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Wiebe N, Hunt A, Taylor T. "Everything new is happening all at once": a qualitative study of early career obstetrician and gynaecologists' preparedness for independent practice. CANADIAN MEDICAL EDUCATION JOURNAL 2024; 15:6-17. [PMID: 39114783 PMCID: PMC11302748 DOI: 10.36834/cmej.77329] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
Background The transition from residency training into practice is associated with increasing risks of litigation, burnout, and stress. Yet, we know very little about how best to prepare graduates for the full scope of independent practice, beyond ensuring clinical competence. Thus, we explored the transition to independent practice (TTP) experiences of recent Obstetrics and Gynaecology graduates to understand potential gaps in their perceived readiness for practice. Methods Using constructivist grounded theory, we conducted semi-structured interviews with 20 Obstetricians/Gynaecologists who graduated from nine Canadian residency programs within the last five years. Iterative data collection and analysis led to the development of key themes. Results Five key themes encompassed different practice gaps experienced by participants throughout their transition. These practice gaps fit into five competency domains: providing clinical care, such as managing unfamiliar low-risk ambulatory presentations; navigating logistics, such as triaging referrals; managing administration, such as hiring or firing support staff; reclaiming personhood, such as boundary-setting between work and home; and bearing ultimate responsibility, such as navigating patient complaints. Mitigating factors were found to widen or narrow the extent to which new graduates experienced a practice gap. There was a shared sense among participants that some practice gaps were impossible to resolve during training. Conclusions Existing practice gaps are multi-dimensional and perhaps not realistically addressed during residency. Instead, TTP mentorship and training opportunities must extend beyond residency to ensure that new graduates are equipped for the full breadth of independent practice.
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Affiliation(s)
- Nicole Wiebe
- Schulich School of Medicine & Dentistry, Western University, Ontario, Canada
| | - Andrea Hunt
- Schulich School of Medicine & Dentistry, Western University, Ontario, Canada
- Department of Obstetrics and Gynaecology, Guelph General Hospital, Ontario, Canada
| | - Taryn Taylor
- Department of Obstetrics and Gynaecology, London Health Sciences Centre, Ontario, Canada
- The Centre for Education Research and Innovation, Schulich School of Medicine & Dentistry, Ontario, Canada
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Sevestre A, Dochez V, Souron R, Deschamps T, Winer N, Thubert T. Evaluation Tools for Assessing Autonomy of Surgical Residents in the Operating Room and Factors Influencing Access to Autonomy: A Systematic Literature Review. JOURNAL OF SURGICAL EDUCATION 2024; 81:182-192. [PMID: 38160113 DOI: 10.1016/j.jsurg.2023.11.003] [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: 07/03/2023] [Revised: 10/16/2023] [Accepted: 11/01/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Surgical residents in France lack a clear pedagogical framework for achieving autonomy in the operating room. The progressive acquisition of surgical autonomy is a determining factor in the confidence of operators for their future independent practice. Currently, there is no autonomy scale commonly used in Europe. The objective of this study is to identify existing tools for quantifying the autonomy of residents and the factors that influence it. MATERIALS AND METHODS We conducted a qualitative systematic review following the recommendations of the Systematic Review Without Meta-Analysis (SWiM) guidelines. Publications were extracted from the MEDLINE (PubMed), EMBASE, and PSYCINFO databases. All publications without date restrictions up to July 2022 were identified. RESULTS Among the 231 identified publications, 21 met the inclusion criteria. Seventeen publications used a graded autonomy assessment tool by the student and/or the teacher, while 4 used evaluations by an observing third party. We found 8 different autonomy scales, with the Zwisch Scale representing 57.1% of the cases. Factors influencing autonomy were diverse, including the work context, experience, and gender of the resident and their teacher. DISCUSSION We found heterogeneity in the tools used to "measure" the autonomy of a resident in the operating room. The SIMPL tool or the Zwisch Scale appear to be the most frequently used tools. The relationship between autonomy, performance, confidence, and knowledge may require multidimensional tools that encompass various areas of competence, but this could make their daily application more challenging. The factors influencing autonomy are numerous; and understanding them would improve teaching in the operating room. There is a significant lack of data on surgical autonomy in France, as well as a lack of evaluation in the field of gynecology-obstetrics worldwide.
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Affiliation(s)
- Anaïs Sevestre
- Nantes Université, CHU Nantes, Service de Gynécologie-Obstétrique, Nantes, France; Nantes Université, CHU Nantes, Movement - Interactions - Performance, Nantes, France
| | - Vincent Dochez
- Nantes Université, CHU Nantes, Service de Gynécologie-Obstétrique, Nantes, France; Nantes Université, CHU Nantes, Movement - Interactions - Performance, Nantes, France.
| | - Robin Souron
- Nantes Université, CHU Nantes, Movement - Interactions - Performance, Nantes, France
| | - Thibault Deschamps
- Nantes Université, CHU Nantes, Movement - Interactions - Performance, Nantes, France
| | - Norbert Winer
- Nantes Université, CHU Nantes, Service de Gynécologie-Obstétrique, Nantes, France; Nantes Université, CHU Nantes, INRAE, Nantes, France
| | - Thibault Thubert
- Nantes Université, CHU Nantes, Service de Gynécologie-Obstétrique, Nantes, France; Nantes Université, CHU Nantes, Movement - Interactions - Performance, Nantes, France
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McColl T, Paterson Q, Yiu S, Velji A, Woods R, Frank J, Magee K, Nath A, Russell M, Thurgur L, Ting DK, Zaver F, Cheung WJ. Ready for practice? National recommendations for emergency medicine transition to practice curriculum. CAN J EMERG MED 2023; 25:558-567. [PMID: 37389772 DOI: 10.1007/s43678-023-00534-x] [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: 05/15/2023] [Accepted: 05/25/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Transition from residency to unsupervised practice represents a critical stage in learning and professional identity formation, yet there is a paucity of literature to inform residency curricula and emergency department transition programming for new faculty. OBJECTIVE The objective of this study was to develop consensus-based recommendations to optimize the transition to practice phase of emergency medicine training. METHODS A literature review and results of a survey of emergency medicine (EM) residency program directors informed focus groups of recent (within 5 years) EM graduates. Focus group transcripts were analyzed following conventional content analysis. Preliminary recommendations, based on identified themes, were drafted and presented at the 2022 Canadian Association of Emergency Physicians (CAEP) Academic Symposium on Education. Through a live presentation, symposium attendees representing the Canadian national EM community participated in a facilitated discussion of the recommendations. The authors incorporated this feedback to construct a final set of 14 recommendations, 8 targeted toward residency training programs and 6 specific to department leadership. CONCLUSION The Canadian EM community used a structured process to develop 14 best practice recommendations to enhance the transition to practice phase of residency training as well as the transition period in the career of junior attending physicians.
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Affiliation(s)
- Tamara McColl
- Department of Emergency Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
| | - Quinten Paterson
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Stella Yiu
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Alkarim Velji
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Rob Woods
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Jason Frank
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kirk Magee
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - Avik Nath
- Department of Emergency Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Mackenzie Russell
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Lisa Thurgur
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Daniel K Ting
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Fareen Zaver
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Warren J Cheung
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
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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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Thomson B, O'Halloran H, Wu L, Gauthier S, Taylor D. Transition to practice curriculum for general internal medicine physicians: scoping review and Canadian national survey. BMC MEDICAL EDUCATION 2022; 22:609. [PMID: 35945567 PMCID: PMC9361703 DOI: 10.1186/s12909-022-03673-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 07/29/2022] [Indexed: 05/16/2023]
Abstract
BACKGROUND There remains a paucity of evidence for curricula for the transition to practice (TTP) stage of Competence by Design internal medicine (IM) training programs. Current entrustable professional activities are based on expert consensus rather than robust subspecialty-specific needs assessment. METHODS A scoping review was completed to identify studies with TTP focus. A national survey was conducted to identify transition experiences for general internal medicine physicians. Results were assessed by grounded theory analysis to identify core topics for TTP curricula. RESULTS Neither scoping review nor national survey identified TTP topics related to the CanMEDS Medical Expert role. Scoping Review: 41 relevant studies were identified. Most (97.6%) were from North America. The most common study types were observational (survey) or curriculum (13/41 31.7% for each). Only two studies were exclusively in IM, and the most common subspecialty studied was surgical (13/41, 31.7%). The most common TTP topics were mentorship, billing and coding, practice management, negotiating contract and job, and financial aspects of practice. National Survey: There were 44 respondents, with the majority (25/44, 56.8%) having completed an IM subspecialty fellowship. Most (38/44) completed medical school in Canada, and most were from academic practice settings (33/44, 75.0%). The most common TTP topics were billing and coding, personal financial planning, practice management, work-life balance and mentorship. Grounded Theory Analysis: There were six themes that encompassed all TTP topics from the scoping review and national survey, being (i) building a career, (ii) continuing professional development, (iii) expectations of the profession, (iv) practice management, (v) Life, health and well-being and (vi) clinical skills. Curriculum competencies and resources for curriculum development were provided. CONCLUSIONS This study identifies topics critical for curricula development for IM transition to practice. Further research is required to evaluate effectiveness of curricula including topics and themes developed from this scoping review and national survey.
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Affiliation(s)
- Benjamin Thomson
- Department of Medicine, Division of General Internal Medicine, Queen's University, 76 Stuart Street, Kingston, ON, K7L-2V7, Canada.
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA.
| | - Heather O'Halloran
- Department of Medicine, Division of General Internal Medicine, Queen's University, 76 Stuart Street, Kingston, ON, K7L-2V7, Canada
| | - Luke Wu
- Department of Medicine, Division of General Internal Medicine, Queen's University, 76 Stuart Street, Kingston, ON, K7L-2V7, Canada
| | - Stephen Gauthier
- Department of Medicine, Division of General Internal Medicine, Queen's University, 76 Stuart Street, Kingston, ON, K7L-2V7, Canada
| | - David Taylor
- Department of Medicine, Division of General Internal Medicine, Queen's University, 76 Stuart Street, Kingston, ON, K7L-2V7, Canada
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Hammaker AC, Dodwad SJM, Salyer CE, Adams SD, Foote DC, Ivascu FA, Kader S, Abelson JS, Al Yafi M, Sutton JM, Smith S, Postlewait LM, Stopenski SJ, Nahmias JT, Harvey J, Farr D, Callahan ZM, Marks JA, Elsaadi A, Campbell SJ, Stahl CC, Hanseman DJ, Patel P, Woeste MR, Martin RCG, Patel JA, Newcomb MR, Greenwell K, Meister KM, Etheridge JC, Cho NL, Thrush CR, Kimbrough MK, Nasim BW, Willis RE, George BC, Quillin RC, Cortez AR. A multi-institutional study from the US ROPE Consortium examining factors associated with directly entering practice upon residency graduation. Surgery 2022; 172:906-912. [PMID: 35788283 DOI: 10.1016/j.surg.2022.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/16/2022] [Accepted: 05/30/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND There is concern regarding the competency of today's general surgery graduates as a large proportion defer independent practice in favor of additional fellowship training. Little is known about the graduates who directly enter general surgery practice and if their operative experiences during residency differ from graduates who pursue fellowship. METHODS Nineteen Accreditation Council for Graduate Medical Education-accredited general surgery programs from the US Resident OPerative Experience Consortium were included. Demographics, career choice, and case logs from graduates between 2010 to 2020 were analyzed. RESULTS There were 1,264 general surgery residents who graduated over the 11-year period. A total of 248 (19.6%) went directly into practice and 1,016 (80.4%) pursued fellowship. Graduates directly entering practice were more likely to be a high-volume resident (43.1% vs 30.5%, P < .01) and graduate from a high-volume program (49.2% vs 33.0%, P < .01). Direct-to-practice graduates performed 53 more cases compared with fellowship-bound graduates (1,203 vs 1,150, P < .01). On multivariable analysis, entering directly into practice was positively associated with total surgeon chief case volume (odds ratio = 1.47, 95% confidence interval 1.18-1.84, P < .01) and graduating from a US medical school (odds ratio = 2.54, 95% confidence interval 1.45-4.44, P < .01) while negatively associated with completing a dedicated research experience (odds ratio = 0.31, 95% confidence interval 0.22-0.45, P < .01). CONCLUSION This is the first multi-institutional study exploring resident operative experience and career choice. These data suggest residents who desire immediate practice can tailor their experience with less research time and increased operative volume. These data may be helpful for programs when designing their experience for residents with different career goals.
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Affiliation(s)
- Austin C Hammaker
- Department of Surgery, Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Cincinnati, OH. https://twitter.com/HammakerAustin
| | - Shah-Jahan M Dodwad
- Department of Surgery, McGovern Medical School at UTHealth, Houston, TX. https://twitter.com/shahofsurgery
| | - Christen E Salyer
- Department of Surgery, Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Cincinnati, OH. https://twitter.com/salyerchristen
| | - Sasha D Adams
- Department of Surgery, McGovern Medical School at UTHealth, Houston, TX. https://twitter.com/SashaTrauma
| | - Darci C Foote
- Department of Surgery, Beaumont Health, Royal Oak, MI
| | | | - Sarah Kader
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA
| | - Jonathan S Abelson
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA. https://twitter.com/jabelsonmd
| | - Motaz Al Yafi
- Department of Surgery, University of Toledo, Toledo, OH
| | - Jeffrey M Sutton
- Department of Surgery, Division of Surgical Oncology, Medical University of South Carolina, Charleston, SC. https://twitter.com/J_M_Sutton
| | | | | | | | - Jeffry T Nahmias
- Department of Surgery, University of California, Irvine, Orange, CA. https://twitter.com/jnahmias1
| | - Jalen Harvey
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas TX. https://twitter.com/JHarvMD20
| | - Deborah Farr
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas TX. https://twitter.com/DVFelaine
| | - Zachary M Callahan
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA. https://twitter.com/zmcallahan
| | - Joshua A Marks
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Ali Elsaadi
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Samuel J Campbell
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX
| | | | - Dennis J Hanseman
- Department of Surgery, Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Cincinnati, OH
| | - Purvi Patel
- Department of Surgery, Loyola University, Maywood, IL. https://twitter.com/pppatelmd
| | | | | | - Jitesh A Patel
- Department of Surgery, University of Kentucky, Lexington, KY. https://twitter.com/Patel_Wildcat
| | | | | | | | | | - Nancy L Cho
- Department of Surgery, Brigham and Women's Hospital, Boston, MA. https://twitter.com/NancyLCho
| | - Carol R Thrush
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Mary K Kimbrough
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR. https://twitter.com/kimbrough_katie
| | - Bilal Waqar Nasim
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Ross E Willis
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Brian C George
- Department of Surgery, Center for Surgical Training and Research (CSTAR), University of Michigan, Ann Arbor, MI. https://twitter.com/bcgeorge
| | - Ralph C Quillin
- Department of Surgery, Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Cincinnati, OH
| | - Alexander R Cortez
- Department of Surgery, Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Cincinnati, OH.
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Santosa KB, Lussiez A, Bellomo TR, Matusko N, Gauger PG, Choi JN, Sandhu G. Identifying Strategies for Struggling Surgery Residents. J Surg Res 2022; 273:147-154. [PMID: 35085942 PMCID: PMC10433882 DOI: 10.1016/j.jss.2021.12.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 12/13/2021] [Accepted: 12/27/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Struggling residents are not uncommon in general surgery. Early identification of these residents and effective remediation remain imperfect. MATERIALS AND METHODS We performed a survey of program directors (PD) across all general surgery residencies. Survey questions included the following: demographic information about the program and PD, 10 vignettes about hypothetical residents struggling in various ACGME milestones to assess how PDs would address these deficiencies, and self-reported PD preparedness and availability of resources to support struggling residents. RESULTS In total, we received 82 responses to our survey. All PDs who participated in our study reported having struggling residents in their program. The three most common ways struggling residents are identified were faculty word-of-mouth, formal evaluations such as milestones and ABSITE performance, and resident word-of-mouth. Over 18% of PDs reported having little to no relevant training in addressing the needs of a struggling resident, and 65.9% of PDs did not feel that their program had 'completely adequate' resources to address these needs. In the majority of cases, PDs offer mentorship with themselves or other faculty as a remediation strategy with infrequent use of other resources. CONCLUSIONS Strategies to identify struggling residents and remediation strategies varied widely across programs. Diversifying remediation approaches should be considered for more effective remediation.
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Affiliation(s)
- Katherine B Santosa
- House Officer, Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Alisha Lussiez
- House Officer, General Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - Niki Matusko
- Senior Statistician, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Paul G Gauger
- Professor, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Jennifer N Choi
- Associate Professor, Department of Surgery, Indiana University, Indianapolis, Indiana
| | - Gurjit Sandhu
- Associate Professor, Department of Surgery, University of Michigan, Ann Arbor, Michigan.
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Sommi C, Kogan M, Eberson CP, Mulcahey MK. The Transition to Practice from Residency and Fellowship. JBJS Rev 2022; 10:01874474-202203000-00009. [PMID: 35358116 DOI: 10.2106/jbjs.rvw.21.00191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» There is currently no standard method or time requirement devoted to the teaching of practice management in orthopaedic residency, but there is widespread agreement that it is a necessary part of orthopaedic education. » Overall, there are 3 major components to an effective transition-to-practice model: mock independent practice, appropriate feedback and oversight, and consistent exposure. » An overarching theme is the importance of debriefing by senior faculty, coupled with mock practice scenarios.
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Gutnik LA, Petroze RT. Optimizing US surgical trainees for global engagement. Am J Surg 2021; 223:222-223. [PMID: 34535291 DOI: 10.1016/j.amjsurg.2021.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/09/2021] [Accepted: 09/09/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Lily A Gutnik
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
| | - Robin T Petroze
- Department of Surgery, University of Florida, Gainesville, Fl, USA
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10
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Retired Surgeons as Mentors for Surgical Training Graduates Entering Practice: An Underutilized Resource. Ann Surg 2021; 273:613-617. [PMID: 30907756 DOI: 10.1097/sla.0000000000003272] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Our study evaluated the willingness of retired surgeons to mentor newly trained surgeons. SUMMARY BACKGROUND DATA Although mentoring is very important during the transition in practice, many novice surgeons are faced with inadequacy or lack of mentoring. METHODS A survey regarding mentorship of new surgeons was sent in April 2018 to retired general, colorectal, vascular, and cardiothoracic surgeons that are members of the American College of Surgeons. The analysis of the data was performed in September 2018 and October 2018. RESULTS A total of 2295 of 5282 surveys were completed (43.4% response rate). Mean age was 79.0 ± 0.8 years, mean retirement age was 63.9 ± 0.1 years, and mean interval since retirement was 15.2 ± 0.9 years. Most retired surgeons were in private practice (66.4%), with other practice environments, including academic teaching hospital (12%), academic/private combination (11.3%), employment by community hospital or health system (6.4%), veteran affairs institution (2.7%), military hospital (1%), and Indian Health Service (0.09%). Approximately a third (31.1%) of respondents were not mentored when they first entered practice. The vast majority (98.3%) of participants considered mentoring beneficial during transition in practice. More than half (51.2%) of retired surgeons are interested in mentoring recently trained surgeons, with most of them (81.8%) willing to mentor even for free. CONCLUSION Our findings suggest that a significant number of retired surgeons are enthusiastic about mentoring young surgeons during their transition in practice. Specific programs are necessary to meet the needs of newly hired surgeons and better utilize the expertise of retired surgeons.
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Smith BQ, Woelfel I, Salani R, Harzman A, Chen X. Resident Self-Entrustment and Expectations of Autonomy: OB > GYN? JOURNAL OF SURGICAL EDUCATION 2021; 78:275-281. [PMID: 32753260 DOI: 10.1016/j.jsurg.2020.07.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/17/2020] [Accepted: 07/14/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Entrustment is a key component connecting to resident preparedness for surgical practice in the operating room (OR). Residents' self-entrustment of their surgical competencies closely associates with their OR training experience and granted autonomy. Some recent studies have investigated how attending surgeons entrusted residents in the OR. There is little to no data, however, in examining these issues from the resident perspective. The goal of this study was to identify the perception and expectations of autonomy from residents' perspective, as well as the self-entrustment of their surgical competencies in obstetrics (OB) and gynecologic (GYN) procedures. METHODS Focus group interviews of OB/GYN residents were performed. Residents were selected by convenience sampling. Audio recordings of each interview were transcribed, iteratively analyzed, and emergent themes identified, using a framework method. RESULTS A total of 123 minutes of interviews were recorded. Eight junior residents (PGY1-2) and 12 senior residents (PGY3-4) participated. Our data illustrated that (1) the perception of autonomy shifted significantly throughout residency training; (2) residents demonstrated higher expectations and self-entrustment for OB surgical procedures than for GYN surgical procedures upon graduation; and (3) case volume, modalities of OR teaching and mutual communication are 3 factors influencing resident self-entrustment of their surgical competencies. CONCLUSIONS Residents showed disparities in their self-entrustment and expectations of autonomy between OB and GYN surgical procedures. Better understanding these differences and the 3 influencing factors could help programs develop a potential solution for improvement in resident entrustment and autonomy upon graduation.
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Affiliation(s)
- Brentley Q Smith
- Division of Gynecologic Oncology, The Ohio State University The James Comprehensive Cancer Center, Columbus, Ohio.
| | - Ingrid Woelfel
- Department of General Surgery, The Ohio State University Wexner Medical Center, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ritu Salani
- Division of Gynecologic Oncology, The Ohio State University The James Comprehensive Cancer Center, Columbus, Ohio
| | - Alan Harzman
- Department of General Surgery, The Ohio State University Wexner Medical Center, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Xiaodong Chen
- Department of General Surgery, The Ohio State University Wexner Medical Center, The Ohio State University Wexner Medical Center, Columbus, Ohio
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12
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Donahue CA, Kuhnen AH, Kleiman DA, Marcello PW, Schoetz DJ, Roberts PL, Breen EM, Saraidaridis JT. How to Get Ahead: Early-Career Colorectal Surgeons Reflect on Their First Few Years in Practice. JOURNAL OF SURGICAL EDUCATION 2021; 78:126-133. [PMID: 32660856 DOI: 10.1016/j.jsurg.2020.06.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/04/2020] [Accepted: 06/25/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To identify strategies and barriers to career progression in early-career colorectal surgeons. DESIGN Qualitative research study performed via semi-structured interviews with early-career, board-certified colon, and rectal surgeons. Responses were analyzed, coded, and categorized to understand strategies towards career progression, perceived barriers to career progression, beliefs about case mix, and referral patterns. SETTING Interviews conducted in person and via telephone across the United States and Canada. PARTICIPANTS Early-career board-certified colorectal surgeons RESULTS: Twenty-two board-certified colorectal surgeons currently employed in 14 states and 1 foreign country were interviewed. Fourty-five percent were female. Their current practice environment was described as academic (77%), private practice (18%), or military (5%). Seventy-seven percent of surgeons were satisfied with their career progression. Seventy-two percent were satisfied with the case volume. Seventy-two percent were satisfied with their case mix. When asked about strategies for career progression, surgeons made 77 comments focused on three main themes: optimization of their job search, optimization of relationships while on the job, and efforts to augment individual achievement. When asked about barriers to career advancement, surgeons most frequently commented on a lack of time and a lack of mentors. When asked about case mix, 63% of surgeons felt that they had no control over it. They were evenly divided between believing that a broad case mix or a niche specialized case mix was more instrumental for career progression. CONCLUSIONS Early-career colorectal surgeons were mostly satisfied with their career progression, volume, and case mix. In discussing their careers, many have developed a number of strategies focused on growth as an individual as well as relationship building. They also identified a number of barriers including lack of time and lack of mentorship. Early-career surgeons may be able to utilize these strategies and anticipate barriers prior to starting their first job, leading to greater likelihood of career satisfaction.
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Affiliation(s)
- Colleen A Donahue
- Division of General Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Angela H Kuhnen
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - David A Kleiman
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Peter W Marcello
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - David J Schoetz
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Patricia L Roberts
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Elizabeth M Breen
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Julia T Saraidaridis
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts.
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Stolarski A, He K, Sell N, Chugh P, O'Neal P, Smink DS, Whang E, Kristo G. Mentoring experience of new surgeons during their transition to independent practice: A nationwide survey. Surgery 2020; 169:1354-1360. [PMID: 33384160 DOI: 10.1016/j.surg.2020.11.044] [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: 07/06/2020] [Revised: 09/10/2020] [Accepted: 11/28/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND New surgeons are faced with inadequate mentoring when first entering practice. Our study examined challenges faced by young surgeons during their transition in practice and their mentoring experience when entering practice. METHODS An article-based survey was mailed in August 2019 to general, colorectal, vascular, and cardiothoracic surgeons that became members of the American College of Surgeons within the past 5 years. RESULTS A total of 853 of 2,915 surveys were completed (29.3% response rate). Both female (38%) and male (62%) surgeons participated. The 3 most common challenges during the transition to practice were confidence building (26.0%), adjusting to a new institutional culture (16.9%), and business and administrative aspects of practice (16.3%). First job attrition rate 44.2%, with the mean duration of the first job being 3.28 ± 0.17 years. Nearly one-third (28.3%) of respondents were not mentored when they first entered practice. The proportion of nonmentored young surgeons leaving their first job (64.3%) was almost twice as that of surgeons who received mentoring (36.3%). Furthermore, the mean duration of the first job was significantly shorter in nonmentored versus mentored surgeons (3.16 ± 0.26 vs 3.76 ± 0.25 years; P < .05). A significant number (43.3%) of respondents reported a desire to be mentored by retired surgeons. CONCLUSION Our survey highlights the importance of mentoring for young surgeons during their transition into practice. With many young surgeons being enthusiastic about mentoring by retired surgeons, specific programs are necessary to better use their expertise.
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Affiliation(s)
- Allan Stolarski
- Department of Surgery, Veterans Affairs Boston Healthcare System, Boston, MA; Department of Surgery, Boston Medical Center, Boston University Medical School, Boston, MA
| | - Katherine He
- Department of Surgery, Veterans Affairs Boston Healthcare System, Boston, MA; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Naomi Sell
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Priyanka Chugh
- Department of Surgery, Veterans Affairs Boston Healthcare System, Boston, MA; Department of Surgery, Boston Medical Center, Boston University Medical School, Boston, MA
| | - Patrick O'Neal
- Department of Surgery, Veterans Affairs Boston Healthcare System, Boston, MA; Department of Surgery, Boston Medical Center, Boston University Medical School, Boston, MA
| | - Douglas S Smink
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Edward Whang
- Department of Surgery, Veterans Affairs Boston Healthcare System, Boston, MA; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Gentian Kristo
- Department of Surgery, Veterans Affairs Boston Healthcare System, Boston, MA; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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Satkunasivam R, Klaassen Z, Ravi B, Fok KH, Menser T, Kash B, Miles BJ, Bass B, Detsky AS, Wallis CJD. Relation between surgeon age and postoperative outcomes: a population-based cohort study. CMAJ 2020; 192:E385-E392. [PMID: 32392499 DOI: 10.1503/cmaj.190820] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Aging may detrimentally affect cognitive and motor function. However, age is also associated with experience, and how these factors interplay and affect outcomes following surgery is unclear. We sought to evaluate the effect of surgeon age on postoperative outcomes in patients undergoing common surgical procedures. METHODS We performed a retrospective cohort study of patients undergoing 1 of 25 common surgical procedures in Ontario, Canada, from 2007 to 2015. We evaluated the association between surgeon age and a composite outcome of death, readmission and complications. We used generalized estimating equations for analysis, accounting for relevant patient-, procedure-, surgeon- and hospital-level factors. RESULTS We found 1 159 676 eligible patients who were treated by 3314 surgeons and ranged in age from 27 to 81 years. Modelled as a continuous variable, a 10-year increase in surgeon age was associated with a 5% relative decreased odds of the composite outcome (adjusted odds ratio [OR] 0.95, 95% confidence interval [CI] 0.92 to 0.98, p = 0.002). Considered dichotomously, patients receiving treatment from surgeons who were older than 65 years of age had a 7% lower odds of adverse outcomes (adjusted OR 0.93, 95% CI 0.88-0.97, p = 0.03; crude absolute difference = 3.1%). INTERPRETATION We found that increasing surgeon age was associated with decreasing rates of postoperative death, readmission and complications in a nearly linear fashion after accounting for patient-, procedure-, surgeon- and hospital-level factors. Further evaluation of the mechanisms underlying these findings may help to improve patient safety and outcomes, and inform policy about maintenance of certification and retirement age for surgeons.
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Affiliation(s)
- Raj Satkunasivam
- Department of Urology (Satkunasivam, Miles) and Center for Outcomes Research (Satkunasivam, Menser, Kash, Bass), Houston Methodist Hospital, Houston, Tex.; Division of Urology (Klaassen), Medical College of Georgia - Augusta University, Augusta, Ga.; Division of Orthopedic Surgery (Ravi), Department of Surgery, and Sunnybrook Health Sciences, Centre, and Division of Urology (Fok, Wallis), Department of Surgery, University of Toronto, Toronto, Ont.; Department of Health Policy and Management (Kash), School of Public Health, Texas A&M University, College Station Tex.; Department of Surgery (Menser, Bass), Houston Methodist Hospital, Houston, Tex.; Institute for Health Policy, Management and Evaluation and Department of Medicine (Detsky), University of Toronto; Department of Medicine (Detsky), Mount Sinai Hospital and University Health Network, Toronto, Ont.; Department of Urology (Wallis), Vanderbilt University Medical Center, Nashville, Tenn.
| | - Zachary Klaassen
- Department of Urology (Satkunasivam, Miles) and Center for Outcomes Research (Satkunasivam, Menser, Kash, Bass), Houston Methodist Hospital, Houston, Tex.; Division of Urology (Klaassen), Medical College of Georgia - Augusta University, Augusta, Ga.; Division of Orthopedic Surgery (Ravi), Department of Surgery, and Sunnybrook Health Sciences, Centre, and Division of Urology (Fok, Wallis), Department of Surgery, University of Toronto, Toronto, Ont.; Department of Health Policy and Management (Kash), School of Public Health, Texas A&M University, College Station Tex.; Department of Surgery (Menser, Bass), Houston Methodist Hospital, Houston, Tex.; Institute for Health Policy, Management and Evaluation and Department of Medicine (Detsky), University of Toronto; Department of Medicine (Detsky), Mount Sinai Hospital and University Health Network, Toronto, Ont.; Department of Urology (Wallis), Vanderbilt University Medical Center, Nashville, Tenn
| | - Bheeshma Ravi
- Department of Urology (Satkunasivam, Miles) and Center for Outcomes Research (Satkunasivam, Menser, Kash, Bass), Houston Methodist Hospital, Houston, Tex.; Division of Urology (Klaassen), Medical College of Georgia - Augusta University, Augusta, Ga.; Division of Orthopedic Surgery (Ravi), Department of Surgery, and Sunnybrook Health Sciences, Centre, and Division of Urology (Fok, Wallis), Department of Surgery, University of Toronto, Toronto, Ont.; Department of Health Policy and Management (Kash), School of Public Health, Texas A&M University, College Station Tex.; Department of Surgery (Menser, Bass), Houston Methodist Hospital, Houston, Tex.; Institute for Health Policy, Management and Evaluation and Department of Medicine (Detsky), University of Toronto; Department of Medicine (Detsky), Mount Sinai Hospital and University Health Network, Toronto, Ont.; Department of Urology (Wallis), Vanderbilt University Medical Center, Nashville, Tenn
| | - Kai-Ho Fok
- Department of Urology (Satkunasivam, Miles) and Center for Outcomes Research (Satkunasivam, Menser, Kash, Bass), Houston Methodist Hospital, Houston, Tex.; Division of Urology (Klaassen), Medical College of Georgia - Augusta University, Augusta, Ga.; Division of Orthopedic Surgery (Ravi), Department of Surgery, and Sunnybrook Health Sciences, Centre, and Division of Urology (Fok, Wallis), Department of Surgery, University of Toronto, Toronto, Ont.; Department of Health Policy and Management (Kash), School of Public Health, Texas A&M University, College Station Tex.; Department of Surgery (Menser, Bass), Houston Methodist Hospital, Houston, Tex.; Institute for Health Policy, Management and Evaluation and Department of Medicine (Detsky), University of Toronto; Department of Medicine (Detsky), Mount Sinai Hospital and University Health Network, Toronto, Ont.; Department of Urology (Wallis), Vanderbilt University Medical Center, Nashville, Tenn
| | - Terri Menser
- Department of Urology (Satkunasivam, Miles) and Center for Outcomes Research (Satkunasivam, Menser, Kash, Bass), Houston Methodist Hospital, Houston, Tex.; Division of Urology (Klaassen), Medical College of Georgia - Augusta University, Augusta, Ga.; Division of Orthopedic Surgery (Ravi), Department of Surgery, and Sunnybrook Health Sciences, Centre, and Division of Urology (Fok, Wallis), Department of Surgery, University of Toronto, Toronto, Ont.; Department of Health Policy and Management (Kash), School of Public Health, Texas A&M University, College Station Tex.; Department of Surgery (Menser, Bass), Houston Methodist Hospital, Houston, Tex.; Institute for Health Policy, Management and Evaluation and Department of Medicine (Detsky), University of Toronto; Department of Medicine (Detsky), Mount Sinai Hospital and University Health Network, Toronto, Ont.; Department of Urology (Wallis), Vanderbilt University Medical Center, Nashville, Tenn
| | - Bita Kash
- Department of Urology (Satkunasivam, Miles) and Center for Outcomes Research (Satkunasivam, Menser, Kash, Bass), Houston Methodist Hospital, Houston, Tex.; Division of Urology (Klaassen), Medical College of Georgia - Augusta University, Augusta, Ga.; Division of Orthopedic Surgery (Ravi), Department of Surgery, and Sunnybrook Health Sciences, Centre, and Division of Urology (Fok, Wallis), Department of Surgery, University of Toronto, Toronto, Ont.; Department of Health Policy and Management (Kash), School of Public Health, Texas A&M University, College Station Tex.; Department of Surgery (Menser, Bass), Houston Methodist Hospital, Houston, Tex.; Institute for Health Policy, Management and Evaluation and Department of Medicine (Detsky), University of Toronto; Department of Medicine (Detsky), Mount Sinai Hospital and University Health Network, Toronto, Ont.; Department of Urology (Wallis), Vanderbilt University Medical Center, Nashville, Tenn
| | - Brian J Miles
- Department of Urology (Satkunasivam, Miles) and Center for Outcomes Research (Satkunasivam, Menser, Kash, Bass), Houston Methodist Hospital, Houston, Tex.; Division of Urology (Klaassen), Medical College of Georgia - Augusta University, Augusta, Ga.; Division of Orthopedic Surgery (Ravi), Department of Surgery, and Sunnybrook Health Sciences, Centre, and Division of Urology (Fok, Wallis), Department of Surgery, University of Toronto, Toronto, Ont.; Department of Health Policy and Management (Kash), School of Public Health, Texas A&M University, College Station Tex.; Department of Surgery (Menser, Bass), Houston Methodist Hospital, Houston, Tex.; Institute for Health Policy, Management and Evaluation and Department of Medicine (Detsky), University of Toronto; Department of Medicine (Detsky), Mount Sinai Hospital and University Health Network, Toronto, Ont.; Department of Urology (Wallis), Vanderbilt University Medical Center, Nashville, Tenn
| | - Barbara Bass
- Department of Urology (Satkunasivam, Miles) and Center for Outcomes Research (Satkunasivam, Menser, Kash, Bass), Houston Methodist Hospital, Houston, Tex.; Division of Urology (Klaassen), Medical College of Georgia - Augusta University, Augusta, Ga.; Division of Orthopedic Surgery (Ravi), Department of Surgery, and Sunnybrook Health Sciences, Centre, and Division of Urology (Fok, Wallis), Department of Surgery, University of Toronto, Toronto, Ont.; Department of Health Policy and Management (Kash), School of Public Health, Texas A&M University, College Station Tex.; Department of Surgery (Menser, Bass), Houston Methodist Hospital, Houston, Tex.; Institute for Health Policy, Management and Evaluation and Department of Medicine (Detsky), University of Toronto; Department of Medicine (Detsky), Mount Sinai Hospital and University Health Network, Toronto, Ont.; Department of Urology (Wallis), Vanderbilt University Medical Center, Nashville, Tenn
| | - Allan S Detsky
- Department of Urology (Satkunasivam, Miles) and Center for Outcomes Research (Satkunasivam, Menser, Kash, Bass), Houston Methodist Hospital, Houston, Tex.; Division of Urology (Klaassen), Medical College of Georgia - Augusta University, Augusta, Ga.; Division of Orthopedic Surgery (Ravi), Department of Surgery, and Sunnybrook Health Sciences, Centre, and Division of Urology (Fok, Wallis), Department of Surgery, University of Toronto, Toronto, Ont.; Department of Health Policy and Management (Kash), School of Public Health, Texas A&M University, College Station Tex.; Department of Surgery (Menser, Bass), Houston Methodist Hospital, Houston, Tex.; Institute for Health Policy, Management and Evaluation and Department of Medicine (Detsky), University of Toronto; Department of Medicine (Detsky), Mount Sinai Hospital and University Health Network, Toronto, Ont.; Department of Urology (Wallis), Vanderbilt University Medical Center, Nashville, Tenn
| | - Christopher J D Wallis
- Department of Urology (Satkunasivam, Miles) and Center for Outcomes Research (Satkunasivam, Menser, Kash, Bass), Houston Methodist Hospital, Houston, Tex.; Division of Urology (Klaassen), Medical College of Georgia - Augusta University, Augusta, Ga.; Division of Orthopedic Surgery (Ravi), Department of Surgery, and Sunnybrook Health Sciences, Centre, and Division of Urology (Fok, Wallis), Department of Surgery, University of Toronto, Toronto, Ont.; Department of Health Policy and Management (Kash), School of Public Health, Texas A&M University, College Station Tex.; Department of Surgery (Menser, Bass), Houston Methodist Hospital, Houston, Tex.; Institute for Health Policy, Management and Evaluation and Department of Medicine (Detsky), University of Toronto; Department of Medicine (Detsky), Mount Sinai Hospital and University Health Network, Toronto, Ont.; Department of Urology (Wallis), Vanderbilt University Medical Center, Nashville, Tenn
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Perceptions of Preparedness in Plastic Surgery Residency Training. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3163. [PMID: 33173679 PMCID: PMC7647638 DOI: 10.1097/gox.0000000000003163] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/10/2020] [Indexed: 12/26/2022]
Abstract
Supplemental Digital Content is available in the text. Graduating competent surgical residents requires progressive independence during training. Recent studies in other surgical subspecialties have demonstrated overall fewer opportunities for resident independence due to changes in residency regulations, medical–legal concerns, and financial incentives. A survey study was conducted to assess perceived autonomy and preparedness during plastic surgery residency training and to assess factors affecting autonomy.
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Sanaee L, Nayer M, Takahashi SG. Practical solutions for implementation of Transition to Practice curricula in a competency-based medical education model. CANADIAN MEDICAL EDUCATION JOURNAL 2020; 11:e39-e50. [PMID: 32821301 PMCID: PMC7417824 DOI: 10.36834/cmej.67821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Although transition from residency to practice represents a critical learning stage, there is a paucity of literature to inform local curriculum development and implementation. OBJECTIVES To describe local curriculum development for Transition to Practice (TTP) for use within a competency-based medical education model, including important content and suitable teaching and assessment strategies. DESIGN We reviewed the literature to construct a definition and develop initial curriculum content for TTP. We then gathered local residency program directors' views on TTP content, teaching, and assessment via online survey and an international educational conference workshop. RESULTS We identified 21 important TTP content areas in the literature and analyzed 35 survey responses, representing 33 residency programs. Survey participants viewed Further sophistication of clinical skills, How to set up a practice, and Time management skills as the three most important content areas. Views on content importance varied by program. For teaching and assessment strategies, most respondents preferred: assessing what residents could do, providing real-life practice opportunities, and offering workplace-based assessments. CONCLUSIONS TTP curricula implementation should reflect nationally set, specialty-specific curriculum elements; locally developed priority content; and assessment and teaching strategies. Individual learner needs and imminent practice context should guide faculty approaches to curriculum delivery.Résumé.
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Affiliation(s)
- Layli Sanaee
- Department of Medicine, Division of Emergency Medicine, University of Toronto, Ontario, Canada
- University Health Network, Ontario, Canada
| | - Marla Nayer
- Department of Postgraduate Medical Education, University of Toronto, Ontario, Canada
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Meyers MO, Charles AG. Transitions in surgical education. Surgery 2019; 167:895-898. [PMID: 31732126 DOI: 10.1016/j.surg.2019.08.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 08/28/2019] [Accepted: 08/30/2019] [Indexed: 10/25/2022]
Abstract
There are multiple transitions in surgical education. Among the most significant are those from medical student to intern, from junior resident to senior resident, and from senior resident/fellow to independent practice. While there are new expectations and responsibilities associated with each of these roles, a surgeon's development should be thought of as more of a continuum with distinct points of greatest change and challenge. There are common themes at these various transitions that may be highlighted for both trainees and educators.
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Affiliation(s)
- Michael O Meyers
- Department of Surgery, The University of North Carolina at Chapel Hill School of Medicine, NC.
| | - Anthony G Charles
- Department of Surgery, The University of North Carolina at Chapel Hill School of Medicine, NC
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Hoops HE, Deveney KE, Brasel KJ. Development of an Assessment Tool for Surgeons in Their First Year of Independent Practice: The Junior Surgeon Performance Assessment Tool. JOURNAL OF SURGICAL EDUCATION 2019; 76:e199-e208. [PMID: 31420272 DOI: 10.1016/j.jsurg.2019.08.001] [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: 03/21/2019] [Revised: 07/04/2019] [Accepted: 08/03/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The purpose of this study was to create an assessment tool to evaluate newly practicing surgeons. DESIGN In this prospective mixed methods study, a needs assessment was performed by conducting focus groups with practicing general surgeons, asking questions regarding essential surgeon qualities, behaviors observed in inexperienced surgeons, current assessment methods, and desired assessment tool elements and attributes. A qualitative analysis was performed using a grounded theory methodology. The Junior Surgeon Performance Assessment Tool (JSPAT) was created using a 4-point scale for each category developed, with themes identified in the qualitative analysis used to create behavioral anchors. The JSPAT was evaluated by focus group participants and by members of the American College of Surgeons Advisory Council for Rural Surgery using an online survey. SETTING Rural and nonuniversity-based hospitals throughout the state of Oregon. PARTICIPANTS Practicing general surgeons. RESULTS Focus groups consisted of 31 surgeons (mean age 49, mean experience 17 years) from 11 different hospitals. Qualitative analysis revealed 91 different themes, which were grouped into 5 domains (technical skills, interaction with patients, interaction with surgeon colleagues, interactions with the greater medical community, and self-care) to create the assessment tool. Twenty online survey responses providing feedback on the assessment tool were obtained, with 75% rating the JSPAT useful or very useful and 69% satisfied or very satisfied with the time to complete the tool. CONCLUSIONS A mixed-methods model was used to create an assessment tool for surgeons in their first year of independent practice. Survey data demonstrated that practicing surgeons find value in the JSPAT.
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Affiliation(s)
- Heather E Hoops
- Oregon Health & Sciences University, Department of Surgery, Portland, Oregon
| | - Karen E Deveney
- Oregon Health & Sciences University, Department of Surgery, Portland, Oregon
| | - Karen J Brasel
- Oregon Health & Sciences University, Department of Surgery, Portland, Oregon.
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Fiedler AG, Sihag S. Entering the great unknown: Transition to academic practice. J Thorac Cardiovasc Surg 2019; 159:1156-1160. [PMID: 31648832 DOI: 10.1016/j.jtcvs.2019.09.076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/05/2019] [Accepted: 09/12/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Amy G Fiedler
- Division of Cardiothoracic Surgery, Department of Surgery, University of Wisconsin, Madison, Wis.
| | - Smita Sihag
- Division of Thoracic Surgery, Department of Surgery, Memorial Sloan Kettering, New York, NY
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Allen M, Gawad N, Park L, Raîche I. The Educational Role of Autonomy in Medical Training: A Scoping Review. J Surg Res 2019; 240:1-16. [DOI: 10.1016/j.jss.2019.02.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 01/30/2019] [Accepted: 02/22/2019] [Indexed: 12/18/2022]
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Huynh C, Wong-Chong N, Vourtzoumis P, Lim S, Marini W, Johal G, Strickland M, Madani A. The future of general surgery training: A Canadian resident nationwide Delphi consensus statement. Surgery 2019; 166:726-734. [PMID: 31280867 DOI: 10.1016/j.surg.2019.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/12/2019] [Accepted: 04/24/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Several models have been introduced to improve and restructure surgical training, but continued barriers exist. Residents are uniquely positioned to offer perspective on practical challenges and needs of reformatting surgical education. This study aimed to establish a nationwide, Delphi consensus statement on the perceptions of Canadian residents regarding the future of general surgery training. METHODS Canadian general surgery residents participated in a moderated focus group using the Nominal Group Technique to discuss early subspecialization, competency-based medical education, and transition to practice. Qualitative verbal data were transcribed, categorized into themes, and synthesized into recommendation statements. During an iterative Delphi survey, resident leaders ranked each statement on a 5-point Likert scale of agreement. The survey was terminated once consensus was achieved (≥2 survey rounds and Cronbach's α ≥ 0.80). RESULTS A total of 66 statements were synthesized by 16 members of the Canadian Association of General Surgeons Resident Committee. A total of 49 residents participated in the Delphi consensus, which was achieved after 2 voting rounds (Cronbach's α = 0.93). Participants agreed that (1) residency should focus on achieving standardized competencies and milestones based on resident ability to meet specific measurable metrics, (2) early streaming should be offered after "core" milestones and competencies have been achieved, and (3) an explicit period should allow transition-to-independent practice with tailored rotations, greater autonomy, and resident-run clinics. We identified 10 barriers to competency-based medical education implementation. CONCLUSION A nationwide consensus regarding the future of surgical training was established among current residents. These findings can inform and help implement guidelines and national curricula that meet the needs of the trainee and address the many challenges they face during their training.
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Affiliation(s)
- Caroline Huynh
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | | | | | - Stephanie Lim
- Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Wanda Marini
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Gurp Johal
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Matt Strickland
- Department of Surgery, University of Manitoba, Winnipeg, MB, Canada; Department of Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA
| | - Amin Madani
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York City, NY, USA.
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Abstract
Orthopaedic resident educators confront many important issues. This may be the most challenging time yet for orthopaedic education. A survey of program directors and chairs aimed to identify the major challenges in orthopaedic education. Many issues were identified, and the following four major themes emerged: (1) loss of professionalism, (2) too much emphasis on procedures, (3) lack of clinical experience, and (4) challenges with external oversight. Professionalism in taking care of patients may be compromised by work-hour limitations and affected by generational differences. Limitations to progressive, graduated responsibility include internal and external factors, resulting in a lack of opportunity. Overemphasis on case volume fosters a training environment where technical skill is seen as most important and can detract from teaching the basic principles of being a doctor, including shared decision making. This paper explores these major challenges to orthopaedic resident education in 2018. Substantial changes will be required to address these challenges, but better understanding of the issues they face should help educators identify, minimize, or ideally avoid threats to optimal resident education.
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Watkins L, DiMeglio M, Laudanski K. Self-Assessment of Preparedness among Critical Care Trainees Transitioning from Fellowship to Practice. Healthcare (Basel) 2019; 7:healthcare7020074. [PMID: 31151167 PMCID: PMC6628175 DOI: 10.3390/healthcare7020074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 05/26/2019] [Accepted: 05/28/2019] [Indexed: 11/16/2022] Open
Abstract
This study evaluated the subjective assessment of preparedness needs of critical care trainees and recent graduates between 2013 and 2014. A questionnaire was developed and validated by the subcommittee of the In-Training Section of Society of Critical Care Medicine (SCCM). The survey was deployed twice between December 2013 and January 2014 via email to any trainee or individual graduated from a critical care fellowship within the previous three years. Six percent (180) of all individuals completed the survey, and 67% of respondents had recently interviewed for a job. Northeast was the preferred location for a job (47%), and academia was favored over private practice (80% vs. 15%). Of the respondents that secured an interview, 55% felt prepared for the interview, 67% felt prepared to build an adequate job portfolio, 33% received formal guidance from their mentor/training program. 89% of total respondents agreed it is important to participate in a formal training course in job search, portfolio development, and interviewing process. The preferred sources of training were equally distributed between their home institution, webinars, and SCCM. There is an ongoing need in education regarding the transition period from fellowship to practice.
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Affiliation(s)
- Laura Watkins
- Department of Pediatrics/Critical Care, School of Medicine and Dentistry, University of Rochester Medical Center, 601 Elmwood Ave, Box 667, Rochester, NY 14642, USA.
| | - Matthew DiMeglio
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA 19131, USA.
| | - Krzysztof Laudanski
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
- Leonard Davis Institute of Health Economics, Philadelphia, PA 19104, USA.
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Sridhar P, Sanchez SE, DiPasco PJ, Novak L, Dechert T, Brahmbhatt TS. Educator and Trainee Perspectives on the Need for a “Real World” Curriculum in General Surgery. J Surg Res 2019; 233:268-275. [DOI: 10.1016/j.jss.2018.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/23/2018] [Accepted: 08/01/2018] [Indexed: 11/27/2022]
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Hoops HE, Burt MR, Deveney K, Brasel KJ. What They May Not Tell You and You May Not Know to Ask: What is Expected of Surgeons in Their First Year of Independent Practice. JOURNAL OF SURGICAL EDUCATION 2018; 75:e134-e141. [PMID: 30318300 DOI: 10.1016/j.jsurg.2018.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 08/09/2018] [Accepted: 09/18/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The objective of this study was to explore the views and expectations that practicing general surgeons have of their junior colleagues who have recently finished training. DESIGN This is a qualitative study performed using focus group data consisting of open-ended questions concentrating on essential qualities and attributes of surgeons, behaviors observed in newly-graduated surgeons, and appropriate oversight of junior partners. Qualitative analysis was performed using grounded theory methodology with transcripts coded by 3 independent reviewers. SETTING Focus groups were conducted with surgeons practicing in rural and urban community settings. PARTICIPANTS Focus groups consisted of practicing general surgeons throughout the state of Oregon. RESULTS Focus groups were comprised of 31 practicing surgeons (10 female, 21 male) with varying ages and levels of experience practicing in both rural and urban environments. Qualitative analysis revealed the need for surgeons with strong interpersonal skills, teamwork, judgment, and broad technical skills who possess the appropriate amount of confidence and know when to ask for help. Frequently noted themes identified, included not knowing when to ask for help, overconfidence or underconfidence, as well as lack of judgment and lack of either quality or breadth of technical skill. Current oversight included direct observation, subjective evaluations from staff and colleagues, analysis of outcomes/quality, and either formal or informal mentorship arrangements. CONCLUSIONS This study highlights the need for graduating surgeons to be competent in multiple domains. The importance of knowing when to ask for help was stressed by practicing surgeons in both the rural and urban community setting, but is underemphasized in residency training, possibly due to less indirect resident supervision. Surgeons also emphasized the importance of mentorship, as professional growth continues long after completion of training.
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Affiliation(s)
- Heather E Hoops
- Department of Surgery, Oregon Health and Science University, Portland, Oregon.
| | - Michael R Burt
- Department of Surgery, Oregon Health and Science University, Portland, Oregon
| | - Karen Deveney
- Department of Surgery, Oregon Health and Science University, Portland, Oregon
| | - Karen J Brasel
- Department of Surgery, Oregon Health and Science University, Portland, Oregon
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Corbetta L, Arru LB, Mereu C, Pasini V, Patelli M. Competence and training in interventional pulmonology. Panminerva Med 2018; 61:203-231. [PMID: 30394710 DOI: 10.23736/s0031-0808.18.03562-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Interventional pulmonology (IP) is experiencing a rapid evolution of new technologies. There is a need to develop structured training programs, organized in high volume expert centers in order to improve trainee education, and including the development of validated metrics for their competency assessment. Concerning teaching methods, a gradual progression from theory to practice, using new teaching techniques, including live sessions and low and high-fidelity simulation, flipped classroom models and problem-based learning (PBL) exercises would provide a training setting more suitable for our current need to improve skills and update professionals. Training programs should be learner-centered and competence-oriented, as well as being based on a spiral-shaped approach in which the same subject is addressed many times, from new and different perspectives of knowledge, ability, behavior and attitude, until the trainee has demonstrated a high degree of skill and professionalism. Furthermore there is a need to standardize the training programs as guide for physicians wishing to undertake a gradual and voluntary improvement of their own competencies, and assist those planning and organizing training programs in IP. The article includes a general part on core curriculum contents, innovative training methods and simulation, and introduces the following articles on the skills that the Interventional Pulmonologist must master in order to perform the different procedures. This monography should be considered a starting point that will evolve over time and results in better training for practitioners and better care for our patients. The task of establishing a trainee's competence to practice independently as an Interventional Pulmonologist remains the responsibility of the IP fellowship program director and faculty, who validate logbooks and assess competence for each procedure. These standards need to be reviewed and approved by national and International Scientific Societies and Healthcare Institutions with the aim to improve, disseminate and incorporate them in healthcare programs.
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Affiliation(s)
- Lorenzo Corbetta
- Unit of Interventional Pulmonology, Department of Experimental and Clinical Medicine, University Hospital of Careggi, University of Florence, Florence, Italy -
| | - Luigi B Arru
- Council of Health of the Region Sardinia, Cagliari, Italy
| | - Carlo Mereu
- Unit of Pneumology, ASL 2 Savonese, Savona, Italy
| | - Valeria Pasini
- Interventional Pulmonary Program, University of Florence, Florence, Italy
| | - Marco Patelli
- Unit of Interventional Pulmonology, University of Florence and Bologna, Florence, Italy
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Sachdeva AK. Educational interventions aimed at the transition from surgical training to surgical practice. Am J Surg 2018; 217:406-409. [PMID: 30309620 DOI: 10.1016/j.amjsurg.2018.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 09/14/2018] [Indexed: 11/20/2022]
Abstract
The transition from surgical training to surgical practice is a critical juncture in the career progression of surgeons. This period is associated with myriad challenges that need to be addressed through specific educational interventions to ensure delivery of safe care to patients and to support the career aspirations of junior surgeons entering the practice environment. These interventions should be based on principles of contemporary surgical education and training, and focus on the needs of surgery residents and junior surgeons entering practice. The specific systems of patient care in which the junior surgeons will work should also be considered while planning and implementing such educational interventions. Senior surgeon colleagues within these systems should play key roles in supporting the junior surgeons entering practice, and may require special training to serve as effective mentors, preceptors, and coaches. Professional societies should play a key role in establishing national standards regarding the educational programs aimed at this transition and develop programs to complement local efforts to address various needs. The American College of Surgeons Division of Education has developed a spectrum of innovative programs that are aimed at this important transition.
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Affiliation(s)
- Ajit K Sachdeva
- Division of Education, American College of Surgeons, 633 N. Saint Clair Street, Chicago, IL, 60611, USA.
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Agyeman KD, Dodds SD, Klein JS, Baraga MG, Hernandez VH, Conway S. Innovation in Resident Education: What Orthopaedic Surgeons Can Learn from Other Disciplines. J Bone Joint Surg Am 2018; 100:e90. [PMID: 29975267 DOI: 10.2106/jbjs.17.00839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Kofi D Agyeman
- Department of Orthopaedic Surgery and Rehabilitation, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Seth D Dodds
- Department of Orthopaedic Surgery and Rehabilitation, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Jason S Klein
- Department of Orthopaedic Surgery and Rehabilitation, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Michael G Baraga
- Department of Orthopaedic Surgery and Rehabilitation, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Victor H Hernandez
- Department of Orthopaedic Surgery and Rehabilitation, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Sheila Conway
- Department of Orthopaedic Surgery and Rehabilitation, University of Miami/Jackson Memorial Hospital, Miami, Florida
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Dahn H, Watts K, Best L, Bowes D. Transition to practice: creation of a transitional rotation for radiation oncology. CANADIAN MEDICAL EDUCATION JOURNAL 2018; 9:e89-e96. [PMID: 30140351 PMCID: PMC6104325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Implementation of Competence by Design (CBD) will require residency training programs to develop formalized "Transition to Practice" (TTP) experiences. A multidisciplinary group of Radiation Oncology stakeholders from tertiary care centres in Atlantic Canada were surveyed regarding a proposed TTP rotation. METHODS The survey asked participants to quantitatively rank various learning objectives based on defined CanMEDS skills that are expected to be mastered by a graduating resident. Mean perceived importance scores were calculated for each objective as well as for their CanMEDS category. Specific written qualitative feedback was also collected. RESULTS The survey was circulated to 59 participants with a response rate of 73%. The three objectives with the highest mean importance score were "Independently assessing and managing patients seen in consultation," "Developing and demonstrating communication skills with patients at an advanced level," and "Independently assessing and managing follow up patients," respectively from highest to lowest. The CanMEDS roles with the highest importance score was "Communicator." CONCLUSION Quantitative and qualitative data from a multidisciplinary survey based on CanMEDS roles guided the implementation of a TTP rotation for PGY-5 residents at a tertiary care centre in Atlantic Canada. These results may be relevant to other training programs developing TTP experiences.
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Affiliation(s)
- Hannah Dahn
- Department of Radiology Oncology, Dalhousie University, Nova Scotia, Canada
| | - Karen Watts
- Department of Radiology Oncology, Dalhousie University, Nova Scotia, Canada
| | - Lara Best
- Department of Radiology Oncology, Dalhousie University, Nova Scotia, Canada
| | - David Bowes
- Department of Radiology Oncology, Dalhousie University, Nova Scotia, Canada
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Competence, Confidence, and Certification: Observations from Both Sides of the Aisle. Dig Dis Sci 2018; 63:1690-1693. [PMID: 29725792 DOI: 10.1007/s10620-018-5105-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Kovatch KJ, Prince MEP, Sandhu G. Weighing Entrustment Decisions with Patient Care during Residency Training. Otolaryngol Head Neck Surg 2018; 158:1024-1027. [PMID: 29558240 DOI: 10.1177/0194599818764652] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Kevin J Kovatch
- 1 Department of Otolaryngology-Head & Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Mark E P Prince
- 1 Department of Otolaryngology-Head & Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Gurjit Sandhu
- 2 Department of Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
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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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Khubchandani JA, Shen C, Ayturk D, Kiefe CI, Santry HP. Disparities in access to emergency general surgery care in the United States. Surgery 2018; 163:243-250. [PMID: 29050886 PMCID: PMC6071308 DOI: 10.1016/j.surg.2017.07.026] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/13/2017] [Accepted: 07/27/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND As fewer surgeons take emergency general surgery call and hospitals decrease emergency services, a crisis in access looms in the United States. We examined national emergency general surgery capacity and county-level determinants of access to emergency general surgery care with special attention to disparities. METHODS To identify potential emergency general surgery hospitals, we queried the database of the American Hospital Association for "acute care general hospital," with "surgical services," and "emergency department," and ≥1 "operating room." Internet search and direct contact confirmed emergency general surgery services that covered the emergency room 7 days a week, 24 hours a day. Geographic and population-level emergency general surgery access was derived from Geographic Information Systems and US Census. RESULTS Of the 6,356 hospitals in the 2013 American Hospital Association database, only 2,811 were emergency general surgery hospitals. Counties with greater percentages of black, Hispanic, uninsured, and low-education individuals and rural counties disproportionately lacked access to emergency general surgery care. For example, counties above the 75th percentile of African American population (10.2%) had >80% odds of not having an emergency general surgery hospital compared with counties below the 25th percentile of African American population (0.6%). CONCLUSION Gaps in access to emergency general surgery services exist across the United States, disproportionately affecting underserved, rural communities. Policy initiatives need to increase emergency general surgery capacity nationwide.
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Affiliation(s)
| | | | - Didem Ayturk
- Department of Surgery, University of Massachusetts Medical School, Worcester, MA; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Catarina I Kiefe
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Heena P Santry
- Department of Surgery, Ohio State University, Columbus, OH.
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Meyerson SL, Sternbach JM, Zwischenberger JB, Bender EM. The Effect of Gender on Resident Autonomy in the Operating room. JOURNAL OF SURGICAL EDUCATION 2017; 74:e111-e118. [PMID: 28669788 DOI: 10.1016/j.jsurg.2017.06.014] [Citation(s) in RCA: 154] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 06/13/2017] [Indexed: 05/08/2023]
Abstract
OBJECTIVE Discrimination against women training in medicine and surgery has been subjectively described for decades. This study objectively documents gender differences in the degree of autonomy given to thoracic surgery trainees in the operating room. DESIGN Thoracic surgery residents and faculty underwent frame of reference training on the use of the 4-point Zwisch scale to measure operative autonomy. Residents and faculty then submitted evaluations of their perception of autonomy granted for individual operations as well as operative difficulty on a real-time basis using the "Zwisch Me!!" mobile application. Differences in autonomy given to male and female residents were elucidated using chi-square analysis and ordered logistic regression. SETTING Seven academic medical centers with thoracic surgery training programs. PARTICIPANTS Volunteer thoracic surgery residents in both integrated and traditional training pathways and their affiliated cardiothoracic faculty. RESULTS Residents (n = 33, female 18%) submitted a total of 596 evaluations to faculty (n = 48, female 12%). Faculty gave less autonomy to female residents with only 56 of 184 evaluations (30.3%) showing meaningful autonomy (passive help or supervision only) compared to 107 of 292 evaluations (36.7%) at those levels for male residents (p = 0.02). Resident perceptions of autonomy showed even more pronounced differences with female residents receiving only 38 of 197 evaluations (19.3%) with meaningful autonomy compared to 133 of 399 evaluations (33.3%) for male residents (p < 0.001). Potential influencing factors explored included attending gender and specialty, case type and difficulty, and resident level of training. In multivariate analysis, only case difficultly, resident gender, and level of training were significantly related to autonomy granted to residents. CONCLUSIONS Evaluations of operative autonomy reveal a significant bias against female residents. Faculty education is needed to encourage allowing female residents more operative autonomy.
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Affiliation(s)
- Shari L Meyerson
- Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
| | - Joel M Sternbach
- Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | | | - Edward M Bender
- Department of Cardiothoracic Surgery, Stanford University, Palo Alto, California
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Chen XP, Sullivan AM, Alseidi A, Kwakye G, Smink DS. Assessing Residents' Readiness for OR Autonomy: A Qualitative Descriptive Study of Expert Surgical Teachers' Best Practices. JOURNAL OF SURGICAL EDUCATION 2017; 74:e15-e21. [PMID: 28712687 DOI: 10.1016/j.jsurg.2017.06.034] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 05/26/2017] [Accepted: 06/27/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE Providing resident autonomy in the operating room (OR) is one of the major challenges for surgical educators today. The purpose of this study was to explore what approaches expert surgical teachers use to assess residents' readiness for autonomy in the OR. We particularly focused on the assessments that experts make prior to conducting the surgical time-out. METHODS We conducted semistructured in-depth interviews with expert surgical teachers from March 2016 to September 2016. Purposeful sampling and snowball sampling were applied to identify and recruit expert surgical teachers from general surgery residency programs across the United States to represent a range of clinical subspecialties. All interviews were audio-recorded, deidentified, and transcribed. We applied the Framework Method of content analysis, discussed and reached final consensus on the themes. RESULTS We interviewed 15 expert teachers from 9 institutions. The majority (13/15) were Program or Associate Program Directors; 47% (7/15) primarily performed complex surgical operations (e.g., endocrine surgery). Five themes regarding how expert surgical teachers determine residents' readiness for OR autonomy before the surgical time-out emerged. These included 3 domains of evidence elicited about the resident (resident characteristics, medical knowledge, and beyond the current OR case), 1 variable relating to attending characteristics, and 1 variable composed of contextual factors. Experts obtained one or more examples of evidence, and adjusted residents' initial autonomy using factors from the attending variable and the context variable. CONCLUSIONS Expert surgical teachers' assessments of residents' readiness for OR autonomy included 5 key components. Better understanding these inputs can contribute to both faculty and resident development, enabling increased resident autonomy and preparation for independent practice.
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Affiliation(s)
- Xiaodong Phoenix Chen
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Amy M Sullivan
- Harvard Medical School, Boston, Massachusetts; Shapiro Institute for Education and Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Adnan Alseidi
- Department of General Surgery, Virginia Mason Medical Center, Seattle, Washington
| | - Gifty Kwakye
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Douglas S Smink
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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Antonoff MB. Expanding surgical skills and knowledge after training: Lifelong learning puts patients first. J Thorac Cardiovasc Surg 2017; 154:380-381. [PMID: 28499593 DOI: 10.1016/j.jtcvs.2017.04.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 04/14/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex.
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Mullen MG, Salerno EP, Michaels AD, Hedrick TL, Sohn MW, Smith PW, Schirmer BD, Friel CM. Declining Operative Experience for Junior-Level Residents: Is This an Unintended Consequence of Minimally Invasive Surgery? JOURNAL OF SURGICAL EDUCATION 2016; 73:609-615. [PMID: 27066854 PMCID: PMC4985608 DOI: 10.1016/j.jsurg.2016.02.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 02/21/2016] [Accepted: 02/24/2016] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Our group has previously demonstrated an upward shift from junior to senior resident participation in common general surgery operations, traditionally performed by junior-level residents. The objective of this study was to evaluate if this trend would correct over time. We hypothesized that junior resident case volume would improve. METHODS A sample of essential laparoscopic and open general surgery procedures (appendectomy, inguinal herniorrhaphy, cholecystectomy, and partial colectomy) was chosen for analysis. The American College of Surgeons National Surgical Quality Improvement Program Participant Use Files were queried for these procedures between 2005 and 2012. Cases were stratified by participating resident post-graduate year with "junior resident" defined as post-graduate year1-3. Logistic regression was performed to determine change in junior resident participation for each type of procedure over time. RESULTS A total of 185,335 cases were included in the study. For 3 of the operations we considered, the prevalence of laparoscopic surgery increased from 2005-2012 (all p < 0.001). Cholecystectomy was an exception, which showed an unchanged proportion of cases performed laparoscopically across the study period (p = 0.119). Junior resident participation decreased by 4.5%/y (p < 0.001) for laparoscopic procedures and by 6.2%/y (p < 0.001) for open procedures. The proportion of laparoscopic surgeries performed by junior-level residents decreased for appendectomy by 2.6%/y (p < 0.001) and cholecystectomy by 6.1%/y (p < 0.001), whereas it was unchanged for inguinal herniorrhaphy (p = 0.75) and increased for partial colectomy by 3.9%/y (p = 0.003). A decline in junior resident participation was seen for all open surgeries, with appendectomy decreasing by 9.4%/y (p < 0.001), cholecystectomy by 4.1%/y (p < 0.002), inguinal herniorrhaphy by 10%/y (p < 0.001) and partial colectomy by 2.9%/y (p < 0.004). CONCLUSIONS Along with the proliferation of laparoscopy for common general surgical procedures there has been a concomitant reduction in the participation of junior-level residents. As previously thought, familiarity with laparoscopy has not translated to redistribution of basic operations from senior to junior residents. This trend has significant implications for general surgery resident education.
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Affiliation(s)
- Matthew G Mullen
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Elise P Salerno
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Alex D Michaels
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Traci L Hedrick
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Min-Woong Sohn
- Department of Public Health Sciences, Health System Old Medical School, University of Virginia, Charlottesville, Virginia
| | - Philip W Smith
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Bruce D Schirmer
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Charles M Friel
- Department of Surgery, University of Virginia, Charlottesville, Virginia.
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