Progressive Surgical Autonomy Observed in a Hand Surgery Resident Clinic Model

Dedicated Chalazion Clinic as a Tool for Early Surgical Education in Ophthalmology Residency

Objective  Ophthalmology residency programs aim to improve resident surgical teaching through increased surgical exposure over a 4-year period. Resident-centric surgical clinics across various surgical specialties have been established to help develop surgical autonomy and experience. We present the first demonstration of a resident-centric chalazion incision and drainage clinic (chalazion clinic) in an ophthalmology residency with the goal of increasing early surgical exposure to residents. Design  The chalazion clinic was founded in July 2019. It is a once weekly procedure clinic conducted by an ophthalmology resident and supervised by an ophthalmology attending. Patients with chalazia were referred directly to this clinic for evaluation and management, rather than the oculoplastics clinic as they were in the past. Retrospective review of Accreditation Council for Graduate Medical Education (ACGME) case logs of all residents per academic year before and after establishment of the chalazion clinic was performed in order to assess the impact on residents' chalazion procedures numbers per academic year. Setting  The study involved a single academic ophthalmology department. Participants  Ophthalmology residents of all years were present. Results  A resident of any year performed an average of 3.0 chalazion procedures per year in the 2018 to 2019 academic year, 3.8 in 2019 to 2020, and 8.4 in the 2020 to 2021, which represents a 180% increase in procedure numbers per resident. Among post-graduate-year 2s (PGY)2s, the average number of chalazion procedures increased from 2.1 procedure per year to 22.3 per year (961.9% increase). Conclusion  To the best of our knowledge, this is the first description of a dedicated resident-centric chalazion clinic in an ophthalmology residency program. PGY2s demonstrated the largest increase in procedural numbers. While chalazion incision and drainage is a minor procedure, increased exposure to surgical procedures early in training could help improve residents' skills and confidence. This clinic provides a proof of concept of a dedicated minor procedure clinic for ophthalmology residents to increase early procedural volume.

Examining the Development of Operative Autonomy in Vascular Surgery Training and When Trainees and Program Directors Agree and Disagree

BACKGROUND

Lack of autonomy in the operating room (OR) during general surgery residency is a major contributing factor to low confidence operating independently after graduation. Although attempts to address decreased autonomy and development of entrustment in the OR are being made in general surgery programs, this issue has not been examined thoroughly in vascular surgery. We sought to determine barriers and opportunities for developing operative autonomy during vascular surgery training by surveying program directors (PDs) and trainees (integrated residents and fellows) in U.S. vascular surgery training programs.

METHODS

An anonymous electronic survey was sent via email to all PDs (n = 155) and trainees (n = 516) in United States vascular surgery training programs. Demographics, academic characteristics, and responses regarding factors impacting the development of entrustment were collected.

RESULTS

Thirty-five PDs and 100 trainees completed the survey (22.5% and 19.4% response rate, respectively). Sixty percent of trainees were integrated residents and 40% were fellows. Twenty percent of PDs and 33% of trainees were female, and 5% of all PDs and trainees were from underrepresented minorities. The single most positive factor affecting the development of autonomy according to trainees and PDs is familiarity of the faculty with the trainee. Both PDs and trainees thought the trainee's preparation for the case positively affected development of autonomy; however, more PDs believed that involvement with preoperative preparation in particular (marking the patient, consenting the patient, filling out a history and physical, prepping and draping the patient) was important (P < 0.05). PDs believed that duty-hour limitations negatively affected the trainee's ability to develop autonomy in the OR, whereas more trainees believed that hospital or OR efficiency policies played a negative role (P < 0.05). Finally, compared with trainees, PDs believed that the appropriate amount of time for safe struggle before the attending should take over the case was when OR efficiency was compromised or at any moment the trainee is unsure of themselves (P < 0.05); trainees believed that the attending should take over the case after the limit of their skill set or troubleshooting ability was reached (P < 0.05).

CONCLUSIONS

Familiarity of the attending physician with the trainee is an important positive factor for development of entrustment and autonomy in vascular surgery trainees. Duty-hour limitations and belief of the need for hospital efficiency may negatively impact operative independence of trainees. An open discussion about balancing OR efficiency and trainees' safe struggle is essential to address the growth of independent operative skills in vascular surgery trainees.

The Effect of the COVID-19 Pandemic on Orthopedic Practices in New York

The SARS-CoV-2 (COVID-19) crisis has strained hospitals and health systems across the world. In the United States, New York City has faced a surge of cases as the epicenter of the North American outbreak. Northwell Health, as the largest regional health system in New York City, has implemented various practices and policies to adapt to the evolving situation and prepare for future global events. [Orthopedics. 2020;43(4):245-249.].

A Systematic Review of Resident Aesthetic Clinic Outcomes

BACKGROUND

Providing residents with comprehensive training in aesthetic surgery has proven challenging. Resident aesthetic clinics propose an educational value to trainees while providing successful patient outcomes.

OBJECTIVES

This study systematically reviewed the available literature regarding resident aesthetic clinic outcomes to determine the efficacy of the clinic in resident training, surgical results, and patient satisfaction.

METHODS

An electronic database search was performed to identify literature reporting on resident aesthetic clinics. Studies were excluded if the resident clinic was not aesthetic in nature, if only nonsurgical aesthetic procedures were performed, and if clinic outcomes were not evaluated. Study quality was assessed using the Newcastle Ottawa Scale for nonrandomized studies.

RESULTS

Ten of 148 identified studies met inclusion criteria; 2 utilized a survey, 3 were retrospective cohort studies, and 5 were retrospective cohort studies also utilizing a survey. Clinic schedules, surgical case volume, and surgical procedures performed all varied. One study received a Newcastle Ottawa Scale score of 7 of a possible 9 stars, 2 studies received 5 stars, 5 studies received 4 stars, and 2 could not be assessed using the scoring system. Six studies analyzed surgical results as a primary outcome, reporting acceptable complication and revision rates. Four studies evaluated patient opinions of the clinics and reported overall high satisfaction rates.

CONCLUSIONS

This systematic review suggests that resident aesthetic clinics enhance resident education while providing safe and successful surgical results to patients.

Resident-run urology clinics: A tool for use in competency-based medical education for teaching and assessing transition-to-practice skills

INTRODUCTION

In a competency-based approach to resident education, a component of training should focus on skills needed for the transition from residency to independent practice. The ability to run an outpatient clinic represents one such skill. Resident-run clinics (RRC) have been implemented in family medicine programs to allow residents to practice this skill, and have enhanced learning while providing excellent patient satisfaction. To date, there has been little experience with RRCs in surgical residency programs. We describe a urology RRC and report assessments of both resident performance and patient satisfaction.

METHODS

The RRC was run independently by a senior urology resident. All cases were reviewed with faculty at the end of the day, and an evaluation form assessing resident performance was completed. Residents also completed a brief self-assessment. All patients completed an anonymous survey to assess aspects of patient satisfaction.

RESULTS

Overall, resident performance was excellent, with changes to the management plan in 6% (3/47) of cases after faculty review. All clinics finished within 30 minutes of planned end time. Residents reported confidence in their ability to manage the clinic (8.25/10). Forty-three patient surveys were completed. On a five-point scale, patient ratings of wait time, clinic environment, and appointment duration were 3.91, 4.23, and 4.12, respectively. Patient ratings of resident skills (communication, sensitivity, treatment options, and answering questions) were 4.30, 4.35, 4.40, and 4.42, respectively. Overall, confidence in residents was 9.07/10 and 100% of patients would recommend the RRC.

CONCLUSIONS

Based on our ongoing experience, RRCs provide well-received, safe patient care and serve as a learning tool for residents as they prepare for independent practice. Given these results, residency programs could consider inclusion of a RRC as a component of the transition- to-practice training within a competency-based curriculum.