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Simons MC, Hunt JA, Anderson SL. Trained to cut? A literature review of veterinary surgical resident training. Vet Surg 2024. [PMID: 38816998 DOI: 10.1111/vsu.14110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 04/04/2024] [Accepted: 04/30/2024] [Indexed: 06/01/2024]
Abstract
A surgical residency trains veterinary graduates to a higher level of expertise in surgical procedures than is possible during veterinary school and prepares a resident to pursue board certification in surgery. The education of veterinary surgical residents has changed minimally since its inception in the twentieth century, and there are insufficient studies to determine if residency programs are producing surgeons with competence in each of the necessary procedural categories. The aims of this review were to report the current theory and methods used to provide surgical education to residents, to discuss the training most likely to create a competent, board-certified surgeon and to review assessment methods used during training. Several literature searches using broad terms such as "veterinary surgery residency," "veterinary surgery resident," and "veterinary surgical training" were performed using PubMed, CAB abstracts, and Google Scholar. Literature pertinent to theory, methods, training, and assessment of veterinary surgical residents was included. The reviewed literature demonstrated the need for research-based learning curves for specific procedures. Simulation training is known to facilitate deliberate practice and should be leveraged where possible to reach competency. The creation of validated assessment methods should be pursued as it enables assessment of competency instead of inferring its development from case logs. Understanding and supporting learner cognition and providing sufficient feedback remain important issues in the field. Surgical educators are urged to continue to search for innovative and evidence-based ways to train competent surgical residents.
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Affiliation(s)
- Micha C Simons
- Department of Small Animal Clinical Sciences, Virginia Maryland Regional College of Veterinary Medicine, Blacksburg, Virginia, USA
| | - Julie A Hunt
- Department of Clinical Sciences, Lincoln Memorial University Richard A. Gillespie College of Veterinary Medicine, Harrogate, Tennessee, USA
| | - Stacy L Anderson
- Department of Clinical Sciences, Lincoln Memorial University Richard A. Gillespie College of Veterinary Medicine, Harrogate, Tennessee, USA
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Miles VP, Schroll RW, Beaty JS. Empowering the Resident Learner. JOURNAL OF SURGICAL EDUCATION 2022; 79:909-917. [PMID: 35490137 DOI: 10.1016/j.jsurg.2022.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/07/2022] [Accepted: 03/22/2022] [Indexed: 06/14/2023]
Abstract
Surgical resident autonomy is an essential element of the transition from supervised training to independent practice. However, in an age of duty hour restrictions, legislative constraints, increased litigation, and heightened societal expectations, training an autonomous resident proves increasingly difficult. To tackle these barriers to training successful surgeons, the American College of Surgeons Committee on Resident Education initiated the Resident Mentored Autonomy Project. As a subdivision of this project, the Empowered Learner research team here presents a framework for training the self-directed and empowered surgical resident learner. There are many strategies by which surgical faculty, program directors and chairs, and residents themselves may engage to improve resident operative autonomy.
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Affiliation(s)
- Victoria P Miles
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee.
| | - Rebecca W Schroll
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
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Mattioli DD, Thomas GW, Long SA, Tatum M, Anderson DD. Minimally Trained Analysts Can Perform Fast, Objective Assessment of Orthopedic Technical Skill from Fluoroscopic Images. IISE TRANSACTIONS ON HEALTHCARE SYSTEMS ENGINEERING 2022; 12:212-220. [PMID: 36147899 PMCID: PMC9488091 DOI: 10.1080/24725579.2022.2035022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Skill assessment in orthopedics has traditionally relied on subjective impressions from a supervising surgeon. The feedback derived from these tools may be limited by bias and other practical issues. Objective analysis of intraoperative fluoroscopic images offers an inexpensive, repeatable, and precise assessment strategy without bias. Assessors generally refrain from using the scores of images obtained throughout the operation to evaluate skill for practical reasons. A new system was designed to facilitate rapid analysis of this fluoroscopy via minimally trained analysts. Four expert and four novice analysts independently measured one objective metric for skill using both a custom analysis software and a commercial alternative. Analysts were able to measure the objective metric three times faster when using the custom software, and without a practical difference in accuracy in comparison to the expert analysts using the commercial software. These results suggest that a well-designed fluoroscopy analysis system can facilitate inexpensive, reliable, and objective assessment of surgical skills.
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Affiliation(s)
- Dominik D. Mattioli
- Department of Industrial & Systems Engineering, University of Iowa, Iowa City, United States
| | - Geb W. Thomas
- Department of Industrial & Systems Engineering, University of Iowa, Iowa City, United States,Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, United States
| | - Steven A. Long
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, United States
| | - Marcus Tatum
- Department of Industrial & Systems Engineering, University of Iowa, Iowa City, United States
| | - Donald D. Anderson
- Department of Industrial & Systems Engineering, University of Iowa, Iowa City, United States,Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, United States
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Evaluating chief resident readiness for the teaching assistant role: The Teaching Evaluation assessment of the chief resident (TEACh-R) instrument. Am J Surg 2021; 222:1112-1119. [PMID: 34600735 DOI: 10.1016/j.amjsurg.2021.09.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The American Board of Surgery has mandated chief residents complete 25 cases in the teaching assistant (TA) role. We developed a structured instrument, the Teaching Evaluation and Assessment of the Chief Resident (TEACh-R), to determine readiness and provide feedback for residents in this role. METHODS Senior (PGY3-5) residents were scored on technical and teaching performance by faculty observers using the TEACh-R instrument in the simulation lab. Residents were provided with their TEACh-R scores and surveyed on their experience. RESULTS Scores in technical (p < 0.01) and teaching (p < 0.01) domains increased with PGY. Higher technical, but not teaching, scores correlated with attending-rated readiness for operative independence (p 0.02). Autonomy mismatch was inversely correlated with teaching competence (p < 0.01). Residents reported satisfaction with TEACh-R feedback and desire for use of this instrument in operating room settings. CONCLUSION Our TEACh-R instrument is an effective way to assess technical and teaching performance in the TA role.
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Weller JM, Coomber T, Chen Y, Castanelli DJ. Key dimensions of innovations in workplace-based assessment for postgraduate medical education: a scoping review. Br J Anaesth 2021; 127:689-703. [PMID: 34364651 DOI: 10.1016/j.bja.2021.06.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/31/2021] [Accepted: 06/20/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Specialist training bodies continue to devise innovative methods of gathering information on trainee workplace performance to meet the requirements of competency-based medical education. We reviewed recent innovations in workplace-based assessment (WBA) tools to identify strengths, weaknesses, and trade-offs inherent in their design and use. METHODS In this scoping review, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we systematically searched databases between 2009 and 2019 for WBA tools with novel characteristics not typically seen in traditional WBAs. These included innovations in rating scales, ways of collecting information, technological innovations, ways of triggering WBAs, and approaches to compiling and using information. RESULTS We identified 30 innovative WBA tools whose characteristics could be categorised into seven dimensions: frequency of assessment, granularity (unit of performance assessed), coverage of the curriculum, rating method, initiation of the WBA, information use, and incentives. These dimensions had multiple interdependencies and trade-offs, often balancing generating assessment data with available resources. Philosophical stance on assessment also influenced WBA choice, for example prioritising trainee-centred learning (i.e. initiation of WBA and transparency of assessment data), perceptions of assessment and feedback as burdensome or beneficial, and holistic vs reductionist views on assessment of performance. CONCLUSIONS Our synthesis of the literature on innovative WBAs provides a framework for categorising tool characteristics across seven dimensions, systematically teasing apart the considerations in design and use of workplace assessments. It also draws attention to the trade-offs inherent in tool design and selection, and enables a more deliberate consideration of the tool characteristics most appropriate to the local context.
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Affiliation(s)
- Jennifer M Weller
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand; Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand.
| | - Ties Coomber
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Yan Chen
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Damian J Castanelli
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
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Hanrahan JG, Sideris M, Pasha T, Dedeilia A, Papalois A, Papalois V. Postgraduate Assessment Approaches Across Surgical Specialties: A Systematic Review of the Published Evidence. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:285-295. [PMID: 32889945 DOI: 10.1097/acm.0000000000003712] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Ensuring competence for surgical trainees requires holistic assessment of the qualities and competencies necessary to practice safely and effectively. To determine the next steps toward achieving this aim, the authors conducted a systematic review to summarize and appraise the available evidence related to any assessment approach to postgraduate surgical training and to identify the dominant themes for assessment approaches across different specialties or countries. METHOD Medline and Embase were searched on January 10, 2019, without language or time restrictions. Any peer-reviewed study that described an assessment framework (in practice or novel) throughout postgraduate surgical training globally was included. An iterative review and thematic analysis were performed on full-text articles to determine assessment themes. Studies were then grouped by assessment themes. A tailored quality assessment of the studies included in the final analysis was conducted. Assessment themes and validity were compared across surgical specialties and countries. RESULTS From an initial 7,059 articles, 91 studies (evaluating 6,563 surgical trainees) were included in the final analysis. Ten defined assessment themes were extracted. Ten studies (11.0%) were deemed low risk of bias based on the quality assessment tool used and thus were determined to be high quality. Minor differences in assessment themes were observed between specialties and countries. Assessment themes neglected by individual surgical specialties and assessment themes that need validated assessment tools were identified. CONCLUSIONS This review highlights the low quality of evidence and fragmented efforts to develop and optimize surgical assessments. The minor differences observed demonstrate a common approach, globally and across specialties, related to surgical assessments. A paradigm shift in assessment approaches, which will require national and international collaboration, is required to optimize design and validation so that a comprehensive assessment of surgical competence can be implemented.
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Affiliation(s)
- John Gerrard Hanrahan
- J.G. Hanrahan is academic foundation doctor, Department of General Surgery, Lister Hospital, Stevenage, United Kingdom
| | - Michail Sideris
- M. Sideris is a specialty trainee in obstetrics and gynaecology, Women's Health Research Unit, Queen Mary University of London, London, United Kingdom
| | - Terouz Pasha
- T. Pasha is a final-year medical student, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Aikaterini Dedeilia
- A. Dedeilia is a final-year medical student, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Apostolos Papalois
- A. Papalois is director, ELPEN Research & Experimental Centre, Athens, Greece
| | - Vassilios Papalois
- V. Papalois is professor of transplant surgery, Department of Surgery and Cancer, Renal Transplant Directorate, Imperial College Healthcare NHS Trust, London, United Kingdom
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Hoops HE, Deveney KE, Brasel KJ. Development of an Assessment Tool for Surgeons in Their First Year of Independent Practice: The Junior Surgeon Performance Assessment Tool. JOURNAL OF SURGICAL EDUCATION 2019; 76:e199-e208. [PMID: 31420272 DOI: 10.1016/j.jsurg.2019.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 07/04/2019] [Accepted: 08/03/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The purpose of this study was to create an assessment tool to evaluate newly practicing surgeons. DESIGN In this prospective mixed methods study, a needs assessment was performed by conducting focus groups with practicing general surgeons, asking questions regarding essential surgeon qualities, behaviors observed in inexperienced surgeons, current assessment methods, and desired assessment tool elements and attributes. A qualitative analysis was performed using a grounded theory methodology. The Junior Surgeon Performance Assessment Tool (JSPAT) was created using a 4-point scale for each category developed, with themes identified in the qualitative analysis used to create behavioral anchors. The JSPAT was evaluated by focus group participants and by members of the American College of Surgeons Advisory Council for Rural Surgery using an online survey. SETTING Rural and nonuniversity-based hospitals throughout the state of Oregon. PARTICIPANTS Practicing general surgeons. RESULTS Focus groups consisted of 31 surgeons (mean age 49, mean experience 17 years) from 11 different hospitals. Qualitative analysis revealed 91 different themes, which were grouped into 5 domains (technical skills, interaction with patients, interaction with surgeon colleagues, interactions with the greater medical community, and self-care) to create the assessment tool. Twenty online survey responses providing feedback on the assessment tool were obtained, with 75% rating the JSPAT useful or very useful and 69% satisfied or very satisfied with the time to complete the tool. CONCLUSIONS A mixed-methods model was used to create an assessment tool for surgeons in their first year of independent practice. Survey data demonstrated that practicing surgeons find value in the JSPAT.
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Affiliation(s)
- Heather E Hoops
- Oregon Health & Sciences University, Department of Surgery, Portland, Oregon
| | - Karen E Deveney
- Oregon Health & Sciences University, Department of Surgery, Portland, Oregon
| | - Karen J Brasel
- Oregon Health & Sciences University, Department of Surgery, Portland, Oregon.
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Burlew CC. Surgical education: Lessons from parenthood. Am J Surg 2017; 214:983-992. [PMID: 28964404 DOI: 10.1016/j.amjsurg.2017.09.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 09/18/2017] [Indexed: 10/18/2022]
Abstract
Although one might think surgery and parenting have little in common, there are clear parallels. Historically there has been little formal education for either role. Educators and parents relied on modelling the behavior of others, or trial and error techniques. Mentorship and role models have played a critical role in professional development and continue to have a profound impact. Over the past two decades there has been a marked increase in the resources that are available. Coaching, debriefing, deliberate practice, and formal training are now incorporated in residency programs. Specific lessons from parenthood that can be applied to surgical education include: providing a framework, learning through graduated responsibility, communicating expectations, creating a culture, setting the example, encouraging resilience, promoting autonomy, providing feedback, and navigating failure. The final lesson from parenthood: trust that you have taught them well. And you have to let them go.
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Affiliation(s)
- Clay Cothren Burlew
- The Department of Surgery, Denver Health Medical Center and the University of Colorado School of Medicine, Denver, CO, USA.
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