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Quinn KM, Runge LT, Griffiths C, Harris H, Pieper H, Meara M, Poulose B, Narula V, Renton D, Collins C, Harzman A, Husain S. Laparoscopic vs robotic inguinal hernia repair: a comparison of learning curves and skill transference in general surgery residents. Surg Endosc 2024; 38:3346-3352. [PMID: 38693306 DOI: 10.1007/s00464-024-10860-5] [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: 02/24/2024] [Accepted: 04/10/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND There is no consensus on whether laparoscopic experience should be a prerequisite for robotic training. Further, there is limited information on skill transference between laparoscopic and robotic techniques. This study focused on the general surgery residents' learning curve and skill transference within the two minimally invasive platforms. METHODS General surgery residents were observed during the performance of laparoscopic and robotic inguinal hernia repairs. The recorded data included objective measures (operative time, resident participation indicated by percent active time on console or laparoscopy relative to total case time, number of handoffs between the resident and attending), and subjective evaluations (preceptor and trainee assessments of operative performance) while controlling for case complexity, patient comorbidities, and residents' prior operative experience. Wilcoxon two-sample tests and Pearson Correlation coefficients were used for analysis. RESULTS Twenty laparoscopic and forty-four robotic cases were observed. Mean operative times were 90 min for robotic and 95 min for laparoscopic cases (P = 0.4590). Residents' active participation time was 66% on the robotic platform and 37% for laparoscopic (P = < 0.0001). On average, hand-offs occurred 9.7 times during robotic cases and 6.3 times during laparoscopic cases (P = 0.0131). The mean number of cases per resident was 5.86 robotic and 1.67 laparoscopic (P = 0.0312). For robotic cases, there was a strong correlation between percent active resident participation and their prior robotic experience (r = 0.78) while there was a weaker correlation with prior laparoscopic experience (r = 0.47). On the other hand, prior robotic experience had minimal correlation with the percent active resident participation in laparoscopic cases (r = 0.12) and a weak correlation with prior laparoscopic experience (r = 0.37). CONCLUSION The robotic platform may be a more effective teaching tool with a higher degree of entrustability indicated by the higher mean resident participation. We observed a greater degree of skill transference from laparoscopy to the robot, indicated by a higher degree of correlation between the resident's prior laparoscopic experience and the percent console time in robotic cases. There was minimal correlation between residents' prior robotic experience and their participation in laparoscopic cases. Our findings suggest that the learning curve for the robot may be shorter as prior robotic experience had a much stronger association with future robotic performance compared to the association observed in laparoscopy.
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Affiliation(s)
- Kristen M Quinn
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
- Department of Surgery, Medical University of South Carolina, 96 Jonathan Lucas St., Charleston, SC, 29425, USA.
| | - Louis T Runge
- Department of Surgery, Medical University of South Carolina, 96 Jonathan Lucas St., Charleston, SC, 29425, USA
| | - Claire Griffiths
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Hannah Harris
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Heidi Pieper
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Michael Meara
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ben Poulose
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Vimal Narula
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - David Renton
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Courtney Collins
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Alan Harzman
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Syed Husain
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Yoder L, Elson N, Fellner AN, Meister K, Guend H. Residents underestimate their robotic performance: evaluating resident robotic console participation time. J Robot Surg 2024; 18:211. [PMID: 38727932 PMCID: PMC11087327 DOI: 10.1007/s11701-023-01790-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 10/24/2023] [Indexed: 05/13/2024]
Abstract
Lack of formal national robotic curriculum results in a void of knowledge regarding appropriate progression of autonomy in robotic general surgery training. One midwestern academic surgical training program has demonstrated that residents expect to independently operate more on the robotic console than they perceive themselves to do. As such, our study sought to evaluate expectations of residents and faculty regarding resident participation versus actual console participation time (CPT) at a community general surgery training program. We surveyed residents and faculty in two phases. Initially, participants were asked to reflect on their perceptions and expectations from the previous six months. The second phase included surveys (collected over six months) after individual cases with subjective estimation of participation versus CPT calculated by the Intuitive Surgical, Inc. MyIntuitive application. Using Mann-Whitney U-Test, we compared resident perceptions of CPT to actual CPT by case complexity and post-graduate year (PGY). Faculty (n = 7) estimated they allowed residents to complete a median of 26-50% of simple and 0-25% of complex cases in the six months prior to the study. They expected senior residents (PGY-4 and PGY-5) to complete more: 51-75% of simple and 26-50% of complex cases. Residents (n = 13), PGY-2-PGY-5, estimated they completed less than faculty perceived (0-25% of simple and 0-25% of complex cases). Sixty-six post-case (after partial colectomy, abdominoperoneal resection, low anterior resection, cholecystectomy, inguinal/ventral hernia repair, and others) surveys were completed. Residents estimated after any case that they had completed 26-50% of the case. However, once examining their MyIntuitive report, they actually completed 51-75% of the case (median). Residents, especially PGY-4 and 5, completed a higher percentage than estimated of robotic cases. Our study confirms that residents can and should complete more of (and increasingly complex) robotic cases throughout training, like the transition of autonomy in open and laparoscopic surgery.
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Affiliation(s)
- Lauren Yoder
- TriHealth Surgical Institute, 375 Dixmyth Ave, Cincinnati, OH, 45220, USA.
| | - Nora Elson
- TriHealth Surgical Institute, 375 Dixmyth Ave, Cincinnati, OH, 45220, USA
| | | | - Katherine Meister
- TriHealth Surgical Institute, 375 Dixmyth Ave, Cincinnati, OH, 45220, USA
| | - Hamza Guend
- TriHealth Surgical Institute, 375 Dixmyth Ave, Cincinnati, OH, 45220, USA
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Abahuje E, Smith KS, Amortegui D, Eng JS, Philbin SE, Verma R, Dastoor JD, Schlick C, Ma M, Mackiewicz NI, Choi JN, Greenberg J, Johnson J, Bilimoria KY, Hu YY. See One, Do One, Improve One's Wellness: Resident Autonomy in US General Surgery Programs, A Mixed-methods Study. Ann Surg 2023; 278:1045-1052. [PMID: 37450707 DOI: 10.1097/sla.0000000000006002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
OBJECTIVE We sought to examine the factors associated with resident perceptions of autonomy and to characterize the relationship between resident autonomy and wellness. BACKGROUND Concerns exist that resident autonomy is decreasing, impacting competence. METHODS Quantitative data were collected through a cross-sectional survey administered after the 2020 ABSITE. Qualitative data were collected through interviews and focus groups with residents and faculty at 15 programs. RESULTS Seven thousand two hundred thirty-three residents (85.5% response rate) from 324 programs completed the survey. Of 5139 residents with complete data, 4424 (82.2%) reported appropriate autonomy, and these residents were less likely to experience burnout [odds ratio (OR) 0.69; 95% CI 0.58-0.83], suicidality (OR 0.69; 95% CI 0.54-0.89), and thoughts of leaving their programs (OR 0.45; 95% CI 0.37-0.54). Women were less likely to report appropriate autonomy (OR 0.81; 95% CI 0.68-0.97). Residents were more likely to report appropriate autonomy if they also reported satisfaction with their workload (OR 1.65; 95% CI 1.28-2.11), work-life balance (OR 2.01; 95% CI 1.57-2.58), faculty engagement (OR 3.55; 95% CI 2.86-4.35), resident camaraderie (OR 2.23; 95% CI, 1.78-2.79), and efficiency and resources (OR 2.37; 95% CI 1.95-2.88). Qualitative data revealed that (1) autonomy gives meaning to the clinical experience of residency, (2) multiple factors create barriers to autonomy, and (3) autonomy is not inherent to the training paradigm, requiring residents to learn behaviors to "earn" it. CONCLUSION Autonomy is not considered an inherent part of the training paradigm such that residents can assume that they will achieve it. Resources to function autonomously should be allocated equitably to support all residents' educational growth and wellness.
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Affiliation(s)
- Egide Abahuje
- Northwestern QUality Improvement, Research, and Education in Surgery (NSQUIRES), Department of Surgery, Northwestern University, Chicago, IL
| | - Kathryn S Smith
- Northwestern QUality Improvement, Research, and Education in Surgery (NSQUIRES), Department of Surgery, Northwestern University, Chicago, IL
| | - Daniela Amortegui
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Indiana University, Indianapolis, IN
| | - Joshua S Eng
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Indiana University, Indianapolis, IN
| | - Sarah E Philbin
- Center for Education in Health Sciences, Northwestern University, Chicago, IL
| | - Rhea Verma
- Northwestern QUality Improvement, Research, and Education in Surgery (NSQUIRES), Department of Surgery, Northwestern University, Chicago, IL
| | - Jehannaz Dinyar Dastoor
- Northwestern QUality Improvement, Research, and Education in Surgery (NSQUIRES), Department of Surgery, Northwestern University, Chicago, IL
| | - Cary Schlick
- Northwestern QUality Improvement, Research, and Education in Surgery (NSQUIRES), Department of Surgery, Northwestern University, Chicago, IL
| | - Meixi Ma
- Northwestern QUality Improvement, Research, and Education in Surgery (NSQUIRES), Department of Surgery, Northwestern University, Chicago, IL
| | - Natalia I Mackiewicz
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Indiana University, Indianapolis, IN
| | | | | | - Julie Johnson
- Northwestern QUality Improvement, Research, and Education in Surgery (NSQUIRES), Department of Surgery, Northwestern University, Chicago, IL
| | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Indiana University, Indianapolis, IN
| | - Yue-Yung Hu
- Northwestern QUality Improvement, Research, and Education in Surgery (NSQUIRES), Department of Surgery, Northwestern University, Chicago, IL
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital, Northwestern University, Chicago, IL
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Clanahan JM, Yee A, Awad MM. Active control time: an objective performance metric for trainee participation in robotic surgery. J Robot Surg 2023; 17:2117-2123. [PMID: 37237112 DOI: 10.1007/s11701-023-01628-5] [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: 05/08/2023] [Accepted: 05/21/2023] [Indexed: 05/28/2023]
Abstract
Trainee participation and progression in robotic general surgery remain poorly defined. Computer-assisted technology offers the potential to provide and track objective performance metrics. In this study, we aimed to validate the use of a novel metric-active control time (ACT)-for assessing trainee participation in robotic-assisted cases. Performance data from da Vinci Surgical Systems was retrospectively analyzed for all robotic cases involving trainees with a single minimally invasive surgeon over 10 months. The primary outcome metric was percent ACT-the amount of trainee console time spent in active system manipulations over total active time from both consoles. Kruskal-Wallis and Mann-Whitney U statistical tests were applied in analyses. A total of 123 robotic cases with 18 general surgery residents and 1 fellow were included. Of these, 56 were categorized as complex. Median %ACT was statistically different between trainee levels for all case types taken in aggregate (PGY1s 3.0% [IQR 2-14%], PGY3s 32% [IQR 27-66%], PGY4s 42% [IQR 26-52%], PGY5s 50% [IQR 28-70%], and fellow 61% [IQR 41-85%], p = < 0.0001). When stratified by complexity, median %ACT was higher in standard versus complex cases for PGY5 (60% vs. 36%, p = 0.0002) and fellow groups (74% vs. 47%, p = 0.0045). In this study, we demonstrated an increase in %ACT with trainee level and with standard versus complex robotic cases. These findings are consistent with hypotheses, providing validity evidence for ACT as an objective measurement of trainee participation in robotic-assisted cases. Future studies will aim to define task-specific ACT to guide further robotic training and performance assessments.
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Affiliation(s)
- Julie M Clanahan
- Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Mailstop 8109-22-9905, Campus Box 8109, St. Louis, MO, 63110-1093, USA.
| | - Andrew Yee
- Data and Analytics, Intuitive Surgical, Inc., Peachtree Corners, GA, 30092, USA
| | - Michael M Awad
- Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Mailstop 8109-22-9905, Campus Box 8109, St. Louis, MO, 63110-1093, USA
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Tolis G, Piechura LM, Mohan N, Pomerantsev EV, Hirji SA, Bloom JP. Operative Teaching of Coronary Bypass and Need for Repeat Catheterization: Does it Matter Who is Sewing? JOURNAL OF SURGICAL EDUCATION 2023; 80:826-832. [PMID: 37080797 DOI: 10.1016/j.jsurg.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/22/2023] [Accepted: 04/01/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE There are no studies to date comparing the patency of coronary bypass grafts constructed by attending surgeons versus trainees and the potential consequences of any such disparities. We explored this issue by comparing the patency of individual anastomoses performed by residents versus the attending surgeon. DESIGN We reviewed 765 continuous cases performed by a single surgeon which involved at least 1 coronary bypass anastomosis, totaling 2,173 distal anastomoses. At a median follow-up time of 36 months (interquartile range 20.5-47.3), 83 (10.9%) patients had undergone 110 cardiac catheterization procedures after their original operation for various indications. This angiographic information provided the data for our comparison cohorts. SETTING Cardiac surgery practice within an academic setting PARTICIPANTS: Adult patient undergoing coronary bypass grafting RESULTS: Of the 83 patients that underwent repeat catheterization, 23 (27.7%) were resident cases, 25 (30.1%) were attending cases and 35 (42.2%) were mixed. There were 4/83 (4.8%) patients with angiographic evidence of internal mammary artery graft compromise of which 3/4 (75%) had been constructed by the attending surgeon. Angiographic evidence of saphenous vein graft compromise was appreciated in 16/83 (19.3%) patients of which 9/16 (56.3%) of the grafts were constructed by the attending surgeon. CONCLUSIONS Liberal involvement of surgical trainees as primary operators in coronary revascularization cases led to equivalent rates of postoperative ischemic complications between the attending and resident groups. The outcome equivalence was also maintained when evaluated at the individual anastomosis patency level between the 2 groups. We conclude that academic programs should continue providing trainees significant experience as primary operating surgeons without fear of clinical outcome compromise.
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Affiliation(s)
- George Tolis
- Division of Thoracic and Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Laura M Piechura
- Division of Thoracic and Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Navyatha Mohan
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Eugene V Pomerantsev
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Sameer A Hirji
- Division of Thoracic and Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jordan P Bloom
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
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Brandão CMDA, Pêgo-Fernandes PM. HANDS-ON: Training Simulation in Surgery. SAO PAULO MED J 2023; 141:e20231413. [PMID: 37042932 PMCID: PMC10085531 DOI: 10.1590/1516-3180.2022.1413230223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Affiliation(s)
- Carlos Manuel de Almeida Brandão
- MD, PhD. Attending Physician Cardiovascular Surgery Department, Heart Institute, University of Sao Paulo Medical School, São Paulo, SP, Brazil
| | - Paulo Manuel Pêgo-Fernandes
- MD, PhD. Vice Director, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Full Professor, Department of Cardiopulmonology, Instituto do Coração, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Director, Scientific Department, Associação Paulista de Medicina (APM), São Paulo (SP), Brazil
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Mehaffey JH, Kron I. General Principles of Teaching Cardiac Surgery. J Thorac Cardiovasc Surg 2022; 164:e487-e490. [DOI: 10.1016/j.jtcvs.2022.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/05/2022] [Accepted: 07/18/2022] [Indexed: 11/26/2022]
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Simmonds A, Otoya D, Lavingia KS, Amendola MF. Assessing Resident Impact on Surgical Outcomes in Below-the-Knee Amputations Based on Operative Autonomy. Ann Vasc Surg 2022; 87:57-63. [PMID: 35472501 DOI: 10.1016/j.avsg.2022.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/14/2022] [Accepted: 04/18/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Gradual increases in resident autonomy with attending physician oversight is crucial to developing safe and competent surgeons1. The Veterans Affairs Surgical Quality Improvement Program (VASQIP) follows surgical outcomes within the VA. We set forth to examine the VASQIP database to compare outcomes between resident independent cases and nonindependent cases during below-the-knee amputations (BKA). METHODS All VASQIP records for BKA from 2000 to 2020 were examined and categorized based on whether the attending was scrubbed during the case. Case matching was performed based on preoperative comorbidities; 30-day postoperative outcomes, including a return to the operating room, wound infection, and mortality, were assessed in addition to operative time, hospital length of stay, and transfusion requirements. Student's t-test and Fisher's Exact Test were utilized. RESULTS A total of 13,208 BKA VASQIP records were obtained. After case control matching, 2,688 cases remained. Cases were identified with the attending surgeon noted as being scrubbed during the case (n = 1,344), or not scrubbed (n = 1,344). Patients were similar in comorbidities across both groups. No statistically significant difference in operative time (1.52 hr ± 0.78 vs. 1.47 hr ± 0.75, P = 0.08), 30-day mortality (3.3% vs. 4.8%, P = 0.05), or complication rate (19.5% vs. 21.3%, P = 0.25). Resident independent cases were noted to have slightly longer postop length of stay (12.47 days ± 12.69 vs. 15.33 days ± 20.56, P < 0.01) and operative bleeding requiring more than 4 units transfused (0.3% vs. 1.3%, P ≤ 0.01). CONCLUSIONS Resident independent operating during below-the-knee amputation at VA hospitals is associated with an increased length of stay and blood transfusion. There was no statistically significant increase in operative time, 30-day mortality, or total complication rate. Further research is required to assess the risks associated with surgical training, resident supervision, and resident preparedness for independent practice.
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Affiliation(s)
- Alexander Simmonds
- Division of Vascular Surgery, Central Virginia Veterans Administration Health System, Richmond, VA
| | - Diana Otoya
- Division of Vascular Surgery, Central Virginia Veterans Administration Health System, Richmond, VA
| | - Kedar S Lavingia
- Division of Vascular Surgery, Central Virginia Veterans Administration Health System, Richmond, VA.
| | - Michael F Amendola
- Division of Vascular Surgery, Central Virginia Veterans Administration Health System, Richmond, VA
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White A, O'Brien D, Singh G, Zheng B, Moon MC, Turner SR. Characterizing the Level of Autonomy in Canadian Cardiac Surgery Residents. Ann Thorac Surg 2022; 114:1538-1541. [PMID: 35339449 DOI: 10.1016/j.athoracsur.2022.02.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 02/04/2022] [Accepted: 02/22/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Abigail White
- Department of Surgery, University of Alberta, Edmonton, Alberta; Mazankowski Alberta Heart Institute, Alberta Health Services.
| | - Devin O'Brien
- Department of Surgery, University of Alberta, Edmonton, Alberta; Mazankowski Alberta Heart Institute, Alberta Health Services
| | - Gurmeet Singh
- Department of Surgery, University of Alberta, Edmonton, Alberta; Mazankowski Alberta Heart Institute, Alberta Health Services; Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta
| | - Bin Zheng
- Department of Surgery, University of Alberta, Edmonton, Alberta
| | - Michael C Moon
- Department of Surgery, University of Alberta, Edmonton, Alberta; Mazankowski Alberta Heart Institute, Alberta Health Services
| | - Simon R Turner
- Department of Surgery, University of Alberta, Edmonton, Alberta
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Olumolade OO, Rollins PD, Daignault-Newton S, George BC, Kraft KH. Closing the Gap: Evaluation of Gender Disparities in Urology Resident Operative Autonomy and Performance. JOURNAL OF SURGICAL EDUCATION 2022; 79:524-530. [PMID: 34782271 DOI: 10.1016/j.jsurg.2021.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/05/2021] [Accepted: 10/23/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Gender disparities have demonstrated influence on several areas of medical trainee academic performance and surgeon professional attainment. The impact of gender on perceived operative autonomy and performance of urology residents is not well understood. This single-institution pilot study explores this relationship by evaluating urology faculty and resident assessment of resident operative autonomy and performance using the Society for Improving Medical Professional Learning app. DESIGN Using Society for Improving Medical Professional Learning, trainees in a single urology residency program were assessed in operative cases on three scales (autonomy, performance, and case complexity). Intraoperative assessments were completed by both faculty and residents (self-evaluation). Respective evaluations were compared to explore differences in ratings by gender. SETTING University of Michigan Health, Ann Arbor, MI. PARTICIPANTS University of Michigan Urology Residents and Faculty. RESULTS A total of 516 evaluations were submitted from 18 urology residents and 20 urology faculty. Self-reported ratings among female and male residents did not differ significantly for autonomy (p = 0.20) or performance (p = 0.82). Female and male residents received overall similar autonomy ratings that were not significantly different from female faculty (p = 0.66) and male faculty (p = 0.81). For female residents, there was no significant difference in performance ratings by faculty gender (p = 0.20). This finding was consistent when the resident was male (p = 0.70). CONCLUSIONS At our institution, there is no overall gender-based difference in self-rated or faculty-rated operative autonomy or performance among urology trainees. Understanding relevant facets of institutional culture as well as educational strategies between faculty and residents may identify factors contributing to this outcome.
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Affiliation(s)
| | - Paris D Rollins
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - Brian C George
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Kate H Kraft
- Department of Urology, University of Michigan, Ann Arbor, Michigan.
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Chen JX, Deng F, Filimonov A, Shuman EA, Marchiano E, George BC, Thorne M, Pletcher SD, Platt M, Teng MS, Kozin ED, Gray ST. Multi-institutional Study of Otolaryngology Resident Intraoperative Experiences for Key Indicator Procedures. Otolaryngol Head Neck Surg 2021; 167:268-273. [PMID: 34609936 DOI: 10.1177/01945998211050350] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There is concern that current otolaryngology residents may not receive adequate surgical training. We aimed to characterize residents' surgical experiences at 5 academic centers performing the 14 key indicator procedures (KIPs) outlined by the Accreditation Council for Graduate Medical Education. STUDY DESIGN Prospective study. SETTING Five otolaryngology training programs. METHODS Data were gathered from December 2019 to December 2020 with a smartphone application from the Society for Improving Medical Professional Learning. After each operation, residents and faculty rated trainee autonomy on a 4-level Zwisch scale and performance on a 5-level modified Dreyfus scale. RESULTS Residents and attendings (n = 92 and 78, respectively) logged 2984 evaluations. Attending ratings of resident autonomy and performance increased with training level (P < .001). Resident self-assessments of autonomy and performance were lower than paired attending assessments (P < .001). Among attending evaluations of KIPs performed by senior residents (postgraduate year 4 or 5), 55% of cases were performed with meaningful autonomy (passive help or supervision only). Similarly, attendings rated 55% of these cases as a practice-ready or exceptional performance. Senior residents had meaningful autonomy for ≥50% of cases for most KIPs, with the exception of flaps and grafts (40%), pediatric/adult airway (39%), and stapedectomy/ossiculoplasty (33%). Similarly, senior residents received practice-ready or exceptional performance ratings for ≥50% of cases across all KIPs other than pediatric/adult airway (42%) and stapedectomy/ossiculoplasty (33%). CONCLUSION In this multicenter study, resident surgical autonomy and performance varied across otolaryngology KIPs. The development of nationwide benchmarks will help programs and residents set educational goals. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Jenny X Chen
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Francis Deng
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrey Filimonov
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York City, New York, USA
| | - Elizabeth A Shuman
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Emily Marchiano
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Brian C George
- Center for Surgical Training and Research, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Marc Thorne
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Steven D Pletcher
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Michael Platt
- Department of Otolaryngology-Head and Neck Surgery, Boston University Medical Center, Boston, Massachusetts, USA
| | - Marita S Teng
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York City, New York, USA
| | - Elliott D Kozin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Stacey T Gray
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
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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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Luc JG, Antonoff MB, Vaporciyan AA, Yanagawa B. Surgeon teachers and millennial learners: Bridging the generation gap. J Thorac Cardiovasc Surg 2021; 162:334-341. [DOI: 10.1016/j.jtcvs.2020.03.177] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 03/08/2020] [Accepted: 03/22/2020] [Indexed: 12/20/2022]
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Werenski HE, Bosley ME, Powell MS, Meredith JW, Randle RW. Outcomes Following Cholecystectomy on a Service Designed to Maximize Chief Resident Entrustment. J Surg Res 2021; 264:474-480. [PMID: 33857791 DOI: 10.1016/j.jss.2021.02.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/10/2021] [Accepted: 02/27/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND The chief resident service provides surgical trainees in their final year of training the opportunity to maximize responsibility, continuity, and decision-making. Although supervised, chief residents operate according to personal preferences instead of adapting to their attendings' preferences. We hypothesized that outcomes following cholecystectomy are equivalent between the chief resident service and standard academic services. METHODS We matched adults undergoing cholecystectomy from 07/2016-06/2019 on the chief resident service to two standard academic service patients based on operative indication and age. We compared demographics, operative details, and 30-d complications. RESULTS This study included 186 patients undergoing cholecystectomy. Body mass index (32.4 versus 32.0, P = 0.49) and Charlson comorbidity index (0.9 versus 1.4, P = 0.16) were similar between chief resident and standard academic services, respectively. Operative approach was similar (95.2% laparoscopic on chief resident service versus 94.4% on standard service), but residents on the chief resident service performed cholangiograms more often (48.4% versus 22.6%, P < 0.01) and averaged longer operative times during laparoscopic cholecystectomy with cholangiogram (146±28 versus 85±22 min, P < 0.01) and without (94±31 versus 76±35 min, P < 0.01) compared with standard academic services, respectively. 30-d complication rates were similar (5.2% chief resident versus 5.0% standard, P = 0.95). No patients suffered bile leak, bile duct injury, or reoperation. Emergency Department visits were similar (12.1% chief resident versus 7.4% standard, P = 0.32); readmissions were less frequent on the chief resident service (0.0% versus 5.0% standard, P = 0.03). CONCLUSIONS With appropriate supervision, chief residents provide safe care for patients undergoing cholecystectomy while directing medical decisions and practicing according to their preferences.
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Affiliation(s)
- Hope E Werenski
- Department of Surgery, Wake Forest Baptist Health, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Maggie E Bosley
- Department of Surgery, Wake Forest Baptist Health, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Myron S Powell
- Department of Surgery, Wake Forest Baptist Health, Wake Forest University School of Medicine, Winston-Salem, NC
| | - J Wayne Meredith
- Department of Surgery, Wake Forest Baptist Health, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Reese W Randle
- Department of Surgery, Wake Forest Baptist Health, Wake Forest University School of Medicine, Winston-Salem, NC.
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Huynh C, Da Cunha Godoy L, Kuo CL, Smeds M, Amankwah KS. Examining the Development of Operative Autonomy in Vascular Surgery Training and When Trainees and Program Directors Agree and Disagree. Ann Vasc Surg 2021; 74:1-10. [PMID: 33826957 DOI: 10.1016/j.avsg.2021.01.121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 01/25/2021] [Accepted: 01/25/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Lack of autonomy in the operating room (OR) during general surgery residency is a major contributing factor to low confidence operating independently after graduation. Although attempts to address decreased autonomy and development of entrustment in the OR are being made in general surgery programs, this issue has not been examined thoroughly in vascular surgery. We sought to determine barriers and opportunities for developing operative autonomy during vascular surgery training by surveying program directors (PDs) and trainees (integrated residents and fellows) in U.S. vascular surgery training programs. METHODS An anonymous electronic survey was sent via email to all PDs (n = 155) and trainees (n = 516) in United States vascular surgery training programs. Demographics, academic characteristics, and responses regarding factors impacting the development of entrustment were collected. RESULTS Thirty-five PDs and 100 trainees completed the survey (22.5% and 19.4% response rate, respectively). Sixty percent of trainees were integrated residents and 40% were fellows. Twenty percent of PDs and 33% of trainees were female, and 5% of all PDs and trainees were from underrepresented minorities. The single most positive factor affecting the development of autonomy according to trainees and PDs is familiarity of the faculty with the trainee. Both PDs and trainees thought the trainee's preparation for the case positively affected development of autonomy; however, more PDs believed that involvement with preoperative preparation in particular (marking the patient, consenting the patient, filling out a history and physical, prepping and draping the patient) was important (P < 0.05). PDs believed that duty-hour limitations negatively affected the trainee's ability to develop autonomy in the OR, whereas more trainees believed that hospital or OR efficiency policies played a negative role (P < 0.05). Finally, compared with trainees, PDs believed that the appropriate amount of time for safe struggle before the attending should take over the case was when OR efficiency was compromised or at any moment the trainee is unsure of themselves (P < 0.05); trainees believed that the attending should take over the case after the limit of their skill set or troubleshooting ability was reached (P < 0.05). CONCLUSIONS Familiarity of the attending physician with the trainee is an important positive factor for development of entrustment and autonomy in vascular surgery trainees. Duty-hour limitations and belief of the need for hospital efficiency may negatively impact operative independence of trainees. An open discussion about balancing OR efficiency and trainees' safe struggle is essential to address the growth of independent operative skills in vascular surgery trainees.
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Affiliation(s)
- Cindy Huynh
- Department of Surgery, Division of Vascular and Endovascular Services, State University of New York Upstate Medical University, Syracuse, NY; Division of Vascular and Endovascular Surgery, University of California, San Francisco, CA
| | - Lucas Da Cunha Godoy
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut (UConn Health), Farmington, CT
| | - Chia-Ling Kuo
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut (UConn Health), Farmington, CT
| | - Matthew Smeds
- Division of Vascular and Endovascular Surgery, Saint Louis University, St. Louis, MO
| | - Kwame S Amankwah
- Department of Surgery, Division of Vascular and Endovascular Services, State University of New York Upstate Medical University, Syracuse, NY; Division of Vascular and Endovascular Surgery, University of Connecticut (UConn Health), Farmington, CT.
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Trends in Female Authorship: A Bibliometric Analysis of The Annals of Thoracic Surgery. Ann Thorac Surg 2021; 111:1387-1393. [PMID: 32827552 DOI: 10.1016/j.athoracsur.2020.06.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/04/2020] [Accepted: 06/08/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Women continue to comprise a small minority of cardiothoracic surgeons. Representation of women in areas of academic achievement has not been well characterized. This study aims to evaluate female representation among authorship positions in high-impact articles published in The Annals of Thoracic Surgery. METHODS Altmetric scores were used to identify the top 50 articles published in 2013, 2015, and 2017 in The Annals of Thoracic Surgery. Article characteristics as well as author demographics were collected. Bibliometric analysis was performed to identify longitudinal changes with regard to female representation as first and last authors. RESULTS Female authors remain underrepresented in authorship, despite a temporal trend toward improvement in female representation over the years for first author position (16% in 2013, 22% in 2015, 20% in 2017) and last author position (8% in 2013, 16% in 2015, 20% in 2017). Articles authored by women were equally likely to achieve high impact as compared with men, as evaluated by Altmetric score (women 30.1 ± 38.6 vs men 39.1 ± 73.5, P = .53), citations (women 14.3 ± 19.1 vs men 17.6 ± 20.8, P = .45), and to be mentioned by news outlets, blogs, patents, Facebook, Wikipedia, Mendeley, Google, LinkedIn, and Reddit. Female first and last authors achieved comparable numbers of publications and H-index scores compared with male authors. CONCLUSIONS Significant sex-based differences in authorship representation persist, but with favorable improvement in female representation over time. Importantly, citations and high-impact status were independent of author sex. Characterization of the representation of women in academic achievement helps us strive for gender equity in our specialty.
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Luc JGY, Reddy RM, Corsini EM, Carrott PW, David EA, Shemanski K, Fabian T, McCarthy DP, Okereke I, Oliver AL, Turner SR, Vaporciyan AA, Antonoff MB. Are Esophagectomy Board Requirements Achievable? A Multi-Institutional Analysis. Semin Thorac Cardiovasc Surg 2021; 33:1158-1168. [PMID: 33711460 DOI: 10.1053/j.semtcvs.2021.02.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 02/01/2021] [Indexed: 11/11/2022]
Abstract
Duty-hour restrictions have implications on trainee operative exposure necessary to meet minimum case-volume requirements. We utilized a previously validated simulation model to evaluate the effect of program volume, trainee numbers and complement, and rotation schedule on the probability of achieving adequate esophagectomy case numbers for cardiothoracic surgery trainees. A ProModel simulator centered on probabilistic distributions of operative cases was utilized. Historical data from five 2-year cardiothoracic surgery training programs were obtained from 2016-2018 and used as inputs to the simulator that generated 10,000 "trainee 2-year periods" per program. Programs varied in annual average esophagectomy volume (12-91 per year), with 2-4 trainees graduating over a 2-year training period. If esophagectomy cases were distributed solely based on scheduling and institutional volume, only 60% of evaluated programs could adequately expose all trainees in esophagectomy to meet case requirements. The 3 programs with adequate esophagectomy volumes had averaged 3.3 times (range 3.0-3.6) the minimum number of board-required cases for their programs' trainees. The ability of programs to provide trainees with adequate esophagectomy volume is challenging based on institutional volume and scheduling. Through simulation, we demonstrate that programs need >2 times the expected minimum number of esophagectomies to ensure that >90% of trainees meet case-volume requirements. Programs may consider strategies such as allowing trainees to select cases based on personal need, train fewer fellows, or enable trainees to seek subspecialty exposure externally to achieve minimum esophagectomy case-load requirements.
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Affiliation(s)
- Jessica G Y Luc
- Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada; Thoracic Education Cooperative Group, Thoracic Surgical Directors Association, Chicago, Illionis
| | - Rishindra M Reddy
- Thoracic Education Cooperative Group, Thoracic Surgical Directors Association, Chicago, Illionis; Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Erin M Corsini
- Thoracic Education Cooperative Group, Thoracic Surgical Directors Association, Chicago, Illionis; Department of Thoracic and Cardiovascular Surgery, UT MD Anderson Cancer Center, Houston, Texas
| | - Philip W Carrott
- Thoracic Education Cooperative Group, Thoracic Surgical Directors Association, Chicago, Illionis; Division of General Thoracic Surgery, Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Elizabeth A David
- Thoracic Education Cooperative Group, Thoracic Surgical Directors Association, Chicago, Illionis; Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California
| | - Kimberly Shemanski
- Thoracic Education Cooperative Group, Thoracic Surgical Directors Association, Chicago, Illionis; Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California
| | - Thomas Fabian
- Thoracic Education Cooperative Group, Thoracic Surgical Directors Association, Chicago, Illionis; Division of Thoracic Surgery, Albany Medical Center, Department of Surgery, Albany Medical College, Albany, New York
| | - Daniel P McCarthy
- Thoracic Education Cooperative Group, Thoracic Surgical Directors Association, Chicago, Illionis; Section of Thoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Ikenna Okereke
- Thoracic Education Cooperative Group, Thoracic Surgical Directors Association, Chicago, Illionis; Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Aundrea L Oliver
- Thoracic Education Cooperative Group, Thoracic Surgical Directors Association, Chicago, Illionis; Division of Thoracic Surgery, Department of Cardiovascular Sciences, East Carolina University Brody School of Medicine, Greenville, North Carolina
| | - Simon R Turner
- Thoracic Education Cooperative Group, Thoracic Surgical Directors Association, Chicago, Illionis; Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Ara A Vaporciyan
- Thoracic Education Cooperative Group, Thoracic Surgical Directors Association, Chicago, Illionis; Department of Thoracic and Cardiovascular Surgery, UT MD Anderson Cancer Center, Houston, Texas
| | - Mara B Antonoff
- Thoracic Education Cooperative Group, Thoracic Surgical Directors Association, Chicago, Illionis; Department of Thoracic and Cardiovascular Surgery, UT MD Anderson Cancer Center, Houston, Texas; Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California.
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Onufer EJ, Andrade E, Caldwell KE, Cullinan D, Vallar K, Turnbull IR, Schuerer D, Wise PE, Klingensmith ME, Punch LJ. SAVE 2.0: Identifying and strengthening resident leadership skills through simulation based team training. J Trauma Acute Care Surg 2021; 90:582-588. [PMID: 33492109 DOI: 10.1097/ta.0000000000003037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The "Surgery for Abdomino-thoracic ViolencE (SAVE)" animate lab engages surgical residents in the management of penetrating injuries in a team setting. Senior residents, representing postgraduate year (PGY) 3-5, assume the role of team leader and facilitate the junior residents, PGY1-2, in operative management of simulated penetrating wounds. Residents completed five scenarios with increasing level of difficulty within set time limits. Senior residents were evaluated on their team's ability to "SAVE" their patient within the time allotted, as well as their communication and leadership skills. METHODS General, vascular, urology, and plastic surgery residents (n = 79) were divided into 25 teams of three to four residents by "resident scores" (R scores, the sum of the team members' PGY) to create balanced teams with comparable years of clinical experience. Residents completed assessments of their senior resident's leadership ability and style. RESULTS Evaluation of a resident's desired learning style changed across PGY with junior residents preferring more hands-on guidance compared with senior residents preferring only verbal correction. Resident leadership evaluations demonstrated that team leaders of varied resident years achieved the highest scores. Greater differences in the mismatch between autonomy provided to and desired by junior residents correlated to greater junior resident discomfort in expressing their opinion, confidence, and leadership ratings of senior residents. However, greater autonomy mismatch also correlated to more rapid time to task completion. CONCLUSION Different from our expectations, clinical experience alone did not define team leader success. Leadership is a powerful influence on the outcome of team performance and may be a skill, which can transcend overall clinical experience. A match between desired and provided resident autonomy and team cohesion may demonstrate a stronger effect on team success in stressful operative situations, such as trauma resuscitation. Enhancement of leadership skills early in residency training may represent an important focus for trauma surgery education.
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Affiliation(s)
- Emily Jean Onufer
- From the Department of Surgery (E.J.O., E.A., K.E.C., D.C., K.V., I.R.T., D.S., P.E.W., M.E.K.), Washington University in St. Louis School of Medicine; and Power4STL (L.P.), St. Louis, Missouri
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Foster MJ, O'Hara NN, Weir TB, Aneizi A, Henn RF, Packer JD, Hasan SA, Slobogean GP, Gilotra MN. Difference in Resident Versus Attending Perspective of Competency and Autonomy During Arthroscopic Rotator Cuff Repairs. JB JS Open Access 2021; 6:JBJSOA-D-20-00014. [PMID: 33748637 PMCID: PMC7963494 DOI: 10.2106/jbjs.oa.20.00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A noted deficiency in orthopaedic resident education is a lack of intraoperative autonomy; however, no studies exist evaluating this issue. The purpose of this study was to determine whether there is a difference between resident and attending perception of resident competency and autonomy during arthroscopic rotator cuff repairs and whether increased perceived competency leads to more autonomy.
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Affiliation(s)
- Michael J Foster
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Nathan N O'Hara
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Tristan B Weir
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Ali Aneizi
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jonathan D Packer
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - S Ashfaq Hasan
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Gerard P Slobogean
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Mohit N Gilotra
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
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Lamb M, Bazan VM, Jax MD, Zwischenberger JB, Meyerson SL. Repair of Pulmonary Vascular Injury: A Take-Home Low-Fidelity Simulator. Ann Thorac Surg 2021; 112:e73-e76. [PMID: 33631153 DOI: 10.1016/j.athoracsur.2020.12.086] [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: 11/12/2020] [Accepted: 12/03/2020] [Indexed: 11/19/2022]
Abstract
We present a low-cost, simple simulation model of major vascular injury repair for cardiothoracic trainees. This model uses commercially available orthopedic elastic bands to allow repetitive practice of the skills necessary during these rare but critical clinical scenarios. Practicing core skills in the simulation setting will help residents be better prepared when the situation arises.
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Affiliation(s)
- Matthew Lamb
- Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Vanessa M Bazan
- University of Kentucky College of Medicine, Lexington, Kentucky
| | - Michael D Jax
- Center for Advanced Training and Stimulation, University of Kentucky, Lexington, Kentucky
| | - Joseph B Zwischenberger
- Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky.
| | - Shari L Meyerson
- Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
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21
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Lau N, Hartman-Kenzler J, Fichtel E, Park J, Ponnala S, Parker SH, Fitzgibbons S, Safford SD. Attending Surgeons Demonstrate Greater Correlations of Skill Assessment and Anticipation of Adverse Events Than Residents During Laparoscopic Cholecystectomy. J Surg Res 2021; 262:140-148. [PMID: 33567387 DOI: 10.1016/j.jss.2020.12.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 12/28/2020] [Accepted: 12/31/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Surgical training includes the development of technical and nontechnical skills. While technical skills are more easily quantified, nontechnical skills such as situation awareness (SA) are more difficult to measure and quantify. This study investigated the relationships between different SA elements and expertise. METHODS Twenty attending and resident surgeons rated their anticipation of an impending adverse event while watching 20 videos of laparoscopic cholecystectomies with and without adverse events. After watching each video, they assessed surgeon skills and self-assessed their anticipation ratings. All participants answered a general confidence questionnaire before and after the study. RESULTS Videos with adverse events led to significantly higher anticipation of adverse events (P < 0.001), lower surgeon skill rating (P < 0.001), and higher self-assessment in their anticipation ratings (P < 0.001) across both participant groups. General confidence was significantly lower for residents than that for attending surgeons (P < 0.001). Compared with the residents, attendings exhibited stronger and more stable correlations between measurements of SA. When viewing videos with adverse events, attendings showed significantly higher correlation between anticipation of an impending adverse event and skill assessment of the surgeon (P = 0.005). CONCLUSIONS This study investigated how different elements of SA and their relationships were influenced by experience. The results indicated that attendings had stronger and more stable correlations between SA elements than residents, demonstrating how measurement correlations could be meaningful and sensitive indicators of expertise and autonomy readiness.
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Affiliation(s)
- Nathan Lau
- Grado Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, Virginia
| | | | - Eric Fichtel
- Grado Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, Virginia
| | - Juyeon Park
- Stony Brook University Medical Center, Stony Brook, New York
| | - Siddarth Ponnala
- Department of Industrial and Systems Engineering, University of Wisconsin, Madison, Wisconsin
| | - Sarah Henrickson Parker
- Virginia Tech Carilion School of Medicine, Virginia Tech, Roanoke, Virginia; Fralin Biomedical Research Institute, Virginia Tech, Roanoke, Virginia; Center for Simulation, Research and Patient Safety, Carilion Clinic, Roanoke, Virginia
| | - Shimae Fitzgibbons
- Department of Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Shawn D Safford
- Virginia Tech Carilion School of Medicine, Virginia Tech, Roanoke, Virginia; Center for Simulation, Research and Patient Safety, Carilion Clinic, Roanoke, Virginia; Department of Surgery, Penn State Health Children's Hospital, Hershey, Pennsylvania.
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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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Commentary: Thoracic surgery trainees on the launching pad: When will they be ready to fly? J Thorac Cardiovasc Surg 2020; 163:360-361. [PMID: 33461812 DOI: 10.1016/j.jtcvs.2020.12.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 11/19/2022]
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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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Luc JGY, Preventza O, Moon MR, Antonoff MB. Keep the Pipeline Open for Women Applying to Cardiothoracic Surgery. Am Surg 2020; 87:162-163. [PMID: 33054363 DOI: 10.1177/0003134820951478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jessica G Y Luc
- Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine and the Texas Heart Institute, Houston, TX, USA
| | - Marc R Moon
- Divison of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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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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Spadafore M, Merryman E, Daniel M. Rapid Expectation Setting for Learners in the Emergency Department. AEM EDUCATION AND TRAINING 2020; 4:433-434. [PMID: 33150289 PMCID: PMC7592828 DOI: 10.1002/aet2.10433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/02/2019] [Accepted: 12/17/2019] [Indexed: 06/11/2023]
Affiliation(s)
| | | | - Michelle Daniel
- Department of Emergency MedicineUniversity of Michigan Medical SchoolAnn ArborMI
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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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Dickinson KJ, Bass BL. A Systematic Review of Educational Mobile-Applications (Apps) for Surgery Residents: Simulation and Beyond. JOURNAL OF SURGICAL EDUCATION 2020; 77:1244-1256. [PMID: 32307244 DOI: 10.1016/j.jsurg.2020.03.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 03/29/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION The number of mobile-applications (Apps) increases daily. The regulation of App content is minimal yet surgical residents use these in daily educational practice. Surgical educators must be aware of the quality, efficacy, and validity of Apps available to effectively educate residents. The aim of this review was to determine the quality, efficacy, and validity evidence for educational Apps used by surgical residents. MATERIALS AND METHODS We searched PubMed, Embase, and ERIC for articles published before September 1, 2019. Controlled vocabulary and natural language describing Apps/surgical residents were used. Two reviewers evaluated abstracts for inclusion. INCLUSION CRITERIA studies measuring the quality, efficacy, or validity of educational Apps for surgical residents. Data was extracted from full text of included articles: study design, participants, App investigated, App development, evidence for efficacy, or validity of App. RESULTS Initial search identified 278 articles. 64 articles were duplicates and 214 articles were screened. A further 156 were excluded with 58 full text articles assessed for eligibility. Forty-five were included in analysis. Simulation (9/45) and Feedback (15/45) Apps were the most commonly studied in surgical residents. These were the main Apps that provided validity evidence for their use in education. CONCLUSION Surgical education is evolving as educational technology becomes more prevalent. To be effective as surgical educators we must understand and appropriately use available tools. Of the educational Apps studied (21 Apps in 8 categories), only 3 categories reported validity evidence. Future studies should take care to measure validity and efficacy of educational Apps for surgical education to ensure quality control.
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Affiliation(s)
| | - Barbara L Bass
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
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Fletcher BP, Gusic ME, Robinson WP. Simulation Training Incorporating a Pulsatile Carotid Endarterectomy Model Results in Increased Procedure-Specific Knowledge, Confidence, and Comfort in Post-graduate Trainees. JOURNAL OF SURGICAL EDUCATION 2020; 77:1289-1299. [PMID: 32505671 DOI: 10.1016/j.jsurg.2020.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/04/2020] [Accepted: 03/22/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Surgical simulation has been used to facilitate the acquisition of vascular surgery skills. However, high cost and limited availability may restrict the use of this educational resource. We report how instruction using a low-cost, pulsatile, carotid endarterectomy (CEA) benchtop surgical simulation model can be used to enhance learners' procedure-specific knowledge, comfort, and confidence in performing the steps of a CEA procedure DESIGN: A single instructor engaged each participant in a one-on-one instructional session during which the instructor demonstrated, and then the participants performed, the steps of a CEA. Participants completed a pre- and postintervention assessment of knowledge and attitudes about preforming a CEA and use of simulation as a learning tool. Postintervention, participants rated the impact of the simulation model on their learning. A Related T-test and Wilcoxin signed Rank Test were used to compare pre- and postintervention results. SETTINGS University of Virginia Health System, Charlottesville, Virginia. PARTICIPANTS Seventeen postgraduate trainees. RESULTS A significant difference was observed in pre- and postknowledge scores (48% vs 91% correct, p < 0.01). Trainee confidence (1.65 vs 2.88, p < 0.01) and comfort (1.59 vs 2.82, p < 0.01) with doing the procedure also increased significantly. Sixteen (94%) responded that use of the simulator was extremely or very important as a tool for learning. All 17 trainees (100%) reported that the simulation experience was either essential or very useful in helping them learn how to perform a CEA. Sixty-five percent responded that they were extremely likely to apply the skills learned during the intervention the next time they performed a CEA. CONCLUSIONS A low-cost, pulsatile CEA simulation model used as an educational tool increased procedure-specific knowledge, comfort, and confidence among trainees. Learner's increased confidence and affirmation that they are likely to apply the learned skills in a clinical setting support the use of this educational approach to impact trainee behaviors.
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Affiliation(s)
- Brian P Fletcher
- University of Virginia of School of Medicine, Department of Vascular and Endovascular Surgery, Charlottesville, Virginia.
| | - Maryellen E Gusic
- University of Virginia School of Medicine, Office of Medical Education, Charlottesville, Virginia
| | - William P Robinson
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, North Carolina
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Modlin DM, Aranda MC, Caddell EC, Faler BJ. An Analysis of Burnout among Military General Surgery Residents. JOURNAL OF SURGICAL EDUCATION 2020; 77:1046-1055. [PMID: 32222352 DOI: 10.1016/j.jsurg.2020.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 02/20/2020] [Accepted: 03/02/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Resident burnout is an increasing issue in graduate medical education programs. Military graduate medical education is unique in numerous ways and may have different rates of burnout as well as different causes. This study aims to assess resident burnout rates and contributing factors among military general surgery residents. DESIGN, SETTING, AND PARTICIPANTS Using Department of Defense approved software, an anonymous survey was created and distributed to all general surgery residents (n = 180) in 6 US medical centers where there are general surgery residency programs. The survey contained an Abbreviated Maslach Burnout Index questionnaire, multiple choice questions including several military-specific questions, and 2 open ended questions. Rates of burnout and potential risk factors associated with burnout were analyzed. RESULTS After the collection period, 92 of 180 (51%) residents completed all Abbreviated Maslach Burnout Index questions, demographics, and military specific questions with an opportunity for written comments. Notable demographic findings of the respondents were that 64% were male, 65% were married or engaged, 40% had children, and 69% had no student loan debt. Overall, there was a 66% rate of burnout in any tertile. Variables found to be significant for overall burnout included the likelihood the resident plans to stay beyond their active duty service obligation and the perceived level of autonomy. Of the written responses, the most commonly cited contributing factor was the work burden from nonclinical and/or administrative tasks while the most common protective factor was resident camaraderie. CONCLUSIONS Overall, burnout rates are similar among military general surgery residents compared to published reports of civilians. The close association with resident burnout and anticipation of early withdrawal from military service demonstrates this topic is potentially important to retention of the military medical force. The topics of increased resident autonomy, decreased non-clinical duties, and efforts to increase resident camaraderie should be more closely evaluated.
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Affiliation(s)
- David M Modlin
- Dwight D Eisenhower Army Medical Center, Department of Surgery, Fort Gordon, Georgia
| | - Marcos C Aranda
- Dwight D Eisenhower Army Medical Center, Department of Surgery, Fort Gordon, Georgia.
| | - Erin C Caddell
- Dwight D Eisenhower Army Medical Center, Department of Surgery, Fort Gordon, Georgia
| | - Byron J Faler
- Dwight D Eisenhower Army Medical Center, Department of Surgery, Fort Gordon, Georgia
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Burning the candle at both ends: Mitigating surgeon burnout at the training stages. J Thorac Cardiovasc Surg 2020; 162:637-642. [PMID: 32792150 DOI: 10.1016/j.jtcvs.2020.06.122] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/16/2020] [Accepted: 06/21/2020] [Indexed: 11/24/2022]
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Wang VL, Pieper H, Gupta A, Chen X, Husain S, Meara M. Expectations versus reality: trainee participation on the robotic console in academic surgery. Surg Endosc 2020; 35:4805-4810. [PMID: 32780235 DOI: 10.1007/s00464-020-07874-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/05/2020] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Trainees underestimate the amount of operative autonomy they receive, whereas faculty overestimate; this has not been studied in robotics. We aimed to assess the perceptions and expectations of our general surgery trainees and faculty on robotic console participation in academic surgery. METHODS A survey was administered to general surgery robotic faculty and trainees eligible to sit at the console. Participants estimated the average percentage of trainee console participation time (CPT) per case for robotic cholecystectomies (CCY) and inguinal hernia repairs (IHR) from January to June 2019. Trainees were additionally asked what CPT they expected according to their training level (novice or senior). Expected CPTs were compared to actual CPTs extracted from robotic console logs during the same time frame. RESULTS Survey response rate was 80% for faculty (4 of 5) and 65% for trainees (15 of 23). Novices expected a higher CPT than they perceived in CCY (42.8% ± 14.8% vs 19.0% ± 17.2%, p = 0.03) and IHR (36.1% ± 17.6% vs. 10.7% ± 13.7%, p = 0.01), but in actuality, they did more CPT than perceived (by 34.9% in CCY, p < 0.01; 14% in IHR, p = 0.10). Senior trainees accurately perceived their CPT in IHR, but expected a higher CPT by 15.9% (p = 0.04). In CCY, seniors perceived a 23.8% higher CPT than in reality (p = 0.04). Faculty generally overperceived trainee CPT by 12.8-16.3% (p > 0.05). Compared to faculty, novices perceived lower CPTs in both CCY by 29.9% (p = 0.16) and IHR by 26.8% (p = 0.07), but seniors tended to agree with the faculty-perceived CPTs (p > 0.05). CONCLUSION Our robotic trainees expect to do more on the console than they perceive. Faculty think they allow their trainees more participation than in reality. Compared to faculty perception, novice trainees perceive a much lower level of trainee participation than senior trainees do. Expectation setting and standardizing learning curves are important for robotic surgery training.
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Affiliation(s)
- Vivian L Wang
- Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, 410 W 10th Avenue, 558 Doan Hall, Columbus, OH, 43210, USA.
| | - Heidi Pieper
- Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, 410 W 10th Avenue, 558 Doan Hall, Columbus, OH, 43210, USA
| | - Anand Gupta
- Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, 410 W 10th Avenue, 558 Doan Hall, Columbus, OH, 43210, USA
| | - Xiaodong Chen
- Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, 410 W 10th Avenue, 558 Doan Hall, Columbus, OH, 43210, USA
| | - Syed Husain
- Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, 410 W 10th Avenue, 558 Doan Hall, Columbus, OH, 43210, USA
| | - Michael Meara
- Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, 410 W 10th Avenue, 558 Doan Hall, Columbus, OH, 43210, USA
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Chiel L, Hasselfeld B, Marcus CH, Winn AS. Time Well Spent: Resident Promotion of Microcompetency-Based Medical Education During Inpatient Pediatric Experiences. J Pediatr 2020; 223:6-7.e1. [PMID: 32711753 DOI: 10.1016/j.jpeds.2020.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 01/10/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Laura Chiel
- Division of Pulmonary Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA.
| | - Brian Hasselfeld
- Office of Johns Hopkins Physicians and Johns Hopkins Community Physicians, Baltimore, MD; Division of General Internal Medicine, Department of Medicine, and Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - Carolyn H Marcus
- Department of Pediatrics, Harvard Medical School, Boston, MA; Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, MA
| | - Ariel S Winn
- Department of Pediatrics, Harvard Medical School, Boston, MA; Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, MA
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Jayanthi P, Patel MB, Mittal V. Effect of Establishing a Teaching Assistant Case Minimum on General Surgery Residents: 18-Year Comparison of a Single Institution to National Data. J Am Coll Surg 2020; 231:172-178. [PMID: 32437741 DOI: 10.1016/j.jamcollsurg.2020.04.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/26/2020] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Teaching assistant (TA) cases are a training mainstay, due to increased resident autonomy. Since 2014, the American Board of Surgery (ABS) requires a 25 TA case minimum for graduating resident eligibility for board certification. Herein, we analyze our institution's experience compared with the national average, for any change effected by the requirement. STUDY DESIGN ACGME case log data were obtained for the July 2001 to June 2018 academic years. We compared average TA cases of our program against the national average and national 50th percentile: 2001 to 2014, and 2014 to 2018 academic years. The program TA cases were also broken down by category, with a comparison before and after 2014. Values of p were calculated using a t-test and Mann-Whitney U test. RESULTS From July 2001 to June 2018, our program averaged 30.1 TA cases/resident, and national 50th percentile average was 28.1. For July 2001 to June 2014 AY (aka pre-2014) and July 2014 to June 2018 AY (aka post-2014) cases per resident, our program averages were 24.9 and 46.1, respectively, and the national 50th percentile averages were 24.4 and 40.3, respectively-both statistically significant increases. Average program percentiles were 46.4 (pre-2014), and 61.5 (post-2014), and 59.6% of program cases logged were biliary, large intestine, and hernia (2001 to 2018 AY), with a statistically significant increase in several case subcategories post-2014. CONCLUSIONS Teaching assistant cases are an invaluable resource for residents, fostering increased autonomy. Since the 2014 minimum, a statistically significant increase in TA cases was noted in our program and nationally. The majority of sub-categories logged were core procedures. Unequivocally, the TA case minimum requirement has made a difference. This will hopefully lead to increased autonomy and therefore, more comfortable and capable general surgeons. Wide variability is noted in what counts as a TA case, with further clarification needed by the ACGME and ABS.
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Affiliation(s)
- Prakash Jayanthi
- Departments of General Surgery, Ascension Providence Hospital / Michigan State University College of Human Medicine, Southfield, MI.
| | - Mitesh Bharat Patel
- Departments of General Surgery, Ascension Providence Hospital / Michigan State University College of Human Medicine, Southfield, MI; Victor Valley Global Medical Center, Victorville, CA
| | - Vijay Mittal
- Departments of General Surgery, Ascension Providence Hospital / Michigan State University College of Human Medicine, Southfield, MI
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Lane SM, Young KA, Hayek SA, Dove JT, Sharp NE, Shabahang MM, Ellison HB. Meaningful autonomy in general surgery training: Exploring for gender bias. Am J Surg 2020; 219:240-244. [DOI: 10.1016/j.amjsurg.2019.11.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 11/14/2019] [Accepted: 11/24/2019] [Indexed: 10/25/2022]
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Lillemoe HA, Stonko DP, George BC, Schuller MC, Fryer JP, Sullivan ME, Terhune KP, Geevarghese SK. A Preoperative Educational Time-Out is Associated with Improved Resident Goal Setting and Strengthens Educational Experiences. JOURNAL OF SURGICAL EDUCATION 2020; 77:18-26. [PMID: 31327734 DOI: 10.1016/j.jsurg.2019.07.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/15/2019] [Accepted: 07/06/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The purpose of this study was to assess the impact of a preoperative Educational Time-Out (ETO) with structured postoperative feedback on resident preoperative goal-setting and the educational experience of a clinical rotation. DESIGN A preoperative ETO was developed during which trainees and faculty jointly identified an operative goal and discussed the trainee's operative autonomy. Postoperative feedback with a smartphone application was encouraged. From November 2016 to October 2017, the intervention was piloted with 1 surgical service. Outcomes included ETO completion rate, goal setting rate, and subjects' perception of the impact of the ETO on identification of performance deficits, trainee autonomy, and receipt of feedback. Data were analyzed using descriptive statistics. SETTING This study was performed in an institutional hospital setting. PARTICIPANTS Third-year general surgery residents and surgical faculty in the Department of Hepatobiliary Surgery and Liver Transplantation at Vanderbilt University Medical Center took part in the intervention. RESULTS Seven residents and 7 attending surgeons participated in this study. Residents performed a median of 15 procurements during an average of 6.5 weeks each on service. The ETO completion rate was 83%. Resident-reported preoperative goal setting increased after the intervention (from 36% to 78%, p = 0.015). Subjects reported a positive impact of the intervention, with high resident agreement that the ETO helped identify deficits (82% median agreement), increased autonomy (82% median agreement), and increased receipt of feedback (84% median agreement). Residents and attendings agreed that the educational experience was stronger due to the ETO (median 81% and 77%, respectively). CONCLUSIONS The ETO intervention improved rates of resident preoperative goal setting and strengthened perceived educational experiences. Resident participants also reported improvements in autonomy and rates of postoperative feedback. Broader implementation of this brief preoperative pause is an easy way to emphasize procedural education in the operating room.
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Affiliation(s)
- Heather A Lillemoe
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - David P Stonko
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Brian C George
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Mary C Schuller
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jonathan P Fryer
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Maura E Sullivan
- Department of Surgery, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Kyla P Terhune
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sunil K Geevarghese
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Goldwag JL, Jung S. Operating room preparation by general surgery residents: A qualitative analysis. Am J Surg 2019; 220:316-321. [PMID: 31882064 DOI: 10.1016/j.amjsurg.2019.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 12/13/2019] [Accepted: 12/14/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Surgical education is changing, with residents having less time to learn more procedures. We aim to explore how residents prepare for the operating room and what factors impact their preparation. METHODS A qualitative study was conducted using conventional content analysis. General surgery residents at one institution were invited to participate in semi-structured interviews. Each interview was recorded, transcribed verbatim, and then inductively examined to generate themes. RESULTS Fourteen residents elected to participate. Six themes were identified: (1) All participants similarly defined preparation, (2) Residents learned through trial and error and co-residents, (3) Factors impacting preparation were time, attendings, autonomy, case complexity, and difficulty finding resources, (4) Resource use varied, (5) PGY level impacted preparation and, (6) Optimal resources were high yield. CONCLUSION Although surgical residents similarly defined operating room preparation, they use a variety of different resources to achieve this, which is often difficult and time consuming.
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Affiliation(s)
- Jenaya L Goldwag
- Department of Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
| | - Sarah Jung
- Department of Surgery, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI, 53792, USA
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Meyerson SL, Odell DD, Zwischenberger JB, Schuller M, Williams RG, Bohnen JD, Dunnington GL, Torbeck L, Mullen JT, Mandell SP, Choti MA, Foley E, Are C, Auyang E, Chipman J, Choi J, Meier AH, Smink DS, Terhune KP, Wise PE, Soper N, Lillemoe K, Fryer JP, George BC. The effect of gender on operative autonomy in general surgery residents. Surgery 2019; 166:738-743. [PMID: 31326184 PMCID: PMC7382913 DOI: 10.1016/j.surg.2019.06.006] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/02/2019] [Accepted: 06/04/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Despite an increasing number of women in the field of surgery, bias regarding cognitive or technical ability may continue to affect the experience of female trainees differently than their male counterparts. This study examines the differences in the degree of operative autonomy given to female compared with male general surgery trainees. METHODS A smartphone app was used to collect evaluations of operative autonomy measured using the 4-point Zwisch scale, which describes defined steps in the progression from novice ("show and tell") to autonomous surgeon ("supervision only"). Differences in autonomy between male and female residents were compared using hierarchical logistic regression analysis. RESULTS A total of 412 residents and 524 faculty from 14 general surgery training programs evaluated 8,900 cases over a 9-month period. Female residents received less autonomy from faculty than did male residents overall (P < .001). Resident level of training and case complexity were the strongest predictors of autonomy. Even after controlling for potential confounding factors, including level of training, intrinsic procedural difficulty, patient-related case complexity, faculty sex, and training program environment, female residents still received less operative autonomy than their male counterparts. The greatest discrepancy was in the fourth year of training. CONCLUSION There is a sex-based difference in the autonomy granted to general surgery trainees. This gender gap may affect female residents' experience in training and possibly their preparation for practice. Strategies need to be developed to help faculty and residents work together to overcome this gender gap.
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Affiliation(s)
| | - David D Odell
- Department of Surgery, Northwestern University, Chicago, IL
| | | | - Mary Schuller
- Department of Surgery, Northwestern University, Chicago, IL
| | | | - Jordan D Bohnen
- Department of Surgery, Massachusetts General Hospital, Boston
| | | | - Laura Torbeck
- Department of Surgery, Indiana University, Indianapolis
| | - John T Mullen
- Department of Surgery, Massachusetts General Hospital, Boston
| | | | - Michael A Choti
- Department of Surgery, Banner MD Anderson Cancer Center, Gilbert, AZ
| | - Eugene Foley
- Department of Surgery, University of Wisconsin, Madison, WI
| | | | - Edward Auyang
- Department of Surgery, University of New Mexico, Albuquerque
| | | | - Jennifer Choi
- Department of Surgery, Indiana University, Indianapolis
| | - Andreas H Meier
- Department of Surgery, State University of New York Upstate Medical University, Syracuse
| | - Douglas S Smink
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Kyla P Terhune
- Department of Surgery, Vanderbilt University, Nashville, TN
| | - Paul E Wise
- Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | | | - Keith Lillemoe
- Department of Surgery, Massachusetts General Hospital, Boston
| | | | - Brian C George
- Department of Surgery, University of Michigan, Ann Arbor
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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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Ni hIci T, Archer M, Harrington C, Luc JGY, Antonoff MB. Trainee Thoracic Surgery Social Media Network: Early Experience With TweetChat-Based Journal Clubs. Ann Thorac Surg 2019; 109:285-290. [PMID: 31348902 DOI: 10.1016/j.athoracsur.2019.05.083] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 05/13/2019] [Accepted: 05/28/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Virtual journal clubs on Twitter (TweetChats) provide a platform to globally discuss publications. The Thoracic Surgery Social Media Network (TSSMN) is an organization that focuses on bringing social media attention to key publications in cardiothoracic surgery. TSSMN recently formed a Trainee Group with the goal of conducting chats covering key topics in cardiothoracic surgical training. The aim of this study was to characterize the pilot experience of this group. METHODS The TSSMN trainee group held 3 TweetChats during the study period between 2017 and 2018. Each TweetChat was a structured discussion of 2 to 4 publications. The number of tweets, participants, most popular tweets, and impressions was assessed for each of the TweetChats. RESULTS The 3 TweetChats had a mean of 40 participants (range, 36-45), generating an average of 497 tweets (range, 451-526) with a mean of 809,746 impressions (range, 591,814-1,140,000). Fruitful discussions on the topics of simulation in surgery, assessment of resident autonomy, and development of optimal organizational cultures to maximize team performance were held. CONCLUSIONS Twitter is a useful tool to collaborate and disseminate information. The 3 TweetChats organized by TSSMN trainee delegates generated approximately 1500 tweets with 2 million impressions. By these metrics, the feasibility of a trainee-led TSSMN TweetChat was confirmed.
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Affiliation(s)
- Tamara Ni hIci
- Department of Cardiothoracic Surgery, Abertawe Bro Morgannwg University Morriston Hospital, Swansea, United Kingdom.
| | - Michael Archer
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Caitlin Harrington
- Department of General Surgery, Oregon Health & Science University, Portland, Oregon
| | - Jessica G Y Luc
- Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
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O'Brien DC, Kellermeyer B, Chung J, Carr MM. Experience with key indicator cases among otolaryngology residents. Laryngoscope Investig Otolaryngol 2019; 4:387-392. [PMID: 31453346 PMCID: PMC6703116 DOI: 10.1002/lio2.274] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 04/30/2019] [Indexed: 11/25/2022] Open
Abstract
Objective To describe the resident experience with respect to key indicator cases for each year of training. Study Design Multi‐institution, cross‐sectional assessment. Methods Using an electronic survey, current otolaryngology residents were solicited to complete a survey regarding their experiences with the key indicator cases to that point. The survey was sent to this cohort in the winter of 2017–2018. Results Three hundred and three residents responded, with 293 completing the survey. Twenty‐three percent were PGY1, 19% PGY2, 21% PGY3, 18% PGY4, and 19% PGY5 or higher. The majority of residents progress from resident assistant as a PGY2, to resident surgeon as a PGY3 and self‐assessed competent surgeon as a PGY4 for the majority of the key indicator cases. Less than 50% of the surveyed PGY5 residents had reached independent practice in all the key indicator cases, with stapedectomy (16%), rhinoplasty (18%), and paramedian forehead flap (14.5%) being the cases least frequently performed independently. Ninety‐five percent of the respondent residents felt their program provided adequate training, but 20% of the respondents were either unsure or believed that they would be unable to perform all the key indicator cases by the completion of their training. Conclusions The majority of otolaryngology residents feel confident in their training, but experience with certain cases lags behind and may not currently be taught as resident level cases. These findings raise the question of whether the current key indicator cases are the best option for assessing breadth and depth of residency training. Level of Evidence NA
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Affiliation(s)
- Daniel C O'Brien
- Department of Otolaryngology-Head and Neck Surgery University of West Virginia Morgantown West Virginia U.S.A
| | | | - Jeffson Chung
- Department of Otolaryngology-Head and Neck Surgery University of West Virginia Morgantown West Virginia U.S.A
| | - Michele M Carr
- Department of Otolaryngology-Head and Neck Surgery University of West Virginia Morgantown West Virginia U.S.A
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Bender EM, Rizzo MG, Meyerson SL, Zwischenberger JB. Surgeon as Programmer: Overcoming Obstacles to the Use of Modern Internet Technology for Cardiothoracic Surgery. Ann Thorac Surg 2019; 108:1551-1554. [PMID: 31207249 DOI: 10.1016/j.athoracsur.2019.04.084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 03/25/2019] [Accepted: 04/24/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Leveraging Internet technologies for academic activities can be complex and expensive, costing tens of thousands of dollars. This report describes an experience in eliminating financial barriers and realizing the potential for a new paradigm in applications for surgical education and practice. METHODS After developing multiple surgical smartphone applications (apps), the report describes the acquisition of skill sets and resources to create state-of-the-art tools. Learning these techniques is nontrivial but is attainable and clearly defined. The report then discusses the trivial costs associated with complex software development, thereby opening new doors to creative uses of technology. RESULTS Acquisition of coding skills for smartphones took approximately 100 hours. For a simple app without data storage, EuroSCORE (European System for Cardiac Operative Risk Evaluation), total programming time was 25 hours with no additional costs. The more complex autonomy evaluation app, Zwisch Me, was used to evaluate more than 1260 cases from 15 cardiothoracic surgery training programs between January 2016 and August 2018 by using smartphone apps for data collection and a Web dashboard for data reporting. During the first year, all enrollment and data reporting was done manually, at a cost of $124. Automating user enrollment and data reporting increased costs by roughly $240, for an annual expense of $364. Total programming time for this app was approximately 120 hours. CONCLUSIONS Mobile software is underused in the academic surgical arena. The historically large financial barriers to adoption can be overcome by acquisition of coding skills by surgical team members. Direct physician involvement will spawn previously undreamed-of creative applications to enhance practice and education.
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Affiliation(s)
- Edward M Bender
- Department of Cardiothoracic Surgery, Stanford University, Palo Alto, California.
| | - Michael G Rizzo
- Department of Orthopaedics, University of Miami, Miami, Florida
| | - Shari L Meyerson
- Section of Cardiothoracic Surgery, University of Kentucky, Lexington, Kentucky
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Eaton M, Scully R, Schuller M, Yang A, Smink D, Williams RG, Bohnen JD, George BC, Fryer JP, Meyerson SL. Value and Barriers to Use of the SIMPL Tool for Resident Feedback. JOURNAL OF SURGICAL EDUCATION 2019; 76:620-627. [PMID: 30770304 DOI: 10.1016/j.jsurg.2019.01.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 01/14/2019] [Accepted: 01/19/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The System for Improving and Measuring Procedural Learning (SIMPL) is a smart-phone application used to provide residents with an evaluation of operative autonomy and feedback. This study investigated the perceived benefits and barriers to app use. DESIGN A database of previously performed SIMPL evaluations was analyzed to identify high, low, and never users. Potential predisposing factors to use were explored. A survey investigating key areas of value and barriers to use for the SIMPL application was sent to resident and faculty users. Respondents were asked to self-identify how often they used the app. The perceived benefits and barriers were correlated with the level of usage. Qualitative analysis of free text responses was used to determine strategies to increase usage. SETTING General surgery training programs who are members of the Procedural Learning and Safety Collaborative. PARTICIPANTS Surgical residents and faculty. RESULTS At least 1 SIMPL evaluation was created for 411 residents and 524 faculty. Thirty percent of both faculty and residents were high-frequency users. Thirty percent of faculty were never users. One hundred eighty-eight residents and 207 faculty (response rate 46%) completed the survey. High-frequency resident users were more likely to perceive a benefit for both numerical evaluations (76% vs 30%) and dictated feedback (92% vs 30%). Faculty and residents commonly blamed each other for not creating and completing evaluations regularly (87% of residents, 81% of faculty). Suggested strategies to increase usage included reminders and integration with existing data systems. CONTRIBUTIONS Frequent users perceive value from the application, particularly from dictated feedback and see a positive impact on feedback in their programs. Faculty engagement represents a major barrier to adoption. Mechanisms which automatically remind residents to initiate an evaluation will help improve utilization but programs must work to enhance faculty willingness to respond and dictate feedback.
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Affiliation(s)
- Megan Eaton
- University of Texas Health San Antonio, San Antonio, Texas
| | - Rebecca Scully
- Massachusetts General Hospital, Department of Surgery, Boston, Massachusetts
| | - Mary Schuller
- Northwestern University, Department of Surgery, Chicago, Illinois
| | - Amy Yang
- Northwestern University, Department of Surgery, Chicago, Illinois
| | - Douglas Smink
- Massachusetts General Hospital, Department of Surgery, Boston, Massachusetts
| | - Reed G Williams
- Indiana University, Department of Surgery, Bloomington, Indiana
| | - Jordan D Bohnen
- Massachusetts General Hospital, Department of Surgery, Boston, Massachusetts
| | - Brian C George
- University of Michigan, Department of Surgery, Ann Arbor, Michigan
| | - Jonathan P Fryer
- Northwestern University, Department of Surgery, Chicago, Illinois
| | - Shari L Meyerson
- University of Kentucky, Department of Surgery, Lexington, Kentucky.
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See one, do one, teach one: A randomized controlled study evaluating the benefit of autonomy in surgical education. Am J Surg 2019; 217:281-287. [DOI: 10.1016/j.amjsurg.2018.10.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 10/18/2018] [Accepted: 10/20/2018] [Indexed: 11/17/2022]
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Hunt MF, Zhou X, Lui C, Yang SC. Educational research and training innovation in cardiothoracic surgery: A year in review. J Thorac Cardiovasc Surg 2019; 157:1722-1727. [PMID: 30685178 DOI: 10.1016/j.jtcvs.2018.12.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 12/05/2018] [Accepted: 12/06/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Megan F Hunt
- Division of Thoracic Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Md.
| | - Xun Zhou
- Division of Thoracic Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Md
| | - Cecillia Lui
- Division of Thoracic Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Md
| | - Stephen C Yang
- Division of Thoracic Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Md
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Dougherty PJ, Cannada LK, Murray P, Osborn PM. Progressive Autonomy in the Era of Increased Supervision: AOA Critical Issues. J Bone Joint Surg Am 2018; 100:e122. [PMID: 30234630 DOI: 10.2106/jbjs.17.01515] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The observation of decreased resident autonomy, ultimately influencing the readiness of a new graduate to practice, has been supported with a number of recent surveys. This perceived lack of autonomy is felt to be due, in part, to many reasons, including duty-hour regulations, increased supervision requirements, patient safety measures, concern for complication rates, and other performance measures. Pressure on faculty members to have increased clinical productivity may not allow for more resident autonomy.Increased clinical exposure to improve resident independence may come from several suggested areas. First, restructuring the residency program to allow for more clinical time may be one way to improve education. Second, increased use of surgical simulation will allow for more experience to develop technical skills within a controlled environment. Surgical simulators can be used to acquire new skills and also as a means of assessing competence. Third, competency-based education (CBE) has been offered as a way to improve resident education. At its core, CBE offers criterion-based assessments for residents and faculty that allow for more frequent feedback.
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Affiliation(s)
- Paul J Dougherty
- Department of Orthopaedic Surgery, University of Florida, Jacksonville, Florida
| | - Lisa K Cannada
- Department of Orthopaedic Surgery, St. Louis University, St. Louis, Missouri
| | - Peter Murray
- Department of Orthopaedic Surgery, Mayo Clinic Florida, Jacksonville, Florida
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Turner SR, Huang J. Moving beyond case numbers: How should we assess technical competence? J Thorac Cardiovasc Surg 2018; 156:1723-1724. [PMID: 29935796 DOI: 10.1016/j.jtcvs.2018.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 05/08/2018] [Accepted: 05/08/2018] [Indexed: 10/14/2022]
Affiliation(s)
- Simon R Turner
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - James Huang
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
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Kovatch KJ, Prince MEP, Sandhu G. Weighing Entrustment Decisions with Patient Care during Residency Training. Otolaryngol Head Neck Surg 2018; 158:1024-1027. [PMID: 29558240 DOI: 10.1177/0194599818764652] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Kevin J Kovatch
- 1 Department of Otolaryngology-Head & Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Mark E P Prince
- 1 Department of Otolaryngology-Head & Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Gurjit Sandhu
- 2 Department of Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
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