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Choi SH, Kuchta K, Rojas A, Mehdi SA, Ramirez Barriga M, Hays S, Talamonti MS, Hogg ME. Residents perform better technically, have less stress and workload, and prefer robotic to laparoscopic technique during inanimate simulation. Surg Endosc 2023; 37:7230-7237. [PMID: 37395804 DOI: 10.1007/s00464-023-10216-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/11/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION With the widespread adoption of minimally invasive surgery, there is a growing need for surgical residents to be trained by a procedure-specific curriculum. This study aimed to evaluate the technical performance and feedback of surgical residents undergoing the robotic and laparoscopic hepaticojejunostomy (HJ) and gastrojejunostomy (GJ) biotissue modules. METHODS A total of 23 PGY-3 surgical residents participated in this study and performed the laparoscopic and robotic HJ and GJ drills, which were recorded and scored by two independent graders using the modified objective structured assessment of technical skills (OSATS). After completing each drill, all participants filled out the NASA Task Load Index (NASA-TLX), Borg Exertion Scale, and Edwards Arousal Rating Questionnaire. RESULTS Twenty-two (95.7%) residents had already received fundamentals of laparoscopic surgery certification. Eighteen (78.3%) residents had robotic virtual simulation training and the median (range) number of robotic surgery console experience was 4 (0-30). In the HJ comparison of the six OSATS domains, the robotic system was superior in Gentleness (p = 0.031). In the GJ comparison, the robotic system was superior in Time and Motion (p < 0.001), Instrument Handling (p = 0.001), Flow of Operation (p = 0.002), Tissue Exposure (p = 0.013), and Summary (p < 0.001). Participants answered significantly higher demand scores for laparoscopy on all six facets of NASA-TLX for both HJ and GJ (p < 0.05). The Borg Level of Exertion was > 2 points higher for laparoscopic HJ and GJ (p < 0.001). Residents rated more Nervousness and Anxiety for laparoscopic compared to robotic (p < 0.05) HJ and GJ. Additionally, when asked to score preference for robotic and laparoscopic approach in terms of technique and ergonomics, residents scored robot as better (laparoscopy worse) for both HJ and GJ in both domains. CONCLUSIONS The robotic surgical system provided a more favorable environment for trainees with less mental and physical burden for minimally invasive HJ and GJ curriculum.
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Affiliation(s)
- Sung Hoon Choi
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Walgreens Building - Floor 2, 2650 Ridge Road, Evanston, IL, 60201, USA
- Division of Hepatobiliary and Pancreas, Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Kristine Kuchta
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Walgreens Building - Floor 2, 2650 Ridge Road, Evanston, IL, 60201, USA
| | - Aram Rojas
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Walgreens Building - Floor 2, 2650 Ridge Road, Evanston, IL, 60201, USA
| | - Syed Abbas Mehdi
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Walgreens Building - Floor 2, 2650 Ridge Road, Evanston, IL, 60201, USA
| | | | - Sarah Hays
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Mark S Talamonti
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Walgreens Building - Floor 2, 2650 Ridge Road, Evanston, IL, 60201, USA
| | - Melissa E Hogg
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Walgreens Building - Floor 2, 2650 Ridge Road, Evanston, IL, 60201, USA.
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Trends in pancreatic surgery experience in general surgery residency in the US, 1990–2021. Am J Surg 2023:S0002-9610(23)00114-9. [PMID: 36990833 DOI: 10.1016/j.amjsurg.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/03/2023] [Accepted: 03/16/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND We hypothesized a decline in resident pancreatic operative experience. The study assesses trends in that experience since 1990. METHODS Accreditation Council for Graduate Medical Education (ACGME) national case log data of general surgery residency graduates from 1990 to 2021 were reviewed. Collected and analyzed were the mean and median total number of pancreatic operations per resident, the mean number of specific case types performed, and the annual number of residency graduates. For selected procedures, the mean number of cases by resident role (Surgeon-Chief and Surgeon-Junior) was also analyzed. RESULTS Both the mean and median total number of resident pancreatic operations has declined since 2009 as have the mean number of several specific pancreatic case types, including resections. The annual number of residency graduates has significantly increased since 1990, and particularly since 2009. CONCLUSIONS Resident volume in pancreatic operations has significantly declined over the last decade.
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Tuma F, Malgor RD, Kapila N, Kamel MK. Trends of core versus subspecialty operative procedures completed in general surgery residency training programs. Postgrad Med J 2021; 98:772-777. [PMID: 37062995 DOI: 10.1136/postgradmedj-2021-140503] [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: 05/17/2021] [Accepted: 07/11/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION General surgery residency involves performing subspecialty procedures in addition to the core general procedures. However, the proportion of core general surgery versus subspecialty procedures during training is variable and its temporal changes are unknown. The goal of our study was to assess the current trends in core general surgery and subspecialty procedure distributions during general surgery residency training. METHODS Data were collected from the ACGME core general surgery national resident available report case logs from 2007 to 2019. Descriptive and time series analyses were used to compare proportions of average procedures performed per resident in the core general surgery category versus the subspecialty category. F-tests were conducted to show whether the slopes of the trend lines were significantly non-zero. RESULTS The mean of total procedures completed for major credit by the average general surgery resident increased from 910.1 (SD=30.31) in 2007 to 1070.5 (SD=37.59) in 2019. Over that same period, the number of general, cardiothoracic, plastic and urology surgery procedures increased by 24.9%, 9.8%, 76.6% and 19.3%, respectively. Conversely, vascular and paediatric surgery procedures decreased by 7.6% and 30.7%, respectively. The neurological surgery procedures remain stable at 1.1 procedures per resident per year. A significant positive correlation in the trend reflecting total (p<0.0001), general (p<0.0001) and plastic (p<0.0016) surgery procedures and the negative correlation in the trend lines for vascular (p<0.0006) and paediatric (p<0.0001) surgery procedures were also noted. CONCLUSIONS Trends in overall surgical case volume performed by general surgery residents over the last 12 years have shown a steady increase in operative training opportunity despite the increasing number of subspecialty training programmes and fellowships. Further research to identify areas for improvement and to study the diversity of operative procedures, and their outcomes is warranted in the years to come.
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Affiliation(s)
- Faiz Tuma
- Central Michigan University College of Medicine, Saginaw, Michigan, USA
| | - Rafael D Malgor
- University of Colorado Denver Anschutz Medical Center Bookstore, Aurora, Colorado, USA
| | - Nikit Kapila
- General Surgery, Central Michigan University College of Medicine East Campus, Saginaw, Michigan, USA
| | - Mohamed K Kamel
- General Surgery, Central Michigan University College of Medicine East Campus, Saginaw, Michigan, USA
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Cortez AR, Potts JR. Resident Education in Biliary Operation: Beyond Laparoscopic Cholecystectomy. J Am Coll Surg 2021; 232:1020-1021. [PMID: 33849747 DOI: 10.1016/j.jamcollsurg.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
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