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Li S, He L, Huang Y, Wang D, Zhu W, Chen Z. Incentive policy for the comprehensive development of young medical talents: an evolutionary game study. Front Public Health 2024; 12:1325166. [PMID: 38371237 PMCID: PMC10869509 DOI: 10.3389/fpubh.2024.1325166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/11/2024] [Indexed: 02/20/2024] Open
Abstract
Introduction Currently in China, there is a lack of well-defined and viable incentive mechanisms at the governmental and hospital levels to support the development of young medical talents, thereby hindering their growth Existing studies primarily investigate the current state and trajectory of incentives, yet they inadequately address the distinctive characteristics of various stakeholders involved in medical talent incentive processes, particularly the lack of research on incentive mechanisms with Chinese attributes. Methods This study adopts evolutionary game theory to investigate the dynamics of replication and the strategies for achieving evolutionary stability in the comprehensive development of young medical talents, considering both scenarios with and without supportive policies. Results In the absence of any supportive policy measures, the evolutionarily stable strategy (ESS) point is O(0,0), the unstable equilibrium point is C(1,1), and the saddle points are A(0,1), B(1,0). The initial state of the system is at the unstable equilibrium point C(1,1), which means that the young medical talents and medical institutions adopt a combination of strategies (actively seeking comprehensive development and taking incentive measures). Under the scenario with supportive policies, the ESS point is C(1,1), the unstable equilibrium point is O(0,0), and the saddle points are A(0,1), B(1,0). The initial state of the system is at the unstable equilibrium point O(0,0), which means that young medical talents and medical institutions adopt (N,N) strategy combinations (inactively seeking comprehensive development, implementing no incentive measure). Discussion (1) Government incentives play a crucial role in motivating young medical talents to seek comprehensive development. (2) The level of government incentive support for young medical talents should exceed the cost increment of individual efforts. Additionally, the policy support provided by the government to medical institutions should surpass the incentive support offered by these institutions to young medical talents. This will enhance the motivation and encouragement efforts of medical institutions in actively promoting comprehensive development among young medical talents. (3) With the backing of certain government incentive policies, medical institutions implementing incentive measures and young medical talents actively seeking comprehensive development will establish a virtuous cycle of mutual promotion.
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Affiliation(s)
- Si Li
- Department of Personnel and Party Affairs, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Lijuan He
- Department of Personnel and Party Affairs, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yaxin Huang
- Department of Personnel and Party Affairs, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Dan Wang
- Department of Personnel and Party Affairs, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Weihua Zhu
- Department of Personnel and Party Affairs, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Zhisong Chen
- Business School, Nanjing Normal University, Nanjing, China
- Stern School of Business, New York University, New York, NY, United States
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Tripathy S, Mohapatra DP, Thiruvoth FM, Sharma RK, Reddy L, Thomas N. An Innovative Skin Simulation Model to Augment Competency-based Training in Facial Plastic Surgery. Indian J Plast Surg 2022; 55:102-106. [PMID: 35444751 PMCID: PMC9015840 DOI: 10.1055/s-0041-1740083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction
Competency-based medical education (CBME) approach in the medical curriculum has been introduced globally with the goal of providing flexibility, accountability, and learner-centeredness among medical learners. Traditional surgical skill training in most places has relied on “see one, do one, teach one model,” while simulation model-based training has been shown to improve competencies in surgical trainees. We wanted to assess the usefulness of a hydrophilic barrier adhesive foam wound dressing as a novel skin simulation model for learning biomechanics and practice of cutaneous flaps among plastic surgical resident trainees at our institute.
Materials and Methods
An absorbent, soft polyurethane foam pad located centrally upon a larger polyurethane membrane, coated with a hydrocolloid adhesive, forming an island dressing, was used as a simulation model for this study. It was obtained from the hospital store either after or nearing their expiry dates of clinical use. Plastic surgery residents in different years of training were invited to participate in a simulation workshop, using this novel model, and give their feedback.
Results
Seventeen residents in different plastic surgery training levels participated in the workshop and gave their feedback on the skin flap simulation model. The simulation model received extremely high (100%) scores on two parameters, namely, utility for flap and suture practice and high scores (88%–94%) for texture, ability to mark, and improving confidence among trainees.
Conclusions
Adhesive bilayer polyurethane foam can be used as a novel cutaneous skin flap simulation model for understanding the biomechanics of skin flaps and cutaneous flap practice.
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Affiliation(s)
- Satyaswarup Tripathy
- Department of Plastic Surgery, Post Graduate Medical Education and Research (PGIMER), Chandigarh, India
| | | | | | - Ramesh Kumar Sharma
- Department of Plastic Surgery, Post Graduate Medical Education and Research (PGIMER), Chandigarh, India
| | - Likhitha Reddy
- Department of Plastic Surgery, JIPMER, Gorimedu, Puducherry, India
| | - Neljo Thomas
- Department of Plastic Surgery, JIPMER, Gorimedu, Puducherry, India
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Novel high-quality and reality biomaterial as a kidney surgery simulation model. PLoS One 2022; 17:e0263179. [PMID: 35176048 PMCID: PMC8853465 DOI: 10.1371/journal.pone.0263179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 01/13/2022] [Indexed: 12/03/2022] Open
Abstract
Surgical training using live animals such as pigs is one of the best ways of achieving skilled techniques and fostering confidence in preclinical medical students and surgeon trainees. However, due to animal welfare ethics, laboratory animals’ usage for training should be kept to a minimum. We have developed a novel kidney organ model utilizing a simple procedure in which the kidney is first refluxed with N-vinyl-2-pyrrolidone (NVP) solution for 1 hour in its bath, followed by permeation for 23 hours, with a subsequent freshwater refluxed for 48 hours in the washing step. Surgical simulation of the prepared kidney model (NVP-fixed kidney) was compared with three types of other basic known simulation models (fresh kidney, freeze-thaw kidney, and FA-fixed kidney) by various evaluations. We found the NVP-fixed kidney to mimicked fresh kidney function the most, pertaining to the hardness, and strength of the renal parenchyma. Moreover, the NVP-fixed kidney demonstrated successful blood-like fluids perfusion and electrocautery. Further, we confirmed that surgical training could be performed under conditions closer to actual clinical practice. Our findings suggest that our model does not only contribute to improving surgical skills but also inspires the utilization of otherwise, discarded inedible livestock organs as models for surgical training.
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Osborn PM, Dowd TC, Schmitz MR, Lybeck DO. Establishing an Orthopedic Program-Specific, Comprehensive Competency-Based Education Program. J Surg Res 2020; 259:399-406. [PMID: 33109403 DOI: 10.1016/j.jss.2020.09.016] [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: 06/02/2020] [Revised: 09/11/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Competency-based education (CBE) seeks to determine resident proficiency in the knowledge, skills, and behaviors required for independent patient care. Multiple assessment instruments evaluate technical skills or direct patient care in the clinic setting, but there are few reports incorporating both within an orthopedic specialty rotation. This study reports a residency program's comprehensive CBE initiative using formative assessments in the clinic and operating room during a sports medicine rotation. MATERIALS AND METHODS The sports medicine rotation used validated formative assessments to evaluate resident performance during clinic encounters and program-defined surgical entrustable professional activities (EPAs). Junior resident (postgraduate year [PGY] 1-2) EPAs included basic knee/shoulder arthroscopic procedures. Senior resident (PYG 5) EPAs comprised anterior cruciate ligament reconstruction, biceps tenodesis, shoulder stabilization, and rotator cuff repair. Assessment scores were compared between individuals and PGY groups. RESULTS Sixty-six clinical skills (CS) and 106 surgical skills assessments were conducted for 22 residents in one academic year. Surgical skills assessments demonstrated significant differences between each PGY group (P < 0.01). All PGY2 and PGY5 residents achieved independence on the evaluated EPAs. PGY5s earned higher scores in CS assessments than the other classes (P < 0.01). PGY2 residents scored higher than PGY1s in 7 of 9 CS domains. CS independence was achieved by 21 of 22 residents by the end of the rotation. CONCLUSIONS The CBE program effectively quantified expected differences in resident performance by PGY for clinic and surgical assessments on a sports medicine rotation. Assessments built an environment where feedback was more structured and standardized, creating a culture to improve resident education.
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Affiliation(s)
- Patrick M Osborn
- Department of Orthopaedic Surgery, San Antonio Military Health System, Ft Sam Houston, Texas.
| | | | - Matthew R Schmitz
- Department of Orthopaedic Surgery, San Antonio Military Health System, Ft Sam Houston, Texas
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St-Louis E, Shaheen M, Mukhtar F, Adessky R, Meterissian S, Boutros M. Towards Development of an Open Surgery Competency Assessment for Residents (OSCAR) Tool - A Systematic Review of the Literature and Delphi Consensus. JOURNAL OF SURGICAL EDUCATION 2020; 77:438-453. [PMID: 31889689 DOI: 10.1016/j.jsurg.2019.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/02/2019] [Accepted: 10/06/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Competency-based education has mandated accurate intra-operative assessment tools. We aimed to define consensus-based open surgical skills perceived by experts as critical for assessment. DESIGN A mixed-method design was employed: systematic review and e-Delphi methodology. SETTING The study was performed at McGill University-affiliated large tertiary academic centers in Montreal, Quebec, Canada. PARTICIPANTS Per PRISMA guidelines, a peer-reviewed search strategy was employed. Studies published in English and those describing technical skill assessment of open abdominal surgery were included; subspecialty-specific skills, conference abstracts, academic memoirs were excluded. Most-cited skills were subjected to e-Delphi methodology to identify those deemed essential by experts, based a 3-point Likert scale. Eighteen McGill University-affiliated general surgeons, representing a variety of subspecialties of General Surgery, were invited to answer the questionnaire. RESULTS Around 120 of 4285 references were retained for analysis. The 12 most cited skills included suturing, tissue and instrument handling, movement economy, instrument knowledge, knot tying, flow, knowledge of procedure, completion time, dissection technique, knowledge of anatomy and sterile technique; 6 of these achieved high or perfect scores and agreement after 2 rounds of survey: suturing, sterile technique, knot tying, knowledge of anatomy, knowledge of procedure, and tissue handling. Median standard deviation decreased (0.495 to 0.450) from first to second round, indicating improvement in consensus. CONCLUSION These results will help develop and validate the OSCAR (objective structured clinical assessment rubric) assessment tool for immediate intra-operative feedback of open technical skills for surgical trainees.
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Affiliation(s)
- Etienne St-Louis
- Colorectal Surgery, Jewish General Hospital, Montreal, Quebec, Canada; Department of General Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Mohammed Shaheen
- Colorectal Surgery, Jewish General Hospital, Montreal, Quebec, Canada; Department of General Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Fareeda Mukhtar
- Center for Medical Education, McGill University, Montreal, Quebec, Canada
| | - Ryan Adessky
- Department of General Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Sarkis Meterissian
- Department of General Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Marylise Boutros
- Colorectal Surgery, Jewish General Hospital, Montreal, Quebec, Canada.
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Krueger CA, Rivera JC, Bhullar PS, Osborn PM. Developing a Novel Scoring System to Objectively Track Orthopaedic Resident Educational Performance and Progression. JOURNAL OF SURGICAL EDUCATION 2020; 77:454-460. [PMID: 31889688 DOI: 10.1016/j.jsurg.2019.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 08/16/2019] [Accepted: 09/11/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Objectively determining orthopedic resident competence remains difficult and lacks standardization across residency programs. We sought to develop a scoring system to measure resident educational activity to stratify participation and performance in particular aspects of training and the effect of these measures on board certification. DESIGN A weighted scoring system (Average Resident Score, ARS) was developed using the number of logged cases, clinic notes dictated, OITE PGY percentile, case minimums met, and scholarly activity completed each academic year (AY), with clinical activity being more heavily weighted. The Resident Effectiveness Score (RES), a z-score showing the number of standard deviations from the mean, was determined using the ARS. The RES effect on the Accreditation Council for Graduate Medical Education (ACGME) Milestones and American Board of Orthopedic Surgery (ABOS) Part 1 percentile score was determined using a Spearman correlation. SETTING Large academic orthopedic residency. PARTICIPANTS Thirty one orthopedic residents graduating between 2011 and 2016 were included. RESULTS The RES did not differ between classes in the same AY, nor change significantly for individual residents during their training. Milestone z-scores increased as residents progressed in their education. The RES correlated with each Milestone competency subscore. The PGY5 OITE score and achieving ACGME minimums correlated with passing ABOS Part 1 (28/31 1st time pass), but the RES did not predict passing the board examination. CONCLUSIONS This study demonstrates a scoring system encompassing multiple facets of resident education to track resident activity and progress. The RES can be tailored to an individual program's goals and aims and help program directors identify residents not maximizing educational opportunities compared to their peers. Monitoring this score may allow tailoring of educational efforts to individual resident needs. This RES may also allow residents to measure their performance and educational accomplishments and adjust their focus to obtain competence and board certification.
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Affiliation(s)
- Chad A Krueger
- San Antonio Uniformed Services Healthcare Education Consortium, Fort Sam Houston, Texas
| | - Jessica C Rivera
- San Antonio Uniformed Services Healthcare Education Consortium, Fort Sam Houston, Texas
| | - Preetinder S Bhullar
- San Antonio Uniformed Services Healthcare Education Consortium, Fort Sam Houston, Texas
| | - Patrick M Osborn
- San Antonio Uniformed Services Healthcare Education Consortium, Fort Sam Houston, Texas.
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Bharathan R, Ghai V, Ind T. Obstetrics and gynaecology trainees' perceptions of the CanMEDS expertise model: implications for training from a regional questionnaire study in the United Kingdom. J OBSTET GYNAECOL 2020; 40:1138-1144. [PMID: 31941386 DOI: 10.1080/01443615.2019.1699039] [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: 10/25/2022]
Abstract
The CanMEDS expertise model is a multi-domain competency framework for doctors. The aims of this study were to assess the perceived importance of the CanMEDS roles and achievement among obstetrics and gynaecology trainees of all grades with a view to identifying opportunities to enhance training. This study was exempt from formal ethical or institutional registration. The data collection was completed in 2017. Following a video introduction, the trainees completed a questionnaire. For each of the CanMEDS domains, trainees of different tiers perceived them to be equally important. Indeed, the junior and senior cohorts of trainees perceived all domains to be equally important, as signified by the significant degree of score correlation. Age was a significant variable for achievement of competency in the roles of a Medical Expert (p = .01), a Communicator (p = .04), a Collaborator (p = .002), a Scholar (p = .01) and a Professional (p = .03). Grade was significant for the Medical Expert (p = .001) and Leader (p = .001) role. Better alignment of clinical activities with CanMEDS competencies and faculty development will complement the training in leadership skills. Impact statementWhat is already known on this subject? The CanMEDS medical expertise model is a multi-domain framework of seven components. This framework has been utilised to assess the training efficacy of curricula and unlock opportunities for improvement. The research application of the CanMEDS framework within Obstetrics and Gynaecology is limited.What does this study add? Results indicate that all trainees recognise the importance of CanMEDS roles: age and grade are significant variables in the perceived achievement of CanMEDS roles. The study identifies areas for improvement in the current training strategy.What are the implications for clinical practice/future research? Research should formalise the assessment of competencies in non-technical skills. Efforts should focus on identifying the activities which will develop leadership skills.
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Affiliation(s)
- Rasiah Bharathan
- Department of Gynaecological Oncology, Maidstone Hospital, Maidstone, UK
| | - Vishalli Ghai
- Department of Obstetrics and Gynaecology, Epsom General Hospital, Epsom, UK
| | - Thomas Ind
- Department of Obstetrics and Gynaecology, St.Georges University Hospitals NHS Foundation Trust, London, UK
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Ying Y, Seabrook C. Health Advocacy Competency: Integrating Social Outreach into Surgical Education. JOURNAL OF SURGICAL EDUCATION 2019; 76:756-761. [PMID: 30503762 DOI: 10.1016/j.jsurg.2018.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/09/2018] [Accepted: 11/18/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Being a strong health advocate is recognized as being an important part of being a good surgeon. Residency training programs have struggled with teaching health advocacy beyond didactic sessions, and in a way that encourages trainees to incorporate changes into their practice. This curriculum development aimed to incorporate reflective practice to encourage patient compassion and advocacy. DESIGN Community service was incorporated as a mandatory component of a postgraduate surgical training program. Residents participated in a community service activity, and reflected upon their learning with a presentation to their peers. PARTICIPANTS Mandatory advocacy curriculum for all 67 first and second year surgical residents. Sixty-four residents chose to participate in a community service activity. Forty-six residents completed year end evaluations on the curriculum. RESULTS Seventy percent of outreach activities were medically related, and 30% nonmedical. Most residents felt that the amount of work required to complete this project was reasonable (90%), and learned from their experiences (76%). Residents who participated in medically related projects self-described greater learning from their activity (93%), and from watching their peer presentations (79%). These trainees were also more likely to alter their patient management based on their experiences (68%). Trainees who participated in nonmedically related outreach projects were less likely to self-reflect learning from their experiences. Despite mandatory teaching in health advocacy, trainees are often unaware of this teaching within their curriculum. CONCLUSIONS A mandatory outreach project in residency can encourage trainees to reflect on their volunteer activities as a physician and how it impacts their patient's health. Academic departments should try to encourage volunteerism within their trainees by providing opportunities for residents to participate in outreach activities related to their specialty.
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Affiliation(s)
- Yvonne Ying
- Office of Surgical Education, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
| | - Christine Seabrook
- Office of Surgical Education, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada.
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van Vendeloo SN, Brand PLP, Kollen BJ, Verheyen CCPM. Changes in Perceived Supervision Quality After Introduction of Competency-Based Orthopedic Residency Training: A National 6-Year Follow-Up Study. JOURNAL OF SURGICAL EDUCATION 2018; 75:1624-1629. [PMID: 29706298 DOI: 10.1016/j.jsurg.2018.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 01/28/2018] [Accepted: 04/03/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To evaluate the perceived quality of the learning environment, before and after introduction of competency-based postgraduate orthopedic education. DESIGN From 2009 to 2014, we conducted annual surveys among Dutch orthopedic residents. The validated Dutch Residency Educational Climate Test (D-RECT, 50 items on 11 subscales) was used to assess the quality of the learning environment. Scores range from 1 (poor) to 5 (excellent). SETTING Dynamic cohort follow-up study. PARTICIPANTS All Dutch orthopedic residents were surveyed during annual compulsory courses. RESULTS Over the 6-year period, 641 responses were obtained (response rate 92%). Scores for "supervision" (95% CI for difference 0.06-0.28, p = 0.002) and "coaching and assessment" (95% CI 0.11-0.35, p < 0.001) improved significantly after introduction of competency-based training. There was no significant change in score on the other subscales of the D-RECT. CONCLUSIONS After the introduction of some of the core components of competency-based postgraduate orthopedic education the perceived quality of "supervision" and "coaching and assessment" improved significantly.
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Affiliation(s)
- Stefan N van Vendeloo
- Department of Orthopaedic Surgery and Traumatology, Isala Hospital, Zwolle, The Netherlands.
| | - Paul L P Brand
- Department of Pediatrics, Princess Amalia Children's Centre, Isala Hospital, Zwolle, The Netherlands; UMCG Postgraduate School of Medicine, University Medical Centre Groningen, University of Groningen, The Netherlands
| | - Boudewijn J Kollen
- Department of General Practice, University Medical Centre Groningen, University of Groningen, The Netherlands
| | - Cees C P M Verheyen
- Department of Orthopaedic Surgery and Traumatology, Isala Hospital, Zwolle, The Netherlands
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Kilty C, Wiese A, Bergin C, Flood P, Fu N, Horgan M, Higgins A, Maher B, O’Kane G, Prihodova L, Slattery D, Stoyanov S, Bennett D. A national stakeholder consensus study of challenges and priorities for clinical learning environments in postgraduate medical education. BMC MEDICAL EDUCATION 2017; 17:226. [PMID: 29166902 PMCID: PMC5700623 DOI: 10.1186/s12909-017-1065-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 11/07/2017] [Indexed: 05/10/2023]
Abstract
BACKGROUND High quality clinical learning environments (CLE) are critical to postgraduate medical education (PGME). The understaffed and overcrowded environments in which many residents work present a significant challenge to learning. The purpose of this study was to develop a national expert group consensus amongst stakeholders in PGME to; (i) identify important barriers and facilitators of learning in CLEs and (ii) indicate priority areas for improvement. Our objective was to provide information to focus efforts to provide high quality CLEs. METHODS Group Concept Mapping (GCM) is an integrated mixed methods approach to generating expert group consensus. A multi-disciplinary group of experts were invited to participate in the GCM process via an online platform. Multi-dimensional scaling and hierarchical cluster analysis were used to analyse participant inputs in regard to barriers, facilitators and priorities. RESULTS Participants identified facilitators and barriers in ten domains within clinical learning environments. Domains rated most important were those which related to residents' connection to and engagement with more senior doctors. Organisation and conditions of work and Time to learn with senior doctors during patient care were rated as the most difficult areas in which to make improvements. CONCLUSIONS High quality PGME requires that residents engage and connect with senior doctors during patient care, and that they are valued and supported both as learners and service providers. Academic medicine and health service managers must work together to protect these elements of CLEs, which not only shape learning, but impact quality of care and patient safety.
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Affiliation(s)
- Caroline Kilty
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
| | - Anel Wiese
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
| | | | - Patrick Flood
- Dublin City University Business School, Dublin, Ireland
| | - Na Fu
- Trinity College Dublin Business School, Dublin, Ireland
| | - Mary Horgan
- School of Medicine, University College Cork, Cork, Ireland
| | - Agnes Higgins
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Bridget Maher
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
| | | | | | | | - Slavi Stoyanov
- Open University of the Netherlands, Heerlen, Netherlands
| | - Deirdre Bennett
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
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Janki S, Mulder EEAP, IJzermans JNM, Tran TCK. Ergonomics in the operating room. Surg Endosc 2016; 31:2457-2466. [PMID: 27752811 PMCID: PMC5443844 DOI: 10.1007/s00464-016-5247-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 09/12/2016] [Indexed: 12/31/2022]
Abstract
Background Since the introduction of minimally invasive surgery, surgeons appear to be experiencing more occupational musculoskeletal injuries. The aim of this study is to investigate the current frequency and effects of occupational musculoskeletal injuries on work absence. Methods An online questionnaire was conducted among all surgeons affiliated to the Dutch Society for Endoscopic Surgery, Gastrointestinal Surgery, and Surgical Oncology. In addition, this survey was conducted among surgeons, gynaecologists, and urologists of one cluster of training hospitals in the Netherlands. Results There were 127 respondents. Fifty-six surgeons currently suffer from musculoskeletal complaints, and 30 have previously suffered from musculoskeletal complaints with no current complaints. Frequently reported localizations were the neck (39.5 %), the erector spinae muscle (34.9 %), and the right deltoid muscle (18.6 %). Most of the musculoskeletal complaints were present while operating (41.8 %). Currently, 37.5 % uses medication and/or therapy to reduce complaints. Of surgeons with past complaints, 26.7 % required work leave and 40.0 % made intraoperative adjustments. More surgeons with a medical history of musculoskeletal complaints have current complaints (OR 6.1, 95 % CI 1.9–19.6). There were no significant differences between surgeons of different operating techniques in localizations and frequency of complaints, or work leave. Conclusions Despite previous various ergonomic recommendations in the operating room, the current study demonstrated that musculoskeletal complaints and subsequent work absence are still present among surgeons, especially among surgeons with a positive medical history for musculoskeletal complaints. Even sick leave was necessary to fully recover. There were no significant differences in reported complaints between surgeons of different operating techniques. Almost half of the respondents with complaints made intraoperative ergonomic adjustments to prevent future complaints. The latter would be interesting for future research.
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Affiliation(s)
- Shiromani Janki
- Division of HPB and Transplant Surgery, Erasmus MC, Department of Surgery, University Medical Center, Room no. H-822k, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Evalyn E A P Mulder
- Division of HPB and Transplant Surgery, Erasmus MC, Department of Surgery, University Medical Center, Room no. H-822k, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Jan N M IJzermans
- Division of HPB and Transplant Surgery, Erasmus MC, Department of Surgery, University Medical Center, Room no. H-822k, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - T C Khe Tran
- Division of HPB and Transplant Surgery, Erasmus MC, Department of Surgery, University Medical Center, Room no. H-822k, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
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Wallenburg I, Hopmans CJ, Buljac-Samardzic M, den Hoed PT, IJzermans JNM. Repairing reforms and transforming professional practices: a mixed-methods analysis of surgical training reform. JOURNAL OF PROFESSIONS AND ORGANIZATION 2016. [DOI: 10.1093/jpo/jov012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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13
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Wouda JC, van de Wiel HBM. Supervisors' and residents' patient-education competency in challenging outpatient consultations. PATIENT EDUCATION AND COUNSELING 2015; 98:1084-1091. [PMID: 26074498 DOI: 10.1016/j.pec.2015.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 05/07/2015] [Accepted: 05/11/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES We compared supervisors' and residents' patient-education competency in challenging consultations in order to establish whether supervisors demonstrate sufficient patient-education competency to act credibly as role models and coaches for residents. METHODS All consultations conducted at one, two, or three of the outpatient clinics of each of the participating physicians were videoed. Each participant selected two challenging consultations from each clinic for assessment. We assessed their patient-education competency using the CELI instrument, we calculated net consultation length for all videoed consultations and we measured patient opinion about the patient education received using a questionnaire. RESULTS Forty-four residents and fourteen supervisors participated in the study. They selected 230 consultations for assessment. On average, supervisors and residents demonstrated similar patient-education competency. Net consultation length was longer for supervisors. Patient opinion did not differ between supervisors and residents. CONCLUSIONS Supervising consultants generally do not possess sufficient patient-education competency to fulfill their teaching roles in workplace-based learning that is aimed at improving residents' patient-education competency. PRACTICE IMPLICATIONS Not only residents but also supervising consultants should improve their patient-education competency. Workplace-based learning consisting of self-assessment of and feedback on videoed consultations could be useful in attaining this goal.
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Affiliation(s)
- Jan C Wouda
- University of Groningen, University Medical Center Groningen, The Netherlands.
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14
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Impact of the European Working Time Directive (EWTD) on the operative experience of surgery residents. Surgery 2015; 157:634-41. [DOI: 10.1016/j.surg.2014.09.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 08/11/2014] [Accepted: 09/16/2014] [Indexed: 12/20/2022]
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15
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Lutz K, Yazdani A, Ross D. From time-based to competency-based standards: core transitional competencies in plastic surgery. JOURNAL OF SURGICAL EDUCATION 2015; 72:228-234. [PMID: 25481801 DOI: 10.1016/j.jsurg.2014.08.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 08/18/2014] [Accepted: 08/24/2014] [Indexed: 06/04/2023]
Abstract
PURPOSE Competency-based medical education is becoming increasingly prevalent and is likely to be mandated by the Royal College in the near future. The objective of this study was to define the core technical competencies that should be possessed by plastic surgery residents as they transition into their senior (presently postgraduate year 3) years of training. METHODS A list of potential core competencies was generated using a modified Delphi method that included the investigators and 6 experienced, academic plastic surgeons from across Canada and the United States. Generated items were divided into 7 domains: basic surgical skills, anesthesia, hand surgery, cutaneous surgery, esthetic surgery, breast surgery, and craniofacial surgery. Members of the Delphi group were asked to rank particular skills on a 4-point scale with anchored descriptors. Item reduction resulted in a survey consisting of 48 skills grouped into the aforementioned domains. This self-administered survey was distributed to all Canadian program directors (n = 11) via e-mail for validation and further item reduction. RESULTS The response rate was 100% (11/11). Using the average rankings of program directors, 26 "core" skills were identified. There was agreement of core skills across all domains except for breast surgery and esthetic surgery. Of them, 7 skills were determined to be above the level of a trainee at this stage; a further 15 skills were agreed to be important, but not core, competencies. CONCLUSIONS Overall, 26 competencies have been identified as "core" for plastic surgery residents to possess as they begin their senior, on-service years. The nature of these skills makes them suitable for teaching in a formal, simulated environment, which would ensure that all plastic surgery trainees are competent in these tasks as they transition to their senior years of residency.
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Affiliation(s)
- Kristina Lutz
- Division of Plastic and Reconstructive Surgery, Western University, St. Joseph's Health Care, London, Ontario, Canada
| | | | - Douglas Ross
- Roth-McFarlane Hand and Upper Limb Centre, St. Joseph's Health Centre, London, Ontario, Canada.
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16
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Hopmans CJ, den Hoed PT, van der Laan L, van der Harst E, van der Elst M, Mannaerts GHH, Dawson I, Timman R, Wijnhoven BPL, IJzermans JNM. Assessment of surgery residents' operative skills in the operating theater using a modified Objective Structured Assessment of Technical Skills (OSATS): a prospective multicenter study. Surgery 2014; 156:1078-88. [PMID: 25231747 DOI: 10.1016/j.surg.2014.04.052] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 04/24/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND With the implementation of competency-based curricula, Objective Structured Assessment of Technical Skills (OSATS) increasingly is being used for the assessment of operative skills. Although evidence for its usefulness has been demonstrated in experimental study designs, data supporting OSATS application in the operating room are limited. This study evaluates the validity and reliability of the OSATS instrument to assess the operative skills of surgery residents in the operating theater. METHODS Twenty-four residents were recruited from seven hospitals within a general surgical training region and classified equally into three groups according to postgraduate training year (PGY). Each resident had to perform five different types of operations. Surgical performance was measured using a modified OSATS consisting of three scales: Global Rating Scale, Overall Performance Scale, and Alphabetic Summary Scale. Validity and reliability metrics included construct validity (Kruskal-Wallis test) and internal consistency reliability (Cronbach's α coefficient). Spearman's correlation coefficients were calculated to determine correlations between the different scales. RESULTS Eighteen residents (PGY 1-2 [n = 7]; PGY 3-4 [n = 8]; PGY 5-6 [n = 3]) performed 249 operations. Comparisons of the performance scores revealed that evidence for construct validity depended on the difficulty level of the selected procedures. For individual operations, internal consistency reliability of the Global Rating Scale ranged from 0.93 to 0.95. Scores on the different scales correlated strongly (r = 0.62-0.76, P < .001). CONCLUSION Assessment of operative skills in the operating theater using this modified OSATS instrument has the potential to establish learning curves, allowing adequate monitoring of residents' progress in achieving operative competence. The Alphabetic Summary Scale seems to be of additional value. Use of the Overall Performance Scale should be reconsidered.
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Affiliation(s)
- Cornelis J Hopmans
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | | | | | | | | | | | - Imro Dawson
- Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, The Netherlands
| | - Reinier Timman
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Bas P L Wijnhoven
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Jan N M IJzermans
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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