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Casas RS, Cooper AB, Westcott AM, Shen C, Dewaters AL. Preparing for the Transition to Academic Practice: A Graduate Medical Education Elective. J Grad Med Educ 2024; 16:461-468. [PMID: 39148879 PMCID: PMC11324162 DOI: 10.4300/jgme-d-24-00002.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 05/10/2024] [Accepted: 06/03/2024] [Indexed: 08/17/2024] Open
Abstract
Background Residents and fellows as educators (RFAE) programs typically focus on clinical teaching skills in single departments, which may not be sustainable for those with limited trainees or faculty. Objective To determine the feasibility and value of a 2-week interdepartmental RFAE elective for advanced teaching skill development and transition to practice as clinician educators. Methods Facilitated discussion, simulation, and critiqued peer presentations developed participants' skills in teaching, curriculum design, professional development, and scholarship. Assessments in this prospective intervention included 2 self-reported surveys addressing: (1) teaching process and motivation (Conceptions of Learning and Teaching [COLT]), and (2) skills and attitudes. We administered both surveys at baseline, immediate-post, and 3-month-post elective with data compared across time points using Kruskal-Wallis tests. Program evaluation comprised daily open-ended surveys on engagement and an end-of-course feedback survey. Results There were 79 participants from 2019 to 2023. Survey response rates were 84.8% (67 of 79) at baseline, 58.2% (46 of 79) immediate-post, and 51.9% (41 of 79) 3-month-post. Most participants were residents (89.9%, 71 of 79), female (60.8%, 48 of 79), from pediatrics and/or medicine departments (77.2%, 61 of 79), and in their final year of training (77.2%, 61 of 79). COLT factor orientation to professional practice scores increased in the immediate-post (3.3) compared to baseline (2.5) surveys (P=.008). Teaching skills attitudes scores increased for all questions in 3-month-post compared to baseline surveys. In open-ended questions, participants emphasized the importance of professional development sessions in guiding their careers toward medical education. Conclusions This interdepartmental elective was feasible, favorably received, and sustained over time, with observed changes in participants' teaching skills attitudes.
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Affiliation(s)
- Rachel S. Casas
- Rachel S. Casas, MD, EdM, is Associate Professor, Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Amanda B. Cooper
- Amanda B. Cooper, MD, is Associate Professor, Departments of Surgery and Humanities, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Amy M. Westcott
- Amy M. Westcott, MD, MHPE, is Professor, Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Chan Shen
- Chan Shen, PhD, is Associate Professor, Department of Surgery, Penn State College of Medicine, Hershey, Pennsylvania, USA; and
| | - Ami L. Dewaters
- Ami L. Dewaters, MD, MSc, is Associate Professor, Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
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Steinhagen E, Khan SZ, Ofshteyn A, Terhune K, Selby L, Miller-Ocuin J, Stein SL, Ammori JB. Creation and Implementation of an Online Tool for Feedback on Resident Teaching: A Pilot Study. JOURNAL OF SURGICAL EDUCATION 2024; 81:713-721. [PMID: 38580499 DOI: 10.1016/j.jsurg.2024.01.010] [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: 06/12/2023] [Revised: 12/11/2023] [Accepted: 01/16/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVE There are few assessments of the competence and growth of surgical residents as educators. We developed and piloted an observation-based feedback tool (FT) to provide residents direct feedback during a specific teaching session, as perceived by medical students (MS). We hypothesized that residents' performance would improve with frequent, low stakes, observation-based feedback. SETTING This prospective study took place at an academic general surgery program. PARTICIPANTS Focus groups of MS, surgical residents, and faculty informed FT development. MS completed the FT regarding resident teaching. DESIGN The FT utilized 5 slider-bar ratings (0 to 100) about the teaching encounter and a checklist of 16 desirable teaching behaviors. QR codes and weekly email links were distributed for 12 months (6 clerkship blocks) to promote use. Residents were sent their results after each block. A survey after each block assessed motivation for use and gathered feedback on the FT. Descriptive statistics were used for analysis (medians, IQRs). Primary measures of performance were median of the slider-bar scores and the number of teaching behaviors. RESULTS The FT was used 111 times; 37 of 46 residents were rated by up to 65 MS. The median rating on the slider-bars was 100 and the median number of desirable teaching behaviors was 12; there were no differences based on gender or PGY level. 10 residents had 5 or more FT observations during the year. Four residents had evaluations completed in 4 or more blocks and 19 residents had evaluations completed in at least 2 blocks. Over time, 13 residents had consistent slider-bar scores, 1 resident had higher scores, and 5 residents had lower scores (defined as a more than 5-point change from initial rating). Frequency of use of the FT decreased over time (38, 32, 9, 21, 7, 5 uses per block). The post-use survey was completed by 24 MS and 19 residents. Most common reasons for usage were interest in improving surgical learning environment, giving positive feedback (MS), and improving teaching skills (residents). Most common reasons for lack of usage from residents were "I did not think I taught enough to ask for feedback," "I forgot it existed," and "I did not know it existed." CONCLUSIONS The FT did not lead to any meaningful improvement in resident scores over the course of the year. This may be due to overall high scores, suggesting that the components of the FT may require reevaluation. Additionally, decreased utilization of the instrument over time made it challenging to assess change in performance of specific residents, likely due to lack of awareness of the FT despite frequent reminders. Successful implementation of observation-based teaching assessments may require better integration with residency or clerkship objectives.
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Affiliation(s)
- Emily Steinhagen
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH; University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES).
| | - Saher-Zahra Khan
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH; University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES)
| | - Asya Ofshteyn
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH; University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES)
| | - Kyla Terhune
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Luke Selby
- University of Kansas Medical Center, Department of Surgery, Kansas City, Kansas
| | | | - Sharon L Stein
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH; University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES)
| | - John B Ammori
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH
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Lee ME, Price J, Schauer J, Carlozzi L, Virk K, Freeman K, Lee J, Johnston TA, Bhat A. Enhanced congenital cardiac surgery knowledge with multidisciplinary collaborative education series for paediatric cardiology fellows and nurse practitioners. Cardiol Young 2024; 34:519-523. [PMID: 37493038 DOI: 10.1017/s1047951123002603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Paediatric cardiologists and nurse practitioners lack structured education tools focused on basic cardiac surgery principles. However, non-surgical specialties caring for surgical patients require this knowledge for comprehensive clinical care. We created a cardiac surgical educational curriculum focused on improving knowledge and attitudes towards communication for non-surgical trainees and advanced practice providers. METHODS Over one academic year, six paediatric cardiology fellows and seven paediatric cardiac surgery nurse practitioners at Seattle Children's Hospital participated in this study. With surgical supervision, six lectures were prepared by each fellow and delivered monthly. Sessions were hybrid and recorded for later viewing. Pre- and post-intervention survey of attitudes regarding surgical topics and pre- and post- test-based knowledge assessments were administered. RESULTS Participants positively rated the usefulness of the lecture series (4.2/5) and would recommend it to a colleague (4.5/5). Self-reported confidence discussing surgical concepts with patients increased from 2.3 to 3.4 among paediatric cardiology fellows (p < 0.001) and from 2.8 to 3.9 among nurse practitioners (p < 0.001), out of 5. In both groups, knowledge assessment scores improved from 54 to 79% post-intervention (p < 0.001). CONCLUSIONS After a six-part educational series taught by paediatric cardiology fellows, both paediatric cardiology fellows and paediatric cardiac surgery nurse practitioners demonstrated improved knowledge and reported increased comfort counselling families on basic cardiac surgery topics. Structured, active-learning lessons taught by fellows for non-surgical audiences can improve attitudes and build clinically relevant knowledge. Creating an effective level-appropriate multidisciplinary curriculum accessible to various types of medical providers could enhance comprehensive care of complex congenital cardiac surgery patients.
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Affiliation(s)
- Madonna E Lee
- Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Joshua Price
- Division of Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Jenna Schauer
- Division of Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Lauren Carlozzi
- Division of Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Kathryn Virk
- Division of Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Kaitlyn Freeman
- Division of Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Joan Lee
- Northwest Congenital Heart Care, Tacoma, WA, USA
| | - Troy A Johnston
- Division of Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Aarti Bhat
- Division of Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
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Gopal K, Desir A, Abdelfattah KR, Park C. A Call for Formalized Training of Surgical Educators. JOURNAL OF SURGICAL EDUCATION 2023; 80:1056-1060. [PMID: 37365118 DOI: 10.1016/j.jsurg.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/30/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023]
Abstract
Current training curricula for future surgeons do not prioritize teaching residents how to teach. With increased expectations but decreased opportunities to operate, developing efficient and effective educators is a pressing necessity. In this article, we discuss the need to formalize the role of the surgical educator, and future directions to implement better training paradigms for surgical educators.
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Affiliation(s)
- K Gopal
- Division of General and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas Texas.
| | - A Desir
- Division of General and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas Texas
| | - K R Abdelfattah
- Division of General and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas Texas
| | - C Park
- Division of General and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas Texas
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Kochhar K, Cico SJ, Whitaker NP, Pettit KE, Brokaw JJ, Nabhan ZM. An Online Resident-as-Teacher Curriculum Improves First-Year Residents' Self-Confidence Teaching in the Clinical Learning Environment. MEDICAL SCIENCE EDUCATOR 2023; 33:847-851. [PMID: 37546196 PMCID: PMC10403463 DOI: 10.1007/s40670-023-01832-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 08/08/2023]
Abstract
We implemented an online Resident-as-Teacher curriculum for all incoming residents (PGY1s) to provide them with a basic foundation for effective teaching in the clinical learning environment. The curriculum consisted of 5 asynchronous modules delivered via the web from 2017-2021. Prior to starting the course, the PGY1s completed a self-assessment of their teaching ability (pre-test) and then again 7-8 months after completing the course (post-test). Analysis of the paired data from 421 PGY1s showed a statistically significant improvement in the self-ratings of their teaching from pre-test to post-test (p < 0.001). Our findings suggest that an online Resident-as-Teacher curriculum can produce lasting benefits in new residents' self-confidence as educators.
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Affiliation(s)
- Komal Kochhar
- Department of Family Medicine, Indiana University School of Medicine, Indianapolis, IN 46202 USA
| | - Stephen J. Cico
- Department of Emergency Medicine, UCF-HCA Florida Healthcare GME Consortium, Orlando, FL 32827 USA
| | - Nash P. Whitaker
- Department of Emergency Medicine, UnityPoint Health, Des Moines, IA 50309 USA
| | - Katie E. Pettit
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN 46202 USA
| | - James J. Brokaw
- Department of Anatomy, Cell Biology & Physiology, Indiana University School of Medicine, Indianapolis, IN 46202 USA
| | - Zeina M. Nabhan
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202 USA
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6
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Chen JX, Gray ST. A paired curriculum for surgical faculty and residents on adult education. Laryngoscope Investig Otolaryngol 2023; 8:636-638. [PMID: 37342111 PMCID: PMC10278104 DOI: 10.1002/lio2.1066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 06/22/2023] Open
Abstract
A paired surgical educator curriculum on adult learning was designed for residents and faculty at a large otolaryngology residency program. In its first year of implementation, 12 core faculty and 20 residents attending the workshops, with positive feedback from all participants and measurable improvements in their understanding of basic terms in adult cognitive learning theory. The curriculum enabled faculty and residents to practice applying educational theories to their every day clinical teaching activities and is adaptable for use in other surgical training programs. Level of Evidence IV.
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Affiliation(s)
- Jenny X. Chen
- Department of Otolaryngology‐Head and Neck SurgeryJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Stacey T. Gray
- Department of Otolaryngology‐Head and Neck SurgeryMass. Eye and Ear, Harvard Medical SchoolBostonMassachusettsUSA
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7
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Gleason A, Harrington C, Alvi S, Han SM, Sullivan ME, Aziz H. Evaluating General Surgical Residency Education Structure and Incorporation of the Resident as Educator Model. JOURNAL OF SURGICAL EDUCATION 2022; 79:1387-1393. [PMID: 35729057 DOI: 10.1016/j.jsurg.2022.05.020] [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: 01/22/2022] [Revised: 04/16/2022] [Accepted: 05/30/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND General surgery education has continued to evolve regarding test preparation, simulation, and skill acquisition. The "Resident as Educator" (RAE) model has been proposed and enacted by programs as a viable education model for general surgery education. This study examines the current education structures in general surgery residency programs in the United States and how many programs have adopted the RAE model or aspects of the model. METHODS A 20-question survey regarding education structure was distributed to all program directors in October 2021. Questions focused on the involvement of residents in leading education sessions, creating the weekly education schedule, program feedback to residents on teaching, and recognition for distinguished resident educators. RESULTS A total of 156 programs responded to the survey. The response rate was 60%. 76.4% of the respondents have a combination of resident and faculty-led didactic sessions, 8.5% have an RAE model, and 15% have faculty-led education sessions. In terms of concerns regarding resident-led didactics-24.4% of respondents stated that their main concern would be the quality of education provided, and 20.4% referenced low resident satisfaction levels with resident-led education. There were no differences among the groups regarding the American Board of Surgery board passage rates. CONCLUSIONS Most residency programs have adopted a model in which residents have significant involvement in creating and maintaining the education calendar and leading formal education sessions. However, only 8.5% have a purely resident-led educational curriculum among the responding programs. More studies are needed to assess how to implement a resident as educator model successfully.
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Affiliation(s)
| | | | - Saba Alvi
- Tufts University School of Medicine, Boston, Massachusetts
| | - Sam M Han
- Tufts University School of Medicine, Boston, Massachusetts
| | - Maura E Sullivan
- The University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Hassan Aziz
- Tufts University School of Medicine, Boston, Massachusetts.
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8
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Nguyen S, Cole KL, Timme KH, Jensen RL. Development of a residents-as-teachers curriculum for neurosurgical training programs. Neurosurg Focus 2022; 53:E6. [DOI: 10.3171/2022.4.focus22161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/18/2022] [Indexed: 11/06/2022]
Abstract
Neurosurgery residents spend a significant amount of their time teaching patients, families, students, residents, and other health professionals. To help ensure competence in their residents’ teaching abilities, many specialties have established formal residents-as-teachers (RAT) curricula; however, such formalized curricula are often lacking in neurosurgery programs. The authors’ goal was to develop and implement a formal RAT curriculum, designed with neurosurgery residents’ other responsibilities in mind, to improve residents’ formal and informal teaching abilities. Here, the authors report on the design of a formalized teaching curriculum tailored for the needs of neurosurgical residents, with a focus on deliberate practice and minimal time needed for preparation. The curriculum, designed using Kern’s 6 steps of curriculum design as a framework, comprises 5 lecture series spread over 3 years, repeated twice through a resident’s training, with each lecture series outlined with its respective topics and objectives. Opportunities for observed teaching as well as informal and formal evaluation will be provided to residents. The program will be evaluated on a yearly basis using direct and anonymized resident feedback on the RAT curriculum. Measures of program success will also include pre- and postprogram medical student and peer evaluation of residents. These data will be used for continual improvement of the curriculum as it is implemented. Successes and shortcomings of this program will be disseminated by publication, presentations, and placement on the authors’ department website and social media. This paper may serve as a foundation for other neurosurgical programs to develop RAT curricula for greater enhancement of resident teaching abilities.
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Affiliation(s)
- Sarah Nguyen
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City
| | - Kyril L. Cole
- School of Medicine, University of Utah, Salt Lake City; and
| | | | - Randy L. Jensen
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City
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9
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Chen B, Jin X, Zhou J, Chen Y, Wang H. Satisfaction of Clinical Teachers on Standardized Residency Training Program (SRTP) in China: A Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095676. [PMID: 35565071 PMCID: PMC9101658 DOI: 10.3390/ijerph19095676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 12/10/2022]
Abstract
BACKGROUND The Standardized Residency Training Program (SRTP) is a significant initiative to deepen health systems and medical education in developing countries like China. Despite the promotion of the SRTP nationwide and its implementation with various improvements, Chinese continuous medical education is still in its infancy. Compared with the residents, little is known about clinical teachers under the SRTP in China. However, clinical teachers effectively determine the training quality as critical disseminators of knowledge, skills, and values in medical practice. Thus, the study aims to analyze critical factors affecting their cognitive job satisfaction and provide continuous improvements for SRTP. METHODS From 1 December 2018 to 31 May 2019, we conducted a self-designed questionnaire with 13 SRTPs (including both training bases and professional bases) in Shaoxing city to evaluate clinical teachers' satisfaction. Altogether, 574 clinical teachers responded to the survey expressing generally high overall satisfaction. We adopted a Chi-square test and Fisher's Exact Test to evaluate the single impact factors affecting the satisfaction of clinical teachers. The multiple factors analysis applied the logistic regression model. RESULTS The male clinical teachers had significant differences in satisfaction with the teaching content (OR: 0.675, [95% CI: 0.477~0.953]), conflicts between study and work (OR: 0.542, [95%CI: 0.371~0.791]), the attention of leaders (OR: 0.403, [95%CI: 0.252~0.645]), and the subsidies of teachers (OR: 0.527, [95%CI: 0.347~0.805]). Compared with internal medicine, clinical teachers from surgery (OR: 2.396, [95%CI: 1.365-4.206]) and other departments (OR: 2.409, [95%CI: 1.406-4.129]) were more satisfied when they considered that residents have high motivation to attend training. In addition, compared with the attending physicians, the deputy chief physicians (OR: 0.493, [95%CI: 0.310-0.783]) and the chief physicians (OR: 0.683, [95%CI: 0.471-0.991]) disagreed more regarding the residents' wage being good enough. CONCLUSION Clinical teachers widely recognize the SRTP. However, teachers' satisfaction varied due to different genders, working departments, and professional titles. The study also discussed possible reasons and strategy implications behind these findings, which combined unique Chinese society characteristics. Further, we believe the analysis and interpretations remind us of the applications of residency training methods from other Western countries, which should also consider the unique socio-cultural challenges.
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Affiliation(s)
- Boyan Chen
- Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China; (B.C.); (X.J.); (J.Z.); (Y.C.)
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
| | - Xiaoyuan Jin
- Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China; (B.C.); (X.J.); (J.Z.); (Y.C.)
| | - Jie Zhou
- Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China; (B.C.); (X.J.); (J.Z.); (Y.C.)
| | - Ying Chen
- Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China; (B.C.); (X.J.); (J.Z.); (Y.C.)
| | - Hongmei Wang
- Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China; (B.C.); (X.J.); (J.Z.); (Y.C.)
- Correspondence:
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Tipton AE, Ofshteyn A, Anderson MJ, Bliggenstorfer JT, Miller M, Ammori JB, Steinhagen E. The impact of a “Residents as Teachers” Workshop at one year follow-up. Am J Surg 2022; 224:375-378. [DOI: 10.1016/j.amjsurg.2022.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 02/07/2022] [Accepted: 03/15/2022] [Indexed: 11/27/2022]
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11
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Qualities of excellent resident and attending teachers recognized by medical students: A qualitative analysis of nominations for surgical clerkship teaching awards. Am J Surg 2022; 224:552-556. [DOI: 10.1016/j.amjsurg.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/18/2022] [Accepted: 02/07/2022] [Indexed: 11/21/2022]
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12
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Feijó LP, Pereira GA, Ruffini VMT, Valente FS, dos Santos RA, Fakhouri SA, Nunes MDPT, Augusto KL. Effectiveness of a SNAPPS in psychiatric residents assessed using objective structured teaching encounters: a case-control study. SAO PAULO MED J 2022; 141:e20211028. [PMID: 36197349 PMCID: PMC10065108 DOI: 10.1590/1516-3180.2021.1028.r1.13072022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 07/13/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Residents play the role of teachers in almost one-quarter of their activities in residency programs. OBJECTIVE To evaluate whether a 45-minute class using summarize, narrow, analyze, probe, plan, and select (SNAPPS) could improve psychiatry residents' case discussion skills in diverse practical learning settings. DESIGN AND SETTING This case-control, randomized, blinded study was conducted in a psychiatry hospital at Fortaleza-Ceará. METHODS Using "resident as teacher" (RaT), objective structured teaching encounters (OSTEs), and SNAPPS, we conducted a study with 26 psychiatry residents. We analyzed video footage of psychiatric cases in three settings: outpatient, nursing, and emergency. An intervention was held two months later with the residents, who were then assigned to two groups: group A (lecture on SNAPPS) and group B (lecture on a topics in psychiatry). Shortly after the lectures, they were video recorded while discussing the same cases. Three blinded examiners analyzed the videos using an instrument based on the Stanford Faculty Development Program (SFDP-26). RESULTS We found high internal consistency among external examiners and an interaction effect, group effect, and moment effect (P < 0.05). The residents who received the SNAPPS lecture scored significantly higher than their counterparts who received a traditional case presentation. CONCLUSION This study indicates the efficacy of SNAPPS over traditional case presentation in all three settings as assessed by OSTEs and supports its implementation to improve the teaching of clinical reasoning.
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Affiliation(s)
- Lorena Pinho Feijó
- MSc. Physician and Assistant Professor, Department of Social
Department, Centro Universitário Unichristus, Fortaleza (CE), Brazil
| | - Guilherme Abreu Pereira
- MD. Attending Physician, Department of Internal Medicine,
Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo,
Sao Paulo, SP, BR
| | - Vitor Maia Teles Ruffini
- MD. Physician and Associate Professor, Department of Internal
Medicine, Universidade Santo Amaro (UNISA), São Paulo (SP), Brazil; and Fellow
of Hospital Medicine, Faculdade de Medicina FMUSP, Universidade de Sao Paulo,
Sao Paulo, SP, BR
| | - Fernando Salvetti Valente
- MD. Physician and Assistant Professor, Department of Internal
Medicine, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP,
BR
| | - Renato Antunes dos Santos
- PhD. Physician and Assistant Professor, Department of
Psychiatry, University of Toronto, Toronto, Canada. And Adjunct Professor,
Department of Psychiatry, McMaster University, Ontario, Canada
| | - Saadallah Azor Fakhouri
- PhD. Physician and Professor, Department of Internal Medicine,
Universidade Federal de Uberlândia (UFU), Uberlândia (MG), Brazil
| | - Maria do Patrocínio Tenório Nunes
- PhD. Physician and Associate Professor, Department of Internal
Medicine, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP,
BR
| | - Kristopherson Lustosa Augusto
- PhD. Physician and Assistant Professor, Department of
Internal Medicine, Faculdade de Medicina, Universidade de Fortaleza (UNIFOR),
Fortaleza (CE), Brazil; Postgraduate Professor at master's level, Centro
Universitário Christus-Unichristus Fortaleza (CE), Brazil; and Assistant
Professor, Department of Internal Medicine, Faculdade de Medicina da
Universidade Federal do Ceará (UFC), Fortaleza (CE), Brazil
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Seelig S, Bright E, Bod J, Della-Giustina D, Goldflam K, Coughlin R, Tsyrulnik A. Educating Future Educators–Resident Distinction in Education: A Longitudinal Curriculum for Physician Educators. West J Emerg Med 2021; 23:100-102. [PMID: 35060872 PMCID: PMC8782133 DOI: 10.5811/westjem.2021.11.53890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/11/2021] [Indexed: 11/11/2022] Open
Affiliation(s)
- Sandra Seelig
- Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
| | - Erin Bright
- Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
| | - Jessica Bod
- Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
| | - David Della-Giustina
- Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
| | - Katja Goldflam
- Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
| | - Ryan Coughlin
- Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
| | - Alina Tsyrulnik
- Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
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14
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Kobritz M, Demyan L, Hoffman H, Bolognese A, Kalyon B, Patel V. "Residents as Teachers" Workshops Designed by Surgery Residents for Surgery Residents. J Surg Res 2021; 270:187-194. [PMID: 34688990 DOI: 10.1016/j.jss.2021.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 09/08/2021] [Accepted: 09/14/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND A core tenet of medical education is the expectation that senior residents will teach junior residents and medical students. However, many general surgery residency programs lack a formalized curriculum to equip trainees with necessary teaching skills. We evaluated the impact of resident-led residents-as-teachers (RAT) workshops (RATW) and assessed adaptability from in-person to virtual delivery. We hypothesized these courses would improve trainees' confidence in their roles as resident-teachers. METHODS Pre-COVID-19, an in-person workshop for residents (PGY1-5) was conducted over two days. During the COVID-19 pandemic, a virtual RATW for incoming interns (PGY1) was conducted during intern boot camp. Topic fidelity was preserved between the two RATWs. Resident-educators were responsible for content and delivery; the program director and associate program directors served as facilitators only. Surveys were used to evaluate residents' confidence in four core topics. A Wilcoxon test was used to compare quantitative data. RESULTS There was significant improvement in confidence in all areas following RATW attendance, except for "Teaching in the OR". In sub-analysis, there was a significant improvement in this category among incoming interns post-RATW (P < 0.001). The majority of interns agreed that the RATW helped them transition into their new teaching role and agreed that the resident-led RATW was effective. CONCLUSIONS A resident-designed and resident-led RAT curriculum in general surgery effectively improves residents' confidence in teaching and is well received by residents. We recommend the implementation of a RAT curriculum in general surgery residency and intern boot camp. The RATW was well adapted to distance-learning format.
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Affiliation(s)
- Molly Kobritz
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York.
| | - Lyudmyla Demyan
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Hannah Hoffman
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Alexandra Bolognese
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Bilge Kalyon
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Vihas Patel
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
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Ofshteyn A, Bingmer K, Tseng E, Times M, Miller M, Ammori J, Steinhagen E. Effect of "Residents as Teachers" Workshop on Learner Perception of Trainee Teaching Skill. J Surg Res 2021; 264:418-424. [PMID: 33848841 DOI: 10.1016/j.jss.2021.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 02/21/2021] [Accepted: 02/27/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Surgical residencies use variable structures for formal training in education. We hypothesized that a one-day workshop intervention would improve resident teaching ability measured by self-assessment and learner evaluation. MATERIALS AND METHODS Faculty educators delivered a Residents as Teachers (RAT) workshop to general surgery residents on setting expectations, positive learning environment, difficult feedback and the 1-min preceptor model. For three months before and after the workshop, junior residents and medical students evaluated their supervising residents' teaching skill monthly using a Likert scale questionnaire. Pre- and postworkshop surveys were administered to resident participants to assess their knowledge of the material and teaching confidence. Results were analyzed using Wilcoxon rank sum tests. This study was conducted at a tertiary academic center with a large surgical residency program. RESULTS Thirty-nine PGY 1-5 residents participated in the Residents as Teachers workshop and were included in the study. Pre- and post- workshop survey results demonstrated significant improvements in participants' knowledge and teaching confidence. On monthly assessments of seniors by junior residents, significant improvements were noted in three domains. Medical student ratings did not reflect significant improvements in resident teaching skill. CONCLUSIONS This is the first study using learner evaluation of a comprehensive surgical RAT program. Despite a significant increase in surgery residents' self-assessment following participation in an education workshop, no improvement was seen in resident teaching skill as perceived by medical students.
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Affiliation(s)
- Asya Ofshteyn
- University Hospitals Cleveland Medical Center, Department of General Surgery, Cleveland Ohio; University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Cleveland Ohio
| | - Katherine Bingmer
- University Hospitals Cleveland Medical Center, Department of General Surgery, Cleveland Ohio; University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Cleveland Ohio
| | - Esther Tseng
- MetroHealth Medical Center, Department of General Surgery, Cleveland Ohio
| | - Melissa Times
- MetroHealth Medical Center, Department of General Surgery, Cleveland Ohio
| | - Megan Miller
- University Hospitals Cleveland Medical Center, Department of General Surgery, Cleveland Ohio; University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Cleveland Ohio
| | - John Ammori
- University Hospitals Cleveland Medical Center, Department of General Surgery, Cleveland Ohio; University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Cleveland Ohio
| | - Emily Steinhagen
- University Hospitals Cleveland Medical Center, Department of General Surgery, Cleveland Ohio; University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Cleveland Ohio.
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Huang J, Licatino L, Sims CR. Training the Trainer: Preparing Anesthesiology Residents to be Trainers in the Operating Room. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11116. [PMID: 33768148 PMCID: PMC7970634 DOI: 10.15766/mep_2374-8265.11116] [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: 04/24/2020] [Accepted: 12/24/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The transition into clinical anesthesiology is a challenging period that requires swift acquisition of clinical knowledge and procedural skills. Senior residents are in a prime position to help their junior colleagues into the operating room environment due to their ability to relate from personal experience. We created a workshop for enhancing peer apprenticeship during this transition. METHODS The workshop consisted of PowerPoint didactics interspersed with small-group practice sessions. Surveys were administered pre-, post-, 1-week post-, and 1-month postworkshop. The primary outcome was pre-post improvement in the proportion of residents prepared to be a trainer. Secondary outcomes included pre- to 1-week postworkshop improvement, pre-postworkshop change in knowledge of learning theory concepts, and pre-postworkshop change in first-year clinical anesthesiology perceptions of trainers. RESULTS Of residents, 12 of 43 (28%) eligible to be resident trainers attended the workshop. The proportion of residents who felt prepared increased from 75% preworkshop to 100% postworkshop and remained at 93% at 1 week. Knowledge of cognitive load and microskills improved from 0% preworkshop to 83% postworkshop but dropped to 0% at 1 month. Comfort using microskills improved from 0% preworkshop to 83% postworkshop. DISCUSSION Early anesthesiology training demands rapid acquisition of novel cognitive and procedural skills. Senior anesthesiology residents are in a prime position to train junior residents, yet many are uncomfortable with this role. We developed a workshop to transition residents into a peer trainer role and significantly increased their confidence to be a trainer. Other programs may benefit from implementing similar training.
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Affiliation(s)
- Jeffrey Huang
- Fellow, Department of Critical Care, Mayo Clinic Rochester
| | - Lauren Licatino
- Assistant Professor, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester
| | - Charles R. Sims
- Assistant Professor, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester; Assistant Professor, Department of Critical Care, Mayo Clinic Rochester
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McKinley SK, Cassidy DJ, Sell NM, Mullen JT, Saillant N, Petrusa E, Phitayakorn R, Gee D. A qualitative study of the perceived value of participation in a new Department of Surgery Research Residents as teachers program. Am J Surg 2020; 220:1194-1200. [PMID: 32723491 DOI: 10.1016/j.amjsurg.2020.06.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/06/2020] [Accepted: 06/25/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aims to understand the perspectives of surgical residents who completed a Research Residents as Teachers Program (RRATP). METHODS Our RRATP included a 6 h workshop followed by formal teaching opportunities across one academic year. Resident teachers participated in semi-structured interviews, which were inductively analyzed for prominent themes. RESULTS Eight surgical research residents completed the RRATP workshop and taught 330 h (median = 26 h, range: 8-105). Interview participation rate was 100%; kappa was 0.81. Residents reported four themes: 1) increased knowledge of teaching principles with subsequent teaching changes, specific factors that contributed to their development as a teacher, numerous personal benefits to participation, and broad positive consequences for the surgical department including improved culture and patient care. CONCLUSION A RRATP can generate a significant number of formal teaching hours by surgical research residents, who perceive a high value of formal education training to themselves and their surgical residency program.
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Affiliation(s)
- Sophia K McKinley
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street GRB 425, Boston, MA, 02114, USA.
| | - Douglas J Cassidy
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street GRB 425, Boston, MA, 02114, USA.
| | - Naomi M Sell
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street GRB 425, Boston, MA, 02114, USA.
| | - John T Mullen
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street GRB 425, Boston, MA, 02114, USA.
| | - Noelle Saillant
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street GRB 425, Boston, MA, 02114, USA.
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street GRB 425, Boston, MA, 02114, USA.
| | - Roy Phitayakorn
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street GRB 425, Boston, MA, 02114, USA.
| | - Denise Gee
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street GRB 425, Boston, MA, 02114, USA.
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Anderson MJ, Ofshteyn A, Miller M, Ammori J, Steinhagen E. "Residents as Teachers" Workshop Improves Knowledge, Confidence, and Feedback Skills for General Surgery Residents. JOURNAL OF SURGICAL EDUCATION 2020; 77:757-764. [PMID: 32057743 DOI: 10.1016/j.jsurg.2020.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 12/25/2019] [Accepted: 01/21/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Surgical residents receive limited formal training in education, yet they are expected to teach medical students and one another. A "Residents as Teachers" curriculum was developed and implemented to improve residents' knowledge of educational strategies, confidence in teaching abilities, and quality of feedback given to learners. DESIGN A 6-hour workshop was delivered at an academic general surgery residency program. It included 3 interactive sessions: "Teaching on the wards", "How to give and receive feedback", and "Teaching in the operating room (OR)". Pre- and postsession surveys were administered to evaluate participants' knowledge and confidence regarding teaching skills. Standard statistical analyses were used to compare pre- and postcurriculum scores. SETTING General surgery residents at Case Western Reserve University/University Hospitals Cleveland Medical Center Program attended a 6-hour educational seminar entitled "Residents as Teachers". Three attending surgeons with expertise in surgical education administered the curriculum. PARTICIPANTS Twenty-four residents completed the course and surveys (5 PGY-5s, 6 PGY-4s, 4 PGY-3s, 5 PGY-2s, and 4 PGY-1s). RESULTS On a 5-point Likert scale, residents' self-rating of teaching skills (pre = 1.8, post = 3.04, p < 0.001) and understanding of adult learning (pre = 1.88, post = 4.42, p < 0.001) improved significantly. The greatest gain was in describing effective strategies for teaching in the OR (pre = 1.75, post = 4.38, p < 0.001). Residents reported improved understanding of effective feedback characteristics (pre = 2.5, post = 4.33, p < 0.001), and felt more prepared to provide feedback to learners (pre = 2.73, post = 3.17, p = 0.01). Scores on 5 of 10 knowledge-based questions significantly improved following the intervention. All participants agreed or strongly agreed that the workshop improved the program's surgical education curriculum (mean score 4.42 of 5). CONCLUSIONS A "Residents as Teachers" workshop improved resident confidence in teaching and feedback skills, particularly for intraoperative instruction, and improved knowledge in the 3 specific educational domains included in the session.
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Affiliation(s)
- Mark J Anderson
- Case Western Reserve University School of Medicine, Cleveland, Ohio; University Hospitals Cleveland Medical Center, Cleveland, Ohio; University Hospitals Research in Surgical Outcomes and Effectiveness Center (UH-RISES), Cleveland, Ohio
| | - Asya Ofshteyn
- Case Western Reserve University School of Medicine, Cleveland, Ohio; University Hospitals Cleveland Medical Center, Cleveland, Ohio; University Hospitals Research in Surgical Outcomes and Effectiveness Center (UH-RISES), Cleveland, Ohio
| | - Megan Miller
- Case Western Reserve University School of Medicine, Cleveland, Ohio; University Hospitals Cleveland Medical Center, Cleveland, Ohio; University Hospitals Research in Surgical Outcomes and Effectiveness Center (UH-RISES), Cleveland, Ohio
| | - John Ammori
- Case Western Reserve University School of Medicine, Cleveland, Ohio; University Hospitals Cleveland Medical Center, Cleveland, Ohio; University Hospitals Research in Surgical Outcomes and Effectiveness Center (UH-RISES), Cleveland, Ohio
| | - Emily Steinhagen
- Case Western Reserve University School of Medicine, Cleveland, Ohio; University Hospitals Cleveland Medical Center, Cleveland, Ohio; University Hospitals Research in Surgical Outcomes and Effectiveness Center (UH-RISES), Cleveland, Ohio.
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Lee CH, Chen PJ, Lai HY, Lee CY, Fan KH, Tsang NM, Chang JTC. A scoping review of medical education research for residents in radiation oncology. BMC MEDICAL EDUCATION 2020; 20:13. [PMID: 31931783 PMCID: PMC6958614 DOI: 10.1186/s12909-020-1927-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 01/06/2020] [Indexed: 05/10/2023]
Abstract
BACKGROUND Both medical education and radiation oncology have progressed significantly in the past decade, but a generalized overview of educational research for radiation oncology residents has not been produced. This study examines recent research trends in medical education for residents in radiation oncology through a scoping review. METHODS We conducted a scoping review of medical education research for residents in radiation oncology to survey the research trends. We used publications available on MEDLINE, PubMed, and Scopus to conduct this scoping review. RESULTS We screened 221 full-text articles, 146 of which met our inclusion criteria. These publications showed increased activity in medical education research for residents, most involving affiliations in the United States. We identified persistent interest in training-, contouring-, and technology-related issues. An increase in research related to career, treatment quality, and multidisciplinary training was also observed. However, no research about teacher training was identified. CONCLUSIONS This scoping review presents the trends in study interests among stakeholders of medical education research in radiation oncology. With an investigation of existing studies, this research identifies areas of high priority and a lack of studies about teacher training. This study provides potential future directions for medical education research for residents in radiation oncology.
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Affiliation(s)
- Ching-Hsin Lee
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Chang Gung Memorial Hospital at Linkou, No.5, Fuxing St., Guishan Dist, Taoyuan City, 333 Taiwan
| | - Po-Jui Chen
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Chang Gung Memorial Hospital at Linkou, No.5, Fuxing St., Guishan Dist, Taoyuan City, 333 Taiwan
| | - Hung-Yi Lai
- Chang Gung Medical Education Research Centre (CG-MERC), Chang Gung Memorial Hospital at Linkou, No.5, Fuxing St., Guishan Dist, Taoyuan City, 333 Taiwan
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, No.5, Fuxing St., Guishan Dist, Taoyuan City, 333 Taiwan
| | - Ching-Yi Lee
- Chang Gung Medical Education Research Centre (CG-MERC), Chang Gung Memorial Hospital at Linkou, No.5, Fuxing St., Guishan Dist, Taoyuan City, 333 Taiwan
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, No.5, Fuxing St., Guishan Dist, Taoyuan City, 333 Taiwan
| | - Kang-Hsing Fan
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Chang Gung Memorial Hospital at Linkou, No.5, Fuxing St., Guishan Dist, Taoyuan City, 333 Taiwan
| | - Ngan-Ming Tsang
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Chang Gung Memorial Hospital at Linkou, No.5, Fuxing St., Guishan Dist, Taoyuan City, 333 Taiwan
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Chang Gung Memorial Hospital at Linkou, No.5, Fuxing St., Guishan Dist, Taoyuan City, 333 Taiwan
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