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Dion L, Sousa C, Legendre G, Nyangoh-Timoh K, Le Lous M, Morel O, Lavoue V, Descamps P. Assessment of the self-confidence of obstetrics & gynecology fellows to perform a postpartum hemostasis hysterectomy. J Gynecol Obstet Hum Reprod 2023; 52:102548. [PMID: 36781074 DOI: 10.1016/j.jogoh.2023.102548] [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: 11/22/2022] [Revised: 02/06/2023] [Accepted: 02/06/2023] [Indexed: 02/13/2023]
Abstract
INTRODUCTION Hemostasis Hysterectomy (HH) is a last resort surgical procedure performed in situations of uncontrolled post-partum hemorrhage in maternity wards. The chances of being confronted with this situation are scarce during residency, and the situation is not well suited for teaching. Nevertheless, every obstetrician-gynecologist can be confronted with this stressful situation, and should therefore possess the surgical competence required, regardless of his routine practice. The aim of the present study is to evaluate clinical exposure and self-awareness concerning HH amongst obstetrics and gynecology residents and fellows. MATERIEL AND METHODS We performed a survey amongst French obstetrics and gynecology fellows. An anonymous survey was sent by email between December 1, 2020 to July 1, 2021. RESULTS Half of the interrogated fellows had practiced (as operator) an HH during residency with a senior and only 22,6% in post-residency. During the last year of residency 70% of them had performed less than 10 scheduled hysterectomies as primary operator. The laparoscopic approach was the most frequently practiced. Very few hysterectomies were performed as primary operator. Fellows with a surgical or mixed activity (both gynecological surgery and obstetrical activity in current practice) felt significantly more capable of performing HH compared to those with exclusive obstetrical or reproductive medicine activity; respectively 60% vs 36%, p = 0.008; Odds Ratio: 2.629 (95% CI 1.2214; 5.8094). CONCLUSION The number of scheduled hysterectomies or HH performed as primary operator is very low during residency or fellowship. It remains largely inferior to the number deemed necessary in previous publications about the learning curve for scheduled hysterectomy, which varies from 18 to 80 interventions. Nowadays, the increasing number of residents, added to the decrease of hemostasis hysterectomies through better management of post-partum hemorrhage, pushes towards the development of specific training, such as "damage control simulation".
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Affiliation(s)
- Ludivine Dion
- Rennes University Hospital, Department of Gynecology, Hôpital Sud, France; Irset - Inserm UMR_S 1085, Rennes, France.
| | - Carla Sousa
- Rennes University Hospital, Department of Gynecology, Hôpital Sud, France; Irset - Inserm UMR_S 1085, Rennes, France
| | | | | | - Maëla Le Lous
- Rennes University Hospital, Department of Gynecology, Hôpital Sud, France
| | - Olivier Morel
- Nancy University Hospital, Department of Obstetrics, France
| | - Vincent Lavoue
- Rennes University Hospital, Department of Gynecology, Hôpital Sud, France; Irset - Inserm UMR_S 1085, Rennes, France
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Ludwig J, Jakobsen RB, Charles YP, Seifert J, Incoll I, Wood ML, Parmar D, Canter R. What it takes to become an orthopaedic surgeon: A comparison of orthopaedic surgical training programmes in 10 countries focusing on structure and fellowship requirements. Int J Surg 2021; 95:106150. [PMID: 34715383 DOI: 10.1016/j.ijsu.2021.106150] [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: 08/04/2021] [Revised: 09/28/2021] [Accepted: 10/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The quality of surgical training has been highlighted as one of the most important patient safety issues in the future. Training surgeons and supporting them to do their best should be considered integral in providing optimum and safe care for the individual patient and the best possible return on investment in training medical professionals. In 2011, an international consensus statement defined fundamental principles for surgical training. PURPOSE This study examines orthopaedic surgical training to explore the similarities and differences in the requirements for trainees to obtain board certification in ten countries. METHODS Countries of the Commonwealth Health Care Comparison: Canada, the United Kingdom, the United States of America, Australia, New Zealand, Germany, France, the Netherlands, Norway and Switzerland were chosen to be compared. The relevant information was extracted from official information from authorities and administrative bodies. RESULTS The study revealed significant differences in duration, organisation and assessment of training. So-called "competency-based" training is not featured in every country, and the manner of its implementation is variable. In particular, the numbers in surgical cases required to be accredited varies by country ranging from 1260 (UK) to 340 (Norway). CONCLUSION Despite the recommendation in 2011 for some degree of uniformity across surgical training in industrialised countries, evidence suggests wide variation in the training programmes which is likely to be a concern in both quality of training as well as present and future patient safety.
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Affiliation(s)
- Johanna Ludwig
- BG Klinikum, Unfallkrankenhaus Berlin, Germany Kellogg College, University of Oxford, Oxford, United Kingdom Department of orthopedic surgery, Department of Health Management and Health Economics, Akershus University hospital and Institute of Health and Society, University Oslo, OSLO, Norway Hôpitaux Universitaires de Strasbourg, Department of Spine Surgery, Faculté de Médecine, Université de Strasbourg, France Department of Traumatology, University medicine, Universitätsmedizin Greifswald, University Greifswald, Greifswald, Germany University of Newcastle, District Clinical Director of Surgery; Clinical Lead, Quality & Innovation - Central Coast Local Health District, Graduate Programs in Surgical Education -University of Melbourne, Australia Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada Nuffield Department of Surgical Sciences, University of Oxford, United Kingdom
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Learning Curve of Total Laparoscopic Hysterectomy for a Resident in a High-Volume Resident Training Setup. J Obstet Gynaecol India 2021; 72:267-273. [PMID: 35928096 PMCID: PMC9343509 DOI: 10.1007/s13224-021-01540-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022] Open
Abstract
Study Objective To evaluate the resident learning curve, demographic and comparative analysis of total laparoscopic hysterectomy. Design This retrospective observational study was conducted in a high-volume resident training setup. Setting Tertiary care center is used in the study. Materials and Methods Eight hundred and one total laparoscopic hysterectomy patients operated by the residents between July 2013 and June 2019 were evaluated with respect to the learning curve, duplication of the steps, the results in terms of intra- and postoperative complications and the time taken for the surgery. Surgeries were assigned as per the institutional inclusion criteria for the residents. The fellowship program enrolled six residents per year for training period of 1 year. The residents initially performed ten simple cases under the supervision of the director followed by ten cases which were performed independently, and based on their learning curve, they then performed advanced cases independently. Results TLH was successfully performed in all women by surgical residents in training. The surgical time was 61-120 min in majority (49.3%). 2.99% had intra-operative complications while 7.61% had postoperative complications which were identified and managed. All women recovered uneventfully. Conclusions Dedicated teaching staff, uniform surgical protocols and high-volume centers contribute to the safety of TLH.
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Terzi H, Biler A, Demirtas O, Guler OT, Peker N, Kale A. Total laparoscopic hysterectomy: Analysis of the surgical learning curve in benign conditions. Int J Surg 2016; 35:51-57. [PMID: 27633451 DOI: 10.1016/j.ijsu.2016.09.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 09/06/2016] [Accepted: 09/10/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To assess the learning curve for total laparoscopic hysterectomy. METHODS This study was a retrospective analysis of the learning curve for two surgeons during their first 257 consecutive cases of total laparoscopic hysterectomy at a teaching hospital. Patients were divided sequentially into groups comprising the first 75 patients, the next 75, and the final 107 patients. Age, body mass index, gestational parity, indications for laparoscopic hysterectomy, previous pelvic surgery, operating time, haemoglobin decline, complications, need for transfusion, and length of hospital stay were evaluated. RESULTS The mean operating time for total laparoscopic hysterectomy reduced significantly from 76.2 min to 68.9 min (p = 0.001) between the first and second 75-patient groups. Linear regression analysis showed a plateau was reached on the learning curve after 71-80 cases. The rate of all complications started at 8% in the first group of 75 patients, reduced to 6.7% in the next group, and decreased further in the final group to 4.7%. The decline was not statistically significant (p = 0.6). The difference in the need for transfusion was statistically significant between the first 75 patients and the second group of 75 (p = 0.04). Conversion from laparoscopy to laparotomy was required in five patients, four in the early group and one in the final group. Age, body mass index, parity, previous pelvic surgery, decline in haemoglobin, and length of hospital stay were similar among the three groups. CONCLUSIONS A plateau in the learning curve for TLH was reached after the first 75 cases. We can infer that there is a learning curve for TLH as confirmed by the decrease in operating time (accompanied by no change in complications) correlated to gain in experience. On the other hand, one should not disregard the fact that laparoscopy is not a complication-free surgery and achievement of the learning curve does not exclude complications. Gynaecological surgeons can perform TLH securely during the learning curve.
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Affiliation(s)
- Hasan Terzi
- Department of Obstetrics and Gynecology, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Alper Biler
- Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Izmir, Turkey.
| | - Omer Demirtas
- Department of Obstetrics and Gynecology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Omer Tolga Guler
- Department of Obstetrics and Gynecology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Nuri Peker
- Department of Obstetrics and Gynecology, Acibadem University Faculty of Medicine, Istanbul, Turkey
| | - Ahmet Kale
- Department of Obstetrics and Gynecology, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
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Campo R, Wattiez A, Tanos V, Di Spiezio Sardo A, Grimbizis G, Wallwiener D, Brucker S, Puga M, Molinas R, O’Donovan P, Deprest J, Van Belle Y, Lissens A, Herrmann A, Tahir M, Benedetto C, Siebert I, Rabischong B, De Wilde RL. Gynaecological endoscopic surgical education and assessment. A diploma programme in gynaecological endoscopic surgery. GYNECOLOGICAL SURGERY 2016; 13:133-137. [PMID: 27478427 PMCID: PMC4949291 DOI: 10.1007/s10397-016-0957-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
In recent years, training and education in endoscopic surgery has been critically reviewed. Clinicians, both surgeons as gynaecologist who perform endoscopic surgery without proper training of the specific psychomotor skills, are at higher risk to increased patient morbidity and mortality. Although the apprentice-tutor model has long been a successful approach for training of surgeons, recently, clinicians have recognised that endoscopic surgery requires an important training phase outside the operating theatre. The Gynaecological Endoscopic Surgical Education and Assessment programme (GESEA) recognises the necessity of this structured approach and implements two separated stages in its learning strategy. In the first stage, a skill certificate on theoretical knowledge and specific practical psychomotor skills is acquired through a high-stake exam; in the second stage, a clinical programme is completed to achieve surgical competence and receive the corresponding diploma. Three diplomas can be awarded: (a) the Bachelor in Endoscopy, (b) the Minimally Invasive Gynaecological Surgeon (MIGS) and (c) the Master level. The Master level is sub-divided into two separate diplomas: the Master in Laparoscopic Pelvic Surgery and the Master in Hysteroscopy. The complexity of modern surgery has increased the demands and challenges to surgical education and the quality control. This programme is based on the best available scientific evidence, and it counteracts the problem of the traditional surgical apprentice-tutor model. It is seen as a major step toward standardisation of endoscopic surgical training in general.
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Affiliation(s)
- Rudi Campo
- />Life Expert Centre, Schipvaartstraat 2 Bus 4, 3000 Leuven, Belgium
- />European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium
- />European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium
- />European Board and College of Obstetrics and Gynaecology, Brussels, Belgium
| | - Arnaud Wattiez
- />Life Expert Centre, Schipvaartstraat 2 Bus 4, 3000 Leuven, Belgium
- />European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium
- />European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Vasilis Tanos
- />European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium
- />European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium
| | | | - Grigoris Grimbizis
- />European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Diethelm Wallwiener
- />European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium
- />Department of Women’s Health, University Hospital Tuebingen, Calwerstraat 7, 72077 Tuebingen, Germany
| | - Sara Brucker
- />European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium
- />Department of Women’s Health, University Hospital Tuebingen, Calwerstraat 7, 72077 Tuebingen, Germany
| | - Marco Puga
- />European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Roger Molinas
- />European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Peter O’Donovan
- />European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium
- />European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Jan Deprest
- />European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium
- />Center for Surgical Technologies, Leuven, Belgium
| | - Yves Van Belle
- />European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Ann Lissens
- />European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium
- />Center for Surgical Technologies, Leuven, Belgium
- />University Hospitals Leuven, Leuven, Belgium
| | - Anja Herrmann
- />Pius-Hospital Oldenburg, Department of Gynecology, Obstetrics and Gynaecological Oncology, Carlvon Ossietzky University, Georgstraße 12, 26121 Oldenburg, Germany
| | - Mahmood Tahir
- />European Board and College of Obstetrics and Gynaecology, Brussels, Belgium
| | - Chiara Benedetto
- />European Board and College of Obstetrics and Gynaecology, Brussels, Belgium
| | - Igno Siebert
- />African Endoscopic Training Academy, Cape Town, South Africa
| | - Benoit Rabischong
- />International Centre for Endoscopic Surgery, Clermont-Ferrand, France
| | - Rudy Leon De Wilde
- />European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium
- />Pius-Hospital Oldenburg, Department of Gynecology, Obstetrics and Gynaecological Oncology, Carlvon Ossietzky University, Georgstraße 12, 26121 Oldenburg, Germany
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Campo R, Wattiez A, Tanos V, Di Spiezio Sardo A, Grimbizis G, Wallwiener D, Brucker S, Puga M, Molinas R, O'Donovan P, Deprest J, Van Belle Y, Lissens A, Herrmann A, Tahir M, Benedetto C, Siebert I, Rabischong B, De Wilde RL. Gynaecological Endoscopic Surgical Education and Assessment. A diploma programme in gynaecological endoscopic surgery. Eur J Obstet Gynecol Reprod Biol 2016; 199:183-6. [PMID: 26946312 DOI: 10.1016/j.ejogrb.2016.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 01/29/2016] [Accepted: 02/05/2016] [Indexed: 11/30/2022]
Abstract
In recent years, training and education in endoscopic surgery has been critically reviewed. Clinicians, both surgeons as gynaecologist who perform endoscopic surgery without proper training of the specific psychomotor skills are at higher risk to increased patient morbidity and mortality. Although the apprentice-tutor model has long been a successful approach for training of surgeons, recently, clinicians have recognised that endoscopic surgery requires an important training phase outside the operating theatre. The Gynaecological Endoscopic Surgical Education and Assessment programme (GESEA), recognises the necessity of this structured approach and implements two separated stages in its learning strategy. In the first stage, a skill certificate on theoretical knowledge and specific practical psychomotor skills is acquired through a high stake exam; in the second stage, a clinical programme is completed to achieve surgical competence and receive the corresponding diploma. Three diplomas can be awarded: (a) the Bachelor in Endoscopy; (b) the Minimally Invasive Gynaecological Surgeon (MIGS); and (c) the Master level. The Master level is sub-divided into two separate diplomas: the Master in Laparoscopic Pelvic Surgery and the Master in Hysteroscopy. The complexity of modern surgery has increased the demands and challenges to surgical education and the quality control. This programme is based on the best available scientific evidence and it counteracts the problem of the traditional surgical apprentice tutor model. It is seen as a major step toward standardization of endoscopic surgical training in general.
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Affiliation(s)
- Rudi Campo
- Life Expert Centre, Schipvaartstraat 2 Bus 4, 3000 Leuven, Belgium; European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium; European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium; European Board and College of Obstetrics and Gynaecology, Brussels, Belgium.
| | - Arnaud Wattiez
- Life Expert Centre, Schipvaartstraat 2 Bus 4, 3000 Leuven, Belgium; European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium; European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Vasilis Tanos
- European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium; European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium
| | | | - Grigoris Grimbizis
- European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Diethelm Wallwiener
- European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium; Department of Women's Health, University Hospital Tuebingen, Calwerstraat 7, 72077 Tuebingen, Germany
| | - Sara Brucker
- European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium; Department of Women's Health, University Hospital Tuebingen, Calwerstraat 7, 72077 Tuebingen, Germany
| | - Marco Puga
- European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Roger Molinas
- European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Peter O'Donovan
- European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium; European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Jan Deprest
- European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium; Center for Surgical Technologies, Leuven, Belgium, University Hospitals Leuven, Leuven, Belgium.
| | - Yves Van Belle
- European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Ann Lissens
- European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium; Center for Surgical Technologies, Leuven, Belgium, University Hospitals Leuven, Leuven, Belgium
| | - Anja Herrmann
- Pius-Hospital Oldenburg, Department of Gynecology, Obstetrics and Gynaecological Oncology, Carlvon Ossietzky University, Georgstraße 12, 26121 Oldenburg, Germany
| | - Mahmood Tahir
- European Board and College of Obstetrics and Gynaecology, Brussels, Belgium
| | - Chiara Benedetto
- European Board and College of Obstetrics and Gynaecology, Brussels, Belgium
| | - Igno Siebert
- African Endoscopic Training Academy, Cape Town, South Africa
| | - Benoit Rabischong
- International Centre for Endoscopic Surgery, Clermont-Ferrand, France
| | - Rudy Leon De Wilde
- European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium; Pius-Hospital Oldenburg, Department of Gynecology, Obstetrics and Gynaecological Oncology, Carlvon Ossietzky University, Georgstraße 12, 26121 Oldenburg, Germany
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Jokinen E, Brummer T, Jalkanen J, Fraser J, Heikkinen AM, Mäkinen J, Sjöberg J, Tomàs E, Mikkola TS, Härkki P. Hysterectomies in Finland in 1990-2012: comparison of outcomes between trainees and specialists. Acta Obstet Gynecol Scand 2015; 94:701-707. [DOI: 10.1111/aogs.12654] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 04/08/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Ewa Jokinen
- Department of Obstetrics and Gynecology; Hospital District of Helsinki and Uusimaa/Hyvinkää Hospital; Hyvinkää Finland
| | - Tea Brummer
- Department of Obstetrics and Gynecology; Østfold Central Hospital; Fredrikstad Norway
| | - Jyrki Jalkanen
- Department of Obstetrics and Gynecology; Central Finland Central Hospital; Jyväskylä Finland
| | - Jaana Fraser
- Department of Obstetrics and Gynecology; North Karelia Central Hospital; Joensuu Finland
| | | | - Juha Mäkinen
- Department of Obstetrics and Gynecology; Turku University Hospital; Turku Finland
| | - Jari Sjöberg
- Department of Obstetrics and Gynecology; Helsinki University Central Hospital; Helsinki Finland
| | - Eija Tomàs
- Department of Obstetrics and Gynecology; Tampere University Hospital; Tampere Finland
| | - Tomi S. Mikkola
- Department of Obstetrics and Gynecology; Helsinki University Central Hospital; Helsinki Finland
| | - Päivi Härkki
- Department of Obstetrics and Gynecology; Helsinki University Central Hospital; Helsinki Finland
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Evaluating Physical Therapist Students’ Clinical Performance in Acute Care: A Retrospective Analysis Comparing Student-Treated and Staff-Treated Patient Outcomes After Total Knee Arthroplasty. ACTA ACUST UNITED AC 2015. [DOI: 10.1097/00001416-201529020-00006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Conization of the uterine cervix: does the level of gynecologist's training predict margin status? Int J Gynecol Pathol 2012; 31:382-6. [PMID: 22653354 DOI: 10.1097/pgp.0b013e318242118c] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The management of cervical intraepithelial neoplasia is becoming more individualized. The European Federation of Colposcopy has developed guidelines for quality assurance and also certifies specialists. The status of the resection margins of conization specimens is prognostically important and is a quality feature. We examined the rate of positive margins in conization specimens according to the training level of the gynecologic surgeon. We reviewed the hospital charts of 411 consecutive patients who underwent conization for cervical intraepithelial neoplasia or adenocarcinoma in situ between November 2006 and December 2009. Preoperative colposcopy was performed to localize and characterize the transformation zone and the lesion in all cases. Ninety-seven conizations were performed by residents, 138 by staff members, and 124 by 1 certified specialist for colposcopy. A total of 334 cold-knife conizations and 25 loop electrosurgical excision procedures were carried out. The rates of positive histologic margins in conization specimens were 16%, 22%, and 5% for residents, staff members, and the certified specialist, respectively (P<0.001). Expertise of the gynecologic surgeon in performing conization procedures appears to influence the rate of involved margins after conization. These data support quality-assured preoperative colposcopy and European Federation of Colposcopy quality assurance criteria. Specialization of gynecologic staff members in the field of colposcopy is warranted.
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Tsai MJ, Huang JY, Wei PJ, Wang CY, Yang CJ, Wang TH, Hwang JJ. Outcomes of the patients in the respiratory care center are not associated with the seniority of the caring resident. Kaohsiung J Med Sci 2012; 29:43-9. [PMID: 23257256 DOI: 10.1016/j.kjms.2012.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 01/02/2012] [Indexed: 11/20/2022] Open
Abstract
Although many studies show that the experience level of physicians is significantly associated with the outcomes of their patients, little evidence exists to show whether junior residents provide worse care than senior residents. This study was conducted to analyze whether the experience level of residents may affect the outcomes of patients cared for in a well-organized setting. We conducted a 7-year retrospective study utilizing statistical data from a respiratory care center (RCC) in a medical center between October 2004 and September 2011. In addition to the two medical residents who had been trained in the intensive care unit (ICU), the RCC team also included attending physicians in charge, a nurse practitioner, a case manager, a dietitian, a pharmacist, a social worker, registered respiratory therapists, and nursing staff. Weaning from mechanical ventilation was done according to an established weaning protocol. The 84 months analyzed were classified into five groups according to the levels of the two residents working in the RCC: R2 + R1, R2 + R2, R3 + R1, R3 + R2, and R3 + R3. The monthly weaning rate and mortality rate were the major outcomes, while the mean ventilator days, rate of return to the ICU, and nosocomial infection incidence rate were the minor outcomes. The groups did not differ significantly in the monthly weaning rate, mortality rate, mean ventilator days, rate of return to the ICU, or nosocomial infection incidence rate (p > 0.1). Further analysis showed no significant difference in the monthly weaning rate and mortality rate between months with a first-year resident (R1) and those with two senior residents (p > 0.2). Although the weaning rate in the RCC gradually improved over time (p < 0.001), there was no significant difference in the monthly weaning rate between the groups after adjusting for time and disease severity (p > 0.7). Thus, we concluded that in a well-organized setting, the levels (experiences) of residents did not significantly affect patient outcomes. This result may be attributed to the well-developed weaning protocol and teamwork processes in place, which avoid a large effect from any single factor and provide stable and high-quality care to the patients.
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Affiliation(s)
- Ming-Ju Tsai
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Hwang JH, Yoo HJ, Joo J, Kim S, Lim MC, Song YJ, Park SY. Learning curve analysis of laparoscopic radical hysterectomy and lymph node dissection in early cervical cancer. Eur J Obstet Gynecol Reprod Biol 2012; 163:219-23. [DOI: 10.1016/j.ejogrb.2012.05.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 03/13/2012] [Accepted: 05/02/2012] [Indexed: 11/25/2022]
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12
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van der Leeuw RM, Lombarts KMJMH, Arah OA, Heineman MJ. A systematic review of the effects of residency training on patient outcomes. BMC Med 2012; 10:65. [PMID: 22742521 PMCID: PMC3391170 DOI: 10.1186/1741-7015-10-65] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 06/28/2012] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Residents are vital to the clinical workforce of today and tomorrow. Although in training to become specialists, they also provide much of the daily patient care. Residency training aims to prepare residents to provide a high quality of care. It is essential to assess the patient outcome aspects of residency training, to evaluate the effect or impact of global investments made in training programs. Therefore, we conducted a systematic review to evaluate the effects of relevant aspects of residency training on patient outcomes. METHODS The literature was searched from December 2004 to February 2011 using MEDLINE, Cochrane, Embase and the Education Resources Information Center databases with terms related to residency training and (post) graduate medical education and patient outcomes, including mortality, morbidity, complications, length of stay and patient satisfaction. Included studies evaluated the impact of residency training on patient outcomes. RESULTS Ninety-seven articles were included from 182 full-text articles of the initial 2,001 hits. All studies were of average or good quality and the majority had an observational study design. Ninety-six studies provided insight into the effect of 'the level of experience of residents' on patient outcomes during residency training. Within these studies, the start of the academic year was not without risk (five out of 19 studies), but individual progression of residents (seven studies) as well as progression through residency training (nine out of 10 studies) had a positive effect on patient outcomes. Compared with faculty, residents' care resulted mostly in similar patient outcomes when dedicated supervision and additional operation time were arranged for (34 out of 43 studies). After new, modified or improved training programs, patient outcomes remained unchanged or improved (16 out of 17 studies). Only one study focused on physicians' prior training site when assessing the quality of patient care. In this study, training programs were ranked by complication rates of their graduates, thus linking patient outcomes back to where physicians were trained. CONCLUSIONS The majority of studies included in this systematic review drew attention to the fact that patient care appears safe and of equal quality when delivered by residents. A minority of results pointed to some negative patient outcomes from the involvement of residents. Adequate supervision, room for extra operation time, and evaluation of and attention to the individual competence of residents throughout residency training could positively serve patient outcomes. Limited evidence is available on the effect of residency training on later practice. Both qualitative and quantitative research designs are needed to clarify which aspects of residency training best prepare doctors to deliver high quality care.
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Affiliation(s)
- Renée M van der Leeuw
- Professional Performance Research Group, Department of Quality Management and Process Innovation, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
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De Wilde RL. The Danger of Time-Consuming Operative Laparoscopies: Avoiding Severe Complications. Geburtshilfe Frauenheilkd 2012; 72:291-292. [PMID: 25284833 DOI: 10.1055/s-0031-1298395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- R L De Wilde
- Department of Obstetrics, Gynecology and Gynecological Oncology, Pius Clinic, 26121 Oldenburg
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Schuster MW, Wheeler TL, Richter HE. Endometriosis after laparoscopic supracervical hysterectomy with uterine morcellation: a case control study. J Minim Invasive Gynecol 2012; 19:183-7. [PMID: 22265051 PMCID: PMC3292633 DOI: 10.1016/j.jmig.2011.09.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 09/06/2011] [Accepted: 09/08/2011] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE To compare the incidence of new-onset endometriosis after laparoscopic supracervical hysterectomy (LSH) with uterine morcellation to traditional routes. DESIGN Single center case-control study (Canadian Task Force classification II-2) of hysterectomies performed from January 2006 through December 2008. PATIENTS Two hundred seventy-seven laparoscopic supracervical hysterectomies with morcellation (cases) and 187 transvaginal or abdominal hysterectomies without morcellation (controls) were performed from January 2006 through December 2008. INTERVENTIONS A total of 464 women underwent hysterectomy, 277 cases via laparoscopic supracervical approach (LSH) with morcellation and 187 performed either transvaginally or abdominally without morcellation. Repeat operative procedures were performed for other benign indications on 16 of 464 (3.5%) patients who had undergone prior hysterectomy. MEASUREMENTS AND MAIN RESULTS One hundred two patients had endometriosis at the time of hysterectomy diagnosed by pathologic evaluation or gross visualization. In those without endometriosis, repeat operative procedures were performed for pain and bleeding in 3.3% (12/362). Sixty percent (3/5) of patients treated with LSH and 28.6% (2/7) of the control group were found to have newly diagnosed endometriosis, conferring a rate of 1.4% (3/217) in the LSH group and 1.4% (2/145) in the control subjects. In patients with endometriosis, repeat operative procedures for pain or bleeding occurred in 2.9% (3/102): 3/60 patients treated with LSH and none in the control group (0/42). Two of these 3 patients undergoing a second surgery had recurrent/continued endometriosis. CONCLUSION Newly diagnosed endometriosis was noted in 1.4% of patients after hysterectomy, with a similar incidence between the LSH and control groups. Reoperation for those with endometriosis at the time of LSH with morcellation was infrequent, but endometriosis was usually found. Further research is needed to delineate risk factors for development of de novo endometriosis after hysterectomy.
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Affiliation(s)
| | - Thomas L. Wheeler
- Department of Obstetrics and Gynecology, UMG Greenville Hospital Systems, Greenville, SC
| | - Holly E. Richter
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
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Sessler DI, Kurz A, Saager L, Dalton JE. Operation Timing and 30-Day Mortality After Elective General Surgery. Anesth Analg 2011; 113:1423-8. [DOI: 10.1213/ane.0b013e3182315a6d] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ng JSY, Fong YF, Tong PSY, Yong EL, Low JJH. Gynaecologic Robot-Assisted Cancer and Endoscopic Surgery (GRACES) in a Tertiary Referral Centre. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2011. [DOI: 10.47102/annals-acadmedsg.v40n5p208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction: Robotic-assisted gynaecologic surgery is gaining popularity and it offers the advantages of laparoscopic surgery whilst overcoming the limitations of operative dexterity. We describe our experience with the first 40 cases operated under the GRACES (Gynaecologic Robot-Assisted Cancer and Endoscopic Surgery) programme at the Department of Obstetrics & Gynecology, National University Hospital, Singapore. Materials and Methods: A review was performed for the first 40 women who had undergone robotic surgery, analysing patient characteristics, surgical timings and surgery-related complications. All cases were performed utilising the da Vinci® surgical system (Intuitive Surgical, Sunnyvale, CA) with 3 arms and 4 ports. Standardised instrumentation and similar cuff closure techniques were used. Results: Seventeen (56%) were for endometrial cancer and the rest, for benign gynaecological disease. The mean age of the patients was 52.3 years. The average docking time was 11 minutes (SD 0.08). The docking and operative times were analysed in tertiles. Data for patients with endometrial cancer and benign cases were analysed separately. There were 3 cases of complications- cuff dehiscence, bleeding from vaginal cuff and tumour recurrence at vaginal vault. Conclusion: Our caseload has enabled us to replicate the learning curve reported by other centres. We advocate the use of a standard instrument set for the first 20 cases. We propose the following sequence for successful introduction of robot-assisted gynaecologic surgery – basic systems training, followed shortly with a clinical case, and progressive development of clinical competence through a proctoring programme.
Key words: Clinical outcomes, Cost effectiveness, Gynaecology, Learning curve, Robotics
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Affiliation(s)
- Joseph SY Ng
- National University Hospital, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yoke Fai Fong
- National University Hospital, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Pearl SY Tong
- National University Hospital, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Eu Leong Yong
- National University Hospital, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jeffrey JH Low
- National University Hospital, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Defining a structured training program for acquiring basic and advanced laparoscopic psychomotor skills in a simulator. ACTA ACUST UNITED AC 2010. [DOI: 10.1007/s10397-010-0594-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Neal CJ, Rosner MK. Resident learning curve for minimal-access transforaminal lumbar interbody fusion in a military training program. Neurosurg Focus 2010; 28:E21. [DOI: 10.3171/2010.1.focus1011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Object
Minimal-access transforaminal lumbar interbody fusion (TLIF) has gained popularity as a method of achieving interbody fusion via a posterior-only approach with the aim of minimizing injury to adjacent tissue. While many studies have reported successful outcomes, questions remain regarding the potential learning curve for successfully completing this procedure. The goal of this study, based on a single resident's experience at the only Accreditation Council for Graduate Medical Education–approved neurosurgical training center in the US military, was to determine if there is in fact a significant learning curve in performing a minimal-access TLIF.
Methods
The authors retrospectively reviewed all minimal-access TLIFs performed by a single neurosurgical resident between July 2006 and January 2008. Minimal-access TLIFs were performed using a tubular retractor inserted via a muscle-dilating exposure to limit approach-related morbidity. The accuracy of screw placement and operative times were assessed.
Results
A single resident/attending team performed 28 minimal-access TLIF procedures. In total, 65 screws were placed at L-2 (1 screw), L-3 (2 screws), L-4 (18 screws), L-5 (27 screws), and S-1 (17 screws) from the resident's perspective. Postoperative CTs were reviewed to determine the accuracy of screw placement. An accuracy of 95.4% (62 of 65) properly placed screws was noted on postoperative imaging. Two screws (at L-5 in the patient in Case 17 and at S-1 in the patient in Case 9) were lateral, and no revision was needed. One screw (at L-4 in Case 24) was 1 mm medial without symptoms or the need for revision. In evaluating the operative times, 2 deformity cases (Grade III spondylolisthesis) were excluded. The average operating time per level in the remaining 26 cases was 113.25 minutes. The average time per level for the first 13 cases was 121.2 minutes; the amount of time decreased to 105.3 minutes for the second group of 13 cases (p = 0.25).
Conclusions
In summary, minimal-access TLIF can be safely performed in a training environment without a significant complication rate due to the expected learning curve.
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Affiliation(s)
- Chris J. Neal
- 1Division of Neurosurgery, National Naval Medical Center, Bethesda, Maryland; and
| | - Michael K. Rosner
- 2Division of Neurosurgery, Walter Reed Army Medical Center, Washington, DC
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Frumovitz M, Soliman PT, Greer M, Schmeler KM, Moroney J, Bodurka DC, Ramirez PT. Laparoscopy training in gynecologic oncology fellowship programs. Gynecol Oncol 2008; 111:197-201. [DOI: 10.1016/j.ygyno.2008.08.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Revised: 08/10/2008] [Accepted: 08/12/2008] [Indexed: 10/21/2022]
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Molinas CR, De Win G, Ritter O, Keckstein J, Miserez M, Campo R. Feasibility and construct validity of a novel laparoscopic skills testing and training model. ACTA ACUST UNITED AC 2008. [DOI: 10.1007/s10397-008-0391-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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