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Tan H, Bowden SG, Siler DA, O'Neill BE, Shahin MN, Fecker AL, Fleming-Sheffels S, Han SJ, Selden NR, Winer J, Orina JN. On-Call Workload Differences in Neurosurgery: Resident Call "Weather" and a Departure from Colored Cloud Labels. Neurosurgery 2024; 94:756-763. [PMID: 37874131 DOI: 10.1227/neu.0000000000002740] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 09/13/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Labeling residents as "black" or "white" clouds based on perceived or presumed workloads is a timeworn custom across medical training and practice. Previous studies examining whether such perceptions align with objective workload patterns have offered conflicting results. We assessed whether such peer-assigned labels were associated with between-resident differences in objective, on-call workload metrics in three classes of neurosurgery junior residents. In doing so, we introduce more inclusive terminology for perceived differences in workload metrics. METHODS Residents were instructed to complete surveys to identify "sunny", "neutral", and "stormy" residents, reflecting least to greatest perceived workloads, of their respective classes. We retrospectively reviewed department and electronic medical records to record volume of on-call work over the first 4 months of each resident's 2nd postgraduate academic year. Inter-rater agreement of survey responses was measured using Fleiss' kappa. All statistical analyses were performed with a significance threshold of P < .05. RESULTS Across all classes, there was strong inter-rater agreement in the identification of stormy and sunny residents (Kappa = 1.000, P = .003). While differences in on-call workload measures existed within each class, "weather" designations did not consistently reflect these differences. There were significant intraclass differences in per shift consult volume in two classes ( P = .035 and P = .009); however, consult volume corresponded to a resident's weather designations in only one class. Stormy residents generally saw more emergencies and, in 2 classes, performed more bedside procedures than their peers. CONCLUSION Significant differences in objective on-call experience exist between junior neurosurgery residents. Self- and peer-assigned weather labels did not consistently align with a pattern of these differences, suggesting that other factors contribute to such labels.
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Affiliation(s)
- Hao Tan
- Department of Neurological Surgery, Oregon Health & Science University, Portland , Oregon , USA
| | - Stephen G Bowden
- Department of Neurological Surgery, Oregon Health & Science University, Portland , Oregon , USA
| | - Dominic A Siler
- Department of Neurological Surgery, Oregon Health & Science University, Portland , Oregon , USA
| | - Brannan E O'Neill
- Department of Neurological Surgery, Oregon Health & Science University, Portland , Oregon , USA
| | - Maryam N Shahin
- Department of Neurological Surgery, Oregon Health & Science University, Portland , Oregon , USA
| | - Adeline L Fecker
- Department of Neurological Surgery, Oregon Health & Science University, Portland , Oregon , USA
| | | | - Seunggu Jude Han
- Department of Neurosurgery, Stanford Medicine, Palo Alto , California , USA
| | - Nathan R Selden
- Department of Neurological Surgery, Oregon Health & Science University, Portland , Oregon , USA
| | - Jesse Winer
- Department of Neurological Surgery, Oregon Health & Science University, Portland , Oregon , USA
| | - Josiah N Orina
- Department of Neurological Surgery, Oregon Health & Science University, Portland , Oregon , USA
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Rausch LA, McKay KG, Liu Y, Walker JC, LeCompte MT, Ewing JK, Walia S, Davidson M, Forbes RC, Shaffer D, Terhune KP. The Kidney Transplant: Maintaining Excellent Outcomes While Increasing Skills Acquisition. JOURNAL OF SURGICAL EDUCATION 2023; 80:1850-1858. [PMID: 37739890 DOI: 10.1016/j.jsurg.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 07/20/2023] [Accepted: 08/15/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVE/BACKGROUND Kidney transplantation is a complex operation that incorporates multiple fundamental surgical techniques and is an excellent opportunity for surgical skill development during residency training. We hypothesized that increasing resident competency, measured as anastomosis time, could be demonstrated while maintaining high-quality surgical outcomes during the learning process. METHODS We performed a retrospective cohort study of surgical resident involvement in kidney transplantation and recorded the anastomosis time. The study population comprised adult, single organ kidney transplants (n = 2052) at a large academic transplant center between 2006 and 2019. Descriptive statistics included frequencies, medians, and means. A mixed model of anastomosis time on number of procedures was fitted. Poisson models were fitted with outcomes of the number of patients with delayed graft function and number of patients that underwent reoperation postoperatively, with the exposure being number of kidney transplants performed by resident. RESULTS Results from the mixed model suggest that as the number of times a resident performs the surgery increases, the time to conduct the operation decreases with statistical significance. The Poisson regression demonstrated no significant relationship between the operative volume of a resident and postoperative complications. CONCLUSION This study demonstrated statistical evidence that with an increase in the number of renal transplantations performed by a surgical resident, anastomosis time decreased. It also demonstrated no significant relationship between number of kidney transplants performed by a resident and postoperative complications, suggesting that patient outcomes for this operation are not adversely affected by resident involvement.
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Affiliation(s)
- Laura A Rausch
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt University Masters of Public Health School, Nashville, Tennessee.
| | - Katlyn G McKay
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yangzi Liu
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Jasmine C Walker
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael T LeCompte
- Department of Surgery, University of North Carolina Healthcare, Chapel Hill, North Carolina
| | - John K Ewing
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sonal Walia
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mario Davidson
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rachel C Forbes
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David Shaffer
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kyla P Terhune
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Impact of educational video on performance in robotic simulation training (TAKUMI-1): a randomized controlled trial. J Robot Surg 2023:10.1007/s11701-023-01556-4. [PMID: 36905486 PMCID: PMC10374749 DOI: 10.1007/s11701-023-01556-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/01/2023] [Indexed: 03/12/2023]
Abstract
The use of virtual reality for simulations plays an important role in the initial training for robotic surgery. This randomized controlled trial aimed to investigate the impact of educational video on the performance of robotic simulation. Participants were randomized into the intervention (video) group that received an educational video and robotic simulation training or the control group that received only simulation training. The da Vinci® Skills Simulator was used for the basic course, including nine drills. The primary endpoint was the overall score of nine drills in cycles 1-10. Secondary endpoints included overall, efficiency, and penalty scores in each cycle, as well as the learning curves evaluated by the cumulative sum (CUSUM) analysis. Between September 2021 and May 2022, 20 participants were assigned to the video (n = 10) and control (n = 10) groups. The video group had significantly higher overall scores than the control group (90.8 vs. 72.4, P < 0.001). Significantly higher overall scores and lower penalty scores were confirmed, mainly in cycles 1-5. CUSUM analysis revealed a shorter learning curve in the video group. The present study demonstrated that educational video training can be effective in improving the performance of robotic simulation training and shortening the learning curve.
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Pecoraro A, Andras I, Boissier R, Hevia V, Prudhomme T, Serni S, Breda A, Campi R, Territo A. The learning curve for open and minimally-invasive kidney transplantation: a systematic review. Minerva Urol Nephrol 2022; 74:669-679. [PMID: 35622352 DOI: 10.23736/s2724-6051.22.04909-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION There is lack of evidence on the impact of surgeons' learning curve on postoperative outcomes after open (OKT) or minimally-invasive (robot-assisted) kidney transplantation (RAKT). The aim of the review was to assess the learning curve (LC) for OKT and RAKT, focusing on intra-, perioperative and functional outcomes. EVIDENCE ACQUISITION A systematic review of the English-language literature published between 01/01/2000 - 10/12/2021 was conducted using the MEDLINE (Via PubMed), Web of Science and the Cochrane Library databases according to the principles highlighted by the EAU Guidelines Office and the PRISMA statement recommendations. The review protocol was registered on PROSPERO (CRD42022301132). The overall quality of evidence was assessed according to GRADE recommendations. EVIDENCE SYNTHESIS Twelve studies were included in the qualitative analysis. Surgical competence in terms of operative and re-warming times was defined after 30 cases in OKT and after 11-35 cases in RAKT. Decreased complications rates were observed after 20-33 cases in OKT and 10-30 cases in RAKT. Optimal functional outcomes were achieved after 33 cases in OKT and 15-25 cases in RAKT. However, while a poor OKT experience did not influence the LC for RAKT, lack of robotic surgery exposure could lead to a longer LC for the robotic approach. CONCLUSIONS OKT and RAKT appear to have similar LCs and might require about 30 cases to achieve optimal surgical and functional outcomes. Previous expertise in OKT is warranted to shorten the LC for RAKT. Further research is needed to validate these thresholds using standardized reporting metrics.
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Affiliation(s)
- Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Iulia Andras
- Department of Urology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Romain Boissier
- Department of Urology and Renal Transplantation, La Conception University Hospital, Marseille, France
| | - Vital Hevia
- Department of Urology, Hospital Ramón y Cajal, IRYCIS, Alcalá University, Madrid, Spain
| | - Thomas Prudhomme
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alberto Breda
- Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Angelo Territo
- Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain -
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Takagi K, Kimenai HJAN, Terkivatan T, Tran KTC, Ijzermans JNM, Minnee RC. Learning curves of minimally invasive donor nephrectomy in a high-volume center: A cohort study of 1895 consecutive living donors. Int J Surg 2021; 86:7-12. [PMID: 33429077 DOI: 10.1016/j.ijsu.2020.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/23/2020] [Accepted: 12/28/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Few studies have investigated the learning curves of minimally invasive donor nephrectomy (MIDN) using the cumulative sum (CUSUM) analysis. In addition, no study has compared the learning curves of the different surgical MIDN techniques in one cohort study using the CUSUM analysis. This study aims to evaluate and compare learning curves for several MIDN using the CUSUM analysis. METHODS A retrospective review of consecutive donors, who underwent MIDN between 1997 and 2019, was conducted. Three laparoscopic-assisted techniques were applied in our institution and included for analysis: laparoscopic (LDN), hand-assisted retroperitoneoscopic (HARP), and robot-assisted laparoscopic (RADN) donor nephrectomy. The outcomes were compared based on surgeon volume to develop learning curves for the operative time per surgeon. RESULTS Out of 1895 MIDN, 1365 (72.0%) were LDN, 427 (22.5%) were HARP, and 103 (5.4%) were RADN. The median operative time and median blood loss were 179 (IQR, 139-230) minutes and 100 (IQR, 40-200) mL, respectively. The incidence of major complication was 1.2% with no mortality, and the median hospital stay was three (IQR, 3-4) days. The CUSUM analysis resulted in learning curves, defined by decreased operative time, of 23 cases in LDN, 45 cases in HARP, and 26 cases in RADN. CONCLUSIONS Our study shows different learning curves in three MIDN techniques with equal post-operative complications. The LDN and RADN learning curves are shorter than that of the hand-assisted donor nephrectomy. Our observations can be helpful for informing the development of teaching requirements for fellows to be trained in MIDN.
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Affiliation(s)
- Kosei Takagi
- Department of Surgery, Division of HPB & Transplant Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
| | - Hendrikus J A N Kimenai
- Department of Surgery, Division of HPB & Transplant Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Turkan Terkivatan
- Department of Surgery, Division of HPB & Transplant Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Khe T C Tran
- Department of Surgery, Division of HPB & Transplant Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Jan N M Ijzermans
- Department of Surgery, Division of HPB & Transplant Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Robert C Minnee
- Department of Surgery, Division of HPB & Transplant Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
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A commentary on "Learning curve of kidney transplantation in a high-volume centre: A cohort study of 1466 consecutive recipients" [Int. J. Surg. 80 (2020) 128-134]. Int J Surg 2020; 82:2-3. [PMID: 32827697 DOI: 10.1016/j.ijsu.2020.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 08/02/2020] [Indexed: 11/21/2022]
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Akay T, Leblebici M. An Invited Commentary on "Learning curve of kidney transplantation in a high-volume center: A cohort study of 1466 consecutive recipients". Int J Surg 2020; 82:14-15. [PMID: 32822838 DOI: 10.1016/j.ijsu.2020.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/09/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Tamer Akay
- Medicine Doctor. Bandırma State Hospital, General Surgery Department, 10200, Balıkesir, Turkey.
| | - Metin Leblebici
- Assistant Professor. Istanbul Medeniyet University, Department of General Surgery, Istanbul, Turkey.
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