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Zambare WV, Hess DT, Kenzik K, Pernar LI. Outcomes in Laparoscopic Roux-en-Y Gastric Bypass and Implications for Surgical Resident Education. JOURNAL OF SURGICAL EDUCATION 2021; 78:e161-e168. [PMID: 34219036 DOI: 10.1016/j.jsurg.2021.06.005] [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: 03/24/2021] [Revised: 05/12/2021] [Accepted: 06/08/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Some surgery residents feel inadequately prepared to perform advanced operations, partly due to losing operative opportunities to fellows. In turn, they are prompted to pursue fellowships. Allowing residents the opportunity to participate in advanced procedures and complex cases may alleviate this cycle, if their participation is safe. This study examined the effects of resident participation in laparoscopic Roux-en-Y gastric bypass procedures (LRYGBs). DESIGN Our MBSAQIP database was used to identify LRYGBs performed at our institution between 2015 and 2018. Operative notes were reviewed to determine training level of the assistant. Patient comorbidities and outcomes (duration of surgery, length of stay, post-operative complications, readmissions, and reoperations) were stratified by assistant level of training for comparison. SETTING Urban tertiary care hospital. PARTICIPANTS Trainees and attending surgeons acting as assistants during LRYGBs. RESULTS Among 987 total cases, the assistants for the procedures were chief residents (n = 549, 56%), fourth-year residents (n = 258, 26%), attending surgeons (n = 143, 14%), and third-year residents (n = 37, 4%). Attending surgeons assisted more often when patients had a BMI ≥ 45 (38% attendings vs. 25% residents, p = 0.007), ≥ 2 comorbidities (54% vs. 40%, p = 0.007), or had a history of prior bariatric surgery (22% vs. 3%, p < 0.0001).Post-operative complication rate was low (4%) and did not differ significantly between all training levels (p = 0.86). Average length of stay, readmission rates, and reoperation rates were not significantly different across training levels (p = 0.75, p = 0.072, and p = 0.91 respectively). CONCLUSION Complication rates, hospital length of stay, readmission rates, and reoperation rates were equivalent for patients regardless of the level of training of the assistant for LRYGBs. Involving residents in complex bariatric procedures such as LRYGB is a safe model of education that does not compromise patient safety or hospital outcomes. Involvement in advanced cases allows general surgery residents to more confidently move toward independent practice.
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Affiliation(s)
| | - Donald T Hess
- Boston University School of Medicine, Boston, MA; Department of Surgery, Boston Medical Center, Boston, Massachusetts
| | - Kelly Kenzik
- Department of Surgery, Boston Medical Center, Boston, Massachusetts; Institute for Cancer Outcomes and Survivorship; University of Alabama at Birmingham, Birmingham, Alabama
| | - Luise I Pernar
- Boston University School of Medicine, Boston, MA; Department of Surgery, Boston Medical Center, Boston, Massachusetts.
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Reddavid R, Allum W, Polom K, Resendiz A, Hyung WJ, Kassab P, Molena D, Lanzarini E, Terashima M, Biondi A, Hilegersberg RV, D'Ugo D, Fumagalli U, Santi S, De Manzoni G, Roviello F, Degiuli M. Upper GI training of young surgeons: a reality full of hurdles. An international survey. Updates Surg 2021; 73:627-637. [PMID: 33417186 DOI: 10.1007/s13304-020-00955-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 12/18/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Anecdotal evidence suggests that the training of young surgeons in Upper GI is not homogeneous across the world. This survey aimed to investigate the different training programs and the level of satisfaction of young surgeons with their surgical and scientific education pathway. DESIGN A multiple-choice and single best answer format questionnaire was sent to 36 Upper GI chairs from international referral centres and then forwarded to young surgeons (attending physician less than 40 years old). The same questionnaire containing 5 main topics (demographics, residency, fellowship, academic research and activities, manual skill improvement) was posted online on a Surveymonkey website. SETTING San Luigi University Hospital, Orbassano (Turin), Italy; Tertiary University Hospital. RESULTS Fourteen replies were received from colleagues in 36 referral centres (39% response rate) and 65 voluntary answers from the survey monkey platform. During residency training, only 43% of residents had a specific training in upper GI tract surgery, which was characterized by a small number of interventions performed both with trainer scrubbed and unscrubbed. Fellowship programmes were undertaken by 49% of participants and 64% spent this training period abroad. Operative experience was reported by nearly all respondents with only 27% performing > 10 gastrectomies and only 11% performing > 10 oesophagectomies with the trainer scrubbed. The majority attended less than 10 meetings (58%), and 70% of them published less than 5 papers. CONCLUSIONS The present survey reveals that the young surgeons of the twenty-first century face many hurdles during their surgical training. Overall, the surgical education settings are limited for both practical and scientific training for upper GI trainees. As a result, it is not possible to train in upper GI surgery to a level of competent independent practice.
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Affiliation(s)
- Rossella Reddavid
- University of Turin, Department of Oncology, San Luigi University Hospital, Surgical Oncology and Digestive Surgery Unit, Regione Gonzole 10, Orbassano, 10043, Turin, Italy
| | - William Allum
- Department of Academic Surgery, Royal Marsden NHS Foundation Trust London, London, UK
| | - Karol Polom
- Department of Surgical Oncology, Medical University of Gdansk, Gdańsk, Poland
| | - Aridai Resendiz
- University of Turin, Department of Oncology, San Luigi University Hospital, Surgical Oncology and Digestive Surgery Unit, Regione Gonzole 10, Orbassano, 10043, Turin, Italy
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Paolo Kassab
- Department of Surgery, School of Medicine, University of Santa Casa, São Paulo, Brasil
| | - Daniela Molena
- Division of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Enrique Lanzarini
- Department of Surgery, University Hospital, University of Chile, Santos Dumont #999, Santiago, Chile
| | - Masanori Terashima
- Division of Gastric Surgery, Shizuoka Cancer Center, Nagaizumi, Shizuoka, 411-8777, Japan
| | - Alberto Biondi
- Division of General Surgery, Department of Surgical Sciences, Catholic University, Rome, Italy
| | - Richard Van Hilegersberg
- Department of Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Domenico D'Ugo
- Division of General Surgery, Department of Surgical Sciences, Catholic University, Rome, Italy
| | - Uberto Fumagalli
- Digestive Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Stefano Santi
- Unit of Esophageal Surgery, Department of Surgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Via Paradisa 2, 56124, Pisa, Italy
| | | | - Franco Roviello
- Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Maurizio Degiuli
- University of Turin, Department of Oncology, San Luigi University Hospital, Surgical Oncology and Digestive Surgery Unit, Regione Gonzole 10, Orbassano, 10043, Turin, Italy.
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Donley DK, Graybill CK, Fekadu A, Fitzgerald TN, Hayton RA. Transition to Practice: A Global Surgery Approach. JOURNAL OF SURGICAL EDUCATION 2018; 75:392-396. [PMID: 28802786 DOI: 10.1016/j.jsurg.2017.07.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 06/14/2017] [Accepted: 07/25/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To determine the feasibility of a global surgery setting for a transition to practice experience. SETTING A rural hospital in Malawi, Africa. PARTICIPANTS A recent graduate of a U.S. general surgery residency program. RESULTS Fellow performed 305 cases across the surgical disciplines with demonstrated improvements in operative ability. CONCLUSION The global surgery approach to transition to practice offers a unique opportunity to complement domestic training while providing critical assistance to communities with few surgical providers.
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Affiliation(s)
- Dustin K Donley
- Department of Surgery, Malamulo Mission Hospital, Thyolo, Malawi.
| | - Cassandra K Graybill
- Department of Surgery, Malamulo Mission Hospital, Thyolo, Malawi; Department of Obstetrics/Gynecology, Loma Linda University Medical Center, Loma Linda, California
| | - Arega Fekadu
- Department of Surgery, Malamulo Mission Hospital, Thyolo, Malawi
| | - Tamara N Fitzgerald
- Paul L. Foster School of Medicine, Department of Surgery, Texas Tech University, El Paso, Texas
| | - Ryan A Hayton
- Department of Surgery, Malamulo Mission Hospital, Thyolo, Malawi; Department of Surgery, Loma Linda University Medical Center, Loma Linda, California
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Kantor O, Schneider AB, Rojnica M, Benjamin AJ, Schindler N, Posner MC, Matthews JB, Roggin KK. Implementing a resident acute care surgery service: Improving resident education and patient care. Surgery 2016; 161:876-883. [PMID: 27932029 DOI: 10.1016/j.surg.2016.09.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/10/2016] [Accepted: 09/24/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND To simulate the duties and responsibilities of an attending surgeon and allow senior residents more intraoperative and perioperative autonomy, our program created a new resident acute care surgery consult service. METHODS We structured resident acute care surgery as a new admitting and inpatient consult service managed by chief and senior residents with attending supervision. When appropriate, the chief resident served as a teaching assistant in the operation. Outcomes were recorded prospectively and reviewed at weekly quality improvement conferences. The following information was collected: (1) teaching assistant case logs for senior residents preimplentation (n = 10) and postimplementation (n = 5) of the resident acute care surgery service; (2) data on the proportion of each case performed independently by residents; (3) resident evaluations of the resident acute care surgery versus other general operative services; (4) consult time for the first 12 months of the service (June 2014 to June 2015). RESULTS During the first year after implementation, the number of total teaching assistant cases logged among graduating chief residents increased from a mean of 13.4 ± 13.0 (range 4-44) for preresident acute care surgery residents to 30.8 ± 8.8 (range 27-36) for postresident acute care surgery residents (P < .01). Of 323 operative cases, the residents performed an average of 82% of the case independently. There was a significant increase in the satisfaction with the variety of cases (mean 5.08 vs 4.52, P < .01 on a 6-point Likert scale) and complexity of cases (mean 5.35 vs 4.94, P < .01) on service evaluations of resident acute care surgery (n = 27) in comparison with other general operative services (n = 127). In addition, creation of a 1-team consult service resulted in a more streamlined consult process with average consult time of 22 minutes for operative consults and 25 minutes for nonoperative consults (range 5-90 minutes). CONCLUSION The implementation of a resident acute care surgery service has increased resident autonomy, teaching assistant cases, and satisfaction with operative case variety, as well as the efficiency of operative consultation at our institution.
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Affiliation(s)
- Olga Kantor
- Department of Surgery, University of Chicago Medicine, Chicago, IL
| | | | - Marko Rojnica
- Department of Surgery, University of Chicago Medicine, Chicago, IL
| | | | - Nancy Schindler
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL
| | | | | | - Kevin K Roggin
- Department of Surgery, University of Chicago Medicine, Chicago, IL.
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Kempenich JW, Willis RE, Blue RJ, Al Fayyadh MJ, Cromer RM, Schenarts PJ, Van Sickle KR, Dent DL. The Effect of Patient Education on the Perceptions of Resident Participation in Surgical Care. JOURNAL OF SURGICAL EDUCATION 2016; 73:e111-e117. [PMID: 27663084 DOI: 10.1016/j.jsurg.2016.05.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/05/2016] [Accepted: 05/09/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To decipher if patient attitudes toward resident participation in their surgical care can be improved with patient education regarding resident roles, education, and responsibilities. DESIGN An anonymous questionnaire was created and distributed in outpatient surgery clinics that had residents involved with patient care. In total, 3 groups of patients were surveyed, a control group and 2 intervention groups. Each intervention group was given an informational pamphlet explaining the role, education, and responsibilities of residents. The first pamphlet used an analogy-based explanation. The second pamphlet used literature citations and statistics. SETTING Keesler Medical Center, Keesler AFB, MS. University of Texas Health Science Center at San Antonio, San Antonio, TX. PARTICIPANTS A total of 454 responses were collected and analyzed-211 in the control group, 118 in the analogy pamphlet group, and 125 in the statistics pamphlet group. RESULTS Patients had favorable views of residents assisting with their surgical procedures, and the majority felt that outcomes were the same or better regardless of whether they read an informational pamphlet. Of all the patients surveyed, 80% agreed or strongly agreed that they expect to be asked permission for residents to be involved in their care. Further, 52% of patients in the control group agreed or strongly agreed to a fifth-year surgery resident operating on them independently for routine procedures compared to 62% and 65% of the patients who read the analogy pamphlet and statistics pamphlet, respectively (p = 0.05). When we combined the 2 intervention groups compared to the control group, this significant difference persisted (p = 0.02). CONCLUSION Most patients welcome resident participation in their surgical care, but they expect to be asked permission for resident involvement. Patient education using an information pamphlet describing resident roles, education, and responsibilities improved patient willingness to allow a chief resident to operate independently.
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Affiliation(s)
- Jason W Kempenich
- Department of General Surgery, Keesler Medical Center, Keesler AFB, Biloxi, Mississippi.
| | - Ross E Willis
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Robert J Blue
- Department of General Surgery, Keesler Medical Center, Keesler AFB, Biloxi, Mississippi
| | - Mohammed J Al Fayyadh
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Robert M Cromer
- Department of General Surgery, Keesler Medical Center, Keesler AFB, Biloxi, Mississippi
| | - Paul J Schenarts
- Division of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Kent R Van Sickle
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Daniel L Dent
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Chapman WC. Surgical Training in the United States: Is It Time for a Paradigm Shift? J Am Coll Surg 2016; 223:1-7. [PMID: 27012839 DOI: 10.1016/j.jamcollsurg.2016.01.055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 01/22/2016] [Indexed: 11/18/2022]
Affiliation(s)
- William C Chapman
- Division of General Surgery, Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St Louis, MO.
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