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Bajestani N, Singh A, Gerald M, Ueno C. Examining the Most Impactful Strategies for In-service Preparation: A Systemic Review. JOURNAL OF SURGICAL EDUCATION 2024; 81:1203-1214. [PMID: 38971679 DOI: 10.1016/j.jsurg.2024.06.003] [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: 01/01/2024] [Revised: 04/25/2024] [Accepted: 06/02/2024] [Indexed: 07/08/2024]
Abstract
INTRODUCTION Resident performance on the Plastic Surgery In-Service Examination (PSITE) is used as a predictor of success on the American Board of Plastic Surgery Written Examination, as well as resident progression and fellowship applications. However, information specifically addressing strategies on optimal PSITE preparation is lacking in the plastic surgery literature when compared to general surgery. For this reason, we aim to understand if the topic is well-studied and denote effective study strategies and curricular interventions in both fields that can help residents and programs optimize PSITE performance. METHODS A literature search including studies from 2012 to 2022 was conducted following PRISMA guidelines in PubMed and EMBASE to identify articles on strategies to improve in-service exam scores for general surgery and plastic surgery. Only studies that reported measurable outcomes in raw score, percentile score, or percent correct were included. RESULTS Qualitative analysis of 30 articles revealed 2 categories of interventions: individual study habits and institutional curricular interventions. In general surgery literature, 27 articles examined interventions positively impacting resident ABSITE scores, with 21 studies classified as institutional curricular interventions and 6 articles addressing individual study habits. Themes associated with improved ABSITE performance included mandatory remediation programs, dedicated study time, and problem-based learning interventions. In contrast, only 3 articles in plastic surgery literature discussed interventions associated with improved PSITE scores, all falling under curricular interventions. CONCLUSION Unfortunately, the plastic surgery literature lacks concrete evidence on how residents can improve performance. Future research in plastic surgery should replicate successful strategies from general surgery and further investigate optimal preparation strategies for the PSITE. Such endeavors can contribute to improving resident performance and advancing plastic surgery education and patient care.
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Affiliation(s)
- Nojan Bajestani
- Ohio State College of Medicine - 1645 Neil Ave, Columbus, OH 43210.
| | - Anusha Singh
- Ohio State College of Medicine - 1645 Neil Ave, Columbus, OH 43210
| | - Mykal Gerald
- Ohio State Department of Plastic Surgery - 915 Olentangy River Rd 2nd Floor Suite 2140
| | - Cristiane Ueno
- Ohio State College of Medicine - 1645 Neil Ave, Columbus, OH 43210; Ohio State Department of Plastic Surgery - 915 Olentangy River Rd 2nd Floor Suite 2140
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Margolin EJ, Schoenfeld D, Miles CH, Merrill SB, Raman JD, Thompson RH, Reese AC, Parekh DJ, Brown ET, Klausner A, Williams DH, Lee RK, Zaslau S, Guzzo TJ, Shenot PJ, Anderson CB, Badalato GM. Longitudinal Changes in the Operative Experience for Junior Urology Residents. Urology 2023; 179:32-38. [PMID: 37400019 DOI: 10.1016/j.urology.2023.03.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/04/2023] [Accepted: 03/29/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE To evaluate longitudinal trends in surgical case volume among junior urology residents. There is growing perception that urology residents are not prepared for independent practice, which may be linked to decreased exposure to major cases early in residency. METHODS Retrospective review of deidentified case logs from urology residency graduates from 12 academic medical centers in the United States from 2010 to 2017. The primary outcome was the change in major case volume for first-year urology (URO1) residents (after surgery internship), measured using negative binomial regression. RESULTS A total of 391,399 total cases were logged by 244 residency graduates. Residents performed a median of 509 major cases, 487 minor cases, and 503 endoscopic cases. From 2010 to 2017, the median number of major cases performed by URO1 residents decreased from 64 to 49 (annual incidence rate ratio 0.90, P < .001). This trend was limited to oncology cases, with no change in reconstructive or pediatric cases. The number of major cases decreased more for URO1 residents than for residents at other levels (P-values for interaction <.05). The median number of endoscopic cases performed by URO1 residents increased from 85 to 194 (annual incidence rate ratio 1.09, P < .001), which was also disproportionate to other levels of residency (P-values for interaction <.05). CONCLUSION There has been a shift in case distribution among URO1 residents, with progressively less exposure to major cases and an increased focus on endoscopic surgery. Further investigation is needed to determine if this trend has implications on the surgical proficiency of residency graduates.
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Affiliation(s)
- Ezra J Margolin
- Department of Urology, Columbia University Irving Medical Center, New York, NY
| | - Daniel Schoenfeld
- Department of Urology, Columbia University Irving Medical Center, New York, NY
| | - Caleb H Miles
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY
| | | | - Jay D Raman
- Department of Urology, Penn State Health, Hershey, PA
| | | | - Adam C Reese
- Department of Urology, Temple University Lewis Katz School of Medicine, Philadelphia, PA
| | - Dipen J Parekh
- Desai Sethi Urology Institute at University of Miami Miller School of Medicine, Miami, FL
| | - Elizabeth T Brown
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC
| | - Adam Klausner
- Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, VA
| | | | - Richard K Lee
- Department of Urology, Weill Cornell Medical Center, New York, NY
| | - Stanley Zaslau
- Department of Urology, West Virginia University, Morgantown, WV
| | - Thomas J Guzzo
- Division of Urology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Patrick J Shenot
- Department of Urology, Thomas Jefferson University, Philadelphia, PA
| | | | - Gina M Badalato
- Department of Urology, Columbia University Irving Medical Center, New York, NY.
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Bowden SG, Siler DA, Shahin MN, Mazur-Hart DJ, Munger DN, Ross MN, O’Neill BE, Nerison CS, Rothbaum M, Han SJ, Wright JM, Orina JN, Winer JL, Selden NR. Effects of 24-hour versus night-float call schedules on the clinical and operative experiences of postgraduate year 2 and 3 neurosurgical residents. Neurosurg Focus 2022; 53:E12. [DOI: 10.3171/2022.5.focus22181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/10/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
To comply with the removal of the 88-hour week exemption and to support additional operative experience during junior residency, Oregon Health & Science University (OHSU) switched from a night-float call schedule to a modified 24-hour call schedule on July 1, 2019. This study compared the volumes of clinical, procedural, and operative cases experienced by postgraduate year 2 (PGY-2) and PGY-3 residents under these systems.
METHODS
The authors retrospectively studied billing and related clinical records, call schedules, and Accreditation Council for Graduate Medical Education case logs for PGY-2 and PGY-3 residents at OHSU, a tertiary academic health center, for the first 4 months of the academic years from 2017 to 2020. The authors analyzed the volumes of new patient consultations, bedside procedures, and operative procedures performed by each PGY-2 and PGY-3 resident during these years, comparing the volumes experienced under each call system.
RESULTS
Changing from a PGY-2 resident–focused night-float call system to a 24-hour call system that was more evenly distributed between PGY-2 and PGY-3 residents resulted in decreased volume of new patient consultations, increased volume of operative procedures, and no change in volume of bedside procedures for PGY-2 residents. PGY-3 residents experienced a decrease in operative procedure volume under the 24-hour call system.
CONCLUSIONS
Transition from a night-float system to a 24-hour call system altered the distribution of clinical and procedural experiences between PGY-2 and PGY-3 residents. Further research is necessary to understand the impact of these changes on educational outcomes, quality and safety of patient care, and resident satisfaction.
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Affiliation(s)
- Stephen G. Bowden
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Dominic A. Siler
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Maryam N. Shahin
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - David J. Mazur-Hart
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Daniel N. Munger
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Miner N. Ross
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Brannan E. O’Neill
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Caleb S. Nerison
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Michael Rothbaum
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Seunggu J. Han
- Department of Neurosurgery, Stanford University, Palo Alto, California
| | - James M. Wright
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Josiah N. Orina
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Jesse L. Winer
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Nathan R. Selden
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
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Kassam AF, Singer KE, Winer LK, Browne D, Sussman JJ, Goodman MD, Makley AT. Acquisition and retention of surgical skills taught during intern surgical boot camp. Am J Surg 2020; 221:987-992. [PMID: 32981654 DOI: 10.1016/j.amjsurg.2020.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/11/2020] [Accepted: 09/11/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Surgical residencies have implemented boot-camps for early acquisition of basic technical skills for interns. However, educators worry that retention is poor. We hypothesized that a structured boot-camp curriculum would improve skills. METHODS Interns underwent eight boot-camp sessions at the beginning of residency. Interns completed pre-, post-boot-camp, and end-of-year skills assessments, as well as post-boot camp and end-of-year porcine procedure labs. Proficiency was measured on a 5-point scale and by completion time. RESULTS After boot-camp, interns improved all domains of knot-tying. Median time decreased for skin-closure (8.3 vs 9.9 min, p < 0.01), peg transfer (57 vs 87 s, p < 0.01), intracorporeal (178 vs 300 s, p < 0.01), and extracorporeal knot-tying (140 vs 259 s, p < 0.01). At the end-of-year assessment, interns exhibited retention of all skills and improved in knot-tying and central line skills. During the retention porcine lab, interns progressed basic but not complex skills. CONCLUSIONS An eight-week boot-camp effectively improved technical skills among surgery interns. Interns retained all skills and improved upon techniques frequently practiced during intern year.
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Affiliation(s)
- Al-Faraaz Kassam
- Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Kathleen E Singer
- Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Leah K Winer
- Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Deborah Browne
- Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Jeffrey J Sussman
- Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Michael D Goodman
- Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Amy T Makley
- Department of Surgery, University of Cincinnati, Cincinnati, OH, USA.
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Abstract
BACKGROUND Plastic surgery residency programs in Israel have undergone several changes over the years, but the perspectives and satisfaction of the residents have not been investigated. METHODS An anonymous national survey of plastic surgery residents in Israel was performed. Demographic, professional, and education variables were summarized using descriptive statistics, and findings were related to self-reported satisfaction levels using univariate analysis. RESULTS The response rate was 75.9%. Response rates to surgery and education-related items were as follows: 60% performed 5 to 15 surgeries/month; 60.3% performed fewer than 5 surgeries/month as the primary surgeon; 57.3% and 77.8%, respectively, received surgical and academic instruction from fewer than half the attending physicians; 33.9% and 32.3%, respectively, had little or no in-hospital exposure to aesthetic surgeries. The average overall satisfaction rate was 3.33/5. Ten variables were significantly associated with increased satisfaction: total number of surgeries performed (P = 0.01); active participation in complex procedures (P = 0.0009); performing preoperative and postoperative management for one's patients (P = 0.016); marking one's patients preoperatively (P = 0.037); managing complications of one's patients (P = 0.0027); receipt of surgical instruction (P = 0.0035); receipt of academic medical instruction (P < 0.0001); sense that the training will provide the proper professional level (P < 0.0001) and independence (P = 0.0002); and subjective correspondence between demands and capabilities (P = 0.0004). CONCLUSIONS This study identifies several factors associated with plastic surgery resident satisfaction. It highlights factors that warrant changes by plastic surgery departments and faculty to improve resident training and increase their satisfaction. The questionnaire can also serve as a diagnostic and follow-up tool.
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Song SY, Kang MK, Kim EK. Frozen-thawed Abdominal Flap Remnant as an education material for a Medium Group Surgical Skills Education Workshop. Ann Surg Treat Res 2018; 96:53-57. [PMID: 30746352 PMCID: PMC6358597 DOI: 10.4174/astr.2019.96.2.53] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 09/03/2018] [Accepted: 10/05/2018] [Indexed: 11/30/2022] Open
Abstract
Purpose Residents' duty-hour regulations and the evolution of minimally invasive surgical techniques require more effective and efficient surgical skill teaching models. We used frozen-thawed human tissue remnants harvested during abdominoplasty or abdominal tissue-based breast reconstruction to allow for a medium-sized group workshop program, simulating a realistic surgical environment and visual/haptic feedback. Methods Full-thickness abdominal tissue (skin and subcutaneous fat) were donated from patients who underwent autologous breast reconstruction and gave consent to use their tissue for comprehensive research and medical educational purposes. Anonymized tissue was frozen-preserved and then thawed the day of the surgical skills workshop. A total of 53 residents completed 50-minute hands-on training in 3-to-5 person modules in four sessions of the workshop program. Results Thawed tissue regained almost normal texture and consistency. Structural integrity was also histologically confirmed. All participants were generally satisfied with the program, especially regarding the suture material provided. Conclusion Frozen-thawed tissue remnants from abdominoplasty or autologous breast reconstruction could be preserved and used as a suture education material in medium-group workshops for surgery residents or medical students given anonymity and with proper consent guaranteed. This approach provided an excellent model maintaining relatively real anatomic structure and consistency with minimal cost.
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Affiliation(s)
- Sin Young Song
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min Kyu Kang
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Key Kim
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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