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Implementation, evaluation, and modification of a near-peer learning group in graduate surgical education. Am J Surg 2023; 225:591-592. [PMID: 36443105 DOI: 10.1016/j.amjsurg.2022.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 11/06/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022]
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Developing and refining a surgical curriculum. Surgery 2020; 167:528-531. [DOI: 10.1016/j.surg.2019.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 05/24/2019] [Accepted: 06/17/2019] [Indexed: 11/21/2022]
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Fischer LE, Snyder M, Sullivan SA, Foley EF, Greenberg JA. Evaluating the effectiveness of a mock oral educational program. J Surg Res 2016; 205:305-311. [DOI: 10.1016/j.jss.2016.06.088] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 04/17/2016] [Accepted: 06/26/2016] [Indexed: 11/27/2022]
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Guarner J, Amukele T, Mehari M, Gemechu T, Woldeamanuel Y, Winkler AM, Asrat D, Wilson ML, Rio CD. Building capacity in laboratory medicine in Africa by increasing physician involvement: a laboratory medicine course for clinicians. Am J Clin Pathol 2015; 143:405-11. [PMID: 25696799 DOI: 10.1309/ajcpnyt1wpsrclc6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES To describe a 4-day laboratory medicine course for clinicians given at Addis Ababa University, Ethiopia, designed to improve the use of laboratory-based diagnoses. METHODS Each day was dedicated to one of the following topics: hematology, blood bank/transfusion medicine and coagulation, chemistry, and microbiology. The course included lectures, case-based learning, laboratory tours, and interactive computer case-based homework. The same 12-question knowledge quiz was given before and after the course. RESULTS Twenty-eight participants took the quiz before and 21 after completing the course. The average score was 5.28 (range, 2-10) for the initial quiz and 8.09 (range, 4-11) for the second quiz (P = .0001). Two of 12 and 8 of 12 questions were answered correctly by more than 60% of trainees on the initial and second quiz, respectively. CONCLUSIONS Knowledge and awareness of the role of the laboratory increased after participation in the course. Understanding of laboratory medicine principles by clinicians will likely improve use of laboratory services and build capacity in Africa.
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Affiliation(s)
- Jeannette Guarner
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
| | - Timothy Amukele
- Department of Pathology and Laboratory Medicine, Johns Hopkins University, Baltimore, MD
| | - Meheretu Mehari
- Clinical Laboratory, Black Lion Hospital, Addis Ababa, Ethiopia
| | - Tufa Gemechu
- College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Anne M. Winkler
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
| | - Daniel Asrat
- College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Michael L. Wilson
- Department of Pathology and Laboratory Medicine, University of Colorado, Denver
| | - Carlos del Rio
- Hubert Department of Global Health, Rollins School of Public Health of Emory University, Atlanta, GA
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
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Spicer JO, Kraft CS, Burd EM, Armstrong WS, Guarner J. The value of case-based teaching vignettes in clinical microbiology rounds. Am J Clin Pathol 2014; 141:318-22. [PMID: 24515758 DOI: 10.1309/ajcpw71hrnssbypo] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES To describe the implementation and evaluation of a case-based microbiology curriculum during daily microbiology rounds. METHODS Vignettes consist of short cases with images and questions that facilitate discussion among microbiologists, pathologists, infectious disease physicians, and trainees (residents and fellows). We performed a survey to assess the value of these vignettes to trainees. RESULTS Motivation to come to rounds on time increased from 60% to 100%. Trainees attending rounds after implementation of the vignettes perceived the value of microbiology rounds to be significantly higher compared with those who attended rounds before implementation (P = .04). Pathology residents found that vignettes were helpful for retaining knowledge (8.3 of 10 points). CONCLUSIONS The vignettes have enhanced the value of microbiology rounds by serving as a formalized curriculum exposing trainees from multiple specialties to various microbiology topics. Emphasis on interdisciplinary interactions between clinical and laboratory personnel was highlighted with this case-based curriculum.
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Affiliation(s)
- Jennifer O. Spicer
- Departments of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Colleen S. Kraft
- Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
| | - Eileen M. Burd
- Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
| | - Wendy S. Armstrong
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
| | - Jeannette Guarner
- Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
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Burns TL, DeBaun MR, Boulet JR, Murray GM, Murray DJ, Fehr JJ. Acute care of pediatric patients with sickle cell disease: a simulation performance assessment. Pediatr Blood Cancer 2013; 60:1492-8. [PMID: 23633232 DOI: 10.1002/pbc.24558] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 03/11/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND Sickle cell disease (SCD) is a rare disorder with cardinal features including hospitalization for vaso-occlusive pain episodes, acute pulmonary injury, and increased infection rates. For physician-trainees, learning optimal SCD management is challenging because of limited exposure to life threatening complications requiring timely interventions. PROCEDURE To create, demonstrate reliability, and validate simulation-based, acute care SCD scenarios for physician-trainees, seven scenarios were derived from SCD patient cases. For each scenario, participants had 5 minutes to complete diagnostic and treatment interventions. Participants were divided into two groups based on clinical experience: interns or residents/fellows. Two raters scored performances using diagnostic and therapeutic checklists--indicating whether specific actions were performed and a global, 1 (poor) to 9 (excellent), rating. Scenario scores were calculated by averaging rater scores on each metric. Reliability was defined through uniformity in rater scoring and consistency of participant performance over scenarios. Validity was demonstrated by the performance gradient where the more experienced trainees outperform those early in training. RESULTS Twenty-eight pediatric residents and hematology fellows took part in the study. Reliability for assessment scores overall was moderate. Performance on all but one scenario was moderately predictive of overall performance. Senior resident/fellows performed significantly better than interns. Positive associations existed between overall performance scores (P < 0.01) and months of postgraduate training (P < 0.01). CONCLUSIONS Mannequin-based simulation is a novel method for teaching pediatric residents SCD-specific acute care skills. The assessment provided reliable and valid measures of trainees' performance. Further studies are needed to determine simulation's utility in education and evaluation.
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Affiliation(s)
- Tracy L Burns
- Washington University in St. Louis School of Medicine, Doris Duke Clinical Research Fellowship, St. Louis, MO 63110, USA
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Barriers to adoption of the surgical resident skills curriculum of the American College of Surgeons/Association of Program Directors in Surgery. Surgery 2013; 154:23-8. [DOI: 10.1016/j.surg.2013.04.058] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 04/26/2013] [Indexed: 11/22/2022]
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Davis JS, Garcia GD, Jouria JM, Wyckoff MM, Alsafran S, Graygo JM, Withum KF, Schulman CI. Identifying pitfalls in chest tube insertion: improving teaching and performance. JOURNAL OF SURGICAL EDUCATION 2013; 70:334-9. [PMID: 23618442 DOI: 10.1016/j.jsurg.2012.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 12/13/2012] [Accepted: 12/27/2012] [Indexed: 05/21/2023]
Abstract
OBJECTIVE Chest tube thoracostomies are common surgical procedures, but little is known about how practitioners learn the skill. This study evaluates the frequency with which correctly performed tasks are executed by subjects during chest tube thoracostomies. DESIGN In this prospective study, we developed a mobile-learning module, containing stepwise multimedia guidance on chest tube insertion. Next, we developed and tested a 14-item checklist, modeled after key skills in the module. Participants, defined as "novice" (fewer than 10 chest tubes placed) or "expert" (10 or more placed), were assigned to either the video or control group. A trained clinician used the checklist to rate participants while they inserted a chest tube on a TraumaMan simulator. SETTING University of Miami, Miller School of Medicine, a tertiary care academic institution. PARTICIPANTS Current medical students, residents, and the United States Army Forward Surgical Team members rotating through the institution. One hundred twenty-eight subjects entered and finished the study. RESULTS One hundred twenty-eight subjects enrolled in the study; 86 (67%) were residents or US Army Forward Surgical Team members, 66 (77%) were novices, and 20 (23%) were experts. Novices most frequently connected the tube to suction (91%), adequately dissected the soft tissue (82%), and scrubbed or anesthetized appropriately (80%). They least frequently completed full finger sweeps (33%), avoided the neurovascular bundle (35%), and performed a controlled pleural puncture (39%). Comparing the novice video group with the novice control group, the video group was more likely to correctly perform a finger sweep (42%, p<0.001) and clamp the distal end of the chest tube (42%, p<0.001). Of all the steps, experts least frequently completed full finger sweeps (70%) and avoided the neurovascular bundle (75%). Comparing the expert video group with the expert control group, the video group was more likely to correctly perform finger sweeps, the incision, and clamping the distal chest tube (20%, p = not significant). CONCLUSIONS Avoiding the neurovascular bundle, controlled pleural entry, and finger sweeps are most often performed incorrectly among novices. This information can help instructors to emphasize key didactic steps, possibly easing trainees' learning curve.
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Affiliation(s)
- James S Davis
- Leonard M. Miller School of Medicine, Department of Surgery, University of Miami, Miami, Florida 33101, USA
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Stroud L, Oulanova O, Szecket N, Ginsburg S. "The benefits make up for whatever is lost": altruism and accountability in a new call system. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2012; 87:1421-1427. [PMID: 22914519 DOI: 10.1097/acm.0b013e31826768d4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE A new internal medicine call structure was implemented at two teaching hospitals at the University of Toronto, Canada, in 2009, motivated by patient safety concerns, new duty hours regulations, and dissatisfaction among attending physicians. This study aimed to determine attendings', residents', and students' experiences with the new structure and to look carefully for unintended consequences. METHOD Between June and August 2009, the authors conducted an in-depth qualitative study using level-specific focus groups of attending physicians, residents, and medical students (n=28) with experience of both the old and new call systems. Discussions were analyzed using grounded theory. RESULTS Analysis revealed six themes (physician, manager, learner, teacher, workload, and "teamness") as well as the overarching theme of accountability. Although participants perceived the new system as better for patient care, there were several trade-offs. For example, workload was more predictable and equitable but less flexible, and senior residents reported less personal continuity for patients but increased continuity of care on the team level. Teaching and learning were negatively affected. Despite the negative effects, participants perceived that overall accountability improved on many levels, and participants felt the trade-offs were worth the perceived benefits. CONCLUSIONS Residents were flexible and altruistic, accepting trade-offs in their own experiences in favor of patient care. Education was negatively affected. This study highlights the importance of carefully studying changes to look for anticipated and unanticipated consequences.
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Affiliation(s)
- Lynfa Stroud
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Davis JS, Garcia GD, Wyckoff MM, Alsafran S, Graygo JM, Withum KF, Schulman CI. Use of mobile learning module improves skills in chest tube insertion. J Surg Res 2012; 177:21-6. [DOI: 10.1016/j.jss.2012.03.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 02/17/2012] [Accepted: 03/12/2012] [Indexed: 10/28/2022]
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[Teaching surgery: new times, new methods]. Cir Esp 2011; 90:17-23. [PMID: 21955836 DOI: 10.1016/j.ciresp.2011.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 05/25/2011] [Accepted: 05/25/2011] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The organisation, follow-up and quality of post-graduate teaching may be in need of appraisal in our area. This study sets out a clear objective: to use a more practical and effective teaching tool than we currently have available. Not only will it set out to assess the resident, but also provide material already approved and reviewed by their tutors. All this will be achieved using an easy, accessible and free method which ensures their basic training. MATERIAL AND METHOD Firstly, we identified the practical problems in the general surgery residency in our area. We prepared a questionnaire and sent it by e-mail to all second year and over residents of the Basque Country Autonomous Community. From the results obtained, we designed a file system with Google Documents™ and we started to apply it the third and fourth years. RESULTS The teaching methods in Surgery have partly become obsolete due to the initiative of Information Sciences Technology. The new generations naturally dominate the Internet along with the more common computer applications. Within our reach we have a series of tools that, due to lack of knowledge or lack of time, we do not use. This article attempts to provide a working option that will help the job of the tutor as a teaching figure, since the health care activity often has no place for interaction with the resident.
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Chand DV. Observational study using the tools of lean six sigma to improve the efficiency of the resident rounding process. J Grad Med Educ 2011; 3:144-50. [PMID: 22655134 PMCID: PMC3184924 DOI: 10.4300/jgme-d-10-00116.1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 08/31/2010] [Accepted: 12/21/2010] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Recent focus on resident work hours has challenged residency programs to modify their curricula to meet established duty hour restrictions and fulfill their mission to develop the next generation of clinicians. Simultaneously, health care systems strive to deliver efficient, high-quality care to patients and families. The primary goal of this observational study was to use a data-driven approach to eliminate examples of waste and variation identified in resident rounding using Lean Six Sigma methodology. A secondary goal was to improve the efficiency of the rounding process, as measured by the reduction in nonvalue-added time. METHODS We used the "DMAIC" methodology: define, measure, analyze, improve, and control. Pediatric and family medicine residents rotating on the pediatric hospitalist team participated in the observation phase. Residents, nurses, hospitalists, and parents of patients completed surveys to gauge their attitudes toward rounds. The Mann-Whitney test was used to test for differences in the median times measured during the preimprovement and postimprovement phases, and the Student t test was used for comparison of survey data. RESULTS AND DISCUSSION Collaborative, family-centered rounding with elimination of the "prerounding" process, as well as standard work instructions and pacing the process to meet customer demand (takt time), were implemented. Nonvalue-added time per patient was reduced by 64% (P = .005). Survey data suggested that team members preferred the collaborative, family-centered approach to the traditional model of rounding. CONCLUSIONS Lean Six Sigma provides tools, a philosophy, and a structured, data-driven approach to address a problem. In our case this facilitated an effort to adhere to duty hour restrictions while promoting education and quality care. Such approaches will become increasingly useful as health care delivery and education continue to transform.
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