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Niznik T, Chen S, Gernsback J. Through the Looking Glass: Comparing Resident and Attending Views on Competency and Autonomy. World Neurosurg 2024; 186:e290-e295. [PMID: 38548051 DOI: 10.1016/j.wneu.2024.03.125] [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: 01/16/2024] [Accepted: 03/21/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Surgical residencies act as an apprenticeship to train new surgeons, ideally with increasing trainee autonomy and competency. Objective methods of measuring these two qualities are needed. METHODS The objective of this pilot study is to use the Surgical Autonomy Program to compare resident and attending perception of competency, via Zones of Proximal Development (ZPDs), and autonomy, via Teach, Advise, Guide, Solo (TAGS) scale for a common pediatric neurosurgical procedure. The most common pediatric neurosurgical procedure, a ventriculoperitoneal shunt, was broken down into four ZPDs. After each procedure, the resident and the attending rated the competency of the resident by ZPD and their autonomy using TAGS. These ratings were then compared to see if the attending and the resident agreed on their levels of competency and autonomy. RESULTS There were no significant differences in the rating of competency or autonomy between the residents and the attendings. Postgraduate year was significantly associated with differences in TAGS ratings with those having less experience showing a positive perception gap. Other covariates (age, gender) were not associated with differences in rating. The residents found that the ZPDs checklist was a useful tool for communicating with the attending and for getting appropriate autonomy in the operating room. CONCLUSIONS Pediatric neurosurgical trainees and attendings had concordance on their perceptions of resident autonomy and competency, suggesting that this tool could be a useful way of objectively grading the progress of neurosurgical residents in surgery.
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Affiliation(s)
- Taylor Niznik
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Department of Neurosurgery, Section of Pediatric Neurosurgery, Oklahoma Children's Hospital, University of Oklahoma School of Medicine, Oklahoma City, OK, USA
| | - Sixia Chen
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Joanna Gernsback
- Department of Neurosurgery, University of Texas Health Science Center San Antonio, San Antonio, TX, USA.
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Schulze M, Streith L, Wiseman SM. Intraoperative teaching methods, models, and frameworks: A scoping review for surgical resident education. Am J Surg 2024; 231:24-40. [PMID: 38342713 DOI: 10.1016/j.amjsurg.2024.01.024] [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: 11/20/2023] [Revised: 01/15/2024] [Accepted: 01/24/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND This review aimed to consolidate the existing literature on intraoperative teaching strategies and highlight areas for future research. OBJECTIVE The objective is to review the research conducted regarding the implementation of various teaching frameworks for surgical learners and to present their feasibility, benefits, and limitations within surgical residencies, as well as areas for future research. METHODS Two independent investigators searched MEDLINE, EMBASE, and ERIC and reviewed articles on intraoperative teaching strategies for surgical resident education. RESULTS 3050 abstracts were reviewed, and 66 studies (2.2%) were included. The most common study type was single cohort studies (33%), followed by survey studies (17%). The majority of articles were carried out in General Surgery (50%), or a combination of surgical specialties (17%). CONCLUSIONS The BID model encompasses perioperative teaching time points and suggests a universal organizational approach to intraoperative teaching that would likely be compatible with documented competency assessments for residents.
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Affiliation(s)
- Marie Schulze
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, Canada
| | - Lucas Streith
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, Canada
| | - Sam M Wiseman
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, Canada.
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3
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D’Abbondanza JA, Shih JG, Knox ADC, Zhygan N, Brown MH, Fish JS, Courtemanche DJ. Resident Exposure and Involvement in Core Procedural Competencies within Pediatric Plastic Surgery. Plast Surg (Oakv) 2024; 32:347-354. [PMID: 38681244 PMCID: PMC11046279 DOI: 10.1177/22925503221109072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/02/2022] [Accepted: 05/11/2022] [Indexed: 05/01/2024] Open
Abstract
Introduction: The implementation of competency-based residency training in plastic surgery is underway. Key competencies in plastic surgery have been previously identified, however, within the domain of pediatrics, data suggest limited exposure throughout training for Canadian graduates. This study aims to identify the exposure and involvement of residents in core pediatric cases. Methods: We performed a retrospective, multicenter review of plastic surgery resident case logs (T-Res, POWER, New Innovations) across 10 Canadian, English-speaking training programs between 2004 and 2014. Case logs were coded according to the 8 core pediatric competencies previously identified by a modified Delphi technique. Results: A total of 3061 of 59 405 cases (5.2%) logged by 55 graduating residents were core pediatric procedures with an average of 55.6 ± 23.0 cases logged per resident. The top 3 most commonly logged procedures were cleft lip repair, cleft palate repair, and setback otoplasty. The number of cases per program varied widely with the most at 731 and least at 85 logged cases. Roles across procedures have wide variation and residents are most commonly identified as the assistant rather than surgeon or co-surgeon. Conclusion: These findings highlight variability both within and across residency programs with a paucity of exposure and involvement in pediatric plastic surgery cases. This may present a conflict between current recommendations for residency-specific procedural competencies and true clinical exposure. Further curriculum development and simulation may be of benefit.
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Affiliation(s)
- Josephine A. D’Abbondanza
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jessica G. Shih
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Aaron D. C. Knox
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Nick Zhygan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of British Columbia, Victoria, British Columbia, Canada
| | - Mitchell H. Brown
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Joel S. Fish
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Douglas J. Courtemanche
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of British Columbia, Victoria, British Columbia, Canada
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4
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Ng IKS, Mok SF, Teo D. Competency in medical training: current concepts, assessment modalities, and practical challenges. Postgrad Med J 2024:qgae023. [PMID: 38376156 DOI: 10.1093/postmj/qgae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/23/2024] [Indexed: 02/21/2024]
Abstract
In the past two decades, competency-based medical education (CBME) has rapidly become the cornerstone of medical training and accreditation programmes worldwide. It has increasingly replaced traditional time-based educational approaches which were often rigid, fragmented, and overly emphasized clinical content knowledge over practical skillsets and attitudes. CBME adoption was in the hope of better preparing medical graduates for the demands and responsibilities of real-world clinical practice. For all the supposed merits of CBME, there hitherto remains difficulties in arriving at comprehensive and practical 'competency' definitions, and actual challenges with implementation of clinical competency assessment modalities pertaining to construct validity, reliability, and applicability with the use and interpretation of evaluation metrics. Therefore, in this article, we describe the various conceptualizations of 'competency' in medical education literature and attempt to refine its usage in practice to meet the evolving needs and expectations of healthcare stakeholders, as well as incorporate emerging concepts in the medical education discourse. We herein propose that clinical 'competencies' should be defined as multi-domain clinical expertise, comprising medical knowledge, skills, attitudes and metacognitive capabilities that reflects the prevailing needs of healthcare stakeholders, and is inferred from performance evaluations of medical trainees. In order to attain 'competence', there must then be a process of integrating multi-domain competencies into meaningful professional identity formation that is commensurate with the context and stage of medical training. In addition, we review the current competency assessment modalities, including common pitfalls with their usage, and sought to provide practical strategies to mitigate the identified challenges.
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Affiliation(s)
- Isaac K S Ng
- Department of Medicine, National University Hospital, Singapore 119228, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore 117597, Singapore
| | - Shao Feng Mok
- Yong Loo Lin School of Medicine, National University of Singapore 117597, Singapore
- Division of Endocrinology, Department of Medicine, National University Hospital, Singapore 119228, Singapore
| | - Desmond Teo
- Yong Loo Lin School of Medicine, National University of Singapore 117597, Singapore
- Fast and Chronic Programmes, Alexandra Hospital, Singapore 159964, Singapore
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, Singapore 119228, Singapore
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Thelen AE, Marcotte KM, Diaz S, Gates R, Chen X, George BC, Krumm AE. Variation in Competence of Graduating General Surgery Trainees. JOURNAL OF SURGICAL EDUCATION 2024; 81:17-24. [PMID: 38036389 DOI: 10.1016/j.jsurg.2023.11.005] [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: 02/25/2023] [Revised: 07/22/2023] [Accepted: 11/03/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE To examine the readiness of general surgery residents in their final year of training to perform 5 common surgical procedures based on their documented performance during training. DESIGN Intraoperative performance ratings were analyzed using a Bayesian mixed effects approach, adjusting for rater, trainee, procedure, case complexity, and postgraduate year (PGY) as random effects as well as month in academic year and cumulative, procedure-specific performance per trainee as fixed effects. This model was then used to estimate each PGY 5 trainee's final probability of being able to independently perform each procedure. The actual, documented competency rates for individual trainees were then identified across each of the 5 most common general surgery procedures: appendectomy, cholecystectomy, ventral hernia repair, groin hernia repair, and partial colectomy. SETTING This study was conducted using data from members of the SIMPL collaborative. PARTICIPANTS A total of 17,248 evaluations of 927 PGY5 general surgery residents were analyzed from 2015 to 2021. RESULTS The percentage of residents who requested a SIMPL rating during their PGY5 year and achieved a ≥90% probability of being rated as independent, or "Practice-Ready," was 97.4% for appendectomy, 82.4% for cholecystectomy, 43.5% for ventral hernia repair, 24% for groin hernia repair, and 5.3% for partial colectomy. CONCLUSIONS There is substantial variation in the demonstrated competency of general surgery residents to perform several common surgical procedures at the end of their training. This variation in readiness calls for careful study of how surgical residents can become more adequately prepared to enter independent practice.
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Affiliation(s)
- Angela E Thelen
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan; MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
| | - Kayla M Marcotte
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan; University of Michigan Medical School, Ann Arbor, Michigan; Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan
| | - Sarah Diaz
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan; University of Michigan Medical School, Ann Arbor, Michigan
| | - Rebecca Gates
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Xilin Chen
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Brian C George
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Andrew E Krumm
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan
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Flewelling K, Alfred A, Jose J, Elian A, Norman E, Timmons J, Munene G, Sawyer R, Shebrain S. Do Surgery Residents Prepare Enough for Surgical Cases? JOURNAL OF SURGICAL EDUCATION 2024; 81:48-55. [PMID: 38030443 DOI: 10.1016/j.jsurg.2023.09.015] [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: 05/15/2023] [Revised: 09/13/2023] [Accepted: 09/20/2023] [Indexed: 12/01/2023]
Abstract
IMPORTANCE This study aimed to identify both modifiable and nonmodifiable factors that affect intraoperative-specific surgical education and performance, with an overall goal of increasing cognizance of such factors to improve surgical training. OBJECTIVE To determine whether surgery residents prepare adequately for participation in surgical cases and to examine specific variables that affect resident preparation. DESIGN This study is a retrospective survey-based study that included data from 1945 postoperative case evaluations completed by 59 different general surgery residents over a period of 8 years (2014-2022). SETTING A Midwestern medical school's general surgery residency program. PARTICIPANTS Fifty-nine general surgery residents at Western Michigan University's medical school; 50 attending surgeons and faculty with whom residents regularly operate. The sample was comprised of residents and attendings who voluntarily filled out postoperative performance surveys after elective cases. RESULTS This retrospective survey-based study included postoperative evaluation data from 1945 procedures performed by 59 different residents and 50 attendings. Participants included 36 male residents, 23 female residents, 39 male attendings, and 11 female attendings. All included data were for elective cases. Self-reported preoperative communication was worst at the PGY1 level with positive correlation of improvement yearly (r = 0.30, p < 0.001). Positive correlation was seen between overall preparedness and case complexity (r = 0.25, p < 0.001). Positive correlation was seen between case complexity and resident perception of intraoperative teaching quality (r = 0.53, p < 0.001). Preoperative communication initiated by residents was significantly worse when the attending surgeon was female, regardless of resident gender (p < 0.001); this effect was particularly profound with male residents. Male residents overall rated themselves as more prepared compared to their female counterparts (11.13 ± 1.96 vs. 10.84 ± 2.03, p = 0.003). CONCLUSIONS AND RELEVANCE There is a need to identify and address quantifiable gaps in communication between residents and faculty to optimize surgical education; one of the first steps is characterizing nonmodifiable factors that correlate with differences in pre-operative communication and case preparation.
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Affiliation(s)
- Kayla Flewelling
- Department of Surgery, Western Michigan University, Homer Stryker MD School of Medicine, Kalamazoo, Michigan.
| | - Andrew Alfred
- Department of Surgery, Western Michigan University, Homer Stryker MD School of Medicine, Kalamazoo, Michigan
| | - Joslyn Jose
- Department of Surgery, Western Michigan University, Homer Stryker MD School of Medicine, Kalamazoo, Michigan
| | - Alain Elian
- Department of Surgery, Western Michigan University, Homer Stryker MD School of Medicine, Kalamazoo, Michigan
| | - Earl Norman
- Department of Surgery, Western Michigan University, Homer Stryker MD School of Medicine, Kalamazoo, Michigan
| | - Jennifer Timmons
- Department of Surgery, Western Michigan University, Homer Stryker MD School of Medicine, Kalamazoo, Michigan
| | - Gitonga Munene
- Department of Surgery, Western Michigan University, Homer Stryker MD School of Medicine, Kalamazoo, Michigan
| | - Robert Sawyer
- Department of Surgery, Western Michigan University, Homer Stryker MD School of Medicine, Kalamazoo, Michigan
| | - Saad Shebrain
- Department of Surgery, Western Michigan University, Homer Stryker MD School of Medicine, Kalamazoo, Michigan
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Zwischenberger JB, Hatchett SP, Rahman NA, Chadha P, Sebok-Syer SS, George BC. Implementing Workplace-Based Assessments at Scale: The SIMPL Approach. ANNALS OF SURGERY OPEN 2023; 4:e353. [PMID: 38144481 PMCID: PMC10735067 DOI: 10.1097/as9.0000000000000353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 09/25/2023] [Indexed: 12/26/2023] Open
Abstract
Over the past decade, medical education has shifted from a time-based approach to a competency-based approach for surgical training. This transition presents many new systemic challenges. The Society for Improving Medical Professional Learning (SIMPL) was created to respond to these challenges through coordinated collaboration across an international network of medical educators. The primary goal of the SIMPL network was to implement a workplace-based assessment and feedback platform. To date, SIMPL has developed, implemented, and sustained a platform that represents the earliest and largest effort to support workplace-based assessment at scale. The SIMPL model for collaborative improvement demonstrates a potential approach to addressing other complex systemic problems in medical education.
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Affiliation(s)
- Joseph B. Zwischenberger
- From the Department of Surgery, Diagnostic Radiology, Pediatrics, and Biomedical Engineering, College of Medicine, University of Kentucky
| | | | - Naveed A. Rahman
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY
| | - Priyal Chadha
- College of Medicine, SUNY Upstate Medical University, Syracuse, NY
| | | | - Brian C. George
- Department of Surgery, University of Michigan, College of Medicine, Ann Arbor, MI
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8
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Hendricks A. [Expectations of surgical residents for their residency training]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:905-910. [PMID: 37580585 DOI: 10.1007/s00104-023-01938-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND The young generation of surgeons sets new requirements for educational and working conditions. This is frequently interpreted as a lack of motivation to perform; however, instead there is a claim for high-quality training with the aim of acquiring competence in the operative and perioperative setting as well as for responsible working time models. OBJECTIVE Aim of this article is to present expectations of surgical residents regarding residency training under current influencing factors, such as a high workload, the new training regulations or expected changes in the hospital landscape and to identify options for optimizing training and working conditions. MATERIAL AND METHODS In addition to an extensive literature search, this article is based on published opinions and survey results as well as lectures and discussions at congresses held in the past year. RESULTS AND DISCUSSION To ensure a modern high-quality education and to maintain enthusiasm for surgery, the need for adjustments and innovation must be recognized and long-requested modifictions to established structures must be implemented. Flexible working models, the structured and transparent implementation of surgical residency training and modern training units, long-term planning of training curricula and new personnel structures with an expansion of teaching and feedback culture are options for improvement.
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Affiliation(s)
- Anne Hendricks
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Uniklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.
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Phatak UP, Encandela J, Green M, Slade M, Osborn R, Weiss P. Feedback Culture Perceived by Trainees in an Academic Institution: A Mixed Methods Study. Hosp Pediatr 2023; 13:984-991. [PMID: 37791431 DOI: 10.1542/hpeds.2022-007004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
OBJECTIVES Lack of a well-functioning institutional feedback culture can undermine acquisition of skills essential for high quality patient care. The objective of this study was to assess feedback culture perceived by resident and fellow trainees, utilizing a mixed methods design. METHODS Pediatric fellows and residents completed an anonymous feedback environment survey consisting of 7 constructs: source credibility, feedback quality, feedback delivery, reinforcing feedback, constructive feedback, source availability, and promotion of feedback seeking, using a 7-point Likert scale. Trainee ratings were compared using two-sided Fisher's exact tests. Multivariable analyses used a linear regression model. For the qualitative study, semistructured interviews of residents were conducted. The constant comparative method was used to incrementally code, categorize data, and derive themes. RESULTS Fifty-two residents and 21 fellows completed the survey (response rates 65% and 47%, respectively). Scores were more favorable for fellows compared with residents in 6 of 7 feedback constructs (P < .05), including on multivariate analysis. Hispanic ethnicity and female gender were associated with lower scores on source credibility (P = .04) and constructive feedback (P = .03), respectively. Two qualitative themes were identified: expectation of efficiency in patient care compromises the quality and quantity of feedback, and a culture that prioritizes courtesy over candor negatively impacts feedback quality. These themes were more pronounced when residents worked with pediatric subspecialists compared with hospitalists. CONCLUSIONS We described the feedback culture, which was less favorable in the residency program. The need for efficient patient care and a culture of courtesy adversely impacted the quality of feedback, especially among subspecialists.
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Affiliation(s)
- Uma Padhye Phatak
- Yale School of Medicine
- Department of Pediatrics
- Pediatric Gastroenterology, Hepatology and Nutrition
| | - John Encandela
- Yale School of Medicine
- Yale Teaching and Learning Center, School of Medicine, Yale University, New Haven, Connecticut
| | - Michael Green
- Yale School of Medicine
- Yale Teaching and Learning Center, School of Medicine, Yale University, New Haven, Connecticut
- Divisions of General Medicine, Department of Internal Medicine
| | - Martin Slade
- Yale School of Medicine
- Yale Teaching and Learning Center, School of Medicine, Yale University, New Haven, Connecticut
| | - Rachel Osborn
- Yale School of Medicine
- Department of Pediatrics
- Hospital Medicine
| | - Pnina Weiss
- Yale School of Medicine
- Department of Pediatrics
- Pulmonology, Allergy, Immunology, and Sleep Medicine
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Gates RS, Marcotte K, Moreci R, George BC, Kim GJ, Kraft KH, Soltani T, Ötleş E, Krumm AE. Association of Gender and Operative Feedback Quality in Surgical Residents. JOURNAL OF SURGICAL EDUCATION 2023; 80:1516-1521. [PMID: 37385931 DOI: 10.1016/j.jsurg.2023.06.004] [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: 02/24/2023] [Revised: 05/12/2023] [Accepted: 06/02/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE Feedback is critical for learning, however, gender differences exist in the quality of feedback that trainees receive. For example, narrative feedback on surgical trainees' end-of-block rotations differs based on trainee-faculty gender dyads, with female faculty giving higher quality feedback and male trainees receiving higher quality feedback. Though this represents evidence of gender bias in global evaluations, there is limited understanding of how much bias might be present in operative workplace-based assessments (WBAs). In this study, we explore the quality of narrative feedback among trainee-faculty gender dyads in an operative WBA. DESIGN A previously validated natural language processing model was used to examine instances of narrative feedback and assign a probability of being characterized as high quality feedback (defined as feedback which was relevant as well as corrective and/or specific). A linear mixed model was performed, with probability of high quality feedback as the outcome, and resident gender, faculty gender, PGY, case complexity, autonomy rating, and operative performance rating as explanatory variables. PARTICIPANTS Analyses included 67,434 SIMPL operative performance evaluations (2,319 general surgery residents, 70 institutions) collected from September 2015 through September 2021. RESULTS Of 36.3% evaluations included narrative feedback. Male faculty were more likely to provide narrative feedback compared to female faculty. Mean probabilities of receiving high quality feedback ranged from 81.6 (female faculty-male resident) to 84.7 (male faculty-female resident). Model-based results demonstrated that female residents were more likely to receive high quality feedback (p < 0.01), however, there was no significant difference in probability of high quality narrative feedback based on faculty-resident gender dyad (p = 0.77). CONCLUSIONS Our study revealed resident gender differences in the probability of receiving high-quality narrative feedback following a general surgery operation. However, we found no significant differences based on faculty-resident gender dyad. Male faculty were more likely to provide narrative feedback compared to their female colleagues. Further research using general surgery resident-specific feedback quality models may be warranted.
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Affiliation(s)
- Rebecca S Gates
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan.
| | - Kayla Marcotte
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan; University of Michigan Medical School, Ann Arbor, Michigan; Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan
| | - Rebecca Moreci
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Brian C George
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan; Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Grace J Kim
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Kate H Kraft
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan; Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Tandis Soltani
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Erkin Ötleş
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Andrew E Krumm
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan; University of Michigan Medical School, Ann Arbor, Michigan; Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan
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11
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Wang TN, Woelfel IA, Pieper H, Haisley KR, Meara MP, Chen XP. Is Robotic Console Time a Surrogate for Resident Operative Autonomy? JOURNAL OF SURGICAL EDUCATION 2023; 80:1711-1716. [PMID: 37296003 DOI: 10.1016/j.jsurg.2023.05.008] [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: 02/16/2023] [Revised: 04/18/2023] [Accepted: 05/08/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Robotic-assisted surgery is an increasing part of general surgery training, but resident autonomy on the robotic platform can be hard to quantify. Robotic console time (RCT), the percentage of time the resident controls the console, may be an appropriate measure of resident operative autonomy. This study aims to characterize the correlation between objective resident RCT and subjectively scored operative autonomy. METHODS Using a validated resident performance evaluation instrument, we collected resident operative autonomy ratings from residents and attendings performing robotic cholecystectomy (RC) and robotic inguinal hernia repair (IH) at a university-based general surgery program between 9/2020-6/2021. We then extracted RCT data from the Intuitive surgical system. Descriptive statistics, t-tests and ANOVA were performed. RESULTS A total of 31 robotic operations (13 RC, 18 IH) performed by 4 attending surgeons and 8 residents (4 junior, 4 senior) were matched and included. 83.9% of cases were scored by both attending and resident. The average RCT per case was 35.6%(95% CI 13.0%,58.3%) for junior residents (PGY 2-3) and 59.7%(CI 51.1%,68.3%) for senior residents (PGY 4-5). The mean autonomy evaluated by residents was 3.29(CI 2.85,3.73) out of a maximum score of 5, while the mean autonomy evaluated by attendings was 4.12(CI 3.68,4.55). RCT significantly correlated with subjective evaluations of resident autonomy (r=0.61, p=0.0003). RCT also moderately correlated with resident training level (r=0.5306, p<0.0001). Neither attending robotic experience nor operation type significantly correlated with RCT or autonomy evaluation scores. CONCLUSIONS Our study suggests that resident console time is a valid surrogate for resident operative autonomy in robotic cholecystectomy and inguinal hernia repair. RCT may be a valuable measure in objective assessment of residents' operative autonomy and training efficiency. Future investigation into how RCT correlates with subjective and objective autonomy metrics such as verbal guidance or distinguishing critical operative steps is needed to validate the study findings further.
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Affiliation(s)
- Theresa N Wang
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Ingrid A Woelfel
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Heidi Pieper
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Kelly R Haisley
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Michael P Meara
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Xiaodong Phoenix Chen
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Hida K, Hirano S, Poudel S, Kurashima Y, Stefanidis D, Hashimoto D, Akiyama H, Eguchi S, Fukui T, Hagiwara M, Izaki T, Kawamoto S, Otomo Y, Nagai E, Takami H, Takeda Y, Toi M, Yamaue H, Yoshida M, Yoshida S, Kodera Y, Saito M. The degree of satisfaction and level of learning in male and female surgical residents: a nationwide questionnaire survey of graduating residents in Japan. Surg Today 2023; 53:1275-1285. [PMID: 37162584 DOI: 10.1007/s00595-023-02683-z] [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: 08/07/2022] [Accepted: 03/14/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE Since 2002, the Japan Surgical Society has established a board certification system for surgeons to be certified for a specialty. Surgery remains a male-dominated field in Japan. This study aimed to clarify if the Japanese surgical residency training system is equally suitable for female and male residents. METHODS The Japan Surgical Society conducted the first questionnaire survey regarding the system of surgical training for the residents in 2016. The questionnaire included the degree of satisfaction with 7 aspects of the training system, including the number and variety of cases experienced and duration and quality of instruction, and the learning level for 31 procedures. The degree of satisfaction and level of learning were compared between female and male residents. RESULTS The degree of satisfaction was similar for all items between female and male residents. Female residents chose breast surgery as their subspecialty more frequently than male residents and were more confident in breast surgery procedures than male residents. Conversely, fewer female residents chose gastrointestinal surgery and were less confident in gastrointestinal surgery procedures than male residents. CONCLUSION Female residents were as satisfied with the current surgical training system as male residents. However, there may be room for improvement in the surgical system, considering that fewer applications for gastrointestinal surgery come from female residents than from males.
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Affiliation(s)
- Koya Hida
- Department of Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan.
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Saseem Poudel
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Yo Kurashima
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Dimitrios Stefanidis
- Department of Surgery, School of Medicine, Indiana University, Indianapolis, USA
| | | | - Hirotoshi Akiyama
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Kumamoto University, Kumamoto, Japan
| | - Masaru Hagiwara
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Tomoko Izaki
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shunsuke Kawamoto
- Division of Cardiovascular Surgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Eishi Nagai
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hideki Takami
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuko Takeda
- Division of Medical Education, Juntendo University School of Medicine, Tokyo, Japan
| | - Masakazu Toi
- Department of Breast Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
| | - Motofumi Yoshida
- Department of Medical Education, Graduate School of Medicine, International University of Health and Welfare, Narita, Japan
| | - Shigetoshi Yoshida
- Department of Thoracic Surgery, International University of Health and Welfare School of Medicine, Narita, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mitsue Saito
- Department of Breast Oncology, Juntendo University School of Medicine, Tokyo, Japan
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Sebok-Syer SS, Lingard L, Panza M, Van Hooren TA, Rassbach CE. Supportive and collaborative interdependence: Distinguishing residents' contributions within health care teams. MEDICAL EDUCATION 2023; 57:921-931. [PMID: 36822577 DOI: 10.1111/medu.15064] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/04/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Individual assessments disregard team contributions, while team assessments disregard an individual's contributions. Interdependence has been put forth as a conceptual bridge between our educational traditions of assessing individual performance and our imminent challenge of assessing team-based performance without losing sight of the individual. The purpose of this study was to develop a more refined conceptualisation of interdependence to inform the creation of measures that can assess the interdependence of residents within health care teams. METHODS Following a constructivist grounded theory approach, we conducted 49 semi-structured interviews with various members of health care teams (e.g. physicians, nurses, pharmacists, social workers and patients) across two different clinical specialties-Emergency Medicine and Paediatrics-at two separate sites. Data collection and analysis occurred iteratively. Constant comparative inductive analysis was used, and coding consisted of three stages: initial, focused and theoretical. RESULTS We asked participants to reflect upon interdependence and describe how it exists in their clinical setting. All participants acknowledged the existence of interdependence, but they did not view it as part of a linear spectrum where interdependence becomes independence. Our analysis refined the conceptualisation of interdependence to include two types: supportive and collaborative. Supportive interdependence occurs within health care teams when one member demonstrates insufficient expertise to perform within their scope of practice. Collaborative interdependence, on the other hand, was not triggered by lack of experience/expertise within an individual's scope of practice, but rather recognition that patient care requires contributions from other team members. CONCLUSION In order to assess a team's collective performance without losing sight of the individual, we need to capture interdependent performances and characterise the nature of such interdependence. Moving away from a linear trajectory where independence is seen as the end goal can also help support efforts to measure an individual's competence as an interdependent member of a health care team.
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Affiliation(s)
| | - Lorelei Lingard
- Department of Medicine and Centre for Education Research and Innovation, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Michael Panza
- Centre for Education Research and Innovation, Western University, London, Ontario, Canada
| | - Tamara A Van Hooren
- Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Murakami M, Onishi S, Yamada K, Ogawa K, Yokoyama S, Kurashima Y, Miyano G, Ishimaru T, Kawashima H, Uchida H, Yamataka A, Okuyama H, Ieiri S. How many cases do instructor class pediatric surgeons need to experience to be an independent operator in performing advanced endoscopic surgery? A nationwide survey to establish an ideal curriculum for pediatric endoscopic surgery in Japan. Pediatr Surg Int 2023; 39:271. [PMID: 37684432 DOI: 10.1007/s00383-023-05550-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 09/10/2023]
Abstract
PURPOSE To ensure the safe spread of pediatric endoscopic surgery, it is essential to build a training curriculum, and a survey of the current situation in Japan is necessary. The present study assessed an efficient training curriculum by clarifying instructor class pediatric surgeons' experiences, including autonomy when performing advanced endoscopic surgeries. METHODS An online nationwide questionnaire survey was conducted among pediatric surgeons who had Endoscopic Surgical Skill Qualification (ESSQ) and board-certified instructors who had skills comparable to ESSQ. We assessed participants' training experience, opinions concerning the ideal training curriculum, and the correlation between surgical experience and the level of autonomy. The Zwisch scale was used to assess autonomy. RESULTS Fifty-two participants responded to the survey (response rate: 86.7%). Only 57.7% of the respondents felt that they had received sufficient endoscopic surgery training. Most respondents considered an educational curriculum for endoscopic surgery including off-the-job training essential during the training period. Autonomy had been acquired after experiencing two to three cases for most advanced endoscopic surgeries. CONCLUSION This first nationwide survey in Japan showed that instructor class pediatric surgeons acquired autonomy after experiencing two to three for most advanced endoscopic surgeries. Our findings suggest that training, especially off-the-job training, has been insufficient.
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Affiliation(s)
- Masakazu Murakami
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Shun Onishi
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Koji Yamada
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Katsuhiro Ogawa
- Department of Gastroenterological and Pediatric Surgery, Oita University, Oita, Japan
| | - Shinichiro Yokoyama
- Department of Pediatric Surgery, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Japan
| | - Yo Kurashima
- Clinical Simulation Center, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Go Miyano
- Department of Pediatric Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Tetsuya Ishimaru
- Department of Pediatric Surgery, Saitama Prefectural Children's Medical Center, Saitama, Japan
| | - Hiroshi Kawashima
- Department of Pediatric Surgery, Saitama Prefectural Children's Medical Center, Saitama, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Atsuyuki Yamataka
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroomi Okuyama
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Satoshi Ieiri
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan.
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15
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Downie S, Cherry J, Dunn J, Harding T, Eastwood D, Gill S, Johnson S. The role of Gender in Operative Autonomy in orthopaedic Surgical Trainees (GOAST). Bone Joint J 2023; 105-B:821-832. [PMID: 37399113 DOI: 10.1302/0301-620x.105b7.bjj-2023-0132.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
Aims Global literature suggests that female surgical trainees have lower rates of independent operating (operative autonomy) than their male counterparts. The objective of this study was to identify any association between gender and lead/independent operating in speciality orthopaedic trainees within the UK national training programme. Methods This was a retrospective case-control study using electronic surgical logbook data from 2009 to 2021 for 274 UK orthopaedic trainees. Total operative numbers and level of supervision were compared between male and female trainees, with correction for less than full-time training (LTFT), prior experience, and time out during training (OOP). The primary outcome was the percentage of cases undertaken as lead surgeon (supervised and unsupervised) by UK orthopaedic trainees by gender. Results All participants gave permission for their data to be used. In total, 274 UK orthopaedic trainees submitted data (65% men (n = 177) and 33% women (n = 91)), with a total of 285,915 surgical procedures logged over 1,364 trainee-years. Males were lead surgeon (under supervision) on 3% more cases than females (61% (115,948/189,378) to 58% (50,285/86,375), respectively; p < 0.001), and independent operator (unsupervised) on 1% more cases. A similar trend of higher operative numbers in male trainees was seen for senior (ST6 to 8) trainees (+5% and +1%; p < 0.001), those with no time OOP (+6% and +8%; p < 0.001), and those with orthopaedic experience prior to orthopaedic specialty training (+7% and +3% for lead surgeon and independent operator, respectively; p < 0.001). The gender difference was less marked for those on LTFT training, those who took time OOP, and those with no prior orthopaedic experience. Conclusion This study showed that males perform 3% more cases as the lead surgeon than females during UK orthopaedic training (p < 0.001). This may be due to differences in how cases are recorded, but must engender further research to ensure that all surgeons are treated equitably during their training.
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Affiliation(s)
- Samantha Downie
- Department of Trauma & Orthopaedics, Ninewells Hospital & Medical School, Dundee, UK
| | | | - Jennifer Dunn
- Department of Trauma & Orthopaedics, Ninewells Hospital & Medical School, Dundee, UK
| | - Thomas Harding
- Department of Trauma & Orthopaedics, Ninewells Hospital & Medical School, Dundee, UK
| | | | - Sarah Gill
- Department of Orthopaedic Surgery, Queen Elizabeth University Hospital Glasgow, Glasgow, UK
| | - Simon Johnson
- Department of Trauma & Orthopaedics, Ninewells Hospital & Medical School, Dundee, UK
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16
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Griffiths A, Sun A, Feinberg J, Wiesel O, Rhee R. The Whiteboard Time Out: A Novel Tool to Improve Resident Learning in the Operating Room. JOURNAL OF SURGICAL EDUCATION 2023; 80:912-921. [PMID: 37105862 DOI: 10.1016/j.jsurg.2023.04.003] [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: 11/20/2022] [Revised: 03/08/2023] [Accepted: 04/05/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE "Flipping the classroom" is a strategy that has been implemented in various educational environments to create a student-centered learning environment. Within this model of teaching, "first exposure" occurs prior to the classroom in a lower form of cognitive demand, allowing students to employ higher forms of cognition within the classroom. Surgical education has evolved over recent years to incorporate different modalities of learning; however, optimal educational approaches within the operating room (OR) have not been clearly defined. The Whiteboard Time Out (WBTO) utilizes the idea of "flipping the classroom" to make learning within the OR more resident centered. Residents complete most of the preoperative work prior to the case with a focus on the indications, steps of the procedure, and potential complications associated with the procedure. Residents then utilize a whiteboard located in the OR to outline, diagram, and discuss this information with the attending. Aims of the study are to enhance higher level intraoperative resident learning and attending teaching and improve resident knowledge and the ability to communicate surgical steps. DESIGN Faculty and residents completed a preimplementation questionnaire aligned to the Student Evaluation of Educational Quality (SEEQ) in July 2021. Participants were assigned 3 digit codes to ensure anonymity. The questionnaire was composed of 6 questions with a 5-point Likert scale. Whiteboards were mounted in every operating room, 19 total, in both the general OR and an ambulatory surgical center. The residents were expected to go to the OR, prior to scrubbing the case, and use the whiteboard to outline the indications, key steps and potential complications. After the resident completed the white board, the resident and attending reviewed the white board together prior to the start of the case. After the procedure, residents uploaded a picture of the whiteboard with a self-evaluation and faculty provided resident feedback via an online Wufoo Survey link. The start of the utilization of the whiteboards occurred after the initial survey in July 2021. The SEEQ questionnaire was again administered in October 2021, 3 months post-WBTO implementation, to assess resident and attending satisfaction. SEEQ questionnaire results were compared using a t-test. PARTICIPANTS Participants included surgical residents and attendings at Maimonides Medical Center (MMC). MMC is a 700-bed university-affiliated, academic, tertiary medical center in Brooklyn, New York. The General Surgery Residency is approved for up to 5 graduates annually. RESULTS A total of 17 attendings and 17 residents filled out the questionnaire. The average number of whiteboards completed was highest amongst the PGY1 class with an average of 18 whiteboards per resident. However, the average number of whiteboards completed declined amongst more senior residents. There was a statistically significant increase in overall SEEQ survey score amongst residents and attendings after implementation of the WBTO suggesting that whiteboards were useful (p < 0.03 and p < 0.02, respectively). Residents found that the whiteboard was an effective means of teaching surgical education compared to the current curriculum (p < 0.04). CONCLUSIONS The whiteboard timeout is a tool created to enhance resident education in the OR. This idea is centered on a "flipped classroom," an educational strategy to increase student engagement. Our data demonstrates that the whiteboard timeout is an effective method of intraoperative teaching.
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Affiliation(s)
- Alexa Griffiths
- Department of Surgery, Maimonides Medical Center, Brooklyn, New York.
| | - Arony Sun
- Department of Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Joshua Feinberg
- Department of Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Ory Wiesel
- Baruch Padeh Medical Center, The Faculty of Medicine in Galilee-Bar Ilan University, Israel
| | - Rebecca Rhee
- Department of Surgery, Maimonides Medical Center, Brooklyn, New York
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Goldman MP, Auerbach MA. Autonomy Is Desired, Entrustment Is What Matters. Hosp Pediatr 2023; 13:e150-e152. [PMID: 37153966 DOI: 10.1542/hpeds.2023-007205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Affiliation(s)
- Michael P Goldman
- Department of Pediatrics, Section of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Marc A Auerbach
- Department of Pediatrics, Section of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
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18
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Collings AT, Doster DL, Longtin K, Choi J, Torbeck L, Stefanidis D. Surgical Resident Perspectives on the Preferred Qualities of Effective Intraoperative Teachers: A Qualitative Analysis. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:629-635. [PMID: 36598471 DOI: 10.1097/acm.0000000000005131] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
PURPOSE Intraoperative teaching is a critical component of surgery residents' education. Although prior studies have investigated best practices from the viewpoint of the expert educator, the perspective of the learner has been less explored. This study examined the ideal faculty teaching behaviors that optimize intraoperative teaching from the surgical residents' perspective. METHOD Using a grounded theory method, this study explored perspectives on intraoperative faculty teaching qualities of 5 focus groups of categorical clinical general surgical residents of the same postgraduate year from June to August 2021. Focus group discussions were recorded, transcribed, and coded. Emerging themes were identified, along with their corresponding subthemes. RESULTS Thirty-nine general surgery residents participated in the focus groups. Overall, 6 themes emerged regarding resident priorities of intraoperative teaching, with 10 subthemes. Themes included the following: (1) character, with subthemes of caring, respect for resident, and self-control; (2) intraoperative skill, with subthemes of clinical and operative skill and modeling leadership in the operating room; (3) instructional approach; (4) feedback, with subthemes of content of feedback and debriefing; (5) discernment of resident needs, with subthemes of managing expectations, individualizing instruction, and autonomy; and (6) variety of teachers. CONCLUSIONS Certain tangible strategies, such as demonstrating genuine care for the learner, using clear directional words, and giving actionable feedback, were considered vital by residents. In the development of great surgical educators, the emphasis should not be on conformity to a single idealized teaching style but should celebrate and encourage diversity of personas and teaching styles within a department or program.
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Affiliation(s)
- Amelia T Collings
- A.T. Collings is a surgery resident, Department of Surgery, University of Louisville, Louisville, Kentucky. At the beginning of this work, the author was a surgical education research fellow, Indiana University School of Medicine, Indianapolis, Indiana
| | - Dominique L Doster
- D.L. Doster is a surgical education research fellow, Indiana University School of Medicine, Indianapolis, Indiana
| | - Krista Longtin
- K. Longtin is associate professor of communication studies, Indiana University School of Liberal Arts at Indiana University-Purdue University Indianapolisassistant dean of faculty affairs and professional development, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jennifer Choi
- J. Choi is associate professor of clinical surgery and program director for general surgery residency, Indiana University School of Medicine, Indianapolis, Indiana
| | - Laura Torbeck
- L. Torbeck is professor of surgery and vice chair of professional development, Department of Surgeryassistant dean for faculty affairs and professional development, Indiana University School of Medicine, Indianapolis, Indiana
| | - Dimitrios Stefanidis
- D. Stefanidis is professor of surgery and vice chair of education, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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Nyren MQ, Filiberto AC, Underwood PW, Abbott KL, Balch JA, Efron PA, George BC, Shickel B, Upchurch GR, Sarosi GA, Loftus TJ. A simulation curriculum for laparoscopic common bile duct exploration, balloon sphincterotomy, and endobiliary stenting: Associations with resident performance and autonomy in the operating room. Surgery 2023; 173:950-956. [PMID: 36517292 DOI: 10.1016/j.surg.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/30/2022] [Accepted: 11/11/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Laparoscopic common bile duct exploration is safe and effective for managing choledocholithiasis, but laparoscopic common bile duct exploration is rarely performed, which threatens surgical trainee proficiency. This study tests the hypothesis that prior operative or simulation experience with laparoscopic common bile duct exploration is associated with greater resident operative performance and autonomy without adversely affecting patient outcomes. METHODS This longitudinal cohort study included 33 consecutive patients undergoing laparoscopic common bile duct exploration in cases involving postgraduate years 3, 4, and 5 general surgery residents at a single institution during the implementation of a laparoscopic common bile duct exploration simulation curriculum. For each of the 33 cases, resident performance and autonomy were rated by residents and attendings, the resident's prior operative and simulation experience were recorded, and patient outcomes were ascertained from electronic health records for comparison among 3 cohorts: prior operative experience, prior simulation experience, and no prior experience. RESULTS Operative approach was similar among cohorts. Overall morbidity was 6.1% and similar across cohorts. The operative performance scores were higher in prior experience cohorts according to both residents (3.0 [2.8-3.0] vs 2.0 [2.0-3.0]; P = .01) and attendings (3.0 [3.0-4.0]; P < .001). The autonomy scores were higher in prior experience cohorts according to both residents (2.0 [2.0-3.0] vs 2.0 [2.0-2.0]; P = .005) and attendings (2.5 [2.0-3.0] vs 2.0 [1.0-2.0]; P = .001). Prior simulation and prior operative experience had similar associations with performance and autonomy. CONCLUSION Simulation experience with laparoscopic common bile duct exploration was associated with greater resident operative performance and autonomy, with effects that mimic prior operative experience. This illustrates the potential for simulation-based training to improve resident operative performance and autonomy for laparoscopic common bile duct exploration.
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Affiliation(s)
- Molly Q Nyren
- College of Medicine, University of Florida, Gainesville, FL
| | | | | | - Kenneth L Abbott
- Department of Surgery, University of Florida Health, Gainesville, FL
| | - Jeremy A Balch
- Department of Surgery, University of Florida Health, Gainesville, FL
| | - Philip A Efron
- Department of Surgery, University of Florida Health, Gainesville, FL
| | - Brian C George
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | | | | | - George A Sarosi
- Department of Surgery, University of Florida Health, Gainesville, FL
| | - Tyler J Loftus
- Department of Surgery, University of Florida Health, Gainesville, FL.
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20
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Filiberto AC, Abbott KL, Shickel B, George BC, Cochran AL, Sarosi GA, Upchurch GR, Loftus TJ. Resident Operative Autonomy and Attending Verbal Feedback Differ by Resident and Attending Gender. ANNALS OF SURGERY OPEN 2023; 4:e256. [PMID: 37600892 PMCID: PMC10431433 DOI: 10.1097/as9.0000000000000256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/02/2023] [Indexed: 02/05/2023] Open
Abstract
Objectives This study tests the null hypotheses that overall sentiment and gendered words in verbal feedback and resident operative autonomy relative to performance are similar for female and male residents. Background Female and male surgical residents may experience training differently, affecting the quality of learning and graduated autonomy. Methods A longitudinal, observational study using a Society for Improving Medical Professional Learning collaborative dataset describing resident and attending evaluations of resident operative performance and autonomy and recordings of verbal feedback from attendings from surgical procedures performed at 54 US general surgery residency training programs from 2016 to 2021. Overall sentiment, adjectives, and gendered words in verbal feedback were quantified by natural language processing. Resident operative autonomy and performance, as evaluated by attendings, were reported on 5-point ordinal scales. Performance-adjusted autonomy was calculated as autonomy minus performance. Results The final dataset included objective assessments and dictated feedback for 2683 surgical procedures. Sentiment scores were higher for female residents (95 [interquartile range (IQR), 4-100] vs 86 [IQR 2-100]; P < 0.001). Gendered words were present in a greater proportion of dictations for female residents (29% vs 25%; P = 0.04) due to male attendings disproportionately using male-associated words in feedback for female residents (28% vs 23%; P = 0.01). Overall, attendings reported that male residents received greater performance-adjusted autonomy compared with female residents (P < 0.001). Conclusions Sentiment and gendered words in verbal feedback and performance-adjusted operative autonomy differed for female and male general surgery residents. These findings suggest a need to ensure that trainees are given appropriate and equitable operative autonomy and feedback.
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Affiliation(s)
- Amanda C. Filiberto
- From the Department of Surgery, University of Florida Health, Gainesville, FL
| | - Kenneth L. Abbott
- From the Department of Surgery, University of Florida Health, Gainesville, FL
| | - Benjamin Shickel
- Department of Medicine, University of Florida Health, Gainesville, FL
| | - Brian C. George
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI
| | - Amalia L. Cochran
- From the Department of Surgery, University of Florida Health, Gainesville, FL
| | - George A. Sarosi
- From the Department of Surgery, University of Florida Health, Gainesville, FL
| | - Gilbert R. Upchurch
- From the Department of Surgery, University of Florida Health, Gainesville, FL
| | - Tyler J. Loftus
- From the Department of Surgery, University of Florida Health, Gainesville, FL
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21
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Pellizzeri K, Soltani T. Bringing Back the Art of Medicine to Surgery. Am Surg 2023:31348231158690. [PMID: 36802726 DOI: 10.1177/00031348231158690] [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: 02/19/2023]
Abstract
In a relatively short period of time, the need for incorporating primary surgical palliative care into surgical education and residency curriculum has become apparent. This provides an opportunity for growth for surgeons and surgical residents and a method to explore spirituality and wholeness of the patient. It also has the potential for increasing the sense of fulfillment that residents and surgeons alike can drive from caring for complex surgical patients. Given the significant constraints of today's graduate medical education world, there remain challenges that must be overcome when designing curricula and incorporating surgical palliative care into practice and resident education. The Surgical Palliative Care Society brings hope for the future of this specialty and encourages multidisciplinary discussions about the practice of, education in, and research on surgical palliative care.
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Affiliation(s)
- Katherine Pellizzeri
- Department of Surgery, Division of Trauma and Critical Care, Clinical Assistant Professor of Surgery, 2313University of South Carolina School of Medicine Affiliate Faculty, Prisma Health, Greenville, SC, USA
| | - Tandis Soltani
- Department of Surgery, 2313University of Michigan, Ann Arbor, MI, USA
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22
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Nyren MQ, Filiberto AC, Underwood PW, Abbott KL, Balch JA, Mas FD, Cobianchi L, Efron PA, George BC, Shickel B, Upchurch GR, Sarosi GA, Loftus TJ. Surgical resident experience with common bile duct exploration and assessment of performance and autonomy with formative feedback. World J Emerg Surg 2023; 18:13. [PMID: 36747289 PMCID: PMC9901129 DOI: 10.1186/s13017-023-00480-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/23/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Common bile duct exploration (CBDE) is safe and effective for managing choledocholithiasis, but most US general surgeons have limited experience with CBDE and are uncomfortable performing this procedure in practice. Surgical trainee exposure to CBDE is limited, and their learning curve for achieving autonomous, practice-ready performance has not been previously described. This study tests the hypothesis that receipt of one or more prior CBDE operative performance assessments, combined with formative feedback, is associated with greater resident operative performance and autonomy. METHODS Resident and attending assessments of resident operative performance and autonomy were obtained for 189 laparoscopic or open CBDEs performed at 28 institutions. Performance and autonomy were graded along validated ordinal scales. Cases in which the resident had one or more prior CBDE case evaluations (n = 48) were compared with cases in which the resident had no prior evaluations (n = 141). RESULTS Compared with cases in which the resident had no prior CBDE case evaluations, cases with a prior evaluation had greater proportions of practice-ready or exceptional performance ratings according to both residents (27% vs. 11%, p = .009) and attendings (58% vs. 19%, p < .001) and had greater proportions of passive help or supervision only autonomy ratings according to both residents (17% vs. 4%, p = .009) and attendings (69% vs. 32%, p < .01). CONCLUSIONS Residents with at least one prior CBDE evaluation and formative feedback demonstrated better operative performance and received greater autonomy than residents without prior evaluations, underscoring the propensity of feedback to help residents achieve autonomous, practice-ready performance for rare operations.
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Affiliation(s)
- Molly Q. Nyren
- grid.15276.370000 0004 1936 8091University of Florida College of Medicine, Gainesville, FL USA
| | - Amanda C. Filiberto
- grid.430508.a0000 0004 4911 114XDepartment of Surgery, University of Florida Health, PO Box 100286, Gainesville, FL 32610 USA
| | - Patrick W. Underwood
- grid.430508.a0000 0004 4911 114XDepartment of Surgery, University of Florida Health, PO Box 100286, Gainesville, FL 32610 USA
| | - Kenneth L. Abbott
- grid.430508.a0000 0004 4911 114XDepartment of Surgery, University of Florida Health, PO Box 100286, Gainesville, FL 32610 USA
| | - Jeremy A. Balch
- grid.430508.a0000 0004 4911 114XDepartment of Surgery, University of Florida Health, PO Box 100286, Gainesville, FL 32610 USA
| | - Francesca Dal Mas
- grid.7240.10000 0004 1763 0578Department of Management, Ca’ Foscari University of Venice, Venice, Italy
| | - Lorenzo Cobianchi
- grid.8982.b0000 0004 1762 5736Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy ,grid.419425.f0000 0004 1760 3027IRCCS Policlinico San Matteo Foundation, General Surgery, Pavia, Italy
| | - Philip A. Efron
- grid.430508.a0000 0004 4911 114XDepartment of Surgery, University of Florida Health, PO Box 100286, Gainesville, FL 32610 USA
| | - Brian C. George
- grid.214458.e0000000086837370Department of Surgery, University of Michigan, Ann Arbor, MI USA
| | - Benjamin Shickel
- grid.15276.370000 0004 1936 8091Department of Biomedical Engineering, University of Florida, Gainesville, FL USA
| | - Gilbert R. Upchurch
- grid.430508.a0000 0004 4911 114XDepartment of Surgery, University of Florida Health, PO Box 100286, Gainesville, FL 32610 USA
| | - George A. Sarosi
- grid.430508.a0000 0004 4911 114XDepartment of Surgery, University of Florida Health, PO Box 100286, Gainesville, FL 32610 USA
| | - Tyler J. Loftus
- grid.430508.a0000 0004 4911 114XDepartment of Surgery, University of Florida Health, PO Box 100286, Gainesville, FL 32610 USA
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23
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Does Training Background Influence Outcomes after Coronal Scalp Incision for Treating Craniomaxillofacial Injuries?: A German Pilot Study. J Maxillofac Oral Surg 2023; 22:442-452. [PMID: 37122780 PMCID: PMC10130286 DOI: 10.1007/s12663-023-01860-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 01/20/2023] [Indexed: 02/05/2023] Open
Abstract
Abstract
Objectives
To examine outcomes of the coronal scalp approach to craniomaxillofacial (CMF) fractures performed by oral-maxillofacial or craniofacial plastic surgery residents (OMFS/CFPS-Rs) vs. trauma surgery residents (TS-Rs), and to determine differences in treatment outcomes between both operator groups.
Methods
This retrospective cohort study enrolled a sample of CMF fracture adult patients treated via the coronal approach in a German level one trauma center during a two-year interval. The predictor variable was training background (OMFS/CFPS-Rs vs. TS-Rs; each n = 5). All trainees must assist in ≥ two surgeries before self-performance. The main outcomes were length of hospital stay (LHS) and coronal flap-related complications (CFRCs). Appropriate statistics were computed at α = 95%.
Results
Of the 97 patients identified during the study period; 71 of whom (19.7% females; mean age, 40.2 ± 15.2 years; 46.5% operated by TS-Rs; 38% combined upper and midfacial fractures) met the inclusion criteria. Operative time, LHS, CFRCs, readmission rates, and post-discharge emergency room visits were not significantly different between the trainee groups. 60% of CFRCs were visible/unfavorable or hypertrophic scar with/without alopecia. The number needed to treat of short LHS was 44 (95% confidence interval [CI], 3.9 to 4.8), the number needed to harm of CFRCs was 14 (95% CI, 3.6 to 7.4), i.e., the likelihood to be helped or harmed was 0.32.
Conclusions
Coronal flap raising by OMFS/CFPS-Rs does not appear beneficial over that by TS-Rs in terms of LHS and CFRCs evaluated until postoperative month six. Trainees from any surgical specialties could gain partial independence from skilled surgeons in CMF trauma “sub-steps” and favorable clinical outcomes. Further studies in a larger sample cohort are required to confirm this pilot data.
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Hackney L, O'Neill S, O'Donnell M, Spence R. A scoping review of assessment methods of competence of general surgical trainees. Surgeon 2023; 21:60-69. [PMID: 35300909 DOI: 10.1016/j.surge.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/19/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Only rigorous evaluation of competence will result in the production of safe surgeons that are able to provide the best care for patients. The development of competency-based assessment should ultimately be evidence driven. OBJECTIVES Explore the volume of existing evidence pertaining to the different objective assessment methods reported in the literature. ELIGIBILITY CRITERIA Studies describing objective assessment of postgraduate general surgical trainees within the last 20 years. SOURCES OF EVIDENCE PubMed, Ovid Medline and Web of Sciences. CHARTING METHODS A data chart proforma was designed and data were extracted into tables. Basic numerical analysis of extracted data and narrative synthesis of charted data. RESULTS A total of 343 papers were reviewed. 26 were eligible for inclusion. 92% of articles were published from 2008 onwards. 50% have been published in the last five years. The articles originated from 6 different countries, predominantly the United Kingdom (42%), followed by the United States of America (38%). In addition, a small number were published from Canada (8%), Japan (4%), Germany (4%) and Australia (4%). UK publications were predominantly between 2008 and 2014 while the USA had a later predominance between 2015 and 2018. 42% were based on quantitative methodology, 27% had a qualitative approach while 31% had mixed analysis. There were sixteen assessment methods presented. The most common type of assessment was Objective Structured Assessments (27%), which included Objective Structured Assessment of Technical Skill (OSATS) (23%) and Objective Structured Assessment of Non-Technical Skill (4%). Procedure Based Assessment (PBA) (23%) and Entrustability Scales (23%) were also prevalent. CONCLUSIONS This scoping review has identified a range of different assessment methods. The assessment methods with a higher volume and level of supporting evidence were OSATS, PBAs and Entrustability Scales. There was a lower volume and level of supporting evidence found within this review for the remaining assessment methods.
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Affiliation(s)
| | | | | | - Roy Spence
- Queens University Belfast, United Kingdom
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25
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Grant AL, Torti J, Goldszmidt M. "Influential" Intraoperative Educators and Variability of Teaching Styles. JOURNAL OF SURGICAL EDUCATION 2023; 80:276-287. [PMID: 36333173 DOI: 10.1016/j.jsurg.2022.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/04/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Academic surgeons manage their role as intraoperative educators in a variety of ways. Such variability is neither idiosyncratic nor is there a single best approach. This study sought to explore the practices of surgeons deemed influential by their residents, allowing insight into a variety of potentially effective practices. PARTICIPANTS Constructivist grounded theory guided data collection and analysis. Data sources included surveys from senior surgical residents (PGY3-6) and recent graduates from an academic hospital in Canada (36% response rate), intraoperative observations of teaching interactions, and semi-structured interviews with observed surgeons. Rigour was supported by data triangulation, constant comparison, and collection to theoretical sufficiency. DESIGN We developed a framework grouping effective teaching into three overlapping approaches: exacting, empowering, and fostering. The approaches differ based on the level of independence granted and the degree of expectation placed on individual residents. Each demonstrates different strategies for balancing the multiple supervisory roles and patient care obligations faced by academic surgeons. We also identified strategies that could be used across approaches to enhance learning. CONCLUSIONS For surgical educators seeking to improve upon the quality of the intraoperative supervision they provide, frameworks such as this may serve as models of effective supervision. Enhancing surgeons' knowledge of proven strategies, combined with reflecting on how they teach and how they balance responsibilities to patients and trainees, may allow them to broaden their educational practice.
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Affiliation(s)
- Aaron L Grant
- Department of Surgery, Western University, London, Ontario, Canada.
| | - Jacqueline Torti
- Centre for Education Research and Innovation, Western University, London, Ontario, Canada
| | - Mark Goldszmidt
- Centre for Education Research and Innovation and Division of General Internal Medicine, Department of Medicine, Western University, London, Ontario, Canada
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26
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Golubkova A, Liebe H, Leiva T, Lees J, Reinschmidt KM, Hunter CJ. Ethics of Resident Involvement in Surgical Training. THE JOURNAL OF CLINICAL ETHICS 2023; 34:175-189. [PMID: 37229744 DOI: 10.1086/725083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
AbstractBackground: Attending surgeons must maintain balance between promoting education and assuring safe, transparent patient care. This investigation aimed to define ethics that guide surgical training. We hypothesized that resident autonomy in the operating room is influenced by attending approach to patients, specifically patients considered to be vulnerable. MATERIALS AND METHODS After IRB approval, surgeons from three institutions were invited to participate in a pilot, survey, exploring how principles of patient autonomy, physician beneficence, nonmaleficence, and justice apply to participant opinions. Responses were transcribed and coded for quantitative and qualitative analysis. RESULTS 51 attendings and 55 residents completed the survey. We identified that patient autonomy is upheld through transparent consent practices. Intraoperative supervision is a key practice that maintains the principles of physician beneficence and nonmaleficence and mitigates the risk of resident participation. Vulnerable patients were defined by respondents as those unable to participate in their own consent and those limited by social determinants of health and barriers to medical literacy. In contrast, resident participation is not limited in the care of vulnerable patients but is restricted in cases of higher complexity and those procedures deemed to have lower error margins. CONCLUSIONS Although residents measure the success of their training based on their level of intraoperative independence, autonomy afforded to the resident does not only depend on objective skill. There are ethical considerations that the attending must navigate as they decide on effective teaching and safe surgical management, which is especially relevant in the care of complex cases.
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27
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Rodríguez-González MC, Vega-Peña NV. Autonomía y supervisión operatorias del residente de cirugía: Una mirada en la pandemia por COVID-19. REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.2241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introducción. Al declararse la pandemia por SARS-CoV-2, se establecieron múltiples cambios en los sistemas de salud y en las instituciones hospitalarias, influyendo en la actividad quirúrgica global. El objetivo de este estudio fue evaluar el impacto de la pandemia en los niveles de autonomía y supervisión operatorias de los residentes de cirugía.
Métodos. Estudio analítico cuasi-experimental, que incluyó los procedimientos quirúrgicos registrados por residentes de cirugía general de la Universidad de La Sabana, de febrero de 2019 a agosto de 2021. Se analizaron la autonomía y la supervisión mediante la escala Zwisch en los periodos prepandemia y pandemia.
Resultados. Se recolectaron datos de 10.618 procedimientos en el periodo establecido, la mayoría realizados con abordaje abierto (57,4 %) y en rotaciones tronculares de cirugía general (65 %). Los procedimientos realizados más frecuentes fueron apendicectomía (18,6 %), colecistectomía (18,4 %) y herniorrafías (8,6 %). Se encontró una disminución estadísticamente significativa en los niveles globales de autonomía y supervisión entre los periodos analizados de 2, 4/4, 0 a 2, 2/4, 0 (p<0,001).
Discusión. La disminución en la autonomía percibida por los residentes podría corresponder al impacto negativo en la motivación intrínseca de los individuos, en la disminución objetiva en el logro de las competencias esperadas en su proceso de formación quirúrgica y a la pérdida del relacionamiento colectivo propiciado por los aislamientos y limitaciones vividos.
Conclusión. La pandemia por COVID-19 impactó negativamente en la autonomía y supervisión operatoria de los residentes de cirugía general de la Universidad de La Sabana, Chía, Colombia.
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28
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Alibhai KM, Fowler A, Gawad N, Wood TJ, Raîche I. Assessment of laparoscopic skills: comparing the reliability of global rating and entrustability tools. CANADIAN MEDICAL EDUCATION JOURNAL 2022; 13:36-45. [PMID: 36440072 PMCID: PMC9684047 DOI: 10.36834/cmej.72369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Competence by design (CBD) residency programs increasingly depend on tools that provide reliable assessments, require minimal rater training, and measure progression through the CBD milestones. To assess intraoperative skills, global rating scales and entrustability ratings are commonly used but may require extensive training. The Competency Continuum (CC) is a CBD framework that may be used as an assessment tool to assess laparoscopic skills. The study aimed to compare the CC to two other assessment tools: the Global Operative Assessment of Laparoscopic Skills (GOALS) and the Zwisch scale. METHODS Four expert surgeons rated thirty laparoscopic cholecystectomy videos. Two raters used the GOALS scale while the remaining two raters used both the Zwisch scale and CC. Each rater received scale-specific training. Descriptive statistics, inter-rater reliabilities (IRR), and Pearson's correlations were calculated for each scale. RESULTS Significant positive correlations between GOALS and Zwisch (r = 0.75, p < 0.001), CC and GOALS (r = 0.79, p < 0.001), and CC and Zwisch (r = 0.90, p < 0.001) were found. The CC had an inter-rater reliability of 0.74 whereas the GOALS and Zwisch scales had inter-rater reliabilities of 0.44 and 0.43, respectively. Compared to GOALS and Zwisch scales, the CC had the highest inter-rater reliability and required minimal rater training to achieve reliable scores. CONCLUSION The CC may be a reliable tool to assess intraoperative laparoscopic skills and provide trainees with formative feedback relevant to the CBD milestones. Further research should collect further validity evidence for the use of the CC as an independent assessment tool.
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Affiliation(s)
- Kameela Miriam Alibhai
- Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Amanda Fowler
- Division of General Surgery, Department of Surgery, Faculty of Medicine, Memorial University, Newfoundland and Labrador, Canada
| | - Nada Gawad
- Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ontario, Canada
- Department of Innovation in Medical Education (DIME), University of Ottawa, Ontario, Canada
| | - Timothy J Wood
- Department of Innovation in Medical Education (DIME), University of Ottawa, Ontario, Canada
| | - Isabelle Raîche
- Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ontario, Canada
- Department of Innovation in Medical Education (DIME), University of Ottawa, Ontario, Canada
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29
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Marcotte KM, Holmstrom AL, Thelen AE, Gates R, George BC, Krumm AE. Opportunities to Increase Workplace Feedback: A Multi-institutional Examination. JOURNAL OF SURGICAL EDUCATION 2022; 79:e124-e129. [PMID: 36207256 DOI: 10.1016/j.jsurg.2022.08.012] [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: 03/25/2022] [Revised: 06/20/2022] [Accepted: 08/15/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE While feedback is an essential component of resident education, there are few large-scale studies examining when and under what conditions formative feedback is provided. Workplace-based assessment systems offer an opportunity to identify factors influencing when faculty provides feedback to trainees. Influential factors affecting feedback may provide targets for increasing and improving feedback in resident education. DESIGN Data on whether dictated feedback was provided were obtained from the Society for Improving Medical Professional Learning (SIMPL) mobile application. We used generalized linear mixed effects models to identify the degree to which faculty members, procedures, surgical case characteristics, and trainee performance were associated with whether narrative feedback was provided using SIMPL. SETTING This study was conducted using data from members of the SIMPL collaborative. PARTICIPANTS 67,434 evaluations from 70 general surgery programs were included from 2015 to 2021. Of these, 25,355 evaluations included dictated feedback. RESULTS Approximately 61% of the variation in whether dictated feedback was provided was attributable to the individual faculty member. Compared to residents who achieved autonomy ratings of "Active Help," residents who achieved ratings of "Supervision Only" (odds ratio (OR) = 0.80, 95% confidence interval (CI) = 0.72, 0.88) had a lower likelihood of receiving dictated feedback. Residents who achieved ratings of "Intermediate" (OR = 0.81, CI = 0.74, 0.89), "Practice-Ready" (OR = 0.50, CI = 0.45, 0.57), or "Exceptional (OR = 0.64, CI = 0.54, 0.76) showed a lower likelihood of receiving dictated feedback compared to those rated as "Inexperienced." Cases rated as "High" in terms of complexity were associated with an increased likelihood of having dictation (OR = 1.35, CI = 1.26, 1.44). CONCLUSIONS The largest contributing factor for whether dictated feedback is included in a SIMPL evaluation are factors specific to the attending surgeon. Resident performance, resident autonomy, and case complexity had only modest associations with feedback decisions. Efforts to improve the amount of formative feedback for trainees should be directed towards reducing the variation in which attending surgeons elect to provide feedback.
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Affiliation(s)
- Kayla M Marcotte
- Center for Surgical Training and Research, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan.
| | - Amy L Holmstrom
- Northwestern University Feinberg School of Medicine, Department of Surgery, Chicago, Illinois
| | - Angela E Thelen
- Center for Surgical Training and Research, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Rebecca Gates
- Center for Surgical Training and Research, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Brian C George
- Center for Surgical Training and Research, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Andrew E Krumm
- Center for Surgical Training and Research, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan
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30
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Sharma N, Steinhagen E, Marks J, Ammori J. A Comparison of Faculty and Resident Perceptions on the Qualities of Outstanding Surgical Educators. JOURNAL OF SURGICAL EDUCATION 2022; 79:e143-e150. [PMID: 35933310 DOI: 10.1016/j.jsurg.2022.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/24/2022] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The objective of the study is to compare faculty and resident perspectives regarding the competencies of an outstanding surgical educator in practice. DESIGN An IRB-approved survey instrument using a five-point Likert scale assessing 50 competencies and behaviors of a surgical educator was sent to study participants. The competencies and behaviors examined were within the domains of: 1) medical knowledge 2) learner-centeredness 3) interpersonal and communication skills 4) professionalism and role-modeling, and 5) intraoperative teaching. Study participants were asked to rate their level of agreement or disagreement regarding each individual competency as being a requirement for an effective surgical educator. T-test was used to compare faculty surgeons' and residents' responses, and statistically significance was defined as p<0.05. SETTING University Hospitals Cleveland Medical Center, a tertiary care academic institution PARTICIPANTS: Residents, fellows, and attending surgeons in surgical specialties. RESULTS There were 115 study participants, 55 faculty and 60 residents. Twelve of 50 (24%) assessed surgical education competencies were rated significantly differently by faculty and residents, with 6 of 12 (50%) being in the category of "intraoperative teaching." There were no differences in faculty and resident responses to competencies/behaviors in the category "interpersonal and communication skills". There were differences in 2 of 7 (28.6%) competencies in the category "medical knowledge", 2 of 15 (13.3%) competencies in the category "learner centeredness", 1 of 10 (10%) in the category "professionalism and role-modeling", 1 of 9 (11.1%) in the category "professionalism and role-modeling", and 6 of 12 (50%) in the category "intraoperative teaching". CONCLUSIONS In general, there is agreement amongst surgical faculty and residents regarding the competencies and behaviors of an effective surgical educator. The main area of difference is in the perception of educator qualities and behaviors necessary for effective intraoperative teaching.
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Affiliation(s)
- Neha Sharma
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Emily Steinhagen
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio; University Hospitals Research in Surgical Outcomes and Effectiveness (UH RISES), Cleveland, Ohio
| | - Jeffrey Marks
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - John Ammori
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
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Shebrain S, Coster S, Alfred A, De Cecco D, Khalil S, Munene G, Elian A, Timmons J, Sawyer RG. Resident Autonomy and Performance Independence in Surgical Training Are Time- and Skill-Dependent. J Surg Res 2022; 279:285-295. [DOI: 10.1016/j.jss.2022.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/11/2022] [Accepted: 06/14/2022] [Indexed: 11/28/2022]
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32
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Yoo SJ, Hussein N, Barron DJ. Congenital Heart Surgery Skill Training Using Simulation Models: Not an Option but a Necessity. J Korean Med Sci 2022; 37:e293. [PMID: 36193641 PMCID: PMC9530313 DOI: 10.3346/jkms.2022.37.e293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 11/20/2022] Open
Abstract
Congenital heart surgery (CHS) is technically demanding, and its training is extremely complex and challenging. Training of the surgeon's technical skills has relied on a preceptorship format in which the trainees are gradually exposed to patients in the operating room under the close tutelage of senior staff surgeons. Training in the operating room is an inefficient process and the concept of a learning curve is no longer acceptable in terms of patient outcomes. The benefits of surgical simulation in training of congenital heart surgeons are well known and appreciated. However, adequate surgical simulation models and equipment for training have been scarce until the recent development of three-dimensionally (3D) printed models. Using comprehensive 3D printing and silicone-molding techniques, realistic simulation training models for most congenital heart surgical procedures have been produced. Newly developed silicone-molded models allow efficient CHS training in a stress-free environment with instantaneous feedback from the proctors and avoids risk to patients. The time has arrived when all congenital heart surgeons should consider surgical simulation training before progressing to real-life operating in a similar fashion to the aviation industry where all pilots are required to complete simulation training before flying a real aircraft. It is argued here that simulation training is not an option anymore but should be a mandatory component of CHS training.
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Affiliation(s)
- Shi-Joon Yoo
- Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Canada
- Division of Cardiology, Department of Pediatrics, Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Canada.
| | - Nabil Hussein
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, England, UK
| | - David J Barron
- Division of Cardiovascular Surgery, Department of Surgery, Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Canada
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Bosley ME, Werenski HE, Powell MS, Meredith JW, Randle RW. Inguinal Hernia Repairs on the Chief's Service: A Safe Educational Model in Resident Entrustment. JOURNAL OF SURGICAL EDUCATION 2022; 79:1246-1252. [PMID: 35649957 DOI: 10.1016/j.jsurg.2022.05.010] [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: 01/19/2022] [Revised: 04/08/2022] [Accepted: 05/11/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE We hypothesized that a Chief Resident Service educational model provides safe care for patients compared to that received on standard academic services where rotating residents adopt the practices and preferences of their attending. DESIGN We retrospectively identified patients undergoing inguinal hernia repairs from July 2016 through June 2019 and matched Chief's service patients to standard academic service patients 1:1 on CPT, sex and age. We compared patient characteristics, recurrence rates, outcomes and complications. SETTING Tertiary care center, single institution. PARTICIPANTS Overall, 77 patients undergoing inguinal hernia repairs (66% open and 34% laparoscopic) on the Chief's service matched successfully to 77 standard academic service patients during the study period. RESULTS Age, BMI and ASA were similar between the services, but Chief's service patients were less likely to be current smokers (1.3% vs. 24.7%) and more likely to be former smokers (59.7% vs. 26.0%) than standard academic service patients (p < 0.01). Patients presenting with incarcerated hernias (5.2% vs. 9.1%), recurrent (10.4% vs. 5.2%) and bilateral hernias (19.5% vs. 10.4%) were similar between the Chief's service and standard academic services, respectively (all p > 0.05). Operative times were longer for the Chief's service for open (123 min vs. 67, p < 0.01) and laparoscopic (112 min vs. 79, p = 0.02) repairs. Recurrence rates (6.5% vs. 3.9%, p = 0.47) and complications including infection, seroma or hematoma requiring evacuation and need for reoperation were similarly low (p > 0.05) between the Chief's and standard academic services, respectively. Despite low complication rates, Chief's service patients were more likely to present to the ED post-op (14.3% vs. 1.3%; p = 0.001), but readmission rates were similarly low (2.6% vs. 0%, p = 0.09). CONCLUSIONS Providing general surgery chief residents with a supervised opportunity to direct, plan and provide surgical care in clinic and the operating room, as a transition to independent practice following graduation, is safe for patients presenting with inguinal hernias. Concerns about patient safety should not be a barrier to maximizing entrustment for the evaluation and operative management of select core general surgery diagnoses and operations.
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Affiliation(s)
- Maggie E Bosley
- Department of Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina.
| | - Hope E Werenski
- Department of Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Myron S Powell
- Department of Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - J Wayne Meredith
- Department of Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Reese W Randle
- Department of Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina.
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Kirsch EP, Suarez A, McDaniel KE, Dharmapurikar R, Dunn T, Lad SP, Haglund MM. Construct validity of the Surgical Autonomy Program for the training of neurosurgical residents. Neurosurg Focus 2022; 53:E8. [DOI: 10.3171/2022.5.focus22166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/09/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
There is no standard way in which physicians teach or evaluate surgical residents intraoperatively, and residents are proving to not be fully competent at core surgical procedures upon graduating. The Surgical Autonomy Program (SAP) is a novel educational model that combines a modified version of the Zwisch scale with Vygotsky’s social learning theory. The objective of this study was to establish preliminary validity evidence that SAP is a reliable measure of autonomy and a useful tool for tracking competency over time.
METHODS
The SAP breaks each surgical case into 4 parts, or zones of proximal development (ZPDs). Residents are evaluated on a 4-tier autonomy scale (TAGS scale) for each ZPD in every surgical case. Attendings were provided with a teaching session about SAP and identified appropriate ZPDs for surgical cases under their area of expertise. All neurosurgery residents at Duke University Hospital from July 2017 to July 2021 participated in this study. Chi-square tests and ordinal logistic regression were used for the analyses.
RESULTS
Between 2017 and 2021, there were 4885 cases logged by 27 residents. There were 30 attendings who evaluated residents using SAP. Faculty completed evaluations on 91% of cases. The ZPD of focus directly correlated with year of residency (postgraduate year) (χ2 = 1221.1, df = 15, p < 0.001). The autonomy level increased with year of residency (χ2 = 3553.5, df = 15, p < 0.001). An ordinal regression analysis showed that for every year increase in postgraduate year, the odds of operating at a higher level of independence was 2.16 times greater (95% CI 2.11–2.21, p < 0.001). The odds of residents performing with greater autonomy was lowest for the most complex portion of the case (ZPD3) (OR 0.18, 95% CI 0.17–0.20, p < 0.001). Residents have less autonomy with increased case complexity (χ2 = 160.28, df = 6, p < 0.001). Compared with average cases, residents were more likely to operate with greater autonomy on easy cases (OR 1.44, 95% CI 1.29–1.61, p < 0.001) and less likely to do so on difficult cases (OR 0.72, 95% CI 0.67–0.77, p < 0.001).
CONCLUSIONS
This study demonstrates preliminary evidence supporting the construct validity of the SAP. This tool successfully tracks resident autonomy and progress over time. The authors’ smartphone application was widely used among surgical faculty and residents, supporting integration into the perioperative workflow. Wide implementation of SAP across multiple surgical centers will aid in the movement toward a competency-based residency education system.
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Affiliation(s)
- Elayna P. Kirsch
- Department of Neurosurgery, Duke University School of Medicine, Durham
| | - Alexander Suarez
- Department of Neurosurgery, Duke University School of Medicine, Durham
| | | | | | - Timothy Dunn
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
| | - Shivanand P. Lad
- Department of Neurosurgery, Duke University School of Medicine, Durham
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Husk K. Assessment of surgical autonomy: in support of aspirational goals. AJOG GLOBAL REPORTS 2022; 2:100077. [DOI: 10.1016/j.xagr.2022.100077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Stockheim J, Perrakis A, Sabel BA, Waschipky R, Croner RS. RoCS: Robotic Curriculum for young Surgeons. J Robot Surg 2022; 17:495-507. [PMID: 35810233 PMCID: PMC10076401 DOI: 10.1007/s11701-022-01444-3] [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: 03/10/2022] [Accepted: 06/26/2022] [Indexed: 11/26/2022]
Abstract
Robotic-assisted procedures gain increasing acceptance for daily surgical routine. However, structured training programs are designed for surgeons with high expertise. Hence, a comprehensive training curriculum was established to ensure a basic competence in robotic abdominal surgery for young surgeons during their residency. The aim of the current work is to propose a feasible and effective training concept. The development process of this training curriculum is based on a comprehensive literature review which led to the concept of "robotic curriculum for young surgeons" (RoCS). It was implemented in the daily routine of a German university hospital starting in 2020. The robotic assessment questionnaire (RAQ) was used for electronic data collection. After the initial phase adjustments, it led to an improvement of the initial version of the curriculum. RoCS is a multimodal training program containing basic training through assistance at the operation table during robotic-assisted operations and basic console training. Key elements are the robotic team time-out (rTTO), perioperative process standardization including feasible personnel scheduling and useful procedure clustering into organ systems, procedural steps and procedural step complexity. Evaluation of standardized communication, performance assessment, patient factors and individual overall workload using NASA Task Load Index is realizable. Flexibility and adaptability to internal organization processes of surgical departments are the main advantages of the concept. RoCS is a strong training tool to meet the specific needs of young surgeons and evaluate their learning success of robotic procedural training. Furthermore, comparison within the different robotic systems should be considered. Further studies are needed to validate a multicenter concept design.
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Affiliation(s)
- Jessica Stockheim
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Aristotelis Perrakis
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Bernhard A Sabel
- Institute of Medical Psychology, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
| | - Robert Waschipky
- Department of Information Technology (IT) and Medical Engineering, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
| | - Roland S Croner
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
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Miles VP, Schroll RW, Beaty JS. Empowering the Resident Learner. JOURNAL OF SURGICAL EDUCATION 2022; 79:909-917. [PMID: 35490137 DOI: 10.1016/j.jsurg.2022.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/07/2022] [Accepted: 03/22/2022] [Indexed: 06/14/2023]
Abstract
Surgical resident autonomy is an essential element of the transition from supervised training to independent practice. However, in an age of duty hour restrictions, legislative constraints, increased litigation, and heightened societal expectations, training an autonomous resident proves increasingly difficult. To tackle these barriers to training successful surgeons, the American College of Surgeons Committee on Resident Education initiated the Resident Mentored Autonomy Project. As a subdivision of this project, the Empowered Learner research team here presents a framework for training the self-directed and empowered surgical resident learner. There are many strategies by which surgical faculty, program directors and chairs, and residents themselves may engage to improve resident operative autonomy.
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Affiliation(s)
- Victoria P Miles
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee.
| | - Rebecca W Schroll
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
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Eruchalu CN, He K, Etheridge JC, Wu C, Ashley SW, Nitzschke SL, Smink DS, Cho NL. Gender and Racial/Ethnic Disparities in Operative Volumes of Graduating General Surgery Residents. J Surg Res 2022; 279:104-112. [PMID: 35759927 DOI: 10.1016/j.jss.2022.05.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/25/2022] [Accepted: 05/22/2022] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Gender disparities in resident operative experience have been described; however, their etiology is poorly understood, and racial/ethnic disparities have not been explored. This study investigated the relationship between gender, race/ethnicity, and surgery resident case volumes. MATERIALS AND METHODS A retrospective analysis of graduating general surgery resident case logs (2010-2020) at an academic medical center was performed. Self-reported gender and race/ethnicity data were collected from program records. Residents were categorized as underrepresented in medicine (URM) (Black, Hispanic, Native American) or non-URM (White, Asian). Associations between gender and URM status and major, chief, and teaching assistant (TA) mean case volumes were analyzed using t-tests. RESULTS The cohort included 80 residents: 39 female (48.8%) and 17 URM (21.3%). Compared to male residents, female residents performed fewer TA cases (33 versus 47, P < 0.001). Compared to non-URM residents, URM residents graduated with fewer major (948 versus 1043, P = 0.008) and TA cases (32 versus 42, P = 0.038). Male URM residents performed fewer TA cases than male non-URM residents (32 versus 50, P = 0.031). Subanalysis stratified by graduation year demonstrated that from 2010 to 2015, female residents performed fewer chief (218 versus 248, P = 0.039) and TA cases (29 versus 50, P = 0.001) than male residents. However, from 2016 to 2020, when gender parity was achieved, no significant associations were observed between gender and case volumes. CONCLUSIONS Female and URM residents perform fewer TA and major cases than male non-URM residents, which may contribute to reduced operative autonomy, confidence, and entrustment. Prioritizing gender and URM parity may help decrease case volume gaps among underrepresented residents.
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Affiliation(s)
- Chukwuma N Eruchalu
- Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Katherine He
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - James C Etheridge
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Ariadne Labs, Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Christine Wu
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stanley W Ashley
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stephanie L Nitzschke
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Douglas S Smink
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nancy L Cho
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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The Limitations of Surgical Learning from Watching YouTube VDOs. Indian J Surg 2022. [DOI: 10.1007/s12262-021-02903-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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40
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Optimizing surgical education through the implementation of a feedback curriculum. Am J Surg 2022; 224:893-899. [DOI: 10.1016/j.amjsurg.2022.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 04/17/2022] [Accepted: 04/19/2022] [Indexed: 11/21/2022]
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41
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Oliver JB, Kunac A, Anjaria DJ. Operative Autonomy of Surgical Residents and Patient Outcomes-Reply. JAMA Surg 2022; 157:642-643. [PMID: 35353130 DOI: 10.1001/jamasurg.2022.0305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Joseph B Oliver
- Department of Surgery, VA New Jersey Healthcare System, East Orange.,Department of Surgery, Rutgers New Jersey Medical School, Newark
| | - Anastasia Kunac
- Department of Surgery, VA New Jersey Healthcare System, East Orange.,Department of Surgery, Rutgers New Jersey Medical School, Newark
| | - Devashish J Anjaria
- Department of Surgery, VA New Jersey Healthcare System, East Orange.,Department of Surgery, Rutgers New Jersey Medical School, Newark
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White A, O'Brien D, Singh G, Zheng B, Moon MC, Turner SR. Characterizing the Level of Autonomy in Canadian Cardiac Surgery Residents. Ann Thorac Surg 2022; 114:1538-1541. [PMID: 35339449 DOI: 10.1016/j.athoracsur.2022.02.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 02/04/2022] [Accepted: 02/22/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Abigail White
- Department of Surgery, University of Alberta, Edmonton, Alberta; Mazankowski Alberta Heart Institute, Alberta Health Services.
| | - Devin O'Brien
- Department of Surgery, University of Alberta, Edmonton, Alberta; Mazankowski Alberta Heart Institute, Alberta Health Services
| | - Gurmeet Singh
- Department of Surgery, University of Alberta, Edmonton, Alberta; Mazankowski Alberta Heart Institute, Alberta Health Services; Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta
| | - Bin Zheng
- Department of Surgery, University of Alberta, Edmonton, Alberta
| | - Michael C Moon
- Department of Surgery, University of Alberta, Edmonton, Alberta; Mazankowski Alberta Heart Institute, Alberta Health Services
| | - Simon R Turner
- Department of Surgery, University of Alberta, Edmonton, Alberta
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Abahuje E, Bartuska A, Dias RD, Muneza E, Sibomana I, Williams W, Koch R, Robertson JM, Ntakiyiruta G, Evans F, Riviello R, Yule S. Learning NOTSS While Tying Knots: Integrating the Nontechnical Skills for Surgeons Course With Technical Surgical Skills Training, A Mixed Methods Study. ANNALS OF SURGERY OPEN 2022; 3:e133. [PMID: 37600100 PMCID: PMC10431258 DOI: 10.1097/as9.0000000000000133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 01/20/2022] [Indexed: 11/25/2022] Open
Abstract
Objective The aims of this study were to describe the process of integrating 2 established training programs, Nontechnical skills for surgeons, and a traditional essential surgical skills course and to measure the impact of this integrated course on the behaviors of interprofessional surgical teams in Rwandan district hospitals. Background Surgical errors and resulting adverse events are due to variability in both technical and nontechnical surgical skills. Providing technical and nontechnical skills training to the perioperative team may enhance the learning of both of these skills and promote safe intraoperative patient care. Methods A quality improvement framework guided the process of integrating essential surgical skills and nontechnical skills into a single training program for surgical teams. The resulting 2-day training program was delivered to 68-person teams from 17 hospitals. Nontechnical skills for surgeons was taught through didactics and in the operating room, where preoperative briefing, intraoperative interactions, and postoperative debriefing were used as essential and nontechnical skills teaching moments. Postcourse surveys, follow-up interviews, focus groups, and direct observation of participants in the operating room were conducted to assess how participants implemented the knowledge and skills from the training into practice. Results Ninety-seven percent of the participants reported that they were satisfied with the course. Follow-up participant interviews and focus groups reported that the course helped them to improve their preoperative planning, intraoperative communication, decision-making, and postoperative debriefing. Conclusions It is possible to implement an integrated essential surgical skills and nontechnical skills training course. Integrating nontechnical skills into essential surgical skills courses may enhance learning of these skills.
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Affiliation(s)
- Egide Abahuje
- From the Surgical Outcome and Quality Improvement Center, Department of Surgical Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL
- MGH Institute of Health Professions, Boston, MA
- Department of Surgery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Roger D. Dias
- Harvard Medical School, Boston, MA
- Department of Emergency Medicine, Brigham and Women’s Hospital, STRATUS Center for Medical Simulation, Boston, MA
| | - Eugène Muneza
- Department of Surgery, Rwanda Military Hospital, Kigali, Rwanda
| | | | - Wendy Williams
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA
| | - Rachel Koch
- Department of Surgery, School of Medicine, Vanderbilt University, Nashville, TN
| | | | | | - Faye Evans
- Critical Care and Pain Medicine, Boston Children Hospital, Department of Anesthesia, Boston, MA
| | - Robert Riviello
- Harvard Medical School, Boston, MA
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA
- Department of Surgery, School of Medicine, Vanderbilt University, Nashville, TN
| | - Steven Yule
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA
- Department of Surgery, University of Edinburg, Edinburg, Scotland
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Zhao NW, Haddock LM, O'Brien BC. Are You Thinking What I'm Thinking? Exploring Response Process Validity Evidence for a Workplace-based Assessment for Operative Feedback. JOURNAL OF SURGICAL EDUCATION 2022; 79:475-484. [PMID: 34666934 DOI: 10.1016/j.jsurg.2021.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/11/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Workplace-based assessments (WBAs) are used in multiple surgical specialties to facilitate feedback to residents as a form of formative assessment. The validity evidence to support this purpose is limited and has yet to include investigations of how users interpret the assessment and make rating decisions (response processes). This study aimed to explore the validity evidence based on response processes for a WBA in surgery. DESIGN Semi-structured interviews explored the reasonings and strategies used when answering questions in a surgical WBA, the System for Improving and Measuring Procedural Learning (SIMPL). Interview questions probed the interpretation of the three assessment questions and their respective answer categories (level of autonomy, operative performance, case complexity). Researchers analyzed transcripts using directed qualitative content analysis to generate themes. SETTING Single tertiary academic medical center. PARTICIPANTS Eight residents and 13 faculty within the Department of Otolaryngology-Head and Neck Surgery participating in a 6-month pilot of SIMPL. RESULTS We identified four overarching themes that that characterized faculty and resident response processes while completing SIMPL: (1) Faculty and resident users had similar content-level interpretations of the questions and corresponding answer choices; (2) Users employed a variety of cognitive, behavioral, and emotional processes to make rating decisions; (3) Contextual factors influenced ratings; and (4) Tensions during interpretation contributed to rating uncertainty. CONCLUSIONS Response processes are a key source of evidence to support the validity for the formative use of WBAs. Evaluating response process evidence should go beyond basic content-level analysis as contextual factors and tensions that arise during interpretation also play a large role in rating decisions. Additional work and a continued critical lens are needed to ensure that WBAs can truly meet the needs for formative assessment.
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Affiliation(s)
- Nina W Zhao
- Department of Otolaryngology-Head and Neck Surgery, University of California - San Francisco, San Francisco, California; Department of Otolaryngology-Head and Neck Surgery, University of California - Davis, Sacramento, California.
| | - Lindsey M Haddock
- Department of Medicine, University of California - San Francisco, San Francisco, California
| | - Bridget C O'Brien
- Department of Medicine, University of California - San Francisco, San Francisco, California
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Williams J, Thelen AE, Luckoski J, Chen X, George BC. How Do Resident Surgeons Identify Operative Case Complexity? An Analysis of Resident versus Attending Perceptions. JOURNAL OF SURGICAL EDUCATION 2022; 79:469-474. [PMID: 34602380 DOI: 10.1016/j.jsurg.2021.09.009] [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: 03/25/2021] [Revised: 07/28/2021] [Accepted: 09/16/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Accurate recognition of patient-related complexity of an operation is critical for appropriate surgical decision making. It is not yet understood whether general surgery residents are able to accurately assess the relative complexity of a given operative case. This study investigates the agreement of case complexity ratings between residents and attending surgeons and explores whether resident-related factors correlate with any discordance in perception of patient-related operative complexity. DESIGN Residents and attending surgeons rated the relative complexity of completed cases on a 3 point scale via the SIMPL (Society for Improving Medical Professional Learning) operative assessment smartphone app. Additional trainee demographic data, autonomy ratings, and performance ratings were also obtained from the SIMPL registry for each rated case. Complexity agreement was defined as an equal rating between the resident and attending and assigned a value of zero. Over-estimate ratings were assigned a positive value and under-estimate ratings were assigned a negative value. Trends in complexity agreement were analyzed using descriptive statistics and mixed-effects models. RESULTS A total of 43,179 general surgery cases were rated by 1946 categorical general surgery residents and 1520 attending surgeons between 2015 and 2020. Residents and attendings agreed on case complexity in 63.23% of cases, while the residents overestimated complexity in 13.37% of cases and underestimated complexity in 23.40% of cases. Every level of resident except post-graduate year 2 had similar rates of agreement about the complexity of a procedure, while residents who received a higher autonomy rating were more likely to be in agreement with the faculty raters (OR 1.12, 95% CI 1.06-1.19). CONCLUSIONS The results of this study suggest that general surgery residents inaccurately perceive the patient-related complexity of a given case approximately one third of the time. Greater experience and operative autonomy appear to be associated with higher complexity agreement. Future research into factors influencing perceived case complexity may provide insight into how to best implement new teaching for surgical residents regarding the concept of case complexity.
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Affiliation(s)
- Jonathan Williams
- Department of Surgery, Center for Surgical Training and Research, Michigan Medicine, Ann Arbor, Michigan.
| | - Angela E Thelen
- Department of Surgery, Center for Surgical Training and Research, Michigan Medicine, Ann Arbor, Michigan
| | - John Luckoski
- Department of Surgery, Center for Surgical Training and Research, Michigan Medicine, Ann Arbor, Michigan
| | - Xilin Chen
- Department of Surgery, Center for Surgical Training and Research, Michigan Medicine, Ann Arbor, Michigan
| | - Brian C George
- Department of Surgery, Center for Surgical Training and Research, Michigan Medicine, Ann Arbor, Michigan
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Bizzarri N, Pletnev A, Razumova Z, Zalewski K, Theofanakis C, Selcuk I, Nikolova T, Lanner M, Gómez-Hidalgo NR, Kacperczyk-Bartnik J, Querleu D, Cibula D, Verheijen RHM, Fagotti A. Quality of training in cervical cancer radical surgery: a survey from the European Network of Young Gynaecologic Oncologists (ENYGO). Int J Gynecol Cancer 2022; 32:494-501. [PMID: 34992130 DOI: 10.1136/ijgc-2021-002812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The European Society of Gynaecological Oncology (ESGO) and partners are committed to improving the training for gynecologic oncology fellows. The aim of this survey was to assess the type and level of training in cervical cancer surgery and to investigate whether the Laparoscopic Approach to Cervical Cancer (LACC) trial results impacted training in radical surgery for gynecologic oncology fellows. METHODS In June 2020, a 47-question electronic survey was shared with European Network of Young Gynaecologic Oncologists (ENYGO) members. Specialist fellows in obstetrics and gynecology, and gynecologic oncology, from high- and low-volume centers, who started training between January 1, 2017 and January 1, 2020 or started before January 1, 2017 but finished their training at least 6 months after the LACC trial publication (October 2018), were included. RESULTS 81 of 125 (64.8%) respondents were included. The median time from the start of the fellowship to completion of the survey was 28 months (range 6-48). 56 (69.1%) respondents were still fellows-in-training. 6 of 56 (10.7%) and 14 of 25 (56.0%) respondents who were still in training and completed the fellowship, respectively, performed ≥10 radical hysterectomies during their training. Fellows trained in an ESGO accredited center had a higher chance to perform sentinel lymph node biopsy (60.4% vs 30.3%; p=0.027). There was no difference in the mean number of radical hysterectomies performed by fellows during fellowship before and after the LACC trial publication (8±12.0 vs 7±8.4, respectively; p=0.46). A significant reduction in number of minimally invasive radical hysterectomies was noted when comparing the period before and after the LACC trial (38.5% vs 13.8%, respectively; p<0.001). CONCLUSION Exposure to radical surgery for cervical cancer among gynecologic oncology fellows is low. Centralization of cervical cancer cases to high-volume centers may provide an increase in fellows' exposure to radical procedures. The LACC trial publication was associated with a decrease in minimally invasive radical hysterectomies performed by fellows.
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Affiliation(s)
- Nicolò Bizzarri
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | - Andrei Pletnev
- Department of Obstetrics and Gynecology, University of Zielona Góra Faculty of Humanities, Zielona Gora, Poland
| | - Zoia Razumova
- Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Kamil Zalewski
- Gynecologic Oncology, Holycross Cancer Center, Kielce, Holycross, Poland
| | - Charalampos Theofanakis
- Department of Gynaecological Oncology, General Hospital of Athens Alexandra, Athens, Attica, Greece
| | - Ilker Selcuk
- Gynecologic Oncology, Maternity Hospital, Ankara City Hospital, Ankara, Turkey
| | - Tanja Nikolova
- Klinikum Mittelbaden, Academic Teaching Hospital of Heidelberg University, Baden-Baden, Germany
| | - Maximilian Lanner
- Kardinal Schwarzenberg'sches Krankenhaus, Schwarzach im Pongau, Steiermark, Austria
| | - Natalia R Gómez-Hidalgo
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Vall d'Hebron Hospital, Barcelona, Spain
| | | | - Denis Querleu
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Policlinico Agostino Gemelli IRCCS, Rome, Italy.,Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg, France
| | - David Cibula
- Department of Obstetrics and Gynecology, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - René H M Verheijen
- Cancer Center, Department Gynaecological Oncology, UMC Utrecht, Utrecht, The Netherlands.,Nérac, Lot-et-Garonne, France
| | - Anna Fagotti
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Policlinico Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
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Van Heest AE, Armstrong AD, Bednar MS, Carpenter JE, Garvin KL, Harrast JJ, Martin DF, Murray PM, Peabody TD, Saltzman CL, Saniei M, Taitsman LA, Marsh JL. American Board of Orthopaedic Surgery’s Initiatives Toward Competency-Based Education. JB JS Open Access 2022; 7:JBJSOA-D-21-00150. [PMID: 35620526 PMCID: PMC9119638 DOI: 10.2106/jbjs.oa.21.00150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The American Board of Orthopaedic Surgery (ABOS) is the national organization charged with defining education standards for graduate medical education in orthopaedic surgery. The purpose of this article is to describe initiatives taken by the ABOS to develop assessments of competency of residents to document their progress toward the independent practice of orthopaedic surgery and provide feedback for improved performance during training. These initiatives are called the ABOS Knowledge, Skills, and Behavior Program. Web-based assessment tools have been developed and validated to measure competence. These assessments guide resident progress through residency education and better define the competency level by the end of training. The background and rationale for these initiatives and how they serve as steps toward competency-based education in orthopaedic residency education in the United States will be reviewed with a vision of a hybrid of time and competency-based orthopaedic residency education that will remain 5 years in length, with residents assessed using standardized tools.
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Affiliation(s)
- Ann E. Van Heest
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
- E-mail address for A.E. Van Heest:
| | - April D. Armstrong
- Department of Orthopaedics and Rehabilitation, Bone, and Joint Institute, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Michael S. Bednar
- Department of Orthopaedic Surgery and Rehabilitations, Loyola University Medical Center, Chicago, Illinois
| | - James E. Carpenter
- Department of Orthopaedic Surgery, Sports Medicine, Med Sport, Ann Arbor, Michigan
| | - Kevin L. Garvin
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska
| | | | - David F. Martin
- American Board of Orthopaedic Surgery, Chapel Hill, North Carolina
| | - Peter M. Murray
- Department of Orthopaedic Surgery and Neurosurgery, Mayo Clinic, Jacksonville, Florida
| | - Terrance D. Peabody
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Evanston, Illinois
| | | | - Mona Saniei
- American Board of Orthopaedic Surgery, Chapel Hill, North Carolina
| | - Lisa A. Taitsman
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle Washington
| | - J. Lawrence Marsh
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa
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Deer TR, Russo MA, Grider JS, Pope J, Rigoard P, Hagedorn JM, Naidu R, Patterson DG, Wilson D, Lubenow TR, Buvanendran A, Sheth SJ, Abdallah R, Knezevic NN, Schu S, Nijhuis H, Mehta P, Vallejo R, Shah JM, Harned ME, Jassal N, Gonzalez JM, Pittelkow TP, Patel S, Bojanic S, Chapman K, Strand N, Green AL, Pahapill P, Dario A, Piedimonte F, Levy RM. The Neurostimulation Appropriateness Consensus Committee (NACC): Recommendations for Surgical Technique for Spinal Cord Stimulation. Neuromodulation 2022; 25:1-34. [PMID: 35041578 DOI: 10.1016/j.neurom.2021.10.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 09/21/2021] [Accepted: 10/06/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The field of neurostimulation for the treatment of chronic pain is a rapidly developing area of medicine. Although neurostimulation therapies have advanced significantly as a result of technologic improvements, surgical planning, device placement, and postoperative care are of equal importance to optimize outcomes. This Neurostimulation Appropriateness Consensus Committee (NACC) project intends to provide evidence-based guidance for these often-overlooked areas of neurostimulation practice. MATERIALS AND METHODS Authors were chosen based on their clinical expertise, familiarity with the peer-reviewed literature, research productivity, and contributions to the neuromodulation literature. Section leaders supervised literature searches of MEDLINE, BioMed Central, Current Contents Connect, Embase, International Pharmaceutical Abstracts, Web of Science, Google Scholar, and PubMed from the last NACC publication in 2017 to the present. Identified studies were graded using the United States Preventive Services Task Force criteria for evidence and certainty of net benefit. Recommendations are based on evidence strength and consensus when evidence was scant. RESULTS This NACC project provides guidance on preoperative assessment, intraoperative techniques, and postoperative management in the form of consensus points with supportive evidence. These results are based on grade of evidence, strength of consensus, and expert opinion. CONCLUSIONS The NACC has given guidance for a surgical plan that encompasses the patient journey from the planning stage through the surgical experience and postoperative care. The overall recommendations are designed to improve efficacy and the safety of patients undergoing these neuromodulation procedures and are intended to apply throughout the international community.
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Affiliation(s)
- Timothy R Deer
- The Spine and Nerve Centers of the Virginias, Charleston, WV, USA.
| | - Marc A Russo
- Hunter Pain Specialists, Newcastle, New South Wales, Australia
| | - Jay S Grider
- UKHealthCare Pain Services, Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Jason Pope
- Evolve Restorative Center, Santa Rosa, CA, USA
| | - Philippe Rigoard
- Department of Spine Surgery and Neuromodulation, PRISMATICS Lab, Poitiers University Hospital, Poitiers, France
| | - Jonathan M Hagedorn
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ramana Naidu
- California Orthopedics & Spine, Larkspur, CA, USA
| | | | - Derron Wilson
- Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Timothy R Lubenow
- Department of Anesthesiology, Rush University Medical Center, Chicago, IL, USA
| | | | - Samir J Sheth
- Department of Anesthesiology and Pain Medicine, University of California, Davis, Davis, CA, USA
| | - Rany Abdallah
- Center for Interventional Pain and Spine, Milford, DE, USA
| | - N Nick Knezevic
- Department of Anesthesiology and Surgery at University of Illinois, Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA
| | - Stefan Schu
- Leitender Arzt Neuromodulation, Neurochirurgie, Sana Kliniken Duisburg GmbH, Duisburg, Germany
| | - Harold Nijhuis
- Department of Anesthesiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | | | - Jay M Shah
- SamWell Institute for Pain Management, Colonia, NJ, USA
| | - Michael E Harned
- UKHealthCare Pain Services, Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, KY, USA
| | | | - Jose Manuel Gonzalez
- Hospital Clínico Universitario Virgen de la Victoria, Servicio Andaluz de Salud, Málaga, Spain
| | - Thomas P Pittelkow
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | | | - Stana Bojanic
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, England, UK
| | - Kenneth Chapman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, The Pain and Spine Institute of New York, New York, NY, USA
| | - Natalie Strand
- Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Alexander L Green
- Nuffield Department of Surgical Sciences, Oxford University, Oxford, England, UK
| | - Peter Pahapill
- Functional Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Alessandro Dario
- Department of Neurosurgery, ASST Settelaghi, Insubria University, Varese, Italy
| | | | - Robert M Levy
- International Neuromodulation Society, Neurosurgical Services, Clinical Research, Anesthesia Pain Care Consultants, Tamarac, FL, USA
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Nieboer P, Huiskes M, Cnossen F, Stevens M, Bulstra SK, Jaarsma DADC. The Supervisor's Toolkit: Strategies of Supervisors to Entrust and Regulate Autonomy of Residents in the Operating Room. Ann Surg 2022; 275:e264-e270. [PMID: 32224741 DOI: 10.1097/sla.0000000000003887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify what strategies supervisors use to entrust autonomy during surgical procedures and to clarify the consequences of each strategy for a resident's level of autonomy. BACKGROUND Entrusting autonomy is at the core of teaching and learning surgical procedures. The better the level of autonomy matches the learning needs of residents, the steeper their learning curves. However, entrusting too much autonomy endangers patient outcome, while entrusting too little autonomy results in expertise gaps at the end of training. Understanding how supervisors regulate autonomy during surgical procedures is essential to improve intraoperative learning without compromising patient outcome. METHODS In an observational study, all the verbal and nonverbal interactions of 6 different supervisors and residents were captured by cameras. Using the iterative inductive process of conversational analysis, each supervisor initiative to guide the resident was identified, categorized, and analyzed to determine how supervisors affect autonomy of residents. RESULTS In the end, all the 475 behaviors of supervisors to regulate autonomy in this study could be classified into 4 categories and nine strategies: I) Evaluate the progress of the procedure: inspection (1), request for information (2), and expressing their expert opinion (3); II) Influence decision-making: explore (4), suggest (5), or declare the next decision (6); III) Influence the manual ongoing action: adjust (7), or stop the resident's manual activity (8); IV) take over (9). CONCLUSIONS This study provides new insights into how supervisors regulate autonomy in the operating room. This insight is useful toward analyzing whether supervisors meet learning needs of residents as effectively as possible.
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Affiliation(s)
- Patrick Nieboer
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Mike Huiskes
- Center for Language and Cognition, University of Groningen, Groningen, The Netherlands
| | - Fokie Cnossen
- Department of Artificial Intelligence, Bernouilli Institute of Mathematics, Computer Science and Artificial Intelligence, University of Groningen, Groningen, The Netherlands
| | - Martin Stevens
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sjoerd K Bulstra
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Debbie A D C Jaarsma
- Center for Research and Innovation in Medical Education, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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50
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Bergquist CS, Pienta MJ, Sood V, Chang AC, Bolling SF, Watt TMF, Romano JC, Reddy RM. Smartphone-based app for evaluating cardiothoracic residents: Feasibility and engagement. J Card Surg 2021; 36:4684-4687. [PMID: 34719818 DOI: 10.1111/jocs.16016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 08/15/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Timely and high-quality feedback is important in cardiothoracic (CT) surgery education. Feedback on operative proficiency is an area for improvement in CT surgery programs. Traditional evaluations significantly lag behind operative interactions. We hypothesized that use of the System for Improving and Measuring Procedural Learning (SIMPL) app would improve operative feedback for trainees. METHODS Use of SIMPL was evaluated from December 2018 to January, 2021 within an academic CT surgery training program. Ratings include level of supervision, complexity of the operation, and trainee performance. Completion was limited to 72 h after the operation. Descriptive statistics of the users and ratings are presented. RESULTS Over 28 months, 816 evaluations were completed, and of these, 495 had a rating from both the faculty and trainee. There were 19 trainees representing post-graduate years 1-8 and 19 faculty members who received or submitted at least one evaluation over the study period. The number of evaluations for each trainee ranged from 1 to 166 and from 1 to 81 for each of the faculty. The response rate for faculty ranged from 0% to 100%. "Active help" was the most common type of supervision (50.7% by the faculty, 60.4% from the trainees). CONCLUSIONS Use of SIMPL within a CT surgery training program was feasible and engagement was observed from both trainees and faculty. SIMPL provided trainees with timely, concise feedback on operative performance. Further work will focus on correlating SIMPL ratings with pre-existing assessments of performance.
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Affiliation(s)
- Curtis S Bergquist
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael J Pienta
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Vikram Sood
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew C Chang
- Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Steven F Bolling
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Tessa M F Watt
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Jennifer C Romano
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Rishindra M Reddy
- Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
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