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Sathe TS, Shah M, Pokrzywa CJ, Crum RW, Krishnamoorthy S, McManus C. An Open Operative Readiness Standard for Surgical Trainees. J Surg Res 2024; 293:281-290. [PMID: 37804798 DOI: 10.1016/j.jss.2023.09.017] [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: 03/14/2023] [Revised: 08/31/2023] [Accepted: 09/06/2023] [Indexed: 10/09/2023]
Abstract
INTRODUCTION The American Board of Surgery is transitioning from a volume-based to a competency-based assessment of residents using Entrustable Professional Activities. This form of feedback and evaluation should also apply to operative procedures to help residents track their own progress. We describe an operative readiness tool that measures perceived competency in trainees across several operative, procedural, and clinical activities. METHODS We distributed a survey to General Surgery trainees at our institution. Participants were asked to rate their level of comfort in 28 operative, procedural, or clinical activities using the standard Entrustable Professional Activity scale: (1) Observation Only, (2) Direct Supervision, (3) Indirect Supervision, (4) Unsupervised Practice, or (5) Supervising Others. RESULTS 43 of 46 residents (93%) responded to the survey. Median perceived comfort level generally increased with post graduate year level across all competencies. Residents reached a median perceived level of "Unsupervised Practice" by post graduate year 5 in 17 of 28 competencies of various complexity levels. CONCLUSIONS While residents are not expected to achieve an "Unsupervised Practice" comfort level in all competencies, creating a transparent platform for reporting this information provides programs a tool to guide educational quality improvement efforts. In addition, it allows for program directors to have greater resolution into the operative advancement of residents outside of their own specialty. In the future, this tool may be instrumental in the development of national competency standards.
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Affiliation(s)
- Tejas S Sathe
- Department of Surgery, Columbia University, New York, New York.
| | - Meghal Shah
- Department of Surgery, Columbia University, New York, New York
| | | | - Robert W Crum
- Department of Surgery, Columbia University, New York, New York
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Collings AT, Doster DL, Longtin K, Choi J, Torbeck L, Stefanidis D. Surgical Resident Perspectives on the Preferred Qualities of Effective Intraoperative Teachers: A Qualitative Analysis. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:629-635. [PMID: 36598471 DOI: 10.1097/acm.0000000000005131] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
PURPOSE Intraoperative teaching is a critical component of surgery residents' education. Although prior studies have investigated best practices from the viewpoint of the expert educator, the perspective of the learner has been less explored. This study examined the ideal faculty teaching behaviors that optimize intraoperative teaching from the surgical residents' perspective. METHOD Using a grounded theory method, this study explored perspectives on intraoperative faculty teaching qualities of 5 focus groups of categorical clinical general surgical residents of the same postgraduate year from June to August 2021. Focus group discussions were recorded, transcribed, and coded. Emerging themes were identified, along with their corresponding subthemes. RESULTS Thirty-nine general surgery residents participated in the focus groups. Overall, 6 themes emerged regarding resident priorities of intraoperative teaching, with 10 subthemes. Themes included the following: (1) character, with subthemes of caring, respect for resident, and self-control; (2) intraoperative skill, with subthemes of clinical and operative skill and modeling leadership in the operating room; (3) instructional approach; (4) feedback, with subthemes of content of feedback and debriefing; (5) discernment of resident needs, with subthemes of managing expectations, individualizing instruction, and autonomy; and (6) variety of teachers. CONCLUSIONS Certain tangible strategies, such as demonstrating genuine care for the learner, using clear directional words, and giving actionable feedback, were considered vital by residents. In the development of great surgical educators, the emphasis should not be on conformity to a single idealized teaching style but should celebrate and encourage diversity of personas and teaching styles within a department or program.
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Affiliation(s)
- Amelia T Collings
- A.T. Collings is a surgery resident, Department of Surgery, University of Louisville, Louisville, Kentucky. At the beginning of this work, the author was a surgical education research fellow, Indiana University School of Medicine, Indianapolis, Indiana
| | - Dominique L Doster
- D.L. Doster is a surgical education research fellow, Indiana University School of Medicine, Indianapolis, Indiana
| | - Krista Longtin
- K. Longtin is associate professor of communication studies, Indiana University School of Liberal Arts at Indiana University-Purdue University Indianapolisassistant dean of faculty affairs and professional development, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jennifer Choi
- J. Choi is associate professor of clinical surgery and program director for general surgery residency, Indiana University School of Medicine, Indianapolis, Indiana
| | - Laura Torbeck
- L. Torbeck is professor of surgery and vice chair of professional development, Department of Surgeryassistant dean for faculty affairs and professional development, Indiana University School of Medicine, Indianapolis, Indiana
| | - Dimitrios Stefanidis
- D. Stefanidis is professor of surgery and vice chair of education, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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Foretia DA. To decolonize global surgery and global health we must be radically intentional. Am J Surg 2023; 225:595-596. [PMID: 36302698 DOI: 10.1016/j.amjsurg.2022.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Denis A Foretia
- Division of Health Policy and Research, Nkafu Policy Institute, Yaoundé, Cameroon; Center for Multicultural and Global Health, University of Tennessee Health Science Center, Memphis, TN, USA; Global Surgery Institute, University of Tennessee Health Science Center, Memphis, TN, USA.
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Nyren MQ, Filiberto AC, Underwood PW, Abbott KL, Balch JA, Mas FD, Cobianchi L, Efron PA, George BC, Shickel B, Upchurch GR, Sarosi GA, Loftus TJ. Surgical resident experience with common bile duct exploration and assessment of performance and autonomy with formative feedback. World J Emerg Surg 2023; 18:13. [PMID: 36747289 PMCID: PMC9901129 DOI: 10.1186/s13017-023-00480-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/23/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Common bile duct exploration (CBDE) is safe and effective for managing choledocholithiasis, but most US general surgeons have limited experience with CBDE and are uncomfortable performing this procedure in practice. Surgical trainee exposure to CBDE is limited, and their learning curve for achieving autonomous, practice-ready performance has not been previously described. This study tests the hypothesis that receipt of one or more prior CBDE operative performance assessments, combined with formative feedback, is associated with greater resident operative performance and autonomy. METHODS Resident and attending assessments of resident operative performance and autonomy were obtained for 189 laparoscopic or open CBDEs performed at 28 institutions. Performance and autonomy were graded along validated ordinal scales. Cases in which the resident had one or more prior CBDE case evaluations (n = 48) were compared with cases in which the resident had no prior evaluations (n = 141). RESULTS Compared with cases in which the resident had no prior CBDE case evaluations, cases with a prior evaluation had greater proportions of practice-ready or exceptional performance ratings according to both residents (27% vs. 11%, p = .009) and attendings (58% vs. 19%, p < .001) and had greater proportions of passive help or supervision only autonomy ratings according to both residents (17% vs. 4%, p = .009) and attendings (69% vs. 32%, p < .01). CONCLUSIONS Residents with at least one prior CBDE evaluation and formative feedback demonstrated better operative performance and received greater autonomy than residents without prior evaluations, underscoring the propensity of feedback to help residents achieve autonomous, practice-ready performance for rare operations.
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Affiliation(s)
- Molly Q Nyren
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Amanda C Filiberto
- Department of Surgery, University of Florida Health, PO Box 100286, Gainesville, FL, 32610, USA
| | - Patrick W Underwood
- Department of Surgery, University of Florida Health, PO Box 100286, Gainesville, FL, 32610, USA
| | - Kenneth L Abbott
- Department of Surgery, University of Florida Health, PO Box 100286, Gainesville, FL, 32610, USA
| | - Jeremy A Balch
- Department of Surgery, University of Florida Health, PO Box 100286, Gainesville, FL, 32610, USA
| | - Francesca Dal Mas
- Department of Management, Ca' Foscari University of Venice, Venice, Italy
| | - Lorenzo Cobianchi
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- IRCCS Policlinico San Matteo Foundation, General Surgery, Pavia, Italy
| | - Philip A Efron
- Department of Surgery, University of Florida Health, PO Box 100286, Gainesville, FL, 32610, USA
| | - Brian C George
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Benjamin Shickel
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Gilbert R Upchurch
- Department of Surgery, University of Florida Health, PO Box 100286, Gainesville, FL, 32610, USA
| | - George A Sarosi
- Department of Surgery, University of Florida Health, PO Box 100286, Gainesville, FL, 32610, USA
| | - Tyler J Loftus
- Department of Surgery, University of Florida Health, PO Box 100286, Gainesville, FL, 32610, USA.
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Bobel MC, Al Hinai A, Roslani AC. Cultural Sensitivity and Ethical Considerations. Clin Colon Rectal Surg 2022; 35:371-375. [PMID: 36111081 PMCID: PMC9470284 DOI: 10.1055/s-0042-1746186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Global surgery is a burgeoning area of global health. Surgeons can engage in one-or many-of the facets of global healthcare delivery: clinical care, capacity building, education, research, etc. Working in an increasingly global community, surgeons must be aware of the richness of cultural diversity at home and around the world such that they can provide culturally sensitive care. This chapter focuses on the most common way in which surgeons engage in global surgery: surgical short-term experiences in global health (STEGHs). Surgical STEGHs pose an intricate set of ethical dilemmas. As team leaders, surgeons must understand the community they intend to serve on these trips. Further, they should confirm that everyone who joins them is prepared to deliver care in a culturally sensitive and competent manner. Finally, surgeons must consider potential ethical dilemmas that may arise before, during, and after surgical STEGHs and have strategies to navigate them.
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Affiliation(s)
| | - Alreem Al Hinai
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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From the editor - In - chief: Featured papers in the February 2022 issue. Am J Surg 2021; 223:221. [PMID: 34952687 DOI: 10.1016/j.amjsurg.2021.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Gutnik LA, Petroze RT. Optimizing US surgical trainees for global engagement. Am J Surg 2021; 223:222-223. [PMID: 34535291 DOI: 10.1016/j.amjsurg.2021.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/09/2021] [Accepted: 09/09/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Lily A Gutnik
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
| | - Robin T Petroze
- Department of Surgery, University of Florida, Gainesville, Fl, USA
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