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Keuning MC, Lambert B, Nieboer P, Huiskes M, Diemers AD. Perceptions and Guiding Strategies to Regulate Entrusted Autonomy of Residents in the Operating Room: A Systematic Literature Review. JOURNAL OF SURGICAL EDUCATION 2024; 81:93-105. [PMID: 37838573 DOI: 10.1016/j.jsurg.2023.09.008] [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: 09/17/2022] [Revised: 12/24/2022] [Accepted: 09/11/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVE To provide a systematic literature review of intraoperative entrusted autonomy for surgical residents. Specifically, perceptions from residents and supervising surgeons, supervising behavior and influencing factors on intraoperative teaching and learning are analyzed. BACKGROUND Increasing demands on surgical training and the need for effective development of technical skills, amplify the importance of making the most of intraoperative teaching and learning opportunities in the operating room. It is critical for residents to gain the greatest benefit from every surgical case and to achieve operative competence. METHODS A systematic literature search identified 921 articles from 2000 to 2022 that addressed surgical education/training, intraoperative supervision/teaching, autonomy and entrustment. 40 studies with heterogeneous designs and methodologies were included. RESULTS Four themes were established in the analysis: patient safety, learner, learning environment and supervising surgeon. The patient is identified as the primary responsibility during intraoperative teaching and learning. Supervisors continuously guard patient safety as well as the resident's learning process. Ideal intraoperative learning occurs when the resident has optimal entrusted autonomy during the procedure matching with the current surgical skills level. A safe learning environment with dedicated time for learning are prerequisites for both supervising surgeons and residents. Supervising surgeons' own preferences and confidence levels also play an important role. CONCLUSIONS This systematic literature review identifies patient safety as the overriding principle for supervising surgeons when regulating residents' entrusted autonomy. When the supervisor's responsibility toward the patient has been met, there is room for intraoperative teaching and learning. In this process the learner, the learning environment and the supervising surgeon's own preferences all intertwine, creating a triangular responsibility. This review outlines the challenge of establishing an equilibrium in this triangle and the broad arsenal of strategies supervising surgeons use to keep it in balance.
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Affiliation(s)
- Martine C Keuning
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, The Netherlands.
| | - Bart Lambert
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Patrick Nieboer
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Mike Huiskes
- Center for Language and Cognition Groningen, University of Groningen, Groningen, The Netherlands
| | - Agnes D Diemers
- Lifelong Learning, Education and Assessment Research Network (LEARN), University Medical Center Groningen, Groningen, The Netherlands
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Zanini A, von Sochaczewski CO, Basson S, Brisighelli G, Di Cesare A, Gabler T, Gentilino V, Gopal M, Grieve A, Harrison D, Patel N, Westgarth-Taylor C, Withers A, Loveland JA. Globalization in Pediatric Surgical Training: The Benefit of an International Fellowship in a Low-to-Middle-Income Country Academic Hospital. Eur J Pediatr Surg 2022; 32:363-369. [PMID: 34407553 DOI: 10.1055/s-0041-1734029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE A relative oversupply of pediatric surgeons led to increasing difficulties in surgical training in high-income countries (HIC), popularizing international fellowships in low-to-middle-income countries (LMIC). The aim of this study was to evaluate the benefit of an international fellowship in an LMIC for the training of pediatric surgery trainees from HICs. METHODS We retrospectively reviewed and compared the prospectively maintained surgical logbooks of international pediatric surgical trainees who completed a fellowship at Chris Hani Baragwanath Academic Hospital in the last 10 years. We analyzed the number of surgeries, type of involvement, and level of supervision in the operations. Data are provided in mean differences between South Africa and the respective home country. RESULTS Seven fellows were included. Operative experience was higher in South Africa in general (Δx̅ = 381; 95% confidence interval [CI]: 236-656; p < 0.0001) and index cases (Δx̅ = 178; 95% CI: 109-279; p < 0.0001). In South Africa, fellows performed more index cases unsupervised (Δx̅ = 71; 95% CI: 42-111; p < 0.0001), but a similar number under supervision (Δx̅ = -1; 95% CI: -25-24; p = 0.901). Fellows were exposed to more surgical procedures in each pediatric surgical subspecialty. CONCLUSION An international fellowship in a high-volume subspecialized unit in an LMIC can be highly beneficial for HIC trainees, allowing exposure to higher caseload, opportunity to operate independently, and to receive a wider exposure to the different fields of pediatric surgery. The associated benefit for the local trainees is some reduction in their clinical responsibilities due to the additional workforce, providing them with the opportunity for protected academic and research time.
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Affiliation(s)
- Andrea Zanini
- Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Christina Oetzmann von Sochaczewski
- Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.,Clinic and Policlinic for Paediatric Surgery, University of Mainz, Mainz, Germany
| | - Sonia Basson
- Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Giulia Brisighelli
- Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Antonio Di Cesare
- Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.,Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Policlinico Milano, Italy
| | - Tarryn Gabler
- Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Valerio Gentilino
- Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.,Unit of Pediatric Surgery, Woman and Child Department, Filippo del Ponte Hospital - ASST Sette Laghi, Varese, Italy
| | - Milan Gopal
- Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.,Department of Pediatric Surgery, Great North Children's Hospital, Newcastle upon Tyne, United Kingdom
| | - Andrew Grieve
- Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Derek Harrison
- Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Nirav Patel
- Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Chris Westgarth-Taylor
- Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Aletha Withers
- Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Jerome A Loveland
- Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
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Sutkin G, Littleton EB, Arnold L, Kanter SL. Optimizing surgical teaching through the lens of sociocultural learning theory. Am J Surg 2022; 224:379-383. [DOI: 10.1016/j.amjsurg.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 02/01/2022] [Accepted: 03/01/2022] [Indexed: 11/01/2022]
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Zhao NW, Haddock LM, O'Brien BC. Are You Thinking What I'm Thinking? Exploring Response Process Validity Evidence for a Workplace-based Assessment for Operative Feedback. JOURNAL OF SURGICAL EDUCATION 2022; 79:475-484. [PMID: 34666934 DOI: 10.1016/j.jsurg.2021.09.007] [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: 08/02/2021] [Accepted: 09/11/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Workplace-based assessments (WBAs) are used in multiple surgical specialties to facilitate feedback to residents as a form of formative assessment. The validity evidence to support this purpose is limited and has yet to include investigations of how users interpret the assessment and make rating decisions (response processes). This study aimed to explore the validity evidence based on response processes for a WBA in surgery. DESIGN Semi-structured interviews explored the reasonings and strategies used when answering questions in a surgical WBA, the System for Improving and Measuring Procedural Learning (SIMPL). Interview questions probed the interpretation of the three assessment questions and their respective answer categories (level of autonomy, operative performance, case complexity). Researchers analyzed transcripts using directed qualitative content analysis to generate themes. SETTING Single tertiary academic medical center. PARTICIPANTS Eight residents and 13 faculty within the Department of Otolaryngology-Head and Neck Surgery participating in a 6-month pilot of SIMPL. RESULTS We identified four overarching themes that that characterized faculty and resident response processes while completing SIMPL: (1) Faculty and resident users had similar content-level interpretations of the questions and corresponding answer choices; (2) Users employed a variety of cognitive, behavioral, and emotional processes to make rating decisions; (3) Contextual factors influenced ratings; and (4) Tensions during interpretation contributed to rating uncertainty. CONCLUSIONS Response processes are a key source of evidence to support the validity for the formative use of WBAs. Evaluating response process evidence should go beyond basic content-level analysis as contextual factors and tensions that arise during interpretation also play a large role in rating decisions. Additional work and a continued critical lens are needed to ensure that WBAs can truly meet the needs for formative assessment.
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Affiliation(s)
- Nina W Zhao
- Department of Otolaryngology-Head and Neck Surgery, University of California - San Francisco, San Francisco, California; Department of Otolaryngology-Head and Neck Surgery, University of California - Davis, Sacramento, California.
| | - Lindsey M Haddock
- Department of Medicine, University of California - San Francisco, San Francisco, California
| | - Bridget C O'Brien
- Department of Medicine, University of California - San Francisco, San Francisco, California
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Abstract
Within general surgery education circles, the state of autonomy for residents in surgery training programs has been of growing concern. Although there is no direct evidence showing less autonomy in modern surgical training, multiple surrogates have been cited as reasons for concern. Many reasons have been given for lost autonomy including the 80-hour work week, financial constraints, concerns over quality of patient care, patient expectations, new and innovative technologies, legal limitations, and public opinion. This article discusses the current state of general surgery resident autonomy, why autonomy is important, barriers to autonomy, and ways to support autonomy.
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Nieboer P, Huiskes M, Cnossen F, Stevens M, Bulstra SK, Jaarsma DADC. Fingerprints of Teaching Interactions: Capturing and Quantifying How Supervisor Regulate Autonomy of Residents in the Operating Room. JOURNAL OF SURGICAL EDUCATION 2021; 78:1197-1208. [PMID: 33358759 DOI: 10.1016/j.jsurg.2020.12.010] [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: 11/10/2020] [Accepted: 12/13/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Supervisors and residents agree that entrusted autonomy is central to learning in the Operating Room (OR), but supervisors and residents hold different opinions about entrustment: residents regularly experience that they receive insufficient autonomy while supervisors feel their guiding is not appreciated as teaching. These opinions are commonly grounded on general experiences and perceptions, instead of real-time supervisors' regulatory behaviors as procedures unfold. To close that gap, we captured and analyzed when and to what level supervisors award or restrain autonomy during procedures. Furthermore, we constructed fingerprints, an instrument to visualize entrustment of autonomy by supervisors in the OR that allows us to reflect on regulation of autonomy and discuss teaching interactions. DESIGN All interactions between supervisors and residents were captured by video and transcribed. Subsequently a multistage analysis was performed: (1) the procedure was broken down into 10 steps, (2) for each step, type and frequency of strategies by supervisors to regulate autonomy were scored, (3) the scores for each step were plotted into fingerprints, and (4) fingerprints were analyzed and compared. SETTING University Medical Centre Groningen (the Netherlands). PARTICIPANTS Six different supervisor-resident dyads. RESULTS No fingerprint was alike: timing, frequency, and type of strategy that supervisors used to regulate autonomy varied within and between procedures. Comparing fingerprints revealed that supervisors B and D displayed more overall control over their program-year 5 residents than supervisors C and E over their program-year 4 residents. Furthermore, each supervisor restrained autonomy during steps 4 to 6 but with different intensities. CONCLUSIONS Fingerprints show a high definition view on the unique dynamics of real-time autonomy regulation in the OR. One fingerprint functions as a snapshot and serves a purpose in one-off teaching and learning. Multiple snapshots of one resident quantify autonomy development over time, while multiple snapshots of supervisors may capture best teaching practices to feed train-the-trainer programs.
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Affiliation(s)
- Patrick Nieboer
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, the Netherlands.
| | - Mike Huiskes
- Center for Language and Cognition, University of Groningen, Groningen, the Netherlands
| | - Fokie Cnossen
- Department of Artificial Intelligence, Bernouilli Institute of Mathematics, Computer Science and Artificial Intelligence, University of Groningen, Groningen, the Netherlands
| | - Martin Stevens
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Sjoerd K Bulstra
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Debbie A D C Jaarsma
- Center for Research & Innovation in Medical Education, University Medical Center Groningen, Groningen, the Netherlands
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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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Cassidy DJ, McKinley SK, Ogunmuyiwa J, Mullen JT, Phitayakorn R, Petrusa E, Kim MJ. Surgical autonomy: A resident perspective and the balance of teacher development with operative independence. Am J Surg 2021; 221:336-344. [DOI: 10.1016/j.amjsurg.2020.10.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/05/2020] [Accepted: 10/18/2020] [Indexed: 10/23/2022]
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Smith BQ, Woelfel I, Salani R, Harzman A, Chen X. Resident Self-Entrustment and Expectations of Autonomy: OB > GYN? JOURNAL OF SURGICAL EDUCATION 2021; 78:275-281. [PMID: 32753260 DOI: 10.1016/j.jsurg.2020.07.019] [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: 03/27/2020] [Revised: 06/17/2020] [Accepted: 07/14/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Entrustment is a key component connecting to resident preparedness for surgical practice in the operating room (OR). Residents' self-entrustment of their surgical competencies closely associates with their OR training experience and granted autonomy. Some recent studies have investigated how attending surgeons entrusted residents in the OR. There is little to no data, however, in examining these issues from the resident perspective. The goal of this study was to identify the perception and expectations of autonomy from residents' perspective, as well as the self-entrustment of their surgical competencies in obstetrics (OB) and gynecologic (GYN) procedures. METHODS Focus group interviews of OB/GYN residents were performed. Residents were selected by convenience sampling. Audio recordings of each interview were transcribed, iteratively analyzed, and emergent themes identified, using a framework method. RESULTS A total of 123 minutes of interviews were recorded. Eight junior residents (PGY1-2) and 12 senior residents (PGY3-4) participated. Our data illustrated that (1) the perception of autonomy shifted significantly throughout residency training; (2) residents demonstrated higher expectations and self-entrustment for OB surgical procedures than for GYN surgical procedures upon graduation; and (3) case volume, modalities of OR teaching and mutual communication are 3 factors influencing resident self-entrustment of their surgical competencies. CONCLUSIONS Residents showed disparities in their self-entrustment and expectations of autonomy between OB and GYN surgical procedures. Better understanding these differences and the 3 influencing factors could help programs develop a potential solution for improvement in resident entrustment and autonomy upon graduation.
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Affiliation(s)
- Brentley Q Smith
- Division of Gynecologic Oncology, The Ohio State University The James Comprehensive Cancer Center, Columbus, Ohio.
| | - Ingrid Woelfel
- Department of General Surgery, The Ohio State University Wexner Medical Center, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ritu Salani
- Division of Gynecologic Oncology, The Ohio State University The James Comprehensive Cancer Center, Columbus, Ohio
| | - Alan Harzman
- Department of General Surgery, The Ohio State University Wexner Medical Center, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Xiaodong Chen
- Department of General Surgery, The Ohio State University Wexner Medical Center, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Perceptions of Preparedness in Plastic Surgery Residency Training. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3163. [PMID: 33173679 PMCID: PMC7647638 DOI: 10.1097/gox.0000000000003163] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/10/2020] [Indexed: 12/26/2022]
Abstract
Supplemental Digital Content is available in the text. Graduating competent surgical residents requires progressive independence during training. Recent studies in other surgical subspecialties have demonstrated overall fewer opportunities for resident independence due to changes in residency regulations, medical–legal concerns, and financial incentives. A survey study was conducted to assess perceived autonomy and preparedness during plastic surgery residency training and to assess factors affecting autonomy.
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Senociain Gonzalez JE, Dominguez Torres LC. Transferencia de autonomía operatoria en apendicectomía abierta y laparoscópica: Un estudio de métodos mixtos desde la perspectiva de residentes y supervisores. REVISTA COLOMBIANA DE CIRUGÍA 2020. [DOI: 10.30944/20117582.551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. Existe información limitada sobre el desarrollo apropiado de curvas quirúrgicas de aprendizaje, con altos niveles de autonomía, en residentes de cirugía general en Colombia. El objetivo de este estudio fue caracterizar los niveles de autonomía, para la realización de apendicectomía laparoscópica o abierta en un programa de especialización, desde la perspectiva de médicos residentes y supervisores.
Métodos. Estudio de métodos mixtos que se realizó en dos fases. La primera fase incluyó la recolección prospectiva de la información de cada procedimiento (apendicectomía abierta o laparoscópica), realizado entre agosto de 2015 y diciembre de 2018, en la que participaron 29 médicos residentes. Cada residente evaluó su función (cirujano, ayudante), el nivel de supervisión y el nivel de autonomía intraoperatoria mediante la Escala de Zwisch (EZ). En la segunda fase (cualitativa), se realizaron entrevistas a un total de 15 cirujanos generales que supervisaron la práctica de los residentes con preguntas que buscaban explicar los hallazgos cuantitativos.
Resultados. Se analizaron 1732 intervenciones: 629 (36 %) se realizaron por vía abierta y 1103 (63 %) por vía laparoscópica. El 81,4 % (n=1411) de los procedimientos fueron realizados en hospitales privados. La percepción global de autonomía reportada por los residentes de acuerdo con la Escala de Zwisch tuvo nivel A 28,9 % (n=500), nivel B 18,1 % (n=313), nivel C 30,4 % (n=526) y nivel D 22,7 % (n=393). El 35,2 % (n=388) de apendicectomías laparoscópicas y el 17,8% (n=112) por vía abierta fueron realizadas con un nivel A, mientras el 19,5 % (n=215) de apendicectomías laparoscópicas y el 28,2 % (n=178) por vía abierta fueron realizadas con un nivel D. La explicación dada de los hallazgos cuantitativos fue la frecuencia de apendicectomías abiertas en hospitales públicos, aspectos relacionados con la transferencia de autonomía hacia el residente y el aumento progresivo en el nivel de autonomía avanzada entre 2015-2018.
Discusión. Se encontró un mayor nivel de autonomía en la realización de apendicectomía por vía abierta comparada con la vía laparoscópica, y los niveles de autonomía fueron mayores en hospitales públicos. La explicación a estos hallazgos estuvo relacionada con el contexto clínico y profesional de los residentes.
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Woelfel I, Smith BQ, Strosberg D, Villarreal M, Harzman A, Salani R, Cochran A, Chen X(P. Residents’ method for gaining operative autonomy. Am J Surg 2020; 220:893-898. [DOI: 10.1016/j.amjsurg.2020.03.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/10/2020] [Accepted: 03/19/2020] [Indexed: 11/24/2022]
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An Observation of a Resident-as-Teacher Combined with Tutor Guided Hysteroscopy Teaching Program for Standardized Residency Training (SRT) in Obstetrics and Gynecology. JOURNAL OF HEALTHCARE ENGINEERING 2020; 2020:8855099. [PMID: 32802301 PMCID: PMC7414364 DOI: 10.1155/2020/8855099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 07/02/2020] [Accepted: 07/07/2020] [Indexed: 12/02/2022]
Abstract
Objectives The standardized residency training (SRT) program in China is an important link for continuing education and clinical work training for graduate students. The purpose of our study was to enable educators to maintain the effectiveness of hysteroscopy teaching techniques and make the standardized residency training students well experienced in surgery, thus demonstrating that higher efficiency of teaching can lead to better proficiency for surgery. Methods We generated resident-as-teacher teaching round and tutor guided hysteroscopic surgery as well as a questionnaire based on the mastery degree of the basic theoretical knowledge and operational skills of hysteroscopy among seven junior residents and five senior residents of the Obstetrics and Gynecology Department, including four attending gynecologic surgeons of a hysteroscopy teaching program. Results Senior residents felt confident to teach, while junior residents learned effectively through the teaching round. There were statistically significant differences in the whole operation time and the volume of distension fluid used between junior and senior residents (p < 0.05). Conclusions This study acknowledges the need for new approaches to medical education for better characterization of the link between the use of teaching rounds through problem-based learning (PBL) discussion dominated by the residents themselves and overall surgical skills of teaching and learning.
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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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Shebrain S, Mahmood G, Munene G, Miller L, Collins J, Sawyer R. The Role of Manual Dexterity and Cognitive Functioning in Enhancing Resident Operative Autonomy. JOURNAL OF SURGICAL EDUCATION 2019; 76:e66-e76. [PMID: 31221607 DOI: 10.1016/j.jsurg.2019.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/26/2019] [Accepted: 06/02/2019] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Autonomy, both operative and nonoperative, is one of the most critical aspects of successful surgical training. Both surgeon and resident share the responsibility of achieving this goal. We hypothesize that operative autonomy is distinct and depends, for the most part, on the resident's manual dexterity, knowledge of, and preparation for the procedure. METHODS Over a period of 4 academic years, between July 2014 and June 2018, a total of 958 Global Rating Scale of Operative Performance evaluations were completed by 32 general and subspecialty faculty surgeons for 35 residents. Elective procedures were evaluated, including 165 (17.2%) by postgraduate year (PGY)1 residents, 253 (26.4%) by PGY2, 199 (20.8%) by PGY3, 147 (15.3%) by PGY4, and 194 (20.3%) by PGY5. The procedures evaluated were: 261 (27.2%) hernia repairs; 178 (18.6%) cholecystectomies; 102 (10.6%) colorectal and anal procedures; 73 (7.6%) vascular procedures; 56 (5.8%) thyroid and parathyroidectomies; 39 (4.1%) foregut (esophagus and stomach) procedures; 38 (4%) skin, soft tissue, and breast; 92 (10%) hepatopancreatic; 20 (2.1%) pediatric procedures; and 99 (10.3%) other procedures including amputations, cardiothoracic, and solid organs procedures. Each resident was scored from 1 to 5 (1 lowest, 5 highest) in each of the following categories of Global Rating Scale of Operative Performance: respect for tissue (RT), time and motion (T&M), instrument handling (IH), knowledge of the instrument (KI), flow of operation (FO) and resident's preparation for the procedure (RP). Resident operative autonomy (ROA) was assessed using the Zwisch scale, a 4-point scale describing faculty supervision behaviors associated with different degrees of resident autonomy (1: Show and Tell, 2: Active Help, 3: Passive Help, and 4: Supervision Only). RESULTS Correlation and ordinal regression analyses were conducted to examine the relationship between ROA and manual dexterity (RT, T&M, IH, and FO), and cognitive functioning (knowledge of instruments and resident preparation). Results indicated a positive correlation between ROA and RT (r = 0.528, p < 0.001), T&M (r = 0.630, p < 0.001), IH (r = 0.597, p < 0.001), KI (r = 0.490, p < 0.001), FO (r = 0.637, p < 0.001), and RP (r = 0.525, p < 0.001). Additionally, there was a weak inverse correlation between ROA and the number of years the surgeon had been in practice (r = -0.127, p = 0.001). The significant predictors of resident autonomy found by the ordinal logistic regression include time and motion (p < 0.001), flow of operation (p < 0.001), and resident's preparation for the procedure (p < 0.001). CONCLUSIONS Resident operative autonomy is a product of shared responsibility between the faculty and resident. However, residents' inherent and/or acquired skills and preparation for the operative procedures play a critical role. Residents should be advised to use available resources such as simulation to augment their skills preoperatively and to enhance their autonomy in the operating room.
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Affiliation(s)
- Saad Shebrain
- Department of Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan.
| | - Gulrez Mahmood
- Department of Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan
| | - Gitonga Munene
- Department of Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan
| | - Lisa Miller
- Department of Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan
| | - John Collins
- Department of Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan
| | - Robert Sawyer
- Department of Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan
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Meredyth NA, de Melo-Martin I. (Under)Valuing Surgical Informed Consent. J Am Coll Surg 2019; 230:257-262. [PMID: 31622768 DOI: 10.1016/j.jamcollsurg.2019.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/03/2019] [Accepted: 10/03/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Nicole A Meredyth
- Department of Medicine, Division of Medical Ethics, Weill-Cornell Medical Center, New York, NY; Department of Surgery, Weill-Cornell Medical Center, New York, NY.
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17
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Hoops HE, Haley C, Cook MR, Lopez O, Dewey E, Brasel KJ, Spight D, Kiraly LN. Factors influencing amount of guidance in the operating room during laparoscopic cases. Am J Surg 2019; 217:979-985. [PMID: 30929750 DOI: 10.1016/j.amjsurg.2019.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 03/13/2019] [Accepted: 03/20/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Identifying factors associated with resident autonomy may help improve training efficiency. This study evaluates resident and procedural factors associated with level of guidance needed in the operating room. METHODS Intraoperative performance and yearly performance on Fundamentals of Laparoscopic Surgery (FLS) tasks from 74 general surgery residents were retrospectively reviewed. The effect of post-graduate year (PGY), procedure complexity, case difficulty, intraoperative performance, and FLS task performance were analyzed using a mixed-effects model. RESULTS PGY level, procedure complexity, case difficulty, operative technique, and operative knowledge were significantly associated with level of intraoperative guidance. In PGY2-4 residents, ratings of medical knowledge and communication were also significantly associated with guidance. There was no significant association between FLS performance and level of guidance for any PGY level. CONCLUSIONS The amount of intraoperative guidance is influenced by many factors, including resident performance and case characteristics. FLS tasks performance was not significantly associated with intraoperative guidance.
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Affiliation(s)
- Heather E Hoops
- Department of Surgery, Oregon Health and Sciences University, Portland, OR, USA.
| | - Caleb Haley
- Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Mackenzie R Cook
- Department of Surgery, Oregon Health and Sciences University, Portland, OR, USA
| | - Olga Lopez
- Department of Surgery, Oregon Health and Sciences University, Portland, OR, USA
| | - Elizabeth Dewey
- Department of Surgery, Oregon Health and Sciences University, Portland, OR, USA
| | - Karen J Brasel
- Department of Surgery, Oregon Health and Sciences University, Portland, OR, USA
| | - Donn Spight
- Department of Surgery, Oregon Health and Sciences University, Portland, OR, USA
| | - Laszlo N Kiraly
- Department of Surgery, Oregon Health and Sciences University, Portland, OR, USA
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18
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Preventing Error in the Operating Room: Five Teaching Strategies for High-Stakes Learning. J Surg Res 2019; 236:12-21. [DOI: 10.1016/j.jss.2018.10.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/14/2018] [Accepted: 10/26/2018] [Indexed: 01/27/2023]
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19
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Resident autonomy in the operating room: Does gender matter? Am J Surg 2019; 217:301-305. [DOI: 10.1016/j.amjsurg.2018.12.023] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/24/2018] [Accepted: 12/14/2018] [Indexed: 11/19/2022]
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Fryer J, Schuller M, Wnuk G, Meyerson S, Zwischenberger J, Meier A, Williams R, George B. Identifying and Addressing High Priority Issues in General Surgery Training and Education. JOURNAL OF SURGICAL EDUCATION 2019; 76:50-54. [PMID: 30243928 DOI: 10.1016/j.jsurg.2018.06.009] [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: 05/14/2018] [Accepted: 06/13/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Complex problems are often easier to address when multiple entities collaborate. The Procedural Learning and Safety Collaborative (PLSC) was established to address complex problems in general surgery residency training by connectively engaging multiple residency programs in addressing progressive research questions. STUDY DESIGN Recently, PLSC members held a national symposium which included leadership from several leading surgical societies to come to a consensus on what are the most critical issues in general surgery education. RESULTS This paper describes the process used and the end result of this process. This paper describes the process used and the end result of this process.
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Affiliation(s)
- Jonathan Fryer
- University of Kentucky, Department of Surgery, Lexington, Kentucky.
| | - Mary Schuller
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Greg Wnuk
- Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Shari Meyerson
- University of Kentucky, College of Medicine, Lexington, Kentucky
| | | | - Andreas Meier
- SUNY Upstate University Hospital, Syracuse, New York
| | - Reed Williams
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Brian George
- Michigan Medicine, University of Michigan, Ann Arbor, Michigan
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21
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Hill KA, Dasari M, Littleton EB, Hamad GG. How can surgeons facilitate resident intraoperative decision-making? Am J Surg 2017; 214:583-588. [DOI: 10.1016/j.amjsurg.2017.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/26/2017] [Accepted: 06/18/2017] [Indexed: 10/19/2022]
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22
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Entrustment Evidence Used by Expert Gynecologic Surgical Teachers to Determine Residents' Autonomy. Obstet Gynecol 2017; 130 Suppl 1:8S-16S. [DOI: 10.1097/aog.0000000000002201] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Williams RG, George BC, Meyerson SL, Bohnen JD, Dunnington GL, Schuller MC, Torbeck L, Mullen JT, Auyang E, Chipman JG, Choi J, Choti M, Endean E, Foley EF, Mandell S, Meier A, Smink DS, Terhune KP, Wise P, DaRosa D, Soper N, Zwischenberger JB, Lillemoe KD, Fryer JP. What factors influence attending surgeon decisions about resident autonomy in the operating room? Surgery 2017; 162:1314-1319. [PMID: 28950992 DOI: 10.1016/j.surg.2017.07.028] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 07/10/2017] [Accepted: 07/29/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Educating residents in the operating room requires balancing patient safety, operating room efficiency demands, and resident learning needs. This study explores 4 factors that influence the amount of autonomy supervising surgeons afford to residents. METHODS We evaluated 7,297 operations performed by 487 general surgery residents and evaluated by 424 supervising surgeons from 14 training programs. The primary outcome measure was supervising surgeon autonomy granted to the resident during the operative procedure. Predictor variables included resident performance on that case, supervising surgeon history with granting autonomy, resident training level, and case difficulty. RESULTS Resident performance was the strongest predictor of autonomy granted. Typical autonomy by supervising surgeon was the second most important predictor. Each additional factor led to a smaller but still significant improvement in ability to predict the supervising surgeon's autonomy decision. The 4 factors together accounted for 54% of decision variance (r = 0.74). CONCLUSION Residents' operative performance in each case was the strongest predictor of how much autonomy was allowed in that case. Typical autonomy granted by the supervising surgeon, the second most important predictor, is unrelated to resident proficiency and warrants efforts to ensure that residents perform each procedure with many different supervisors.
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Affiliation(s)
- Reed G Williams
- Department of Surgery, Indiana University, Indianapolis, IN.
| | - Brian C George
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | | | - Jordan D Bohnen
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | | | | | - Laura Torbeck
- Department of Surgery, Indiana University, Indianapolis, IN
| | - John T Mullen
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Edward Auyang
- Department of Surgery, University of New Mexico, Albuquerque, NM
| | | | - Jennifer Choi
- Department of Surgery, Indiana University, Indianapolis, IN
| | - Michael Choti
- Department of Surgery, University of Texas Southwestern, Surgery, Dallas, TX
| | - Eric Endean
- Department of Surgery, University of Kentucky, Lexington, KY
| | - Eugene F Foley
- Department of Surgery, University Of Wisconsin, Madison, WI
| | - Samuel Mandell
- Department of Surgery, University of Washington, Surgery, Seattle, WA
| | - Andreas Meier
- Department of Surgery, State University of New York, Surgery, Syracuse, NY
| | - Douglas S Smink
- Department of Surgery, Brigham and Women's Hospital, Surgery, Boston, MA
| | - Kyla P Terhune
- Department of Surgery, Vanderbilt University Medical Center, Surgery, Nashville, TN
| | - Paul Wise
- Department of Surgery, Washington University, Surgery, St. Louis, MO
| | - Debra DaRosa
- Department of Surgery, Northwestern University, Chicago, IL
| | | | | | - Keith D Lillemoe
- Department of Surgery, Massachusetts General Hospital, Boston, MA
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Timberlake MD, Mayo HG, Scott L, Weis J, Gardner AK. What Do We Know About Intraoperative Teaching? Ann Surg 2017; 266:251-259. [DOI: 10.1097/sla.0000000000002131] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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25
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Köhler TS. Assessing Competence in Surgical Training and Becoming a Better Educator. J Sex Med 2017; 14:761-764. [PMID: 28583336 DOI: 10.1016/j.jsxm.2017.04.663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/10/2017] [Accepted: 04/11/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Tobias S Köhler
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA.
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26
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McKendy KM, Watanabe Y, Lee L, Bilgic E, Enani G, Feldman LS, Fried GM, Vassiliou MC. Perioperative feedback in surgical training: A systematic review. Am J Surg 2016; 214:117-126. [PMID: 28082010 DOI: 10.1016/j.amjsurg.2016.12.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 12/09/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Changes in surgical training have raised concerns about residents' operative exposure and preparedness for independent practice. One way of addressing this concern is by optimizing teaching and feedback in the operating room (OR). The objective of this study was to perform a systematic review on perioperative teaching and feedback. METHODS A systematic literature search identified articles from 1994 to 2014 that addressed teaching, feedback, guidance, or debriefing in the perioperative period. Data was extracted according to ENTREQ guidelines, and a qualitative analysis was performed. RESULTS Thematic analysis of the 26 included studies identified four major topics. Observation of teaching behaviors in the OR described current teaching practices. Identification of effective teaching strategies analyzed teaching behaviors, differentiating positive and negative teaching strategies. Perceptions of teaching behaviors described resident and attending satisfaction with teaching in the OR. Finally models for delivering structured feedback cited examples of feedback strategies and measured their effectiveness. CONCLUSIONS This study provides an overview of perioperative teaching and feedback for surgical trainees and identifies a need for improved quality and quantity of structured feedback.
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Affiliation(s)
- Katherine M McKendy
- Henry K.M. de Kuyper Education Center, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.
| | - Yusuke Watanabe
- Henry K.M. de Kuyper Education Center, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.
| | - Lawrence Lee
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.
| | - Elif Bilgic
- Henry K.M. de Kuyper Education Center, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.
| | - Ghada Enani
- Henry K.M. de Kuyper Education Center, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.
| | - Liane S Feldman
- Henry K.M. de Kuyper Education Center, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.
| | - Gerald M Fried
- Henry K.M. de Kuyper Education Center, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.
| | - Melina C Vassiliou
- Henry K.M. de Kuyper Education Center, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.
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Mellinger JD, Williams RG, Sanfey H, Fryer JP, DaRosa D, George BC, Bohnen JD, Schuller MC, Sandhu G, Minter RM, Gardner AK, Scott DJ. Teaching and assessing operative skills: From theory to practice. Curr Probl Surg 2016; 54:44-81. [PMID: 28212782 DOI: 10.1067/j.cpsurg.2016.11.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 11/22/2016] [Indexed: 11/22/2022]
Affiliation(s)
- John D Mellinger
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL.
| | - Reed G Williams
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL; Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Hilary Sanfey
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL; American College of Surgeons, Chicago, IL
| | - Jonathan P Fryer
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Debra DaRosa
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Brian C George
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Jordan D Bohnen
- Department of General Surgery, Massachussetts General Hospital and Harvard University, Boston, MA
| | - Mary C Schuller
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Gurjit Sandhu
- Department of Surgery, University of Michigan, Ann Arbor, MI; Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI
| | - Rebecca M Minter
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Aimee K Gardner
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX; UT Southwestern Simulation Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Daniel J Scott
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX; UT Southwestern Simulation Center, University of Texas Southwestern Medical Center, Dallas, TX
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28
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Williams RG, Kim MJ, Dunnington GL. Practice Guidelines for Operative Performance Assessments. Ann Surg 2016; 264:934-948. [DOI: 10.1097/sla.0000000000001685] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chen XP, Williams RG, Smink DS. Dissecting Attending Surgeons' Operating Room Guidance: Factors That Affect Guidance Decision Making. JOURNAL OF SURGICAL EDUCATION 2015; 72:e137-e144. [PMID: 26153113 DOI: 10.1016/j.jsurg.2015.06.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 05/29/2015] [Accepted: 06/04/2015] [Indexed: 06/04/2023]
Abstract
PURPOSE The amount of guidance provided by the attending surgeon in the operating room (OR) is a key element in developing residents' autonomy. The purpose of this study is to explore factors that affect attending surgeons' decision making regarding OR guidance provided to the resident. METHODS We used video-stimulated recall interviews (VSRI) throughout this 2-phase study. In Phase 1, 3 attending surgeons were invited to review separately 30 to 45 minute video segments of their prerecorded surgical operations to explore factors that influenced their OR guidance decision making. In Phase 2, 3 attending surgeons were observed and documented in the OR (4 operations, 341min). Each operating surgeon reviewed their videotaped surgical performance within 5 days of the operation to reflect on factors that affected their decision making during the targeted guidance events. All VSRI were recorded. Thematic analysis and manual coding were used to synthesize and analyze data from VSRI transcripts, OR observation documents, and field notes. RESULTS A total of 255 minutes of VSRI involving 6 surgeons and 7 surgical operations from 5 different procedures were conducted. A total of 13 guidance decision-making influence factors from 4 categories were identified (Cohen's κ = 0.674): Setting (case schedule and patient morbidity), content (procedure attributes and case progress), resident (current competency level, trustworthiness, self-confidence, and personal traits), and attending surgeon (level of experience, level of comfort, preferred surgical technique, OR training philosophy, and responsibility as surgeon). A total of 5 factors (case schedule, patient morbidity, procedure attributes, resident current competency level, and trustworthiness) influenced attending surgeons' pre-OR guidance plans. "OR training philosophy" and "responsibility as surgeon" were anchor factors that affected attending surgeons' OR guidance decision-making patterns. CONCLUSIONS Surgeons' OR guidance decision making is a dynamic process that is influenced by 13 situational factors. These factors can be used by residency programs to tailor strategies designed to increase resident autonomy in the OR.
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Affiliation(s)
| | - Reed G Williams
- Department of Surgery, Indiana University, Indianapolis, Indiana
| | - Douglas S Smink
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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Kempenich JW, Willis RE, Rakosi R, Wiersch J, Schenarts PJ. How do Perceptions of Autonomy Differ in General Surgery Training Between Faculty, Senior Residents, Hospital Administrators, and the General Public? A Multi-Institutional Study. JOURNAL OF SURGICAL EDUCATION 2015; 72:e193-201. [PMID: 26160132 DOI: 10.1016/j.jsurg.2015.06.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 06/04/2015] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Identify barriers to resident autonomy in today's educational environment as perceived through 4 selected groups: senior surgical residents, teaching faculty, hospital administration, and the general public. DESIGN Anonymous surveys were created and distributed to senior residents, faculty, and hospital administrators working within 3 residency programs. The opinions of a convenience sample of the general public were also assessed using a similar survey. SETTING Keesler Medical Center, Keesler AFB, MS; the University of Texas Health Science of San Antonio, TX; and the University of Nebraska Medical Center, Omaha, NE. PARTICIPANTS A total of 169 responses were collected: 32 residents, 50 faculty, 20 administrators, and 67 general public. RESULTS Faculty and residents agree that when attending staff grant more autonomy, residents' self-confidence and sense of ownership improve. Faculty felt that residents should have less autonomy than residents did (p < 0.001). When asked to reflect on the current level of autonomy at their institution, 47% of residents felt that they had too little autonomy and 38% of faculty agreed. No resident or faculty felt that residents had too much autonomy at their institution. The general public were more welcoming of resident participation than faculty (p = 0.002) and administrators (p = 0.02) predicted they would be. When the general public were asked regarding their opinions about resident participation with complex procedures, they were less welcoming than faculty, administrators, and residents thought (p < 0.001). The general public were less likely to think that resident involvement would improve their quality of care (p < 0.001). CONCLUSION Faculty and senior residents both endorse resident autonomy as important for resident development. The general public are more receptive to resident participation than anticipated. However, with increasing procedural complexity and resident independence, they were less inclined to have residents involved. The general public also had more concerns regarding quality of care provided by residents than the other groups had.
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Affiliation(s)
- Jason W Kempenich
- Department of General Surgery, Keesler Medical Center, Biloxi, Mississippi.
| | - Ross E Willis
- Department of Surgery, University of Texas Health Science Center of San Antonio, San Antonio, Texas
| | - Robert Rakosi
- Department of General Surgery, Keesler Medical Center, Biloxi, Mississippi
| | - John Wiersch
- Department of Surgery, University of Texas Health Science Center of San Antonio, San Antonio, Texas
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Torbeck L, Wilson A, Choi J, Dunnington GL. Identification of behaviors and techniques for promoting autonomy in the operating room. Surgery 2015. [DOI: 10.1016/j.surg.2015.05.030] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sutkin G, Littleton EB, Kanter SL. How surgical mentors teach: a classification of in vivo teaching behaviors part 2: physical teaching guidance. JOURNAL OF SURGICAL EDUCATION 2015; 72:251-257. [PMID: 25468768 DOI: 10.1016/j.jsurg.2014.10.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 09/23/2014] [Accepted: 10/08/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To study surgical teaching captured on film and analyze it at a fine level of detail to categorize physical teaching behaviors. DESIGN We describe live, filmed, intraoperative nonverbal exchanges between surgical attending physicians and their trainees (residents and fellows). From the films, we chose key teaching moments and transcribed participants' utterances, actions, and gestures. In follow-up interviews, attending physicians and trainees watched videos of their teaching case and answered open-ended questions about their teaching methods. Using a grounded theory approach, we examined the videos and interviews for what might be construed as a teaching behavior and refined the physical teaching categories through constant comparison. SETTING We filmed 5 cases in the operating suite of a university teaching hospital that provides gynecologic surgical care. PARTICIPANTS We included 5 attending gynecologic surgeons, 3 fellows, and 5 residents for this study. RESULTS More than 6 hours of film and 3 hours of interviews were transcribed, and more than 250 physical teaching motions were captured. Attending surgeons relied on actions and gestures, sometimes wordlessly, to achieve pedagogical and surgical goals simultaneously. Physical teaching included attending physician-initiated actions that required immediate corollary actions from the trainee, gestures to illustrate a step or indicate which instrument to be used next, supporting or retracting tissues, repositioning the trainee's instruments, and placement of the attending physicians' hands on the trainees' hands to guide them. Attending physicians often voiced surprise at the range of their own teaching behaviors captured on film. Interrater reliability was high using the Cohen κ, which was 0.76 for the physical categories. CONCLUSIONS Physical guidance is essential in educating a surgical trainee, may be tacit, and is not always accompanied by speech. Awareness of teaching behaviors may encourage deliberate teaching and reflection on how to innovate pedagogy for the teaching operating room.
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Affiliation(s)
- Gary Sutkin
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital, Pittsburgh, Pennsylvania.
| | - Eliza B Littleton
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Steven L Kanter
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
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Alken A, Tan E, Luursema JM, Fluit C, van Goor H. Coaching during a trauma surgery team training: perceptions versus structured observations. Am J Surg 2015; 209:163-9. [DOI: 10.1016/j.amjsurg.2014.02.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 01/22/2014] [Accepted: 02/06/2014] [Indexed: 10/25/2022]
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Chen XP, Williams RG, Sanfey HA, Smink DS. A taxonomy of surgeons' guiding behaviors in the operating room. Am J Surg 2014; 209:15-20. [PMID: 25454960 DOI: 10.1016/j.amjsurg.2014.07.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 06/20/2014] [Accepted: 07/09/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND This study explores the nature and the intention of attending surgeons' guiding behaviors performed in the operating room (OR) in order to build taxonomy of OR guiding behavior. METHODS Nine attending surgeons and 8 surgical residents were invited to observe 8 prerecorded surgical cases from 4 common procedures and completed semistructured interviews. All video-based observations were videotaped. Thematic analysis was applied to identify surgeons' OR guiding behavior. RESULTS Seven hundred eighty minutes of video-based observations with interviews were conducted. Sixteen types of OR guiding behaviors in 3 intention-based categories were identified: 3 of the 16 was "teaching" (18.75%), 8 of the 16 was "directing" (50%), and 5 of the 16 was "assisting" (31.25%). CONCLUSIONS Surgeons' OR guiding behaviors were grounded in 3 behavioral intentions: teaching, directing, and assisting. This taxonomy of OR guiding behavior can be used as a basis for developing OR guiding strategy to improve residents' intraoperative competency, autonomy, and independence.
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Affiliation(s)
- Xiaodong Phoenix Chen
- Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
| | - Reed G Williams
- Department of Surgery, Indiana University, 545 Barnhill Drive, Indianapolis, IN 46202
| | - Hilary A Sanfey
- Department of Surgery, Southern Illinois University, 747 N Rutledge Street, Springfield, IL 62794
| | - Douglas S Smink
- Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
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Chen XP, Williams RG, Smink DS. Do residents receive the same OR guidance as surgeons report? Difference between residents' and surgeons' perceptions of OR guidance. JOURNAL OF SURGICAL EDUCATION 2014; 71:e79-e82. [PMID: 24931416 DOI: 10.1016/j.jsurg.2014.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 04/25/2014] [Accepted: 04/27/2014] [Indexed: 06/03/2023]
Abstract
PURPOSE Operating room (OR) guidance is important for surgical residents' performance and, ultimately, for the development of independence and autonomy. This study explores the differences in surgical residents' and attending surgeons' perceptions of OR guidance in prerecorded surgical cases. METHODS A total of 9 attending surgeons and 8 surgical residents observed 8 prerecorded surgical cases and were asked to identify both the presence and the type of attending surgeons' OR guidance. Each recorded case was observed by 2 attending surgeons and 1 resident. A previously developed taxonomy for types of OR guidance was applied to analyze the data to explore the difference. Agreement by both attending surgeons on the presence and the type of OR guidance served as the concordant guidance behaviors to which the responses of the residents were compared. RESULTS Overall, 116 OR guidance events were identified. Attending surgeons agreed on the presence of guidance in 80 of 116 (69.8%) events and consistently identified the type of OR guidance in 91.4% (73/80, Cohen κ = 0.874) of them. However, surgical residents only agreed with attending surgeons on the presence of guidance in 61.25% (49/80) of the events. In addition, there was significant disagreement (Cohen κ = 0.319) between surgical residents and attending surgeons in the type of OR guidance; the residents only identified 54.8% (40/73) of concordant guidance behaviors in the same guidance category as both the surgeons. Among the types of OR guidance, residents and attending surgeons were most likely to agree on the teaching guidance (66.67%) and least likely to agree on the assisting guidance (36.84%). CONCLUSIONS Surgical residents and attending surgeons have different perceptions of both the presence and the type of OR guidance. This difference in perception of OR guidance has important implications for the efficiency of training surgical residents in the OR, and, ultimately on residents' development of independence and autonomy.
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Affiliation(s)
| | - Reed G Williams
- Department of Surgery, School of Medicine, Indiana University, Indianapolis, Indiana
| | - Douglas S Smink
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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Teman NR, Gauger PG, Mullan PB, Tarpley JL, Minter RM. Entrustment of General Surgery Residents in the Operating Room: Factors Contributing to Provision of Resident Autonomy. J Am Coll Surg 2014; 219:778-87. [DOI: 10.1016/j.jamcollsurg.2014.04.019] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 04/20/2014] [Accepted: 04/29/2014] [Indexed: 01/06/2023]
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Torbeck L, Williams RG, Choi J, Schmitz CC, Chipman JG, Dunnington GL. How much guidance is given in the operating room? Factors influencing faculty self-reports, resident perceptions, and faculty/resident agreement. Surgery 2014; 156:797-803. [DOI: 10.1016/j.surg.2014.06.069] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 06/26/2014] [Indexed: 10/24/2022]
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Abstract
BACKGROUND The patient safety imperative has raised expectations regarding the responsibility of medical educators and decision makers to ensure that physicians are competent. Ensuring that trainees are ready for independent practice upon graduation is challenged by reduced work hours such that trainees spend less time in the OR and perform fewer cases than desirable. METHODS The literature on the assessment of technical and non--technical operative skills and professionalism was reviewed in order to make recommendations to identify barriers to evaluation. DISCUSSION Barriers to documenting performance deficiencies include uncertainty as to what should be documented, and concerns about the negative impact of critical evaluations on faculty popularity. Additional challenges include a lack of clear standards for performance and effective remediation options. CONCLUSIONS Trainee performance should be evaluated in a rigorous, reliable and meaningful way to ensure that graduates have the skills necessary for safe, independent practice.
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Abstract
Maintaining a standard of excellence for graduating surgical residents requires a comprehensive and consistent approach to surgical education. The omnipresent and increasing barriers to education must also be recognized and addressed. The implementation of effective teaching strategies is largely dependent on the resources available at each institution and the vision of education. Unfortunately, allocating time for surgeons to teach both inside and outside the operating room has become a foreign concept to administration. Furthermore, the reduction in case numbers performed by trainees now demands "quality over quantity" to ensure success. Quality teaching moments will only be realized when emphasis is placed on preparation, useful instruction during the procedure, and postoperative feedback. Ideal preparation entails a detailed discussion between the trainee and surgeon about the specific learning goals for the case. During the procedure, the faculty surgeon must strive to maximize the experience through effective communication while performing an efficient and safe operation. Numerous validated objective assessment tools exist for postprocedure evaluation but are grossly underutilized. Surgical education must thoughtfully be approached with the same fervor and detail as patient care. As faculty, it is our responsibility to train the next generation of surgeons and therefore "every case must count."
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Affiliation(s)
- Bradley J Champagne
- Division of Colorectal Surgery, Department of Surgery, Case Medical Center, University Hospitals, Cleveland, Ohio
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George BC, Teitelbaum EN, Darosa DA, Hungness ES, Meyerson SL, Fryer JP, Schuller M, Zwischenberger JB. Duration of faculty training needed to ensure reliable or performance ratings. JOURNAL OF SURGICAL EDUCATION 2013; 70:703-8. [PMID: 24209644 DOI: 10.1016/j.jsurg.2013.06.015] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 06/03/2013] [Accepted: 06/25/2013] [Indexed: 05/05/2023]
Abstract
OBJECTIVES The American Board of Surgery has mandated intraoperative assessment of general surgery residents, yet the time required to train faculty to accurately and reliably complete operating room performance evaluation forms is unknown. Outside of surgical education, frame-of-reference (FOR) training has been shown to be an effective training modality to teach raters the specific performance indicators associated with each point on a rating scale. Little is known, however, about what form and duration of FOR training is needed to accomplish reliable ratings among surgical faculty. DESIGN Two groups of surgical faculty separately underwent either an accelerated 1-hour (n = 10) or immersive four-hour (n = 34) FOR faculty development program. Both programs included a formal presentation and a facilitated discussion of sample behaviors for each point on the Zwisch operating room performance rating scale (see DaRosa et al.(8)). The immersive group additionally participated in a small group exercise that included additional practice. After training, both groups were tested using 10 video clips of trainees at various levels. Responses were scored against expert consensus ratings. The 2-sided Mann-Whitney U test was used to compare between group means. SETTING AND PARTICIPANTS All trainees were faculty members in the Department of Surgery of a large midwestern private medical school. RESULTS Faculty undergoing the 1-hour FOR training program did not have a statistically different mean correct response rate on the video test when compared with those undergoing the 4-hour training program (88% vs 80%; p = 0.07). CONCLUSIONS One-hour FOR training sessions are likely sufficient to train surgical faculty to reliably use a simple evaluation instrument for the assessment of intraoperative performance. Additional research is needed to determine how these results generalize to different assessment instruments.
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Affiliation(s)
- Brian C George
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
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Alken A, Tan E, Luursema JM, Fluit C, van Goor H. Feedback activities of instructors during a trauma surgery course. Am J Surg 2013; 206:599-604. [DOI: 10.1016/j.amjsurg.2013.03.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 01/25/2013] [Accepted: 03/21/2013] [Indexed: 01/09/2023]
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Dougherty P, Kasten SJ, Reynolds RK, Prince MEP, Lypson ML. Intraoperative assessment of residents. J Grad Med Educ 2013; 5:333-4. [PMID: 24404284 PMCID: PMC3693705 DOI: 10.4300/jgme-d-13-00074.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Fann JI, Sullivan ME, Skeff KM, Stratos GA, Walker JD, Grossi EA, Verrier ED, Hicks GL, Feins RH. Teaching behaviors in the cardiac surgery simulation environment. J Thorac Cardiovasc Surg 2013; 145:45-53. [DOI: 10.1016/j.jtcvs.2012.07.111] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 05/25/2012] [Accepted: 07/30/2012] [Indexed: 11/29/2022]
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DaRosa DA, Zwischenberger JB, Meyerson SL, George BC, Teitelbaum EN, Soper NJ, Fryer JP. A theory-based model for teaching and assessing residents in the operating room. JOURNAL OF SURGICAL EDUCATION 2013; 70:24-30. [PMID: 23337666 DOI: 10.1016/j.jsurg.2012.07.007] [Citation(s) in RCA: 170] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 06/26/2012] [Accepted: 07/23/2012] [Indexed: 05/14/2023]
Abstract
The operating room (OR) remains primarily a master/apprenticeship-based learning environment for surgical residents. Changes in surgical education and health care systems challenge faculty to efficiently and effectively graduate residents truly competent in operations classified by the Surgical Council on Resident Education as "common essential" and "uncommon essential." Program directors are charged with employing resident evaluation systems that yield useful data, yet feasible enough to fit into a busy surgical faculty member's workflow. This paper proposes a simple model for teaching and assessing residents in the operating room to guide faculty and resident interaction in the OR, and designating a resident's earned level of autonomy for a given procedure. The system as proposed is supported by theories associated with motor skill acquisition and learning.
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Affiliation(s)
- Debra A DaRosa
- Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
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Recognizing Residents with a Deficiency in Operative Performance as a Step Closer to Effective Remediation. J Am Coll Surg 2013; 216:114-22. [DOI: 10.1016/j.jamcollsurg.2012.09.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 09/12/2012] [Accepted: 09/12/2012] [Indexed: 12/25/2022]
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Benson A, Markwell S, Kohler TS, Tarter TH. An Operative Performance Rating System for Urology Residents. J Urol 2012; 188:1877-82. [DOI: 10.1016/j.juro.2012.07.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Aaron Benson
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Stephen Markwell
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Tobias S. Kohler
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Thomas H. Tarter
- Cancer Care Specialists of Central Illinois, S.C., Decatur, Illinois
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Williams RG, Verhulst S, Colliver JA, Sanfey H, Chen X, Dunnington GL. A template for reliable assessment of resident operative performance: Assessment intervals, numbers of cases and raters. Surgery 2012; 152:517-24; discussion 524-7. [DOI: 10.1016/j.surg.2012.07.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 07/05/2012] [Indexed: 11/24/2022]
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Pernar LIM, Ashley SW, Smink DS, Zinner MJ, Peyre SE. Master surgeons' operative teaching philosophies: a qualitative analysis of parallels to learning theory. JOURNAL OF SURGICAL EDUCATION 2012; 69:493-498. [PMID: 22677588 DOI: 10.1016/j.jsurg.2012.02.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 01/03/2012] [Accepted: 02/07/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Practicing within the Halstedian model of surgical education, academic surgeons serve dual roles as physicians to their patients and educators of their trainees. Despite this significant responsibility, few surgeons receive formal training in educational theory to inform their practice. The goal of this work was to gain an understanding of how master surgeons approach teaching uncommon and highly complex operations and to determine the educational constructs that frame their teaching philosophies and approaches. DESIGN Individuals included in the study were queried using electronically distributed open-ended, structured surveys. Responses to the surveys were analyzed and grouped using grounded theory and were examined for parallels to concepts of learning theory. SETTING Academic teaching hospital. PARTICIPANTS Twenty-two individuals identified as master surgeons. RESULTS Twenty-one (95.5%) individuals responded to the survey. Two primary thematic clusters were identified: global approach to teaching (90.5% of respondents) and approach to intraoperative teaching (76.2%). Many of the emergent themes paralleled principles of transfer learning theory outlined in the psychology and education literature. Key elements included: conferring graduated responsibility (57.1%), encouraging development of a mental set (47.6%), fostering or expecting deliberate practice (42.9%), deconstructing complex tasks (38.1%), vertical transfer of information (33.3%), and identifying general principles to structure knowledge (9.5%). CONCLUSIONS Master surgeons employ many of the principles of learning theory when teaching uncommon and highly complex operations. The findings may hold significant implications for faculty development in surgical education.
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Affiliation(s)
- Luise I M Pernar
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
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