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Choinski KN, Vouyouka AG. Understanding and addressing varying perceptions of autonomy. J Vasc Surg Venous Lymphat Disord 2024; 12:101691. [PMID: 37783286 DOI: 10.1016/j.jvsv.2023.09.005] [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: 05/21/2023] [Revised: 09/04/2023] [Accepted: 09/25/2023] [Indexed: 10/04/2023]
Abstract
Recently, there has been a major shift in the concept of resident autonomy in the operating room. As a result, surgical residents' independence has decreased during their training years. This change has been secondary to multiple factors, including fragmented attending resident interactions, hospital demands for productivity, operating room efficiency, and the public's perception of resident participation in surgery. Multiple gender, personality, and racial biases have also influenced the autonomy of surgical residents. In this paper, we have analyzed the impact of all these factors on the current state of resident autonomy after reviewing relevant literature. We have proposed a strategy to increase resident autonomy via increased resident and faculty interactions, case planning, and encouraged recruitment of diverse vascular surgery trainees and faculty.
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Affiliation(s)
- Krystina N Choinski
- Division of Vascular Surgery, Department of Surgery, Mount Sinai Hospital, New York, NY
| | - Ageliki G Vouyouka
- Division of Vascular Surgery, Department of Surgery, Mount Sinai Hospital, New York, NY.
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Wu SC, Swanton AR, Jones JM, Gross MS. New findings regarding the influence of assistants on surgical outcomes in penile prosthesis implantation. Int J Impot Res 2023; 35:736-740. [PMID: 36209303 DOI: 10.1038/s41443-022-00624-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 11/08/2022]
Abstract
Penile prosthesis implantation is the definitive treatment for refractory erectile dysfunction, yet exposure to this procedure during training of urology residents is often limited. To assess the effects of resident participation in penile prosthesis surgery, we compared surgical outcomes in a retrospective case series of 253 penile prosthesis surgeries by a single surgeon at the same institution between 2017 and 2020 with the assistance of either a registered nurse first assistant (RNFA) or a resident. Pertinent patient characteristics and surgical complications including device complications, surgical site infection, postoperative bleeding, iatrogenic injury, cardiovascular events, pulmonary events, and urinary retention were documented. Measured outcomes included operative time, Emergency Room (ER) visits, unplanned postoperative visits, pain medication refills, and surgical complications. Compared to RFNAs, resident-assisted penile prosthesis surgery was associated with significant increase in mean operative time (71.4 min vs. 87.9 min, p < 0.01) and postoperative ER visits (3.0% vs. 10.6%, p = 0.03) but not surgical complications (19.7% vs. 20.8%, OR 1.03, 95% CI [0.46 -2.30]) or other measured outcomes. Compared to a dedicated RFNA, Resident assistance increased operative time by approximately 17 min, but did not increase post-operative surgical complications, supporting the notion that resident assistance in these procedures may be appropriate as an integral part of training.
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Affiliation(s)
- Shuo-Chieh Wu
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Amanda R Swanton
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - James M Jones
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Martin S Gross
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
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Wang R, Lucy A, Cochrun S, Abraham P, Hardiman KM, Corey B, Chen H. Preserving the Pipeline of Surgeon Scientists: The Role of a Structured Research Curriculum. J Surg Res 2023; 290:101-108. [PMID: 37230044 DOI: 10.1016/j.jss.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/22/2023] [Accepted: 04/15/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION With shrinking National Institute of Health support, increased clinical demands, and less time for research training during residency, the future of surgeon scientists is in jeopardy. We evaluate the role of a structured research curriculum and its association with resident academic productivity. METHODS Categorical general surgery residents who matched between 2005 and 2019 at our institution were analyzed (n = 104). An optional structured research curriculum, including a mentor program, grant application support, didactic seminars, and travel funding was implemented in 2016. Academic productivity, including the number of publications and citations, was compared between residents who started in or after 2016 (postimplementation, n = 33) and those before 2016 (preimplementation, n = 71). Descriptive statistics, Mann-Whitney U test, multivariable logistic regression, and inverse probability treatment weighting were performed. RESULTS The postimplementation group had more female (57.6% versus 31.0%, P = 0.010), and nonwhite (36.4% versus 5.6%, P < 0.001) residents and had more publications and citations at the start of residency (P < 0.001). Postimplementation residents were more likely to choose academic development time (ADT) (66.7% versus 23.9%, P < 0.001) and had higher median (IQR) number of publications (2.0 (1.0-12.5) versus 1.0 (0-5.0), P = 0.028) during residency. After adjusting the number of publications at the start of residency, multivariable logistic regression analysis showed that the postimplementation group was five times more likely to choose ADT (95% CI 1.7-14.7, P = 0.04). Further, inverse probability treatment weighting revealed an increase of 0.34 publications per year after implementing the structured research curriculum among residents who chose ADT (95% CI 0.1-0.9, P = 0.023). CONCLUSIONS A structured research curriculum was associated with increased academic productivity and surgical resident participation in dedicated ADT. A structured research curriculum is effective and should be integrated into residency training to support the next generation of academic surgeons.
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Affiliation(s)
- Rongzhi Wang
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Adam Lucy
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Steven Cochrun
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Peter Abraham
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Karin M Hardiman
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, Alabama; Department of Surgery, Birmingham Veteran's Affairs Medical Center, Birmingham, Alabama
| | - Britney Corey
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, Alabama; Department of Surgery, Birmingham Veteran's Affairs Medical Center, Birmingham, Alabama
| | - Herbert Chen
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, Alabama.
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Khalafallah AM, Chakravarti S, Cicalese KV, Porras JL, Kuo CC, Jimenez AE, Brem H, Witham T, Huang J, Mukherjee D. An asynchronous web-based intervention for neurosurgery residents to improve education on cost-effective care. Clin Neurol Neurosurg 2023; 232:107887. [PMID: 37473488 DOI: 10.1016/j.clineuro.2023.107887] [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: 06/19/2023] [Accepted: 07/08/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE To gauge resident knowledge in the socioeconomic aspects of neurosurgery and assess the efficacy of an asynchronous, longitudinal, web-based, socioeconomics educational program tailored for neurosurgery residents. METHODS Trainees completed a 20-question pre- and post-intervention knowledge examination including four educational categories: billing/coding, procedure-specific concepts, material costs, and operating room protocols. Structured data from 12 index cranial neurosurgical operations were organized into 5 online, case-based modules sent to residents within a single training program via weekly e-mail. Content from each educational category was integrated into the weekly modules for resident review. RESULTS Twenty-seven neurosurgical residents completed the survey. Overall, there was no statistically significant difference between pre- vs post-intervention resident knowledge of billing/coding (79.2 % vs 88.2 %, p = 0.33), procedure-specific concepts (34.3 % vs 39.2 %, p = 0.11), material costs (31.7 % vs 21.6 %, p = 0.75), or operating room protocols (51.7 % vs 35.3 %, p = 0.61). However, respondents' accuracy increased significantly by 40.8 % on questions containing content presented more than 3 times during the 5-week study period, compared to an increased accuracy of only 2.2 % on questions containing content presented less often during the same time period (p = 0.05). CONCLUSIONS Baseline resident knowledge in socioeconomic aspects of neurosurgery is relatively lacking outside of billing/coding. Our socioeconomic educational intervention demonstrates some promise in improving socioeconomic knowledge among neurosurgery trainees, particularly when content is presented frequently. This decentralized, web-based approach to resident education may serve as a future model for self-driven learning initiatives among neurosurgical residents with minimal disruption to existing workflows.
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Affiliation(s)
- Adham M Khalafallah
- Department of Neurosurgery, University of Miami, Miami, FL 33146, United States of America
| | - Sachiv Chakravarti
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21231, United States of America
| | - Kyle V Cicalese
- Virginia Commonwealth University School of Medicine, Richmond, VA 23298, United States of America
| | - Jose L Porras
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21231, United States of America
| | - Cathleen C Kuo
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY 14203, United States of America
| | - Adrian E Jimenez
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21231, United States of America
| | - Henry Brem
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21231, United States of America
| | - Tim Witham
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21231, United States of America
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21231, United States of America
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21231, United States of America.
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Evaluating the Impact of ACGME Resident Duty Hour Restrictions on Patient Outcomes for Bilateral Breast Reductions. Plast Reconstr Surg Glob Open 2023; 11:e4820. [PMID: 36761011 PMCID: PMC9904753 DOI: 10.1097/gox.0000000000004820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 12/28/2022] [Indexed: 02/11/2023]
Abstract
The Accreditation Council for Graduate Medical Education (ACGME) implemented duty-hour restrictions limiting residents to 80 hours per week in 2003 and further extended restrictions in 2011 to improve resident and patient well-being. Numerous studies have examined the effects of these restrictions on patient outcomes with inconclusive results. Few efforts have been made to examine the impact of this reform on the safety of common plastic surgery procedures. This study seeks to assess the influence of ACGME duty-hour restrictions on patient outcomes, using bilateral breast reduction mammoplasty as a marker for resident involvement and operative autonomy. Methods Bilateral breast reductions performed in the 3 years before and after each reform were collected from the National Inpatient Sample database: pre-duty hours (2000-2002), duty hours (2006-2008), and extended duty hours (2012-2014). Multivariable logistic regression models were constructed to investigate the association between ACGME duty hour restrictions on medical and surgical complications. Results Overall, 19,423 bilateral breast reductions were identified. Medical and surgical complication rates in these patients increased with each successive iteration of duty hour restrictions (P < 0.001). The 2003 duty-hour restriction independently associated with increased surgical (OR = 1.51, P < 0.001) and medical complications (OR = 1.85, P < 0.001). The 2011 extended duty-hour restriction was independently associated with increased surgical complications (OR = 1.39, P < 0.001). Conclusions ACGME duty-hour restrictions do not seem associated with better patient outcomes for bilateral breast reduction although there are multiple factors involved. These considerations and consequences should be considered in decisions that affect resident quality of life, education, and patient safety.
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Muacevic A, Adler JR. The Impact of Relocating a Trauma Center: Observations on Patient Injury Demographics and Resident Volumes. Cureus 2022; 14:e30256. [PMID: 36381923 PMCID: PMC9652781 DOI: 10.7759/cureus.30256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2022] [Indexed: 01/24/2023] Open
Abstract
Introduction Changing the physical zip code location of an academic trauma center may affect the distribution and surgical volume of its trauma patients. General surgical residency case log requirements may also be affected. This study describes the impact of moving a level I trauma center to a different zip code location, on the hospital and resident trauma case volumes. Methods This retrospective analysis included all patients within the local trauma registry across two fiscal years representing the pre- and post-move timeframes. Variables collected included patient basic sociodemographic and injury information, trauma activation level and transfer status, management (operative management [OPM] versus non-operative management [NOPM]), and resident case logs. Results During fiscal years 2016-2017 and 2017-2018, 3,025 patients were included. Pre-move and post-move trauma volumes were 1,208 and 1,817 respectively. Post-move changes demonstrated differences in basic sociodemographics, with differences in age (six years older), a shift toward white and away from black (12.89%), and males being seen more frequently (11.87%). Injury severity score distribution shifted (7.72%) towards less severe trauma scores (<15), the percentage of patients with blunt trauma (4.19%) and falls increased (ground level and greater than 1 meter, 9.78%) while the number of patients considered full activations were decreased (15.67%). Proportions of OPM and NOPM trauma cases remained unchanged with the exception of a reduction in emergent operative trauma (3.1%). Resident case logs requirements were met both pre- and post-move. Conclusion Relocating the trauma center to a different zip code location did not negatively impact our resident case volumes. Total trauma volumes were increased, with a shift in the demographics and severity distribution of injuries.
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Chen JX, Miller LE, Filimonov A, Shuman EA, Marchiano E, George BC, Thorne M, Pletcher SD, Platt M, Teng M, Kozin ED, Gray ST. Factors affecting operative autonomy and performance during otolaryngology training: A multicenter trial. Laryngoscope Investig Otolaryngol 2022; 7:404-408. [PMID: 35434323 PMCID: PMC9008171 DOI: 10.1002/lio2.750] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/20/2022] [Indexed: 11/05/2022] Open
Abstract
Objective Surgical education is changing in an era of new regulations and evolving training cultures. We sought to understand the factors that affect operative experiences during otolaryngology residency. Methods From December 2019 to December 2020, five otolaryngology training programs used the SIMPL OR smartphone application to evaluate residents after each operation. Residents and attendings rated the trainee's autonomy on a 4‐level Zwisch scale, performance on a 5‐level scale, and case complexity on a 3‐level scale. We examined associations between ratings of autonomy and performance with variables including postgraduate year (PGY), case complexity, gender, week of the academic year (AY), and whether multiple procedures were logged. Results 78 attendings and 92 residents logged 2984 evaluations. PGY level and week of the AY were positively associated with attending ratings of autonomy and performance (PGY3 vs. PGY2: B = 0.63, p < .001 for autonomy and B = 1.05, p < .001 for performance; week of the AY: B = 0.013, p = .002 for autonomy; B = 0.025, p < .001 for performance). Multiple procedures logged and increasing case complexity were negatively associated with attending ratings (multiple procedures: B = −0.19, p = .04 for autonomy and B = −0.48, p < .001 for performance; hardest vs. easiest 1/3 of cases: B = −1.01, p < .001 for autonomy and B = −0.59, p < .001 for performance). Attending and trainee genders were not associated with attending ratings of autonomy or performance. Conclusion Resident autonomy and performance were positively associated with PGY level and week of the academic year, and negatively associated with case complexity and multiple procedures. These findings highlight the need to align training level with case complexity to promote quality operative experiences. 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
| | - Lauren E. Miller
- 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
| | - 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 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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Balduzzi A, Marchegiani G. From Tutoring Gross Anatomy to Pancreatic Surgery Innovation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:359. [PMID: 35010619 PMCID: PMC8744739 DOI: 10.3390/ijerph19010359] [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: 11/22/2021] [Revised: 12/23/2021] [Accepted: 12/29/2021] [Indexed: 06/14/2023]
Abstract
The training for pancreatic surgery still is not conducted according to standardized protocols, and academic programs differ between countries and hospitals. Moreover, due to recent technological innovations such as minimally invasive and robotic surgery, and the broader indications for complex pancreatic procedures due to the use of neoadjuvant chemotherapy, training is continuously redefining itself. The historical paradigm of "see one, do one, teach one" has been challenged and might have become obsolete. Finally, the rising number of surgical residents along with the limited time required practicing during residency might represent a major limitation to becoming an independent surgeon. Gross anatomy is a solid practice for the active learning of human anatomy during medical school. With regards to the pancreas, it offers a unique opportunity to both actively study the pancreatic gland anatomy during dissection and simulate actual surgical procedures. A critical review of the literature was conducted, aiming to assess the role of gross anatomy in surgical training and possible future perspectives.
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Fatigued surgeons: A thematic analysis of the causes, effects and opportunities for fatigue mitigation in surgery. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2021.100382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Cadieux DC, Mishra A, Goldszmidt MA. Before the scalpel: Exploring surgical residents' preoperative preparatory strategies. MEDICAL EDUCATION 2021; 55:733-740. [PMID: 33423328 DOI: 10.1111/medu.14449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/21/2020] [Accepted: 01/05/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This study sought to increase understanding of preoperative preparatory strategies utilised by senior surgical residents and identify how social and material forces come together to shape practice. SUMMARY/BACKGROUND DATA Preoperative preparation can play a powerful role in operative learning. Residents rarely receive guidance, feedback, or explicit expectations on how to prepare for the OR. Understanding current practice and how to support preoperative preparation represents an important gap in our efforts to improve surgical training. METHODS Constructivist grounded theory with sensitizing concepts from sociomateriality guided data collection and analysis. Fifteen senior surgical residents from a range of surgical disciplines were purposefully sampled and participated in an in-depth individual interview. Two return-of-finding focus groups followed with seven residents. Rigor was enhanced through constant comparison, theoretical sampling, pursuit of discrepant data, and investigator triangulation. RESULTS Residents utilised a range of strategies addressing four areas of focus: develop technical skills, improve procedural knowledge, enhance patient-specificity, and know surgical preferences. However, residents also described receiving limited guidance on what it means to 'be prepared' and experience significant challenges in achieving preparedness. A mix of social and material things that enabled or constrained preparatory efforts influenced individual strategies. These included rotation structure, relationships, the OR list, and time. CONCLUSIONS Our findings offer possible solutions by elaborating on preparatory variability and considerations for residents, faculty, and programs to improve practice. As a first step, we suggest programs begin to engage in explicit dialogue and reflection with their residents, faculty, and residency program committees.
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Affiliation(s)
- Danielle C Cadieux
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada
- Centre for Education Research and Innovation, Western University, London, ON, Canada
| | - Anuradha Mishra
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada
| | - Mark A Goldszmidt
- Centre for Education Research and Innovation, Western University, London, ON, Canada
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Heo R, Park CW, You CJ, Choi DH, Park K, Kim YB, Kim WK, Yee GT, Kim MJ, Oh JH. Does work time limit for resident physician affect short-term treatment outcome and hospital length of stay in patients with spontaneous intracerebral hemorrhage?: a two-year experience at a single training hospital in South Korea. J Cerebrovasc Endovasc Neurosurg 2020; 22:245-257. [PMID: 33307619 PMCID: PMC7820262 DOI: 10.7461/jcen.2020.e2020.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/13/2020] [Indexed: 11/28/2022] Open
Abstract
Objective To compare short-term treatment outcomes at hospital discharge and hospital length of stay (LOS) in patients with spontaneous intracerebral hemorrhage (sICH) before and after introduction of resident physician work time limit (WTL). Methods We retrospectively reviewed consecutive patients treated for sICH at our institution between 2016 and 2019. Then we dichotomized these patients into two groups, pre-WTL and post-WTL. We analyzed demographic elements and clinical features, and hospital length of stay (LOS). We evaluated short-term outcome using modified Rankin scale score at hospital discharge and then divided it into “good” and “poor” outcome groups. We subsequently, compared short-term treatment outcome and hospital LOS between the pre-WTL and post-WTL groups. Results Out of 779 patients, 420 patients (53.9%) were included in the pre-WTL group, and 359 (46.1%) in post-WTL. The mortality rate in sICH patients was higher in the post-WTL group (pre-WTL; 13.6% vs. post-WTL; 17.3%), but there was no statistically significant difference in short-term outcome including mortality (p=0.332) between the groups. The LOS also, was not significantly different between the two groups (pre-WTL; 19.0 days vs. post-WTL; 20.2 days) (p=0.341). The initial Glasgow Coma Scale score, personal stroke history, and mean age were the only independent outcome predicting factors for patients with sICH. Conclusions Some neurosurgeons may expect poorer outcome for sICH after implementation of the WTL of the K-MHW for resident physician however, enforcement of the WTL did not significantly influence the short-term outcome and hospital LOS for sICH in our hospital. Further well-designed multi-institutional prospective studies on the effects of WTL in sICH patient outcome, are anticipated.
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Affiliation(s)
- Rojin Heo
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea
| | - Cheol Wan Park
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea.,Department of Emergency Medicine, Section of Critical Care Medicine, Gil Medical Center, Gachon University, Incheon, Korea
| | - Chan Jong You
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea.,Department of Emergency Medicine, Section of Critical Care Medicine, Gil Medical Center, Gachon University, Incheon, Korea
| | - Dae Han Choi
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea.,Department of Emergency Medicine, Section of Critical Care Medicine, Gil Medical Center, Gachon University, Incheon, Korea
| | - Kwangwoo Park
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea.,Department of Emergency Medicine, Section of Critical Care Medicine, Gil Medical Center, Gachon University, Incheon, Korea
| | - Young Bo Kim
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea
| | - Woo Kyung Kim
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea
| | - Gi-Taek Yee
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea
| | - Myeong-Jin Kim
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea
| | - Jin-Hwan Oh
- Integrative Medicine Research Institute, Jangheung Integrative Medical Hospital, Wonkwang University, Jangheung, Korea
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Huffman EM, Anderson TN, Choi JN, Smith BK. Why the Lab? What is Really Motivating General Surgery Residents to Take Time for Dedicated Research. JOURNAL OF SURGICAL EDUCATION 2020; 77:e39-e46. [PMID: 32768383 DOI: 10.1016/j.jsurg.2020.07.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/01/2020] [Accepted: 07/19/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Over one third of general surgery residents interrupt their clinical training to pursue dedicated research time (DRT), which has financial implications for programs and residents. Studies have examined the impact of DRT on academic outcomes, but little is known about why residents pursue DRT. Therefore, this study aimed to examine resident motivations regarding DRT in order to gain an understanding of resident goals and challenges surrounding this phase of training. DESIGN Surgical residents currently participating in DRT and residents considering completing DRT were recruited to participate. Members of the research team at each institution conducted interviews and focus groups, which were recorded and transcribed. Data was analyzed using the qualitative method of open and focused coding. Identified themes guided the development of a conceptual framework. SETTING Interviews and focus groups were held at three geographically diverse US academic health centers. PARTICIPANTS Twenty-one surgery residents participated. RESULTS Reasons for pursuing DRT fell into 1 of 3 themes: strategic career planning, professional development, and personal rejuvenation. Residents described the perceived need for publications or networking to enhance future competitiveness for desired fellowships or academic appointments. Residents also expressed the desire to have time for career exploration and to cultivate mentorship for their professional career. The need to take time off for more personal reasons, including burnout, was pervasive. Additionally, many in DRT felt under-supported in developing their research skills and expressed a desire for more formal instruction and guidance from mentors. CONCLUSIONS General surgery residents' motivations to pursue DRT are multifactorial. Professional development is a pervasive motivation and includes learning skills that can be applied to future research. Current DRT programs may be inadequate in supporting residents to achieve this goal. These results can be used to inform programmatic efforts to optimize DRT for residents and mentors alike.
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Affiliation(s)
| | - Tiffany N Anderson
- Stanford University, Department of Surgery, Goodman Surgical Education Center, Stanford, California
| | - Jennifer N Choi
- Indiana University, Department of Surgery, Indianapolis, Indiana
| | - Brigitte K Smith
- University of Utah, Department of Surgery, Division of Vascular Surgery, Salt Lake City, Utah
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13
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Whelehan DF, Alexander M, Ridgway PF. Would you allow a sleepy surgeon operate on you? A narrative review. Sleep Med Rev 2020; 53:101341. [DOI: 10.1016/j.smrv.2020.101341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 04/17/2020] [Accepted: 04/21/2020] [Indexed: 01/22/2023]
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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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Lentz AC, Rodríguez D, Chandrapal JC, Davis LG, Ghazi A, Gross MS, Munarriz R. Cadaveric Laboratory Simulation Training of Male Stress Urinary Incontinence Treatment Improves Trainee Knowledge and Confidence. Urology 2020; 143:48-54. [PMID: 32574602 DOI: 10.1016/j.urology.2020.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/16/2020] [Accepted: 06/09/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess whether a focused, simulation training course can improve trainee surgical knowledge and confidence in the treatment of male stress urinary incontinence. MATERIALS AND METHODS Urology residents participated in a prosthetic education course as part of the 2018 SUPS and SMSNA annual meeting. The course included didactic lectures and a hands-on cadaveric laboratory. Participants completed questionnaires before and after the lab (2 weeks and 6 months) to assess procedural knowledge and confidence. Analysis of lab responses was performed using the Wilcoxon signed rank test for matched pairs. RESULTS Thirty-two residents (median age 29, range 27-34) participated in the course. The majority were postgraduate year 4 (63%) or postgraduate year 5 (20%). Most participants reported minimal AUS or sling experience with 50% and 94% reporting less than 5 cases, respectively. Overall score from the knowledge assessment improved significantly between the pre-lab versus 2-week post-lab (P = .02) and pre-lab versus 6-month post-lab (P = .01). Similarly, procedural confidence improved between pre-lab vs 2-week post-lab (P < .001) and pre-lab versus 6-month post-lab (P < .001). Knowledge and confidence assessments were not different between year of residency training or pre-lab experience. CONCLUSIONS Simulation training improves knowledge and confidence in prosthetic surgery for male stress incontinence. In the current climate of reduced exposure and limited availability of prosthetic educators, simulation courses can provide much needed educational value.
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Affiliation(s)
- Aaron C Lentz
- Division of Urologic Surgery, Duke University School of Medicine, Durham, NC.
| | | | - Jason C Chandrapal
- Division of Urologic Surgery, Duke University School of Medicine, Durham, NC
| | - Leah G Davis
- Division of Urologic Surgery, Duke University School of Medicine, Durham, NC
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Mahseeri M, Al-Taher RM, Al Habashneh RAM, Alsmadi M, Harb AAAQA, Bustami NB, Shahait A, Alghanem L, Alhalasa F, Mutlaq Al Muhtaseb FB, Subhi Qirem M, Rahman Yaghi SA. Burnout of resident doctors in a teaching hospital in Jordan. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2020. [DOI: 10.4103/injms.injms_81_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Barrett JR, Drezdzon MK, Monawer AH, O'Rourke AP, Scarborough JE. Safety in Allowing Residents to Independently Perform Appendectomy: A Retrospective Review. J Am Coll Surg 2019; 229:621-625. [DOI: 10.1016/j.jamcollsurg.2019.07.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 07/31/2019] [Accepted: 07/31/2019] [Indexed: 12/23/2022]
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Rowse PG, Dearani JA. Deliberate Practice and the Emerging Roles of Simulation in Thoracic Surgery. Thorac Surg Clin 2019; 29:303-309. [DOI: 10.1016/j.thorsurg.2019.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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20
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Quezada J, Achurra P, Jarry C, Asbun D, Tejos R, Inzunza M, Ulloa G, Neyem A, Martínez C, Marino C, Escalona G, Varas J. Minimally invasive tele-mentoring opportunity—the mito project. Surg Endosc 2019; 34:2585-2592. [DOI: 10.1007/s00464-019-07024-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/19/2019] [Indexed: 11/30/2022]
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Robertson EM, Budden CR, Ball BJ, Ladak A. The Utility and Efficiency of a Resident Hand Clinic for the Management of Acute Hand Trauma at the University of Alberta. Plast Surg (Oakv) 2019; 27:195-199. [PMID: 31106180 PMCID: PMC6505360 DOI: 10.1177/2292550318800323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The University of Alberta established a resident-run hand clinic in 2005 to expeditiously manage the growing numbers of patients with traumatic hand injuries. The purpose of this study was to examine the clinical volume and types of cases assessed and treated in the clinic, as well as gauge patient satisfaction with care received. METHODS A retrospective chart review and patient satisfaction questionnaire were conducted for patients assessed in the hand clinic in 2015. Demographic data, referral data, and treatment required were recorded. Patients were asked to complete a survey on their experience at the end of their visit. RESULTS A total of 1022 charts were reviewed. The most common reason for referral was a fracture or dislocation (57%), followed by tendon injury (18%). The average wait time to be seen in clinic was 2.97 ± 2.13 days in the winter and 4.12 ± 2.14 days in the summer. Forty-seven percent of patients required splinting, 17% required a procedure, and 21% of patients were referred for surgery. Patient satisfaction on average was 9.29 ± 0.87 on a satisfaction scale of 10. CONCLUSION In a 6-month period, residents attending hand clinic assessed and treated 1022 patients, providing timely management of acute injuries. A resident-run hand clinic is an effective model to decrease wait times for patients, to decrease time spent assessing nonemergent injuries in the emergency department, and to concentrate hand trauma in a setting conducive to resident training, while still maintaining high patient satisfaction.
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Affiliation(s)
- Emilie M. Robertson
- Division of Plastic and Reconstructive Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Curtis R. Budden
- Division of Plastic and Reconstructive Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Brandon J. Ball
- Division of Plastic and Reconstructive Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Adil Ladak
- Division of Plastic and Reconstructive Surgery, University of Alberta, Edmonton, Alberta, Canada
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Dickerson P, Grande S, Evans D, Levine B, Coe M. Utilizing Intraprocedural Interactive Video Capture With Google Glass for Immediate Postprocedural Resident Coaching. JOURNAL OF SURGICAL EDUCATION 2019; 76:607-619. [PMID: 30833204 DOI: 10.1016/j.jsurg.2018.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 10/02/2018] [Accepted: 10/07/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Video coaching has been found to be an effective teaching method because it incorporates many of the established principles of successful adult learning. The goal of our study was to assess the feasibility and effectiveness of using a point-of-view video camera (Google Glass) to improve the surgical skills education of orthopaedic surgery residents. METHODS Forty-two residents from 4 institutions participated in a partially blinded randomized control trial performing an intra-articular distal tibial fracture reduction task while wearing Google Glass to record the performance. Participants underwent a structured coaching session with 20 participants (intervention group) using the recorded video to augment this session, and 22 participants (control group) receiving verbal coaching alone. The task was repeated again immediately after the coaching session. Performance was scored using an Objective Structured Assessment of Technical Skills checklist, Global Rating Scale, fluoroscopic usage, and reduction quality. A semistructured interview was then performed to assess experience of participants. RESULTS There was no significant difference (p > 0.05) seen in score improvement in the Objective Structured Assessment of Technical Skills checklist, Global Rating Scale, fluoroscopic usage, or reduction quality between the control and intervention groups. Thematic analysis of interview showed majority of participants found video coaching increased effectiveness in understanding of goals, developing techniques and strategies, and process of self-reflection. Their involvement was seen overall as a positive experience, with participants wanting to see more inclusion of video coaching within surgical education. CONCLUSIONS No difference in performance improvement between the 2 groups was seen, but majority of participants found the video coaching sessions valuable and could have potential beneficial role in education.
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Affiliation(s)
| | - Stuart Grande
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | | | - Marcus Coe
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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Fryer J, Schuller M, Wnuk G, Meyerson S, Zwischenberger J, Meier A, Williams R, George B. Identifying and Addressing High Priority Issues in General Surgery Training and Education. JOURNAL OF SURGICAL EDUCATION 2019; 76:50-54. [PMID: 30243928 DOI: 10.1016/j.jsurg.2018.06.009] [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: 05/14/2018] [Accepted: 06/13/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Complex problems are often easier to address when multiple entities collaborate. The Procedural Learning and Safety Collaborative (PLSC) was established to address complex problems in general surgery residency training by connectively engaging multiple residency programs in addressing progressive research questions. STUDY DESIGN Recently, PLSC members held a national symposium which included leadership from several leading surgical societies to come to a consensus on what are the most critical issues in general surgery education. RESULTS This paper describes the process used and the end result of this process. This paper describes the process used and the end result of this process.
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Affiliation(s)
- Jonathan Fryer
- University of Kentucky, Department of Surgery, Lexington, Kentucky.
| | - Mary Schuller
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Greg Wnuk
- Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Shari Meyerson
- University of Kentucky, College of Medicine, Lexington, Kentucky
| | | | - Andreas Meier
- SUNY Upstate University Hospital, Syracuse, New York
| | - Reed Williams
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Brian George
- Michigan Medicine, University of Michigan, Ann Arbor, Michigan
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Kim DJ, Kim SG. Comparative study of the operative experience of surgical residents before and after 80-hour work week restrictions. Ann Surg Treat Res 2018; 95:233-239. [PMID: 30402441 PMCID: PMC6204326 DOI: 10.4174/astr.2018.95.5.233] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/06/2018] [Accepted: 06/01/2018] [Indexed: 11/30/2022] Open
Abstract
Purpose In Korea, the working-hour limitation regulation has been implemented in December 2017. We aimed to define the difference in operative experience of surgical residents before and after implementing this policy in 2 hospitals among 8 affiliated hospitals of the Catholic Medical Center where implemented the 80 working-hour limitation policy since March 2015. Methods All the operation records were reviewed, and the number of resident-participated surgeries between March and August in 2002 and 2017 were compared. Operations performed or participated in by residents as first assistants were defined as resident participated surgery. Results After 2 years from the initiation of the resident work-hour limitations, the number of resident participated surgery has slightly decreased in both hospitals (Yeouido St. Mary's Hospital [YSM]: 317 to 302, St. Paul Hospital [SPH]: 635 to 461). For each resident, changes were like followings: 0 → 21 cases for R1, 65 → 72 cases for R2, 83 → 192 cases for R3, and 169 → 17 cases for R4 in YSM. In SPH, number of resident participating surgery was changed like followings: 4 → 32 cases for R1, 222 → 100 cases for R2, 317 → 300 cases for R3, and 92 → 29 cases for R4. In both hospital, while, total number of resident participating oncologic surgery has been decreased, number of resident participating appendectomy has been far increased. Activity of each grade resident is different according to hospital. Conclusion Although total number of resident participating surgery decreased, variable changes were observed in each grade of resident according to each type of surgery and different hospitals. It is believed that comparisons of experiences from more hospitals in the future would be helpful in establishing the guidelines for surgical experience requirement of residents in Korea.
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Affiliation(s)
- Dong Jin Kim
- Department of General Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Geun Kim
- Department of General Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Lentz AC, Rodríguez D, Davis LG, Apoj M, Kerfoot BP, Perito P, Henry G, Jones L, Carrion R, Mulcahy JJ, Munarriz R. Simulation Training in Penile Implant Surgery: Assessment of Surgical Confidence and Knowledge With Cadaveric Laboratory Training. Sex Med 2018; 6:332-338. [PMID: 30454614 PMCID: PMC6302135 DOI: 10.1016/j.esxm.2018.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/10/2018] [Accepted: 09/13/2018] [Indexed: 02/03/2023] Open
Abstract
Introduction Constraints on surgical resident training (work-hour mandates, shorter training programs, etc.) and availability of expert surgical educators may limit the acquisition of prosthetic surgical skills. As a result, training courses are being conducted to augment the prosthetic surgery learning experience. Aim To evaluate the impact of a hands-on cadaver-based teaching program on resident procedural knowledge and procedural confidence with placement of a penile prosthesis. Main Outcome Measure Changes in procedural knowledge and self-confidence following a focused training program on penile prosthetics. Methods As part of the 2017 Society of Urologic Prosthetic Surgeons and the Sexual Medicine Society of North America Annual Meeting, 31 urology residents participated in a simulation lab in prosthetic urology. The lab included didactic lectures and a hands-on cadaveric laboratory. Participants completed surveys before and after the course. Wilcoxon Signed Rank tests for matched pairs were used to compare respondents’ pre- and postcourse knowledge (% questions answered correctly) and confidence ratings. Prior implant experience was assessed. Results 31 residents participated in this study. The majority of the participants were 4th- (41.9%) and 5th-year residents (38.7%). Participants showed a significant improvement in procedural knowledge test scores (68.8±13.4 vs 74.2 ± 13.0, P < .05) and self-reported increased median surgical confidence levels (4 vs 3, P value < .001) after completion of the cadaveric course. Subgroup analysis demonstrated that residents with prosthetic surgery experience of <10 cases benefited the most. In addition, improvement in surgical confidence levels observed was greater than the improvement in surgical knowledge. The overall cost of the simulation training course was approximately $1,483 per resident. Conclusion Simulation training in prosthetic surgery seems to improve surgical confidence and knowledge. Further research is needed to better understand the benefits and limitations of simulation training. Lentz AC, Rodríguez D, Davis LG. Simulation training in penile implant surgery: Assessment of surgical confidence and knowledge with cadaveric laboratory training. Sex Med 2018;6:332–338.
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Affiliation(s)
- Aaron C Lentz
- Division of Urologic Surgery, Duke University, Raleigh, NC, USA.
| | | | - Leah G Davis
- Division of Urologic Surgery, Duke University, Raleigh, NC, USA
| | - Michel Apoj
- Department of Urology, Boston Medical Center, Boston, MA, USA
| | | | - Paul Perito
- Department of Urology, Coral Gables Hospital, Coral Gables, FL, USA
| | | | | | - Rafael Carrion
- Department of Urology, University of South Florida, Tampa, FL, USA
| | - John J Mulcahy
- Department of Urology, University of Alabama, Madison, AL, USA
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Crippen MM, Barinsky GL, Reddy RK, Elias ML, Eloy JA, Baredes S, Park RCW. The Impact of Duty-Hour Restrictions on Complication Rates Following Major Head and Neck Procedures. Laryngoscope 2018; 128:2804-2810. [PMID: 30284257 DOI: 10.1002/lary.27338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To assess the impact of resident duty-hour restrictions (DHR) in otolaryngology via comparison of postoperative outcomes between otolaryngology teaching hospitals (Oto-TH) and nonteaching hospitals (NTH) before and after complete implementation. STUDY DESIGN Retrospective database review. METHODS The Nationwide Inpatient Sample was queried for all major head and neck cases between 2000 and 2002 (n = 34,064) and 2008 and 2010 (n = 33,094). Cases were stratified into Oto-TH (n = 28,771) and NTH (n = 38,387) and assessed for procedure type, patient comorbidities, and complications. A subpopulation matched by procedure type was generated for direct comparison of complication rates using χ2 and binary logistic regression analyses. RESULTS In the years following DHR, total case volume and average case complexity increased at Oto-TH only. Using a case-matched subpopulation, regression analysis found Oto-TH status to be protective for medical complications both before (odds ratio [OR]: 0.60, P < .001) and after (OR: 0.76, P = .001) DHR. In contrast, Oto-TH cases had lower risk for surgical complications in 2000 to 2002 (OR: 0.77, P < .001) but not 2008 to 2010 (OR: 1.07, P = .275). When comparing time periods, the years following DHR were associated with a significant decrease in medical complications and mortality across hospital cohorts. For surgical complications, rates significantly improved at NTH only (OR: 0.82, P = .002), with no difference at Oto-TH (OR: 0.95, P = .450). CONCLUSIONS In the years following DHR, rates of medical complications, surgical complications, and mortality have significantly improved at NTH. At Oto-TH, there has been a lack of similar improvement in surgical complications, even after accounting for increasing case volume and complexity in more recent years. While the cause is likely multifactorial, DHR in otolaryngology residency may play a role. LEVEL OF EVIDENCE 4 Laryngoscope, 128:2804-2810, 2018.
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Affiliation(s)
- Meghan M Crippen
- Department of Otolaryngology-Head and Neck Surgery , Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Gregory L Barinsky
- Department of Otolaryngology-Head and Neck Surgery , Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Renuka K Reddy
- Department of Otolaryngology-Head and Neck Surgery , Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Marcus L Elias
- Department of Otolaryngology-Head and Neck Surgery , Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery , Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Neurological Institute of New Jersey; Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery , Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Richard Chan Woo Park
- Department of Otolaryngology-Head and Neck Surgery , Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
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Oh CJ, Tripathi PB, Gu JT, Borden P, Wong BJF. Development and evaluation of rhinoplasty spreader graft suture simulator for novice surgeons. Laryngoscope 2018; 129:344-350. [PMID: 30194858 DOI: 10.1002/lary.27326] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/01/2018] [Accepted: 05/07/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Surgical simulators aimed at mimicking elements of rhinoplasty surgery, specifically those aimed at improving cartilage suturing, are not available. Here, we present a surgical simulator for spreader graft placement that uses cartilage rather than synthetic materials and gauge improvement using objective measures for suture placement accuracy, speed, and efficiency of hand motion. METHODS Twenty-two otolaryngologists in two groups (residents [10] and experts [12]) were instructed to secure the two spreader graft specimen into position with three mattress sutures on a nose model that used porcine septal cartilage as a proxy for the human counterpart. Hand motion was tracked using an electromagnetic position sensing device. The time required to complete the suture task, total hand displacement, cumulative number of hand motion direction changes, and accuracy of suture insertion were measured. These measurements were compared between the two cohort groups for construct validity. The subjects completed a survey to evaluate realism and value of the model. RESULTS The expert group had a lower mean time required to complete the task (P < 0.05), total hand displacement (P < 0.01), and number of hand motion direction changes (P < 0.001). No significant difference was observed between the two groups in suture precision measurement. The subjects agreed on the face validity and usefulness of the trainer. CONCLUSIONS Our study suggests that the simulator may be a useful tool to objectively gauge suturing efficiency. Devices such as this may be useful for developing skill with suturing cartilage tissue and potentially be used to assess resident acquisition of surgical skill. LEVEL OF EVIDENCE NA Laryngoscope, 129:344-350, 2019.
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Affiliation(s)
- Connie J Oh
- Loma Linda University School of Medicine, Loma, Linda.,The Beckman Laser Institute and Medical Clinic, Irvine, California, U.S.A
| | - Prem B Tripathi
- Department of Otolaryngology-Head and Neck Surgery, Irvine, California, U.S.A
| | - Jeffrey T Gu
- Department of Otolaryngology-Head and Neck Surgery, Irvine, California, U.S.A
| | - Pamela Borden
- The Beckman Laser Institute and Medical Clinic, Irvine, California, U.S.A
| | - Brian J-F Wong
- Loma Linda University School of Medicine, Loma, Linda.,The Beckman Laser Institute and Medical Clinic, Irvine, California, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Irvine, California, U.S.A.,Department of Biomedical Engineering, University of California, Irvine, California, U.S.A
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Simmerman E, Simmerman A, Lassiter R, King R, Ham B, Adam BL, Ferdinand C, Holsten S. Feasibility and Benefit of Incorporating a Multimedia Cadaver Laboratory Training Program into a Didactics Curriculum for Junior and Senior Surgical Residents. JOURNAL OF SURGICAL EDUCATION 2018; 75:1188-1194. [PMID: 29678532 DOI: 10.1016/j.jsurg.2018.03.012] [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: 08/26/2017] [Revised: 03/06/2018] [Accepted: 03/25/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE As operative experience in general surgery decreases and work hour limitations increase there is less exposure of surgical residents to advanced vascular and trauma exposures. Many institutions have demonstrated benefits of cadaver laboratory courses. We have incorporated a multimedia cadaver laboratory course into our general surgery residency didactics curriculum with the objective to demonstrate a benefit of the program as well as the feasibility of incorporation. STUDY DESIGN This is a prospective study at a tertiary care institution including general surgery residents within our residency program. A curriculum was designed, requiring residents to complete multimedia learning modules before both a trauma cadaver laboratory and vascular exposure cadaver laboratory. Outcome measures included self-efficacy/confidence (precourse and postcourse 5-point Likert surveys), knowledge (net performance on precourse and postcourse multiple choice examinations), and resident perception of the curriculum (postcourse 5-point Likert survey). Data were analyzed using ANOVA paired t-tests. RESULTS For the vascular cadaver laboratory, resident knowledge improved overall from an average of 41.2% to 50.0% of questions correct (p = 0.032) and self-efficacy/confidence improved by 0.59 from 1.52 to 2.11 out of 5 (p = 0.009). Median confidence is 1.37 out of 5 and 2.32 out of 5, before and after course, respectively. Wilcoxon nonparametric test reveals a p = 0.011. Resident's perception of the usefulness of the laboratory evaluation was 3.85 out 5. There were 85.71% agreed that the laboratory is useful and 14.29% were disagree. The Z-score is -0.1579 (means 0.1579 standard deviations a score of 3.85 below the benchmark). The percentile rank is 56.27%. The coefficient of variation is 24.68%. For the trauma cadaver laboratory, resident knowledge improved overall from an average of 55.89% to 66.17% of questions correct (p = 0.001) and self-efficacy/confidence improved by 0.75 from 1.68 out of 5 to 2.43 out of 5 (p = 0.011). Median confidence level is 1.41 out of 5 before the training course and 2.64 out of 5 after the training course. Wilcoxon signed rank test gives a p value of 0.008. Resident's perception of the usefulness of the laboratory evaluation was 3.94 out 5. There were 72.22% agreed that the laboratory is useful and 27.78% were neutral. The Z-score is -0.098 (means 0.098 standard deviations a score of 3.94 below the benchmark). The percentile rank is 53.90%. The coefficient of variation is 15.48%. CONCLUSIONS Incorporating a multimedia cadaver laboratory into a residency education didactics curriculum was both feasible and beneficial for resident education. We demonstrate an improvement in knowledge and self efficacy/confidence following both cadaver laboratory courses.
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Affiliation(s)
- Erika Simmerman
- Department of Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia.
| | - Andrew Simmerman
- Department of Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Randi Lassiter
- Department of Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Ray King
- Department of Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Ben Ham
- Department of Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Bao-Ling Adam
- Department of Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Colville Ferdinand
- Department of Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Steven Holsten
- Department of Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia
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Bhutiani M, Jablonski PM, Ehrenfeld JM, McEvoy MD, Fowler LC, Wanderer JP. Decision Support Tool Improves Real and Perceived Anesthesiology Resident Relief Equity. Anesth Analg 2018; 127:513-519. [DOI: 10.1213/ane.0000000000003479] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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The role of multiorgan procurement for abdominal transplant in general surgery resident education. Am J Surg 2018; 216:331-336. [DOI: 10.1016/j.amjsurg.2017.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 08/17/2017] [Accepted: 08/21/2017] [Indexed: 11/19/2022]
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Mackenzie CF, Bowyer MW, Henry S, Tisherman SA, Puche A, Chen H, Shalin V, Pugh K, Garofalo E, Shackelford SA. Cadaver-Based Trauma Procedural Skills Training: Skills Retention 30 Months after Training among Practicing Surgeons in Comparison to Experts or More Recently Trained Residents. J Am Coll Surg 2018; 227:270-279. [PMID: 29733906 DOI: 10.1016/j.jamcollsurg.2018.04.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/19/2018] [Accepted: 04/19/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Long-term retention of trauma procedural core-competency skills and need for re-training after a 1-day cadaver-based course remains unknown. We measured and compared technical skills for trauma core competencies at mean 14 months (38 residents), 30 months (35 practicing surgeons), and 46 months (10 experts) after training to determine if skill degradation occurs with time. Technical performance during extremity vascular exposures and lower-extremity fasciotomy in fresh cadavers measured by validated individual procedure score (IPS) was the primary outcome. STUDY DESIGN We performed a prospective study between May 2013 and September 2016. RESULTS Practicing surgeons had lower IPS and IPS component scores (p = 0.02 to 0.001) than residents (p < 0.05) and experts (p < 0.002) for vascular procedures. Frequencies of errors were no different among residents and experts. Practicing surgeons made more critical errors (p < 0.05) than experts or residents. Experts had shortest time to proximal vascular control. Fasciotomy procedural errors occurred in all participants. Cluster analysis of anatomy vs procedural steps identified tertiles of performance and wide variance (32.5% practicing surgeons, 26.5% residents vs 13% experts) for vascular procedures. Vascular control duration > 20 minutes (n = 21) and failure to decompress fasciotomy compartments were correlated with incorrect landmarks and skin incisions. Modeling found interval trauma skills experience, not time since training, was associated with lower IPS. CONCLUSIONS Practicing surgeons with low trauma skills experience since training had lower IPS and component scores (p = 0.02 to 0.001) and more errors compared with experts and residents (p < 0.05). Surgeons, including experts with low interval experience performing trauma procedures, may benefit from refreshing of correct landmarks and skin incision placement identification.
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Affiliation(s)
- Colin F Mackenzie
- Shock Trauma Anesthesiology Research Center, Baltimore, MD; University of Maryland, School of Medicine, Baltimore, MD.
| | - Mark W Bowyer
- Department of Surgery, Uniformed Services University of Health Sciences, and the Walter Reed National Military Medical Center, Bethesda, MD
| | - Sharon Henry
- University of Maryland, School of Medicine, Baltimore, MD; Department of Surgery and Shock Trauma Center of the University of Maryland School of Medicine and Medical Center, Baltimore, MD
| | - Samuel A Tisherman
- Shock Trauma Anesthesiology Research Center, Baltimore, MD; University of Maryland, School of Medicine, Baltimore, MD; Department of Surgery and Shock Trauma Center of the University of Maryland School of Medicine and Medical Center, Baltimore, MD
| | - Adam Puche
- University of Maryland, School of Medicine, Baltimore, MD
| | - Hegang Chen
- University of Maryland, School of Medicine, Baltimore, MD
| | - Valerie Shalin
- Department of Psychology, Wright State University, Dayton, OH
| | - Kristy Pugh
- University of Maryland, School of Medicine, Baltimore, MD
| | - Evan Garofalo
- Department of Anatomy, University of Arizona School of Medicine, Phoenix, AZ
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Healy JM, Maxfield MW, Solomon DG, Longo WE, Yoo PS. Beyond 250: A Comprehensive Strategy to Maximize the Operative Experience for Junior Residents. JOURNAL OF SURGICAL EDUCATION 2018; 75:541-545. [PMID: 29097172 DOI: 10.1016/j.jsurg.2017.08.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 07/25/2017] [Accepted: 08/27/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Among surgical educators, duty-hour restrictions led to concern regarding the adequacy of operative experience during residency, especially for junior residents. The American Board of Surgery recently instituted guidelines mandating "a minimum of 250 operations by the end of the PGY-2 year". A series of programmatic and institutional changes were implemented at our institution to augment the junior resident operative experience and to exceed compliance with this mandate. METHODS Operative data from Accreditation Council for Graduate Medical Education case logs for categorical and nondesignated preliminary interns from our large academic surgical residency were identified for 5 consecutive academic years, 2011 until 2016. American Board of Surgery In-Training Examination (ABSITE) scores were collected anonymously. The program systematically instituted the following changes: night float minimization, identification of new surgical opportunities, augmenting use of midlevel care providers, identification of rotations with suboptimal operative experiences, maximizing rotations with involvement of junior residents in the operating room, and systematic review of junior case logs. RESULTS After implementation, average total cases for residents completing postgraduate year (PGY)-2 increased from 176 to 330 (p < 0.001). Specifically, there was an 18% increase for interns (p = 0.059) and a 118% increase for PGY-2 residents (p < 0.001). There were statistically significant increases in skin and soft tissue cases, vascular cases, endoscopy, and complex laparoscopic cases. Average case volumes for senior residents did not change. Night float time was significantly decreased (5.7 vs 3.4 wk; p = 0.04). ABSITE scores were not significantly changed during this time. CONCLUSIONS Before implementation of these interventions, our program would have had 0% compliance with the 250 junior resident case rule. Within 12 months of implementation, total case volumes for residents completing PGY-2 increased by 88%-exceeding minimum standards. Overall, 100% programmatic compliance was achieved. Our program's experience exemplifies how mandates from the American Board of Surgery can lead to programmatic changes that improve the experience of surgical house officers.
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Affiliation(s)
- James M Healy
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
| | - Mark W Maxfield
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Daniel G Solomon
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Walter E Longo
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Peter S Yoo
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
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Granite G, Pugh K, Chen H, Longinaker N, Garofalo E, Shackelford S, Shalin V, Puche A, Pasley J, Sarani B, Henry S, Bowyer M, Mackenzie C. Assessment of Anatomical Knowledge and Core Trauma Competency Vascular Skills. Mil Med 2018; 183:66-72. [PMID: 29635562 DOI: 10.1093/milmed/usx151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 12/24/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Guinevere Granite
- Shock Trauma Anesthesiology Research Center, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201
- Department of Anatomy and Neurobiology, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201
| | - Kristy Pugh
- Shock Trauma Anesthesiology Research Center, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201
| | - Hegang Chen
- Department of Epidemiology, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201
| | - Nyaradzo Longinaker
- Shock Trauma Anesthesiology Research Center, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201
- Department of Epidemiology, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201
| | - Evan Garofalo
- Shock Trauma Anesthesiology Research Center, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201
- Department of Anatomy and Neurobiology, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201
| | - Stacy Shackelford
- US Air Force Center for the Sustainment of Trauma and Readiness Skills, 655 West Baltimore Street, Baltimore, MD 21201
| | - Valerie Shalin
- Department of Psychology, The College of Science and Mathematics, Wright State University, 3640 Colonel Glenn Highway, Dayton, OH 45435
| | - Adam Puche
- Department of Anatomy and Neurobiology, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201
| | - Jason Pasley
- US Air Force Center for the Sustainment of Trauma and Readiness Skills, 655 West Baltimore Street, Baltimore, MD 21201
| | - Babak Sarani
- Department of Surgery, The School of Medicine and Health Sciences, George Washington University, Ross Hall 2300 Eye Street, NW, Washington, DC 20037
| | - Sharon Henry
- Department of Surgery, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201
| | - Mark Bowyer
- Department of Surgery, The Uniformed Services University of Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Colin Mackenzie
- Shock Trauma Anesthesiology Research Center, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201
- Department of Anesthesiology, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201
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Deebel NA, Koontz WW, Klausner AP. Changes in Chief Resident Surgical Volume and Case Type across 70 Years: Lessons Learned from a Urology Training Program. UROLOGY PRACTICE 2018. [DOI: 10.1016/j.urpr.2017.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Nicholas A. Deebel
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia
| | - Warren W. Koontz
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia
| | - Adam P. Klausner
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia
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Thériault B, Marceau-Grimard M, Blais AS, Fradet V, Moore K, Cloutier J. Urology residents on call: Investigating the workload and relevance of calls. Can Urol Assoc J 2018; 12:E71-E75. [PMID: 29381457 DOI: 10.5489/cuaj.4333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION On-call medical services assumed by residents represent many hours of hard work and no studies have documented what it really entails. As part of an effort to improve our on-call system, we examined phone calls received by residents on call. Our objectives were to evaluate the characteristics of phone calls received by residents on call (who, when, why, need to go to the hospital) and to determine residents' perception of these calls. We also looked into implementing strategies to reduce unnecessary calls. METHODS We prospectively collected information about calls using a standardized reporting form with the participation of all residents (10) from a single urology program over two periods of four weeks from November 2014 to March 2015. Residents answered pre- and post-collecting period questionnaires. RESULTS A total of 460 calls were recorded on 97 on-call days in two on-call lists. There was a mean of 3.5 (median 3, range 0-12) calls per weeknight and 7.7 (median 6, range 0-23) calls per weekend full day. Nintey-three calls (20%) led to the need for bedside evaluation and many of these were for new consultations (49%). The majority of calls originated from the clinical in-patient ward (49%) and emergency room (29%), and nurses (66%) and doctors (23%) most commonly initiated the calls. Calls between 11:00 pm and 8:00 am represented 13% of all calls. Most of the calls (77%) were perceived as relevant or very relevant. Most residents reported at least 80% of calls. CONCLUSIONS Although likely representing an underestimate of the reality, we provide a first effort in documenting the call burden of Canadian urology residents.
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Affiliation(s)
- Benoît Thériault
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Maryse Marceau-Grimard
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Anne-Sophie Blais
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Vincent Fradet
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Katherine Moore
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Jonathan Cloutier
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada
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Erturan G, Alvand A, Judge A, Pollard TCB, Glyn-Jones S, Rees JL. Prior Generic Arthroscopic Volume Correlates with Hip Arthroscopic Proficiency: A Simulator Study. J Bone Joint Surg Am 2018; 100:e3. [PMID: 29298267 DOI: 10.2106/jbjs.17.00352] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Changing trends in surgical education and patient expectation are leading to proficiency models of progression and the use of simulators. Hip arthroscopy is increasingly performed and has a steep learning curve mainly addressed during fellowship training. The aim of this study was to assess the impact of previous generic arthroscopic experience on performance at a simulated hip arthroscopy task to both estimate the minimum case numbers that correlate with expert proficiency levels and help to guide selection for hip arthroscopy fellowships. METHODS Fifty-two participants were recruited to a cross-sectional study. Four consultants (expert hip arthroscopists), 28 trainees (residents and fellows), and 20 novices (interns and medical students) performed a standardized bench-top simulated hip arthroscopy task. A validated global rating scale (GRS) score and motion analysis were used to assess surgical performance. Prior arthroscopic experience was recorded from surgical electronic logbooks. Receiver operating characteristic (ROC) curve analyses were conducted to identify optimum cut-points for task proficiency at both expert and competent GRS levels. RESULTS There were significant differences (p < 0.05) between the arthroscopic ability of all experience groups based on GRS assessment and for all motion analysis metrics. There was a significant positive correlation between logbook numbers and GRS scores (p < 0.0001). ROC curve analysis demonstrated that a minimum of 610 prior arthroscopic procedures were necessary to achieve an expert GRS score, and 78 prior arthroscopic procedures were necessary for a competent score. CONCLUSIONS Performing a basic hip arthroscopy task competently requires substantial previous generic arthroscopic experience. The numbers identified in this study provide targets for residents. Program directors appointing to hip arthroscopy fellowship training posts may find these results useful as a guide during the selection process.
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Affiliation(s)
- Gurhan Erturan
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, University of Oxford, Oxford, United Kingdom
| | - Abtin Alvand
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, University of Oxford, Oxford, United Kingdom
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, University of Oxford, Oxford, United Kingdom
| | - Thomas C B Pollard
- Department of Orthopaedic Surgery, Royal Berkshire Hospital, Reading, United Kingdom
| | - Sion Glyn-Jones
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, University of Oxford, Oxford, United Kingdom
| | - Jonathan L Rees
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, University of Oxford, Oxford, United Kingdom
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Relationship of procedural numbers with meaningful procedural autonomy in general surgery residents. Surgery 2017; 163:488-494. [PMID: 29277387 DOI: 10.1016/j.surg.2017.10.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 10/06/2017] [Accepted: 10/10/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Concerns exist regarding the competency of general surgery graduates with performing core general surgery procedures. Current competence assessment incorporates minimal procedural numbers requirements. METHODS Based on the Zwisch scale we evaluated the level of autonomy achieved by categorical PGY1-5 general surgery residents at 14 U.S. general surgery resident training programs between September 1, 2015 and December 31, 2016. With 5 of the most commonly performed core general surgery procedures, we correlated the level of autonomy achieved by each resident with the number of procedures they had performed before the evaluation period, with the intent of identifying specific target numbers that would correlate with the achievement of meaningful autonomy for each procedure with most residents. RESULTS Whereas a definitive target number was identified for laparoscopic appendectomy (i.e. 25), for the other 4 procedures studied (i.e. laparoscopic cholecystectomy, 52; open inguinal hernia repair, 42; ventral hernia repair, 35; and partial colectomy, 60), target numbers identified were less definitive and/or were higher than many residents will experience during their surgical residency training. CONCLUSIONS We conclude that procedural target numbers are generally not effective in predicting procedural competence and should not be used as the basis for determining residents' readiness for independent practice.
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Fletcher B, De La Ree J, Drougas J. Development of a pulsatile, tissue-based, versatile vascular surgery simulation laboratory for resident training. J Vasc Surg Cases Innov Tech 2017; 3:209-213. [PMID: 29349426 PMCID: PMC5765174 DOI: 10.1016/j.jvscit.2017.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 06/15/2017] [Indexed: 01/22/2023] Open
Abstract
Simulation in surgery is becoming an important component of surgical education. Training on bench top models has been demonstrated to improve technical skills. The objective of our project was to create a vascular surgery simulation model. The simulation model consists of a platform, artificial blood reservoir, artificial blood, inflow and outflow limbs, electric motor, battery, pulse generator, and cryopreserved vessel. Three different vascular surgery simulation stations were created: carotid endarterectomy with shunting and patch angioplasty, arterial bypass, and arteriovenous graft formation. A scientific study involving surgical residents will need to be undertaken to determine whether this simulator has intermodal transferability.
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Affiliation(s)
- Brian Fletcher
- Department of Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Va
| | - Jaime De La Ree
- The Bradley Department of Electrical and Computer Engineering, Department of Engineering, Virginia Tech, Roanoke, Va
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Sharma G, Aycart MA, O'Mara L, Havens J, Nehs M, Shimizu N, Smink DS, Gravereaux E, Gates JD, Askari R. A cadaveric procedural anatomy simulation course improves video-based assessment of operative performance. J Surg Res 2017; 223:64-71. [PMID: 29433887 DOI: 10.1016/j.jss.2017.05.067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 05/04/2017] [Accepted: 05/19/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Inadequate anatomic knowledge has been cited as a major contributor to declining surgical resident operative competence. We analyzed the impact of a comprehensive, procedurally oriented cadaveric procedural anatomy dissection laboratory on the operative performance of surgery residents, hypothesizing that trainees' performance of surgical procedures would improve after such a dissection course. MATERIALS AND METHODS Midlevel general surgery residents (n = 9) participated in an 8 wk, 16-h surgery faculty-led procedurally oriented cadaver simulation course. Both before and after completion of the course, residents participated in a practical examination, in which they were randomized to perform one of nine Surgical Council on Resident Education-designated "essential" procedures. The procedures were recorded using wearable video technology. Videos were deidentified before evaluation by six faculty raters blinded to examinee and whether performances occurred before or after an examinee had taken the course. Raters used the validated Operative Performance Rating System and Objective Structured Assessment of Technical Skill scales. RESULTS After the course residents had higher procedure-specific scores (median, 4.0 versus 2.4, P < 0.0001), instrument-handling (4.0 versus 3.0, P = 0.006), respect for tissue (4.0 versus 3.0, P = 0.0004), time and motion (3.0 versus 2.0, P = 0.0007), operation flow (3.0 versus 2.0, P = 0.0005), procedural knowledge (4.0 versus 2.0, P = 0.0001), and overall performance scores (4.0 versus 2.0, P < 0.0001). Operative Performance Rating System and Objective Structured Assessment of Technical Skill scales averaged by number of items in each were also higher (3.2 versus 2.0, P = 0.0002 and 3.1 versus 2.2, P = 0.002, respectively). CONCLUSIONS A cadaveric procedural anatomy simulation course covering a broad range of open general surgery procedures was associated with significant improvements in trainees' operative performance.
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Affiliation(s)
- Gaurav Sharma
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mario A Aycart
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lynne O'Mara
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joaquim Havens
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Matthew Nehs
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Naomi Shimizu
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Douglas S Smink
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Edwin Gravereaux
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jonathan D Gates
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Reza Askari
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Brady JS, Crippen MM, Filimonov A, Nadpara NV, Eloy JA, Baredes S, Park RCW. The effect of training level on complications after free flap surgery of the head and neck. Am J Otolaryngol 2017; 38:560-564. [PMID: 28716300 DOI: 10.1016/j.amjoto.2017.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 06/02/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Analyze postoperative complications after free flap surgery based on PGY training level. METHODS Data on free flap surgeries of the head and neck performed from 2005 to 2013 was collected from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Cases identifying the status of resident participation in the surgery and the PGY level were included. RESULTS There were 582 cases with primary surgeon data available. 63 cases were performed with a junior resident, 211 were performed with the assistance of a senior resident, 279 cases were performed with a fellow, and 29 cases were performed by an attending alone without resident involvement. The overall complication rate was 55.2%. There was no statistically significant difference in the rate of complications between groups (47.6%, 59.7%, 53.0%, 58.6%, p=0.277). After controlling for all confounding variables using multivariate analysis there was no significant difference in morbidity, mortality, readmissions, and reoperation amongst the groups. Furthermore, when comparing resident versus fellow involvement using multivariate analysis there were no significant differences in morbidity (OR=0.768[0.522-1.129]), mortality (OR=1.489[0.341-6.499]), readmissions (OR=1.018[0.458-2.262]), and reoperation (OR=0.863[0.446-1.670]). CONCLUSION Resident and fellow participation in microvascular reconstructive cases does not appear to increase 30-day rates of medical, surgical, or overall complications.
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Affiliation(s)
- Jacob S Brady
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Meghan M Crippen
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Andrey Filimonov
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Neil V Nadpara
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ, USA; Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA; Department of Ophthalmology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Soly Baredes
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Richard Chan Woo Park
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
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Robison W, Patel SK, Mehta A, Senkowski T, Allen J, Shaw E, Senkowski CK. Can fatigue affect acquisition of new surgical skills? A prospective trial of pre- and post-call general surgery residents using the da Vinci surgical skills simulator. Surg Endosc 2017; 32:1389-1396. [DOI: 10.1007/s00464-017-5820-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/03/2017] [Indexed: 10/19/2022]
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Accreditation Council for Graduate Medical Education (ACGME) Surgery Resident Operative Logs: The Last Quarter Century. Ann Surg 2017; 265:923-929. [PMID: 28398961 DOI: 10.1097/sla.0000000000001738] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVE To describe secular trends in operative experience for surgical trainees across an extended period using the most comprehensive data available, the Accreditation Council for Graduate Medical Education (ACGME) case logs. BACKGROUND Some experts have expressed concern that current trainees are inadequately prepared for independent practice. One frequently mentioned factor is whether duty hours' restrictions (DHR) implemented in 2003 and 2004 contributed by reducing time spent in the operating room. METHODS A dataset was generated from annual ACGME reports. Operative volume for total major cases (TMC), defined categories, and four index laparoscopic procedures was evaluated. RESULTS TMC dropped after implementation of DHR but rebounded after a transition period (949 vs 946 cases, P = nonsignificance). Abdominal cases increased from 22% of overall cases to 31%. Alimentary cases increased from 21% to 26%. Trauma and vascular surgery substantially decreased. For trauma, this drop took place well before DHR. The decrease in vascular surgery also began before DHR but continued afterward as well: 148 cases/resident in the late 1990s to 107 currently. CONCLUSIONS Although total operative volume rebounded after implementation of DHR, diversity of operative experienced narrowed. The combined increase in alimentary and abdominal cases is nearly 13%, over a half-year's worth of operating in 5-year training programs. Bedrock general surgery cases-trauma, vascular, pediatrics, and breast-decreased. Laparoscopic operations have steadily increased. If the competence of current graduates has, in fact, diminished. Our analysis suggests that operative volume is not the problem. Rather, changing disease processes, subspecialization, reductions in resident autonomy, and technical innovation challenge how today's general surgeons are trained.
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Mackenzie CF, Garofalo E, Puche A, Chen H, Pugh K, Shackelford S, Tisherman S, Henry S, Bowyer MW. Performance of Vascular Exposure and Fasciotomy Among Surgical Residents Before and After Training Compared With Experts. JAMA Surg 2017; 152:581-588. [PMID: 28249090 PMCID: PMC5540053 DOI: 10.1001/jamasurg.2017.0092] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 12/26/2016] [Indexed: 11/14/2022]
Abstract
Importance Surgical patient outcomes are related to surgeon skills. Objective To measure resident surgeon technical and nontechnical skills for trauma core competencies before and after training and up to 18 months later and to compare resident performance with the performance of expert traumatologists. Design, Setting, and Participants This longitudinal study performed from May 1, 2013, through February 29, 2016, at Maryland State Anatomy Board cadaver laboratories included 40 surgical residents and 10 expert traumatologists. Interventions Performance was measured during extremity vascular exposures and lower extremity fasciotomy in fresh cadavers before and after taking the Advanced Surgical Skills for Exposure in Trauma (ASSET) course. Main Outcomes and Measures The primary outcome variable was individual procedure score (IPS), with secondary outcomes of IPSs on 5 components of technical and nontechnical skills, Global Rating Scale scores, errors, and time to complete the procedure. Two trained evaluators located in the same laboratory evaluated performance with a standardized script and mobile touch-screen data collection. Results Thirty-eight (95%) of 40 surgical residents (mean [SD] age, 31 [2.9] years) who were evaluated before and within 4 weeks of ASSET training completed follow-up evaluations 12 to 18 months later (mean [SD], 14 [2.7] months). The experts (mean [SD] age, 52 [10.0] years) were significantly older and had a longer (mean [SD], 46 [16.3] months) interval since taking the ASSET course (both P < .001). Overall resident cohort performance improved with increased anatomy knowledge, correct procedural steps, and decreased errors from 60% to 19% after the ASSET course regardless of clinical year of training (P < .001). For 21 of 40 residents (52%), correct vascular procedural steps plotted against anatomy knowledge (the 2 IPS components most improved with training) indicates the resident's performance was within 1 nearest-neighbor classifier of experts after ASSET training. Five residents had no improvement with training. The Trauma Readiness Index for experts (mean [SD], 74 [4]) was significantly different compared with the trained residents (mean [SD], 48 [7] before training vs 63 [7] after training [P = .004] and vs 64 [6] 14 months later [P = .002]). Critical errors that might lead to patient death were identified by pretraining IPS decile of less than 0.5. At follow-up, frequency of resident critical errors was no different from experts. The IPSs ranged from 31.6% to 76.9% among residents for core trauma competency procedures. Modeling revealed that interval experience, rather than time since training, affected skill retention up to 18 months later. Only 4 experts and 16 residents (40%) adequately decompressed and confirmed entry into all 4 lower extremity compartments. Conclusions and Relevance This study found that ASSET training improved resident procedural skills for up to 18 months. Performance was highly variable. Interval experience after training affected performance. Pretraining skill identified competency of residents vs experts. Extremity vascular and fasciotomy performance evaluations suggest the need for specific anatomical training interventions in residents with IPS deciles less than 0.5.
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Affiliation(s)
- Colin F. Mackenzie
- Shock Trauma Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore
| | - Evan Garofalo
- Department of Basic Medical Sciences, University of Arizona College of Medicine, Phoenix
| | - Adam Puche
- Department of Anatomy and Neurosciences, University of Maryland School of Medicine, Baltimore
| | - Hegang Chen
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Kristy Pugh
- Henry M. Jackson Foundation, Bethesda, Maryland
| | - Stacy Shackelford
- Joint Trauma System, Defense Center of Excellence for Trauma, US Army Institute of Surgical Research, San Antonio, Texas
| | - Samuel Tisherman
- Shock Trauma Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore
- Department of Surgery, University of Maryland School of Medicine, Baltimore
| | - Sharon Henry
- Department of Surgery, University of Maryland School of Medicine, Baltimore
| | - Mark W. Bowyer
- Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, Maryland
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Elsey EJ, Griffiths G, Humes DJ, West J. Meta-analysis of operative experiences of general surgery trainees during training. Br J Surg 2017; 104:22-33. [PMID: 28000937 DOI: 10.1002/bjs.10396] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/20/2016] [Accepted: 08/24/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND General surgical training curricula around the world set defined operative numbers to be achieved before completion of training. However, there are few studies reporting total operative experience in training. This systematic review aimed to quantify the published global operative experience at completion of training in general surgery. METHODS Electronic databases were searched systematically for articles in any language relating to operative experience in trainees completing postgraduate general surgical training. Two reviewers independently assessed citations for inclusion using agreed criteria. Studies were assessed for quantitative data in addition to study design and purpose. A meta-analysis was performed using a random-effects model of studies with appropriate data. RESULTS The search resulted in 1979 titles for review. Of these, 24 studies were eligible for inclusion in the review and data from five studies were used in the meta-analysis. Studies with published data of operative experience at completion of surgical training originated from the USA (19), UK (2), the Netherlands (1), Spain (1) and Thailand (1). Mean total operative experience in training varied from 783 procedures in Thailand to 1915 in the UK. Meta-analysis produced a mean pooled estimate of 1366 (95 per cent c.i. 1026 to 1707) procedures per trainee at completion of training. There was marked heterogeneity between studies (I2 = 99·6 per cent). CONCLUSION There is a lack of robust data describing the operative experiences of general surgical trainees outside the USA. The number of surgical procedures performed by general surgeons in training varies considerably across the world.
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Affiliation(s)
- E J Elsey
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - G Griffiths
- Department of Vascular Surgery, Ninewells Hospital, Dundee, UK
| | - D J Humes
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK.,National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - J West
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
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Caulley L, Quimby AE, Barrowman N, Moreau K, Vaccani JP. Effect of Home-Call on Otolaryngology Resident Education: A Pilot Study. JOURNAL OF SURGICAL EDUCATION 2017; 74:228-236. [PMID: 27717708 DOI: 10.1016/j.jsurg.2016.08.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 07/29/2016] [Accepted: 08/29/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To inform institutional policies regarding call encounters through an evaluation of the effect of home-call on academic experience and fatigue among surgical residents. This study conducted an assessment of the nature of resident call encounters premidnight and postmidnight and a comparative analysis of sleep deprivation and efficiency in residents during home-call and off call. DESIGN, SETTING, AND PARTICIPANTS All Otolaryngology-Head and Neck Surgery residents (n = 9) at single Canadian institution were asked to establish the time and nature of call encounters during home-call. Residents completed the Stanford Sleepiness Scale precall and postcall to measure sleepiness and wore an Actigraph device to measure sleep efficiency to establish fatigue in the setting of home-call as compared with residents off call. Home-call and off call patterns were studied using a random computer-generated selection of days for participants in both study groups. Analysis was conducted from December 1, 2013 to December 30, 2014. RESULTS Residents received on average 7 pages per night, of which 78.5% of pages were for nonurgent issues. On an average, change in sleep deprivation scores postcall was 3.0 points higher (95% CI: 2.48-3.57, p < 0.0001) in residents who were qualified for a postcall day compared with residents who did not qualify for a postcall day and residents off call according to the Stanford Sleepiness Scale. Postcall sleep deprivation was significantly associated with number of encounters managed after midnight, regardless of management through telephone or in-hospital (p = 0.01). The Actigraph device identified a significant decrease in sleep efficiency in residents who were qualified for a postcall day compared with residents off call (mean = -31.1; 95% CI: -38.9, -23.4; p < 0.001). CONCLUSIONS This is the first study to evaluate surgical residents' home-call experience. We identified a high proportion of nonurgent encounters that residents managed on call and increased postcall fatigue associated with postmidnight telephone encounters. This study highlights the detrimental effects of frequent sleep interruptions because of encounters on call and suggests the need for institutional guidelines to help minimize these interruptions.
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Affiliation(s)
- Lisa Caulley
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada; Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Alexandra E Quimby
- Department of Undergraduate Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Nick Barrowman
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Katherine Moreau
- Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada
| | - Jean-Philippe Vaccani
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada; Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
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Robinson WP, Doucet DR, Simons JP, Wyman A, Aiello FA, Arous E, Schanzer A, Messina LM. An intensive vascular surgical skills and simulation course for vascular trainees improves procedural knowledge and self-rated procedural competence. J Vasc Surg 2017; 65:907-915.e3. [DOI: 10.1016/j.jvs.2016.12.065] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 12/16/2016] [Indexed: 11/26/2022]
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Ferguson J, Middleton R, Alvand A, Rees J. Newly acquired arthroscopic skills: Are they transferable during simulator training of other joints? Knee Surg Sports Traumatol Arthrosc 2017; 25:608-615. [PMID: 26318489 DOI: 10.1007/s00167-015-3766-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 08/18/2015] [Indexed: 01/22/2023]
Abstract
PURPOSE This randomized study investigates whether novices learning simulation-based arthroscopic skills in one anatomical joint environment can immediately transfer their learnt skills to another joint. METHODS Medical students were randomized to a simulated diagnostic knee or shoulder arthroscopic task on benchtop training models. After nine task repetitions over 3 weeks on one model, each participant undertook the simulation task of the other anatomical joint. Performance was objectively measured using a validated electromagnetic motion analysis system and a validated global rating scale (GRS). RESULTS Eighteen students participated; eight started the knee task and ten the shoulder task. All participants demonstrated a learning curve in all parameters during task repetition (time taken, hand path length, number of hand movements and GRS scores; p < 0.001) with learning effects >1 SD from initial performance (range 1.1-2.2 SD). When the groups swapped models, there was no immediate evidence of skill transfer, with a significant drop in performance between the final training episode and the transfer task (all parameters p < 0.003). In particular, the transfer task performance was no better than the first episode performance on that model by these novices. CONCLUSION This study showed basic arthroscopic skills did not immediately transfer to an unfamiliar anatomical environment within a simulated setting. These findings have important clinical implications with regard to surgical training as they potentially challenge the assumption that arthroscopic skills acquired in one joint are universally transferrable to other joints. Future orthopaedic simulation training should aim to deliver exposure to a greater variety of arthroscopic procedures and joint environments. This would allow trainees to become familiar with the different arthroscopic setting before undertaking real surgery and consequently improve patient safety. LEVEL OF EVIDENCE Therapeutic, Level II.
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Affiliation(s)
- Jamie Ferguson
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Lane, Headington, Oxford, OX3 7LD, UK.
| | - Robert Middleton
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Lane, Headington, Oxford, OX3 7LD, UK
| | - Abtin Alvand
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Lane, Headington, Oxford, OX3 7LD, UK
| | - Jonathan Rees
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Lane, Headington, Oxford, OX3 7LD, UK
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Youngerman BE, Zacharia BE, Hickman ZL, Bruce JN, Solomon RA, Benzil DL. Making Milestones. Neurosurgery 2016; 79:492-8. [DOI: 10.1227/neu.0000000000001126] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Yan H, Maximus S, Koopmann M, Keeley J, Smith B, Virgilio CD, Kim DY. Vascular Trauma Operative Experience is Inadequate in General Surgery Programs. Ann Vasc Surg 2016; 33:94-7. [DOI: 10.1016/j.avsg.2016.02.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 02/09/2016] [Accepted: 02/10/2016] [Indexed: 11/29/2022]
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Sharma G, Aycart MA, Najjar PA, van Houten T, Smink DS, Askari R, Gates JD. A cadaveric procedural anatomy course enhances operative competence. J Surg Res 2016; 201:22-8. [DOI: 10.1016/j.jss.2015.09.037] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 09/08/2015] [Accepted: 09/25/2015] [Indexed: 11/15/2022]
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