protocol for BC patients.
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Affiliation(s)
- Parisa Ataee Dizaji
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Ayeh Sheikhaliyan
- Department of Industrial Engineering, Malek Ashtar University of Technology, Tehran, Iran
| | - Akbar Biglarian
- Department of Biostatistics, Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Davey MS, Cassidy JT, Lyons RF, Cleary MS, Niocaill RFM. Changes to Training Practices during a Pandemic - The Experience of the Irish National Trauma & Orthopaedic Training Scheme. Injury 2020; 51:2087-2090. [PMID: 32654851 PMCID: PMC7345416 DOI: 10.1016/j.injury.2020.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/07/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Martin S. Davey
- University Hospital Waterford, Waterford, Ireland,Royal College of Surgeons in Ireland, Dublin, Ireland,Corresponding author at: Department of Trauma & Orthopaedic Surgery, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland
| | - J. Tristan Cassidy
- University Hospital Waterford, Waterford, Ireland,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Rebecca F. Lyons
- University Hospital Waterford, Waterford, Ireland,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - May S. Cleary
- University Hospital Waterford, Waterford, Ireland,Royal College of Surgeons in Ireland, Dublin, Ireland,University College Cork, Cork, Ireland
| | - Ruairi F. Mac Niocaill
- University Hospital Waterford, Waterford, Ireland,Royal College of Surgeons in Ireland, Dublin, Ireland
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Stambough JB, Curtin BM, Gililland JM, Guild GN, Kain MS, Karas V, Keeney JA, Plancher KD, Moskal JT. The Past, Present, and Future of Orthopedic Education: Lessons Learned From the COVID-19 Pandemic. J Arthroplasty 2020; 35:S60-S64. [PMID: 32345564 PMCID: PMC7166110 DOI: 10.1016/j.arth.2020.04.032] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 02/01/2023] Open
Abstract
The COVID-19 global pandemic has upended nearly every medical discipline, dramatically impacted patient care and has had far-reaching effects on surgeon education. In many areas of the country, elective orthopedic surgery has completely stopped to ensure that resources are available for the critically ill and to minimize the spread of disease. COVID-19 is forcing many around the world to re-evaluate existing processes and organizations and adapt to carry out business, of which medicine and education are not immune. Most national and international orthopedic conferences, training programs, and workshops have been postponed or canceled, and we are now critically evaluating the delivery of education to our colleagues as well as residents and fellows. This article describes the evolution of orthopedic education and significant paradigm shifts necessary to continue to teach ourselves and the future leaders of our noble profession.
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Affiliation(s)
- Jeffrey B Stambough
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | | | - Jeremy M Gililland
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
| | - George N Guild
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA
| | - Michael S Kain
- Boston Medical Center, Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, MA
| | - Vasili Karas
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - James A Keeney
- Department of Orthopaedic Surgery, University of Missouri School of Medicine, Columbia, MO
| | - Kevin D Plancher
- Plancher Orthopaedics & Sports, Albert Einstein College of Medicine, New York, NY
| | - Joseph T Moskal
- Department of Orthopaedic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, VA
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11
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Abstract
BACKGROUND Modern total hip arthroplasty has seen an unfortunate increase in proportional implant failures secondary to adverse local tissue reactions (ALTRs) secondary to wear of metal-on-metal (MoM) bearings and mechanically assisted crevice corrosion (MACC) related to corrosion at implant junctions and tapers. The purpose of this study is to describe the appropriate choice of metal ion testing and evaluation of those levels to identify failed total hip arthroplasty implants containing cobalt and chromium. METHODS When presented with an arthroplasty of concern, the surgeon must determine what metal ion levels to obtain and then incorporate those levels into a treatment algorithm. Patients with painful hip arthroplasties are evaluated for chromium and cobalt by obtaining whole blood and synovial metal levels. RESULTS Synovial fluid cobalt had the highest correlation with ALTR compared with the other tests, with a threshold of 19.75 ng/ml, with a specificity of 89%, if the cobalt-to-chromium ratio is greater than 1.4 ng/ml in a metal on polyethylene hip, with a sensitivity of 95%. CONCLUSION The interpretation of whole blood metal ions is a key component of the algorithm in treating the symptomatic hip arthroplasty but is not to be used in a vacuum.
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12
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Developing and refining a surgical curriculum. Surgery 2020; 167:528-531. [DOI: 10.1016/j.surg.2019.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 05/24/2019] [Accepted: 06/17/2019] [Indexed: 11/21/2022]
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13
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Hammond Mobilio M, Brydges R, Patel P, Glatt D, Moulton CAE. Struggles with autonomy: Exploring the dual identities of surgeons and learners in the operating room. Am J Surg 2020; 219:233-239. [DOI: 10.1016/j.amjsurg.2019.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/09/2019] [Accepted: 12/06/2019] [Indexed: 12/21/2022]
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Ahmed A, Wojcik EM, Ananthanarayanan V, Mulder L, Mirza KM. Learning Styles in Pathology: A Comparative Analysis and Implications for Learner-Centered Education. Acad Pathol 2019; 6:2374289519852315. [PMID: 31218251 PMCID: PMC6560795 DOI: 10.1177/2374289519852315] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/22/2019] [Accepted: 04/29/2019] [Indexed: 12/02/2022] Open
Abstract
Initiatives like “American Medical Association (AMA)-Reimagining Residency” and
“Accreditation Council for Graduate Medical Education (ACGME)-Next Accreditation System”
are examples of a paradigm shift toward learner-centered pedagogy in resident education.
Such interventions require an understanding of the basics of the learning process itself.
This study aimed to identify preferred learning styles in pathology with the intent to use
specialty-specific pattern data, if any, to improve pathology training modalities. Kolb’s
learning tool questionnaire was sent to pathology-inclined medical students, pathology
residents, fellows, and faculty in 5 academic programs. Data from 84 respondents (6
students, 37 residents, 12 fellows, 29 attendings) were analyzed. There was remarkable
similarity in learning styles of fellows and faculty, revealing a dominance of
observational learning styles (“assimilating” and “diverging”) that was consistent with
pathology being a visual field. In contrast, residents showed dominance of “learn by
doing” styles (“converging” and “accommodating”). Residents’ stratification by training
year showed a scattered distribution with an upward trend toward “learn by doing”
behavior. While the difference in styles between residents and faculty/fellows may be due
to a generational gap, transition from medical school, or acquisition of technical skills
required for grossing specimens, this is an opportunity for adopting blended learning
models and active learning processes to cater to residents’ different styles and to allow
for flexibility to use all styles as and when needed. Based on these findings, we
hypothesize that partnering juniors and seniors with similar styles has a potential for
successful mentorship and exploration of other psychometrics is recommended for further
understanding and improvement of pathology training.
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Affiliation(s)
- Aadil Ahmed
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Eva M Wojcik
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, IL, USA
| | | | - Lotte Mulder
- Harvard Graduate School of Education, Cambridge, MA, USA
| | - Kamran M Mirza
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, IL, USA
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Back DA, von Malotky J, Sostmann K, Peters H, Hube R, Hoff E. Experiences with using e-learning tools in orthopedics in an uncontrolled field study application. Orthop Traumatol Surg Res 2019; 105:389-393. [PMID: 30858039 DOI: 10.1016/j.otsr.2019.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 10/10/2018] [Accepted: 01/07/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND E-learning is widely used in undergraduate medical education and often in blended learning settings for students learning at home. This study should assess the educative value of e-learning tools in orthopedics and traumatology when used under "field" conditions, in comparison with a controlled laboratory-like setting. MATERIALS AND METHODS Medical students were invited for their voluntary online participation in an uncontrolled study (UCS). They were randomly exposed to digital book chapters or podcasts on four different orthopedic diseases, and then filled in pre-/post-tests and evaluations. Test results indicating insufficient study participation were not included in the subsequent analysis. Results in a gain of knowledge and student's satisfaction were compared to existing data of a randomized controlled trial with the same tools in a laboratory environment (RCT). RESULTS Among 84 included UCS students and 130 RCT students, podcast learners showed a significantly higher gain of knowledge compared to text learners independent of the learning setting (UCS p<0.011; RCT p<0.001). There were no significant differences in the gain of knowledge for the two different learning tools when comparing each the UCS and RCT settings. Evaluations showed positive ratings for both tools, while podcasts were on the average rated higher than texts were. Significantly more UCS participants (n=46) compared to the RCT (n=34) showed signs of disengagement with the study (p<0.05). DISCUSSION The findings suggest that it is possible to achieve a similar gain of knowledge with e-learning tools in uncontrolled settings and in RCTs. The role of e-learning materials in voluntary and formative learning settings is of value and should be explored in future studies. LEVEL OF EVIDENCE III, case-control study.
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Affiliation(s)
- David Alexander Back
- Bundeswehr Hospital Berlin, Department of Traumatology and Orthopedics, Berlin, Germany; Dieter Scheffner Center for Medical Education and Educational Research, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Jennifer von Malotky
- Center for Musculoskeletal Surgery, Department of Orthopedics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Kai Sostmann
- Dieter Scheffner Center for Medical Education and Educational Research, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Harm Peters
- Dieter Scheffner Center for Medical Education and Educational Research, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Robert Hube
- Center for Musculoskeletal Surgery, Department of Orthopedics, Charité - Universitätsmedizin Berlin, Berlin, Germany; Orthopedic Surgery Clinic Munich, Munich, Germany
| | - Eike Hoff
- Clinic for Orthopedic and Traumatologic Surgery - Center for Joint and Spine Surgery, Helios Clinic Emil v. Behring, Berlin, Germany
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Hamilton AER, Young CJ. Surveys still teach vital non-technical lessons in General Surgery. ANZ J Surg 2018; 89:159-164. [PMID: 30485674 DOI: 10.1111/ans.14932] [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: 07/02/2018] [Revised: 09/23/2018] [Accepted: 09/29/2018] [Indexed: 11/27/2022]
Abstract
In general surgery, observational studies are disregarded and often seen as non-noteworthy research. We intend to defend the use of surveys in general surgery and colorectal surgery. This review highlights the historical importance and contemporary utility of surveys internationally and in our region, thus reminding Australasian surgeons and clinicians in numerous disciplines of the usefulness of this research tool. Well-constructed surveys often successfully capture qualitative data otherwise impossible to collect through randomized controlled trial. The results of these surveys may advise national policies and medical registration agencies thus having a direct influence on individuals and their public health. Samples from contemporary survey-based research publications from international and Australasian authors are used to illustrate some of the vital non-technical lessons learned in recent times.
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Affiliation(s)
- Auerilius E R Hamilton
- Colorectal Surgery Unit, Royal Prince Alfred Hospital, Institute of Academic Surgery, Sydney, New South Wales, Australia
| | - Christopher J Young
- Colorectal Surgery Unit, Royal Prince Alfred Hospital, Institute of Academic Surgery, Sydney, New South Wales, Australia.,Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia
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Ovaere S, Zimmerman DDE, Brady RR. Social Media in Surgical Training: Opportunities and Risks. JOURNAL OF SURGICAL EDUCATION 2018; 75:1423-1429. [PMID: 29730180 DOI: 10.1016/j.jsurg.2018.04.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/25/2018] [Accepted: 04/02/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Surgeon engagement with social media is growing rapidly. Innovative applications in diverse fields of health care are increasingly available. OBJECTIVE The aim of this review is to explore the current and future applications of social media in surgical training. In addition, risks and barriers of social media engagement are analyzed, and recommendations for professional social media use amongst trainers and trainees are suggested. METHODS The published, peer-reviewed literature on social media in medicine, surgery and surgical training was reviewed. MESH terms including "social media", "education", "surgical training" and "web applications" were used. RESULTS Different social media surgical applications are already widely available but limited in use in the trainee's curriculum. E-learning modalities, podcasts, live surgery platforms and microblogs are used for teaching purposes. Social media enables global research collaboratives and can play a role in patient recruitment for clinical trials. The growing importance of networking is emphasized by the increased use of LinkedIn, Facebook, Sermo and other networking platforms. Risks of social media use, such as lack of peer review and the lack of source confirmation, must be considered. Governing surgeon's and trainee's associations should consider adopting and sharing their guidelines for standards of social media use. CONCLUSIONS Surgical training is changing rapidly and as such, social media presents tremendous opportunities for teaching, training, research and networking. Awareness must be raised on the risks of social media use.
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Affiliation(s)
- Sander Ovaere
- General Surgery Training Program, University Hospitals Leuven, Leuven, Belgium; Belgian Association of Surgical Trainees.
| | - David D E Zimmerman
- Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Richard R Brady
- Newcastle Centre for Bowel Disease, RVI, Newcastle upon Tyne University Hospitals NHS Foundation Trust, Newcastle, United Kingdom
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18
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Ballard DH, Pennington GP, Chu QD, Samra NS. Resident Duty Hours and American Board of Surgery In-Training Examination Performance. Am Surg 2017. [DOI: 10.1177/000313481708300502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- David H. Ballard
- Department of Surgery Louisiana State University Health Shreveport Shreveport, Louisiana
| | - G. Patton Pennington
- Department of Surgery Louisiana State University Health Shreveport Shreveport, Louisiana
| | - Quyen D. Chu
- Department of Surgery Louisiana State University Health Shreveport Shreveport, Louisiana
| | - Navdeep S. Samra
- Department of Surgery Louisiana State University Health Shreveport Shreveport, Louisiana
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Choi W, Dyens O, Chan T, Schijven M, Lajoie S, Mancini ME, Dev P, Fellander-Tsai L, Ferland M, Kato P, Lau J, Montonaro M, Pineau J, Aggarwal R. Engagement and learning in simulation: recommendations of the Simnovate Engaged Learning Domain Group. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2017. [DOI: 10.1136/bmjstel-2016-000177] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundHealth professions education (HPE) is based on deliberate learning activities and clinical immersion to achieve clinical competence. Simulation is a tool that helps bridge the knowledge-to-action gap through deliberate learning. This paper considers how to optimally engage learners in simulation activities as part of HPE.MethodsThe Simnovate Engaged Learning Domain Group undertook 3 teleconferences to survey the current concepts regarding pervasive learning. Specific attention was paid to engagement in the learning process, with respect to fidelity, realism and emotions, and the use of narratives in HPE simulation.ResultsThis paper found that while many types of simulation exist, the current ways to categorise the types of simulation do not sufficiently describe what a particular simulation will entail. This paper introduces a novel framework to describe simulation by deconstructing a simulation activity into 3 core characteristics (scope, modality and environment). Then, the paper discusses how engagement is at the heart of the learning process, but remained an understudied phenomenon with respect to HPE simulation. Building on the first part, a conceptual framework for engaged learning in HPE simulation was derived, with potential use across all HPE methods.DiscussionThe framework considers how the 3 characteristics of simulation interplay with the dimensions of fidelity (physical, conceptual and emotional), and how these can be conveyed by and articulated through beauty (as a proxy for efficiency) as coexisting factors to drive learner engagement. This framework leads to the translation of deliberately taught knowledge, skills and attitudes into clinical competence and subsequent performance.
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Dietl CA, Russell JC. Effect of Process Changes in Surgical Training on Quantitative Outcomes From Surgery Residency Programs. JOURNAL OF SURGICAL EDUCATION 2016; 73:807-818. [PMID: 27156139 DOI: 10.1016/j.jsurg.2016.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/22/2016] [Accepted: 03/22/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The purpose of this article is to review the literature on process changes in surgical training programs and to evaluate their effect on the Accreditation Council of Graduate Medical Education (ACGME) Core Competencies, American Board of Surgery In-Training Examination (ABSITE) scores, and American Board of Surgery (ABS) certification. DESIGN A literature search was obtained from MEDLINE via PubMed.gov, ScienceDirect.com, Google Scholar on all peer-reviewed studies published since 2003 using the following search queries: surgery residency training, surgical education, competency-based surgical education, ACGME core competencies, ABSITE scores, and ABS pass rate. RESULTS Our initial search list included 990 articles on surgery residency training models, 539 on competency-based surgical education, 78 on ABSITE scores, and 33 on ABS pass rate. Overall, 31 articles met inclusion criteria based on their effect on ACGME Core Competencies, ABSITE scores, and ABS certification. Systematic review showed that 5/31, 19/31, and 6/31 articles on process changes in surgical training programs had a positive effect on patient care, medical knowledge, and ABSITE scores, respectively. ABS certification was not analyzed. The other ACGME core competencies were addressed in only 6 studies. CONCLUSIONS Several publications on process changes in surgical training programs have shown a positive effect on patient care, medical knowledge, and ABSITE scores. However, the effect on ABS certification, and other quantitative outcomes from residency programs, have not been addressed. Studies on education strategies showing evidence that residency program objectives are being achieved are still needed. This article addresses the 6 ACGME Core Competencies.
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Affiliation(s)
- Charles A Dietl
- Division of Cardiothoracic Surgery, Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.
| | - John C Russell
- Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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Evans CH, Schenarts KD. Evolving Educational Techniques in Surgical Training. Surg Clin North Am 2016; 96:71-88. [DOI: 10.1016/j.suc.2015.09.005] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Luc JG, Antonoff MB. Active Learning in Medical Education: Application to the Training of Surgeons. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2016; 3:10.4137_JMECD.S18929. [PMID: 29349326 PMCID: PMC5736298 DOI: 10.4137/jmecd.s18929] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 04/10/2016] [Accepted: 04/12/2016] [Indexed: 05/03/2023]
Abstract
Our article defines active learning in the context of surgical education and reviews the growing body of research on new approaches to teaching. We then discuss future perspectives and the challenges faced by the trainee and surgeon in applying active learning to surgical training. As modern surgical education faces numerous challenges, we hope our article will help surgical educators in the evaluation of curriculum development, methods of instruction, and assessment.
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Affiliation(s)
- Jessica G.Y. Luc
- Faculty of Medicine and Dentistry, University of Alberta, Alberta, Canada
| | - Mara B. Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Kim JJ, Gifford ED, Moazzez A, Sidwell RA, Reeves ME, Hartranft TH, Inaba K, Jarman BT, Are C, Galante JM, Amersi F, Smith BR, Melcher ML, Nelson MT, Donahue T, Jacobsen G, Arnell TD, Lee S, Neville A, de Virgilio C. Program Factors That Influence American Board of Surgery In-Training Examination Performance: A Multi-Institutional Study. JOURNAL OF SURGICAL EDUCATION 2015; 72:e236-e242. [PMID: 26319103 DOI: 10.1016/j.jsurg.2015.06.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 05/19/2015] [Accepted: 06/22/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To determine the influence of program strategies, such as program directors' (PD) attitudes about the American Board of Surgery In-Training Examination (ABSITE) and approach to ABSITE preparation, on residents' ABSITE performance. DESIGN A 17-item questionnaire was sent to PDs at surgical residency programs. The questions were designed to elicit information regarding the educational curriculum, remediation protocols, and opinions relating to the ABSITE. Main outcome measure was categorical resident ABSITE percentile scores from the January 2014 examination. Statistical analysis was performed using the Student t-test, analysis of variance, and linear regression as appropriate. SETTING The study was carried out at general surgery residency programs across the country. PARTICIPANTS In total, 15 general surgery residency PDs participated in the study. RESULTS The PD response rate was 100%. All 460 resident ABSITE scores from the 15 programs were obtained. In total, 10 programs (67%) identified as university affiliated, 4 programs (27%) as independent academic, and 1 program (7%) as hybrid. The mean number of residents per program was 30.7 (range: 15-57). In total, 14 PDs (93%) indicated that an ABSITE review curriculum was in place and 13 PDs (87%) indicated they had a remediation protocol for residents with low ABSITE scores (with differing thresholds of <30th, <35th, and <40th percentile). The median overall ABSITE score for all residents was 61st percentile (interquartile range = 39.5). The mean ABSITE score for each program ranged from 39th to 75th percentile. Program factors associated with higher ABSITE scores included tracking resident reading throughout the year (median 63rd percentile with tracking vs 59th percentile without, p = 0.040) and the type of remediation (by PD: 77th percentile, by PD and faculty: 57th percentile, faculty only: 64th percentile, with Surgical Education and Self-Assessment Program (SESAP): 63rd percentile, outside review course: 43rd percentile; p < 0.001). Programs with a remediation protocol trended toward higher ABSITE scores compared with programs without remediation protocols (median 61st percentile vs 53rd percentile, p = 0.098). Factors not significantly associated with ABSITE performance included number of structured educational hours per week and frequency of ABSITE review sessions. CONCLUSIONS Program factors appear to significantly influence ABSITE performance. Programs where the PD was actively involved in remediation mentorship and the tracking of resident reading achieved higher ABSITE percentile scores on the January 2014 examination. Counterintuitively, residents from programs with a lower ABSITE threshold for remediation performed better on the examination.
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Affiliation(s)
- Jerry J Kim
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
| | - Edward D Gifford
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
| | - Ashkan Moazzez
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
| | - Richard A Sidwell
- Department of Surgery, Iowa Methodist Medical Center, Des Moines, Iowa
| | - Mark E Reeves
- Department of Surgery, Loma Linda University, Loma Linda, California
| | | | - Kenji Inaba
- Department of Surgery, University of Southern California, Los Angeles, California
| | - Benjamin T Jarman
- Department of Surgery, Gundersen Health System, La Crosse, Wisconsin
| | - Chandrakanth Are
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Joseph M Galante
- Department of Surgery, University of California, Davis, California
| | - Farin Amersi
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Brian R Smith
- Department of Surgery, University of California, Irvine, California
| | - Marc L Melcher
- Department of Surgery, Stanford University, Stanford, California
| | - M Timothy Nelson
- Department of Surgery, University of New Mexico HSC, Albuquerque, New Mexico
| | - Timothy Donahue
- Department of Surgery, University of California, Los Angeles, California
| | - Garth Jacobsen
- Department of Surgery, University of California, San Diego, California
| | - Tracey D Arnell
- Department of Surgery, Columbia University College of Physicians and Surgeons New York, New York
| | - Steven Lee
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
| | - Angela Neville
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
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Kim RH, Tan TW. Interventions that affect resident performance on the American Board of Surgery In-Training Examination: a systematic review. JOURNAL OF SURGICAL EDUCATION 2015; 72:418-429. [PMID: 25456409 DOI: 10.1016/j.jsurg.2014.09.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 09/10/2014] [Accepted: 09/25/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To systematically review the published literature on the effectiveness of interventions intended to improve residents' American Board of Surgery In-Training Examination (ABSITE) performances. DESIGN A systematic review was conducted by 2 independent investigators to identify all publications that examined the effect of specific interventions on residents' ABSITE performances from 1975 to 2013. RESULTS Overall, 26 published articles met study criteria. Structured reading programs and setting clear expectations with mandatory remedial programs were consistently effective in improving ABSITE performance, whereas the effect of didactic teaching conferences and problem-based learning groups was mixed. There was marked heterogeneity in the usage of study designs and reporting of results. CONCLUSIONS Structured reading programs and mandatory remedial programs appear to be consistently effective measures that can improve residents' ABSITE performances. There is a need for improved study design and reporting in future research conducted in this field.
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Affiliation(s)
- Roger H Kim
- Department of Surgery, Louisiana State University Health Sciences Center in Shreveport, Shreveport, Louisiana.
| | - Tze-Woei Tan
- Department of Surgery, Louisiana State University Health Sciences Center in Shreveport, Shreveport, Louisiana
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A national survey of educational resources utilized by the Resident and Associate Society of the American College of Surgeons membership. Am J Surg 2015; 209:59-64. [DOI: 10.1016/j.amjsurg.2014.09.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 08/06/2014] [Accepted: 09/05/2014] [Indexed: 01/22/2023]
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Dua A, Sudan R, Desai SS. Improvement in American Board of Surgery in-training examination performance with a multidisciplinary surgeon-directed integrated learning platform. JOURNAL OF SURGICAL EDUCATION 2014; 71:689-693. [PMID: 24776859 DOI: 10.1016/j.jsurg.2014.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 01/29/2014] [Accepted: 02/18/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND The American Board of Surgery In-Training Examination (ABSITE) is a predictor of resident performance on the general surgery-qualifying examination and plays a role in obtaining competitive fellowships. A learning management system (LMS) permits the delivery of a structured curriculum that appeals to the modern resident owing to the ease of accessibility and all-in-one organization. This study hypothesizes that trainees using a structured surgeon-directed LMS will achieve improved ABSITE scores compared with those using an unstructured approach to the examination. STUDY DESIGN A multidisciplinary print and digital review course with practice questions, review textbooks, weekly reading assignments, and slide and audio reviews integrated within an online LMS was made available to postgraduate year (PGY)-3 and PGY-4 residents in 2008 and 2009. Surveys were emailed requesting ABSITE scores to compare outcomes in those trainees that used the course with those who used an unstructured approach. Statistical analysis was conducted via descriptive statistics and Pearson chi-square with p < 0.05 deemed statistically significant. RESULTS Surveys were mailed to 508 trainees. There was an 80% (408) response rate. Residents who used structured approaches in both the years achieved the highest scores, followed by those who adopted a structured approach in PGY-4. The residents using an unstructured approach in both the years showed no significant improvement. CONCLUSION Residents who used a structured LMS performed significantly better than their counterparts who used an unstructured approach. A properly constructed online education curriculum has the potential to improve ABSITE scores.
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Affiliation(s)
- Anahita Dua
- Department of Surgery, Center for Translational Injury Research (CeTIR), University of Texas at Houston Medical School, Houston, Texas
| | - Ranjan Sudan
- Department of Surgery, Duke University, Durham, North Carolina
| | - Sapan S Desai
- Department of Surgery, Duke University, Durham, North Carolina.
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Akelman E. Has the teaching paradigm shifted? The future of education in the digital world. J Hand Surg Am 2014; 39:1166-75. [PMID: 24862113 DOI: 10.1016/j.jhsa.2014.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 03/21/2014] [Indexed: 02/02/2023]
Affiliation(s)
- Edward Akelman
- Medical Office Center, The Warren Alpert Medical School of Brown University, Providence, RI
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Knowledge and usability of a trauma training system for general surgery residents. Am J Surg 2013; 205:681-4. [DOI: 10.1016/j.amjsurg.2012.07.037] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 06/26/2012] [Accepted: 07/17/2012] [Indexed: 11/23/2022]
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Davis JS, Garcia GD, Wyckoff MM, Alsafran S, Graygo JM, Withum KF, Schulman CI. Use of mobile learning module improves skills in chest tube insertion. J Surg Res 2012; 177:21-6. [DOI: 10.1016/j.jss.2012.03.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 02/17/2012] [Accepted: 03/12/2012] [Indexed: 10/28/2022]
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Computer-Enhanced Visual Learning Method to Teach Endoscopic Correction of Vesicoureteral Reflux: An Invitation to Residency Training Programs to Utilize the CEVL Method. Adv Urol 2012; 2012:831384. [PMID: 22272196 PMCID: PMC3261465 DOI: 10.1155/2012/831384] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 09/27/2011] [Indexed: 11/18/2022] Open
Abstract
Herein we describe a standardized approach to teach endoscopic injection therapy to repair vesicoureteral reflux utilizing the CEVL method, an internet-accessed platform. The content was developed through collaboration of the authors' clinical and computer expertises. This application provides personnel training, examination, and procedure skill documentation through the use of online text with narration, pictures, and video. There is also included feedback and remediation of skill performance and teaching “games.” We propose that such standardized teaching and procedure performance will ultimate in improved surgical results. The electronic nature of communication in this journal is ideal to rapidly disseminate this information and to develop a structure for collaborative research.
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Feasibility and impact of a case-based palliative care workshop for general surgery residents. J Am Coll Surg 2011; 214:231-6. [PMID: 22169003 DOI: 10.1016/j.jamcollsurg.2011.11.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 11/03/2011] [Accepted: 11/03/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND The American Board of Surgery has emphasized that palliative care education should be included in surgical training. The few formal curricula for teaching palliative care, although effective, are time-intensive and have low longitudinal participation rates. The aim of this project was to design a feasible and effective palliative care intervention for general surgery residency training. STUDY DESIGN A multidisciplinary group developed a 2-hour case-based palliative care workshop including a brief introductory didactic, 4 case-based scenarios, and role-playing exercises. Program effectiveness was assessed using pre- and 3 weeks post-workshop surveys to measure attitudes toward and knowledge of palliative care. Fisher's exact test was used for data analysis; statistical significance was accepted at p < 0.05. RESULTS Twenty-two (88%) residents attended the workshop and completed the baseline survey; 16 (72.7%) completed the post-workshop survey. The workshop changed residents' attitudes to be more consistent with accepted palliative care principles. Statistically significant shifts were seen in attitudes about the use of total parenteral nutrition for malignant small bowel obstruction (31.8% disagree with use pre- vs 68.8% post-workshop; p < 0.0001); the use of surgical therapy for malignant small bowel obstruction (45.5% disagree pre- vs 68.8% post-workshop; p = 0.002); and that depression is normal in terminal illness (22.7% disagree pre- vs 43.8% post-workshop; p = 0.002). Residents also performed considerably better on knowledge questions about CPR, patient autonomy, and withdrawal of life-sustaining therapy. CONCLUSIONS A brief, interactive workshop is effective in changing general surgery residents' attitudes toward and knowledge of palliative care. The results demonstrate that a single teaching session is a useful intervention.
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Poster 31: Didactic Resident Education: Results of an Internal Survey. J Oral Maxillofac Surg 2011. [DOI: 10.1016/j.joms.2011.06.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Marks A, Maizels M, Mickelson J, Yerkes E, Anthony Herndon CD, Lane J, Ben-Ami T, Maizels E, Stoltz RS, Dixon S, Liu D, Chaviano T, Hagerty J, Kaplan W. Effectiveness of the computer enhanced visual learning method in teaching the society for fetal urology hydronephrosis grading system for urology trainees. J Pediatr Urol 2011; 7:113-7. [PMID: 21094626 DOI: 10.1016/j.jpurol.2010.09.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Accepted: 09/16/2010] [Indexed: 11/18/2022]
Abstract
OBJECTIVE A novel educational tool, Computer Enhanced Visual Learning (CEVL), has been used to improve resident performance of routine orchiopexy. Our objective was to assess the effect of a CEVL teaching module on the diagnostic accuracy of medical trainees in grading neonatal hydronephrosis on ultrasound using the Society for Fetal Urology (SFU) grading system. METHODS The authors designed an online-based computerized tutorial to teach the grading of hydronephrosis using multimedia, practice cases and a grading checklist. In a crossover design trial, 29 residents and medical students were asked to grade 16 standard neonatal renal ultrasounds using the SFU grading system before and after viewing the web-based e-learning module. Primary outcome was percent improvement in grading accuracy. RESULTS The mean percentages of ultrasounds that were graded correctly before and after CEVL intervention were 51% and 72% respectively (mean improvement 21%, 95% CI 3-13%, P < 0.001). Residents graded correctly 56% of ultrasounds before and 74% after CEVL (mean 18%, 7-28%, P = 0.002). Medical students graded correctly 37% before and 69% after CEVL (mean improvement 32%, 95% CI 16-48%, P = 0.002). CONCLUSION Exposure to a computer-based learning module based on the CEVL platform improved urology residents' and medical students' correct assignment of SFU hydronephrosis grading to newborn renal ultrasounds.
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Affiliation(s)
- Andrew Marks
- Division of Urology, Children's Memorial Hospital, Chicago, IL 60614, USA.
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Learning management systems and lecture capture in the medical academic environment. Int Anesthesiol Clin 2010; 48:27-51. [PMID: 20616636 DOI: 10.1097/aia.0b013e3181e5c1d5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
As residents work disparate schedules at multiple locations and because of workweek hour limits mandated by the ACGME, residents may be unable to attend lectures, seminars, or other activities that would enhance their skills. Further, the ACGME requires that residency programs document resident learning in six stated core competencies and provide proof of completion for various other requirements. LMS/LC is a promising technology to provide a means by which residency programs may overcome these obstacles. More studies are needed to show under what conditions an LMS/LC program actually enhances learning, and which elements are most useful to the new generation of learners comfortable with Web 2.0 technologies.
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Khan SA, Khan S. Knowledge, attitudes, and practices (KAP) survey based on two pilot-tested, self-administered questionnaires administered to consenting faculty and resident participants and retrieved in a sealed, anonymized envelope. JOURNAL OF SURGICAL EDUCATION 2010; 67:297-302. [PMID: 21035769 DOI: 10.1016/j.jsurg.2010.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2010] [Revised: 06/16/2010] [Accepted: 07/08/2010] [Indexed: 05/30/2023]
Abstract
BACKGROUND Various socioeconomic changes are driving a review of surgical resident training. Concern exists that these demands are not well perceived by surgical faculty thereby leading to a hiatus between how surgical residents are educated and what is expected of them as independent clinicians. It is necessary to quantify resident and faculty awareness of these issues and to find areas of improvement for making resident education more relevant to this changing socioeconomic setup. OBJECTIVES 1. To gauge awareness among surgical faculty and residents in regard to trends and concepts in postgraduate surgical education. 2. To compare how the attitudes and practices differ among the faculty and residents vis-à-vis resident education. SETTING Aga Khan University Hospital, Karachi, a tertiary care, private teaching hospital in Pakistan. RESULTS With a retrieval rate of 70% for the faculty and 90% for the residents, the survey revealed interesting differences in perceptions between the 2 groups. Knowledge among respondents is very good for certain aspects of adult education, whereas other areas leave room for improvement. Faculty and residents have opposing views on resident work-hour reduction. Faculty overestimate their roles as enablers. Good knowledge about motivations for adult learning is not translated into positive attitudes and humiliation remains prevalent as does indifference toward imbibing advances into resident education. Residents generally were dissatisfied about their operative experience. CONCLUSIONS A gap persists in knowledge about motivations for resident learning and practices. Implementation of a skills-laboratory curriculum, objective-oriented rotations, and interdisciplinary initiatives for imbibing advances are potential avenues for improvement.
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Affiliation(s)
- Shahzad A Khan
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
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Abstract
OBJECTIVE There is a correlation between American Board of Pediatrics In-Training and General Pediatrics Certifying Examination scores. A course targeted mainly for residents "at-risk" based on in-training scores may improve the outcome of the certification exam. The objective of the study was to evaluate the impact of a board review course on pediatric board certification scores, particularly for residents at-risk. METHODS Residents "at-risk" taking the course (Yes) were compared to residents not taking the course who were not at-risk (No) as well as to a cohort of residents predating the onset of the course with mixed risk (Comparison). Analyses compared board exam scores and passing rates in the three groups and in the subcategory of residents who scored </=300 on the in-training exam in each group. RESULTS Standard scores and pass rates were higher for the residents not at risk, middle for residents of mixed risk and lowest for residents at risk. When analyzing the subset of scores for those with in-training score of <300, the scores were higher for the residents in the course than those who never took it. Also, residents with in-training score of <300 achieved higher average point score gains when comparing the certification exam to their last in-training score. Linear regression analysis showed that not delaying board certification, third year in-training scores and taking the board review course were significantly associated with higher board certification scores. CONCLUSIONS Pediatric residents at risk for not passing their Pediatric board certification exams benefited from a board review course.
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Affiliation(s)
- Lita Aeder
- Department of Pediatrics, Maimonides Infants and Children's Hospital of Brooklyn, Brooklyn, NY 11219, USA,
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Lube MW, Borman KR, Fulbright AE, Friedell ML. Retrospective evaluation of residents' American Board of Surgery In-Service Training Examination (ABSITE) scores as a tool to evaluate changes made in a basic science curriculum. JOURNAL OF SURGICAL EDUCATION 2010; 67:167-172. [PMID: 20630428 DOI: 10.1016/j.jsurg.2010.02.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 01/27/2010] [Accepted: 02/24/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of a new basic science curriculum at a university-affiliated general surgery residency program. DESIGN A retrospective evaluation of general surgery residents' American Board of Surgery (ABS) In-Training Examination (ABSITE) scores before and after the implementation of a new basic science curriculum. SETTING Not-for-profit tertiary referral center with a university-affiliated Accreditation Council for Graduate Medical Education (ACGME) accredited community general surgery residency program. PARTICIPANTS Postgraduate year (PGY) 1 through 5 general surgical residents. RESULTS The total questions answered correctly (percent correct) in the main 3 categories improved after implementation of the new curriculum for PGY 1 (total test: 70 +/- 7 vs 60 +/- 9, p < 0.05; clinical science: 71 +/- 10 vs 59 +/- 9, p < 0.05; and basic science: 69 +/- 7 vs 60 +/- 10, p = 0.0003) and for PGY 2 residents (total test: 74 +/- 5 vs 66 +/- 7, p < 0.05; clinical science: 74 +/- 7 vs 66 +/- 8, p = 0.003; and basic science: 74 +/- 5 vs 66 +/- 8, p < 0.05). With the exception of the percentage of clinical questions answered correctly for the PGY 4 level, there was no statistically significant worsening of scores in any other subcategories for any other PGY levels (3 through 5) after implementation of the new program. Before the institution of the new curriculum, 24% (26/110) of residents scored below the 35th percentile, and after the institution of the new curriculum, this number decreased to 12% (12/98), p = 0.006. The first-time passage rate on the ABS Qualifying Examination was unchanged in the period before and after the implementation of the new curriculum (89% vs 86%; p = 0.08). When comparing the bimonthly quizzes with the ABSITE, the correlation coefficient was 0.34. CONCLUSION After the implementation of a new basic science curriculum organized and directed by the faculty, there were statistically significant improvements of PGY 1 and 2 residents' ABSITE scores.
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Fields RC, Bowman MC, Freeman BD, Klingensmith ME. Implementation of an "after hours" resident educational program in a general surgery residency: a paradigm for increasing formal didactic training outside of the hospital setting in the era of the 80-hour workweek. JOURNAL OF SURGICAL EDUCATION 2009; 66:340-343. [PMID: 20142132 DOI: 10.1016/j.jsurg.2009.09.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2009] [Revised: 09/15/2009] [Accepted: 09/16/2009] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Residency programs have been forced to curtail many educational activities to comply with duty-hour restrictions. We describe an "after hours" educational program as a forum to provide small-group education customized for each training level to compliment our formal curriculum. METHODS Sessions within each general surgery specialty were organized such that 1 session each month was open to either junior (R1 and R2) or senior (R3-R5) trainees and hosted by surgical faculty. Attendance was optional and limited to 15 residents per session with the format determined by the hosting faculty. Participants completed a postsession survey. RESULTS Fourteen sessions were held during the 2008-2009 academic year. All sessions were >90% subscribed within 1 week of announcement and attendance was 88%. The average session duration was 2.6 +/- 0.4 hours. Junior resident sessions focused on preparing R1 and R2 residents to handle common consult questions; senior resident sessions were modeled as "mock oral boards." Resident and faculty responses to the postsession questionnaire were similar and favorable with respect to the educational value of this format. CONCLUSIONS There is enthusiasm among faculty and trainees to provide small-group, level-specific educational programs outside of the hospital setting and the 80-hour workweek. Such a program is easily implemented, highly effective, and well received. This format has the added benefit of improving interaction between faculty and residents and increasing the camaraderie of a surgical training program.
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Affiliation(s)
- Ryan C Fields
- Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, Saint Louis, Missouri 63110-8109, USA
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McColl RJ, Karmali S, Reso A, Paolucci E, Sherman V. The effect of a focused instructional session on knowledge of surgical staplers in general surgery residents. JOURNAL OF SURGICAL EDUCATION 2009; 66:288-291. [PMID: 20005503 DOI: 10.1016/j.jsurg.2009.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Revised: 08/18/2009] [Accepted: 08/28/2009] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Surgical stapling devices have been used for a variety of purposes in both laparoscopic and open surgery. Nevertheless, trainees rarely receive any focused instruction on their application and use. This study attempts to determine the baseline knowledge of surgical stapling devices possessed by surgical residents. Furthermore, we attempt to evaluate the effectiveness of a short didactic session in improving the trainee's knowledge of the use and function of surgical staplers. METHODS A 20-question multiple-choice test was created to evaluate a general surgery resident's knowledge on the design and use of circular, linear, and laparoscopic surgical staplers. The test was administered before and after attending a 40-minute instructional session on surgical stapling devices. The tests were then scored by a data analyst. RESULTS A total of 26 residents of 39 in the residency program (26/39, 67%) participated. The pretest mean was 10.62/20 (53%), whereas the posttest mean was 15.38/20 (77%). These results were significantly different on paired samples t-test analysis (t((25)) = -10.3; p < 0.05). The mean pretest scores were also significantly different between resident levels (R1-R2, 9.50; R3-R5, 11.31; t((24)) = -2.10; p < 0.05). Senior-level residents scored higher on posttest analysis, but this result was not significant (R1-R2, 14.70; R3-R5, 15.81; t((24)) = -1.63; p > 0.05). DISCUSSION There is a deficiency of knowledge of surgical staplers in general surgery residents, more so in junior residents. Didactic instruction is effective in raising the level of knowledge of surgical staplers in all residents, up to a similar level. Surgical educators should consider implementing programs like these for staplers and other types of surgical equipment.
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Affiliation(s)
- Ryan J McColl
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
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Rathat G, Hoa D, Gagnayre R, Hoffet M, Mares P. Formation chirurgicale des internes, spécialistes en gynécologie-obstétrique : résultats d’une enquête électronique nationale. ACTA ACUST UNITED AC 2008; 37:672-84. [DOI: 10.1016/j.jgyn.2008.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2007] [Revised: 06/02/2008] [Accepted: 06/16/2008] [Indexed: 11/24/2022]
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Practice patterns and career satisfaction of Canadian female general surgeons. Am J Surg 2008; 197:721-7. [PMID: 18926517 DOI: 10.1016/j.amjsurg.2008.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Revised: 02/25/2008] [Accepted: 03/21/2008] [Indexed: 11/23/2022]
Abstract
BACKGROUND We wanted to study how female general surgeons in Canada manage lifestyle and career demands. METHODS All female Canadian general surgeons registered with the Royal College of Physicians and Surgeons of Canada were asked to complete a survey evaluating their practice patterns, personal lives, and levels of satisfaction related to these factors. RESULTS Eighty-five surveys (66%) were returned. Most respondents work in full-time clinical practices. While it was rare to find women in part-time or shared practices, 35% of women reported interest in these alternative models. Respondents described the necessary factors for a transition into alternative models. Job satisfaction was high (3.8 out of 5), with personal and parenting satisfaction being less highly rated (3.3 and 3.2, respectively). CONCLUSIONS Canadian female general surgeons have active and satisfying careers, although many would like to work in alternative practice models that better conform to their lifestyle demands. This pressure will have a significant impact on the future surgical workforce.
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Kosir MA, Fuller L, Tyburski J, Berant L, Yu M. The Kolb learning cycle in American Board of Surgery In-Training Exam remediation: the Accelerated Clinical Education in Surgery course. Am J Surg 2008; 196:657-62. [PMID: 18789412 DOI: 10.1016/j.amjsurg.2008.07.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Revised: 07/16/2008] [Accepted: 07/16/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND Surgical training integrates the 4 steps of the Kolb learning cycle. Residents who scored at 30th percentile or less on the American Board of Surgery In-Training Exam (ABSITE) were enrolled in the Accelerated Clinical Education in Surgery (ACES) course that incorporated the Kolb cycle. METHODS For concrete experience, Surgical Education and Self-Assessment Program (SESAP-13) was completed according to the syllabus. For reflective consideration, further reading was done on SESAP 13 topics and corresponding ABSITE Keywords. For the abstract hypotheses step; these keywords and topics were reviewed with the mentor. Active testing involved a required weekly on-line quiz based on the syllabus. RESULTS Correct scores on the ABSITE increased for 78.6% of residents in the ACES course, with 28.6% scoring 30th percentile or greater. Senior percent correct scores increased by 7.3% and junior percentile scores by 12.5%. CONCLUSIONS Remediation using the Kolb cycle improved ABSITE performance for a majority of participants.
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Affiliation(s)
- Mary Ann Kosir
- Surgical Service, John D. Dingell Veterans Affairs Medical Center, Detroit, MI, USA.
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Lee L, Brunicardi FC, Scott BG, Berger DH, Bush RL, Awad SS, Brandt ML. Impact of a Novel Education Curriculum on Surgical Training Within an Academic Training Program. J Surg Res 2008; 145:308-12. [DOI: 10.1016/j.jss.2007.03.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2007] [Revised: 02/20/2007] [Accepted: 03/12/2007] [Indexed: 10/22/2022]
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Farrohki ET, Jensen AR, Brock DM, Cole JK, Mann GN, Pellegrini CA, Horvath KD. Expanding resident conferences while tailoring them to level of training: a longitudinal study. JOURNAL OF SURGICAL EDUCATION 2008; 65:84-90. [PMID: 18439525 DOI: 10.1016/j.jsurg.2008.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2007] [Revised: 01/05/2008] [Accepted: 02/14/2008] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To evaluate the effect of changing a 1-hour weekly all-resident didactic conference to an expanded 4-hour bimonthly level-specific didactic conference. DESIGN Prospective outcome measures included an anonymous 10-item perceptions survey administered at 4 time points (preintervention, 6 months postintervention, 1 year postintervention, and 2 years postintervention), mean attendance rates preintervention and postintervention, and mean ABSITE scores preintervention and postintervention. SETTING Large university-based surgical residency. PARTICIPANTS Surgical residents (R1-R5, n = 75) were divided into junior (R1-R3, n = 56) and senior (R4-R5, n = 19) groups. Each group attended a session every other Wednesday. RESULTS Significant improvements were observed in overall resident satisfaction (55% vs 80%, p < 0.005) and level-specific appropriateness of content (81% vs 94%, p < 0.001). Furthermore, resident attendance rates were improved substantially (33% vs 55%, p < 0.001). ABSITE scores were not affected significantly by the change in curriculum structure. CONCLUSIONS An expanded, bimonthly level-specific didactic curriculum is more effective than a shorter, weekly all-resident conference as evidenced by resident attitudes and attendance. Additional benefits of the alternating schedule include a reduced number of residents in each conference and the availability of residents for clinical educational activities (eg, operative cases or clinic). Expanded educational time has allowed the introduction of nontraditional topics that include leadership, communication, practice management, professionalism, and technical skills training.
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Affiliation(s)
- Ellen T Farrohki
- Department of Surgery, University of Washington School of Medicine, Seattle, WA 98195-6419, USA
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Termuhlen PM, Izu B. What will we do for basic science conference this year? Organs in depth. JOURNAL OF SURGICAL EDUCATION 2008; 65:137-139. [PMID: 18439538 DOI: 10.1016/j.jsurg.2007.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Revised: 12/10/2007] [Accepted: 12/11/2007] [Indexed: 05/26/2023]
Affiliation(s)
- Paula M Termuhlen
- Department of Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH 45409, USA.
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Franzese CB, Stringer SP. The Evolution of Surgical Training: Perspectives on Educational Models from the Past to the Future. Otolaryngol Clin North Am 2007; 40:1227-35, vii. [DOI: 10.1016/j.otc.2007.07.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Schulman CI, Levi J, Sleeman D, Dunkin B, Irvin G, Levi D, Spector S, Franceschi D, Livingstone A. Are we training our residents to perform open gall bladder and common bile duct operations? J Surg Res 2007; 142:246-9. [PMID: 17631907 DOI: 10.1016/j.jss.2007.03.073] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2007] [Revised: 03/14/2007] [Accepted: 03/26/2007] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In the new era of resident work hour restrictions and an emphasis on minimally invasive surgery, experience in performing open biliary surgery is diminishing. We sought to review our resident operative experience to determine if it appears adequate for a well-trained general surgeon. METHODS The case logs of the General Surgery, Oncology, and Trauma/Emergency General Surgery (EGS) services were reviewed for a 1-year period. All biliary procedures that included the potential for gallbladder or bile duct surgery were reviewed. RESULTS We performed 745 laparoscopic cholecystectomies last year on our General Surgery, Oncology, and Trauma/EGS services. Conversion to open procedure was 4.5% (16/364) on our elective services and 6% (23/381) on our Trauma/EGS services. Effective clearance of common bile duct stones performed retrograde by endoscopy and transhepatically by interventional radiology limited our residents' experience performing common bile duct surgery for stones to 13 performed laparoscopically and 10 performed open. Other operations that included open cholecystectomies and common bile duct procedures were pancreatico-duodenectomy (87), biliary bypass (22), biliary resection/reconstruction (20), hepatic lobectomy (48), sphincteroplasty and ampullectomy (6). CONCLUSIONS The small number of conversions from laparoscopic to open cholecystectomies and the few common bile duct explorations performed for stone disease would be inadequate to train our six categorical surgical residents to perform open cholecystectomies and common bile duct procedures without a training program that augments this by providing a strong hepato-biliary-pancreatic experience. Programs without a strong hepato-biliary-pancreatic program should review their residents' operative experience.
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Affiliation(s)
- Carl I Schulman
- DeWitt Daughtry Family Department of Surgery, University of Miami-Miller School of Medicine, Miami, Florida 33101, USA.
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