1
|
Feenstra TM, van der Storm SL, Barsom EZ, Bonjer JH, Nieveen van Dijkum EJ, Schijven MP. Which, how, and what? Using digital tools to train surgical skills; a systematic review and meta-analysis. Surg Open Sci 2023; 16:100-110. [PMID: 37830074 PMCID: PMC10565595 DOI: 10.1016/j.sopen.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/02/2023] [Indexed: 10/14/2023] Open
Abstract
Background Digital tools like digital box trainers and VR seem promising in delivering safe and tailored practice opportunities outside of the surgical clinic, yet understanding their efficacy and limitations is essential. This study investigated Which digital tools are available to train surgical skills, How these tools are used, How effective they are, and What skills they are intended to teach. Methods Medline, Embase, and Cochrane libraries were systematically reviewed for randomized trials, evaluating digital skill-training tools based on objective outcomes (skills scores and completion time) in surgical residents. Digital tools effectiveness were compared against controls, wet/dry lab training, and other digital tools. Tool and training factors subgroups were analysed, and studies were assessed on their primary outcomes: technical and/or non-technical. Results The 33 included studies involved 927 residents and six digital tools; digital box trainers, (immersive) virtual reality (VR) trainers, robot surgery trainers, coaching and feedback, and serious games. Digital tools outperformed controls in skill scores (SMD 1.66 [1.06, 2.25], P < 0.00001, I2 = 83 %) and completion time (SMD -1.05 [-1.72, -0.38], P = 0.0001, I2 = 71 %). There were no significant differences between digital tools and lab training, between tools, or in other subgroups. Only two studies focussed on non-technical skills. Conclusion While the efficacy of digital tools in enhancing technical surgical skills is evident - especially for VR-trainers -, there is a lack of evidence regarding non-technical skills, and need to improve methodological robustness of research on new (digital) tools before they are implemented in curricula. Key message This study provides critical insight into the increasing presence of digital tools in surgical training, demonstrating their usefulness while identifying current challenges, especially regarding methodological robustness and inattention to non-technical skills.
Collapse
Affiliation(s)
- Tim M. Feenstra
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, the Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, the Netherlands
| | - Sebastiaan L. van der Storm
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, the Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, the Netherlands
| | - Esther Z. Barsom
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, the Netherlands
| | - Jaap H. Bonjer
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Els J.M. Nieveen van Dijkum
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, the Netherlands
- Amsterdam institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Marlies P. Schijven
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, the Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, the Netherlands
| |
Collapse
|
2
|
Making the Financial Case for Surgical Resident Well-being: A Scoping Review. Ann Surg 2023; 277:397-404. [PMID: 36124776 DOI: 10.1097/sla.0000000000005719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To conduct a scoping review of literature on financial implications of surgical resident well-being. BACKGROUND Surgeon well-being affects clinical outcomes, patient experience, and health care economics. However, our understanding of the relationship between surgical resident well-being and organizational finances is limited. METHODS Authors searched PubMed, Web of Science, and Embase with no date or language restrictions. Searches of the gray literature included hand references of articles selected for data extraction and reviewing conference abstracts from Embase. Two reviewers screened articles for eligibility based on title and abstract then reviewed eligible articles in their entirety. Data were extracted and analyzed using conventional content analysis. RESULTS Twenty-five articles were included, 5 (20%) published between 2003 and 2010, 12 (48%) between 2011 and 2018, and 8 (32%) between 2019 and 2021. One (4%) had an aim directly related to the research question, but financial implications were not considered from the institutional perspective. All others explored factors impacting well-being or workplace sequelae of well-being, but the economics of these elements were not the primary focus. Analysis of content surrounding financial considerations of resident well-being revealed 5 categories; however, no articles provided a comprehensive business case for investing in resident well-being from the institutional perspective. CONCLUSIONS Although the number of publications identified through the present scoping review is relatively small, the emergence of publications referencing economic issues associated with surgical resident well-being may suggest a growing recognition of this area's importance. This scoping review highlights a gap in the literature, which should be addressed to drive the system-level change needed to improve surgical resident well-being.
Collapse
|
3
|
Li Z, Liu D, Liu X, Su H, Bai S. The Association of Experienced Long Working Hours and Depression, Anxiety, and Suicidal Ideation Among Chinese Medical Residents During the COVID-19 Pandemic: A Multi-Center Cross-Sectional Study. Psychol Res Behav Manag 2023; 16:1459-1470. [PMID: 37131958 PMCID: PMC10149078 DOI: 10.2147/prbm.s408792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/14/2023] [Indexed: 05/04/2023] Open
Abstract
Background Long working hours are common among medical residents and may increase the risk of mental disorders. We aimed to investigate the association between experienced long working hours and depression, anxiety, and suicidal ideation among Chinese medical residents during the COVID-19 pandemic. Methods This study was conducted in September 2022; 1343 residents from three center in Northeastern China were included in the final analysis (effective response rate: 87.61%). The data were collected from participants via online self-administered questionnaires. Depression and anxiety were measured by the Patient Health Questionnaire (PHQ-9) and the General Anxiety Disorder (GAD-7) scale, respectively. Adjusted odds ratios and 95% confidence intervals were determined after adjusting for potential confounders by binary unconditional logistic regression. Results The effective response rate was 87.61%. Among the 1343 participants, 12.88% (173), 9.90% (133), and 9.68% (130) had experienced major depression, major anxiety, and suicidal ideation, respectively. We found that longer weekly worktime increased the risk of major depression, particularly in those who worked for more than 60 hours per week (≥ 61 hours vs ≤ 40 hours, OR=1.87, P for trend = 0.003). However, this trend was not observed for either major anxiety or suicidal ideation (P for trend > 0.05 for both). Conclusion This study revealed that there was a considerable incidence of poor mental health among medical residents; furthermore, the longer weekly worktime was associated with a higher risk of major depression, especially for those who worked more than 60 hours per week, but this association was not observed in either major anxiety or suicidal ideation. This may help policymakers to develop targeted interventions.
Collapse
Affiliation(s)
- Zhiyuan Li
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Dongmei Liu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Xiuping Liu
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Hui Su
- Department of Sleep Medical Center, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Song Bai
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China
- Correspondence: Song Bai, Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning, 110004, People’s Republic of China, Tel +86-18940255568, Fax +86-024-83955092, Email
| |
Collapse
|
4
|
Acker R, Swendiman RA, Luks VL, Hanna AN, Lee MK, Williams NN, Kelz RR, Lynn J, Aarons CB. Pulling Back from the Brink: A Multi-Pronged Approach to Address General Surgery Resident Clinical Work Hour Adherence. JOURNAL OF SURGICAL EDUCATION 2022; 79:e17-e24. [PMID: 35697656 DOI: 10.1016/j.jsurg.2022.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/03/2022] [Accepted: 05/18/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE The conflict between prioritizing education for surgical trainees, promoting trainee wellness, and maintaining optimal patient care has remained challenging since the introduction of the Accreditation Council for Graduate Medical Education (ACGME) work hour restrictions in 2003. There is still a dearth of research examining which interventions successfully enable duty hour adherence. This study assessed the impact of a combination of strategic interventions on improving clinical work hour adherence. METHODS Monthly clinical work hour submission rates were assessed for all general surgery residents at a single university-based residency program over a 3-year period (2018-2021). Interventions targeted 3 domains and were implemented between academic years 2018 to 2019 (control) and 2020 to 2021 (intervention): 1) improving the accuracy and transparency of work hour reporting, 2) facilitating more timely interventions, and 3) structural scheduling changes. All 80-hour work week and continuous work hour violations were assessed. Findings were also compared to the corresponding ACGME Resident Survey results. RESULTS There was no significant difference in the rate of monthly work hour submissions pre- and postintervention (78% vs 75%, p = 0.057). However, the number of total reported monthly violations decreased significantly (mean 13.8 vs 2.4, p < 0.01), including decreases in both 80-hour work week and continuous work hour violations (mean 4.7 vs 1.6, p < 0.001 and 9.1 vs 0.8, p < 0.001, respectively). Reported compliance also increased on the annual ACGME resident surveys, where 61% vs 95% of residents felt they were compliant with the 80-hour work week and 71% vs 95% felt they were compliant with the continuous work hours (2018-19 vs 2020-21). CONCLUSION Innovative strategies addressing schedule changes, the culture of work hour reporting, and early intervention significantly decreased the number of duty hour violations at our institution. Reported resident compliance also improved based on ACGME Resident Survey data. These data may inform similar multifaceted approaches at other institutions to improve overall work hour adherence.
Collapse
Affiliation(s)
- Rachael Acker
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Robert A Swendiman
- Division of Pediatric Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Valerie L Luks
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Andrew N Hanna
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Major Kenneth Lee
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Noel N Williams
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Rachel R Kelz
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania; Department of Surgery, Center for Surgery and Health Economics, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jenny Lynn
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Cary B Aarons
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
| |
Collapse
|
5
|
Wu MJ, Knoll RM, Bouhadjer K, Remenschneider AK, Kozin ED. Educational Quality of YouTube Cholesteatoma Surgery Videos: Areas for Improvement. OTO Open 2022; 6:2473974X221120250. [PMID: 36274920 PMCID: PMC9585570 DOI: 10.1177/2473974x221120250] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/16/2022] [Indexed: 11/15/2022] Open
Abstract
Otolaryngology surgical education continues to evolve where trainees increasingly use videos to learn technical skills. Trainees commonly use YouTube, but no study to date has evaluated the educational quality (EQ) of otologic surgical videos on YouTube. We aim to assess the EQ of cholesteatoma surgical videos. Cholesteatoma surgical videos were queried using YouTube search terms, assessed using LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS), a validated assessment tool for publication, and categorized into low (0-6), medium (7-12), and high (13-18) EQ groups. In total, 74 videos were identified (mean LAP-VEGaS score = 9.6 ± 4.0) and 44.6% had medium EQ. Videos commonly lacked graphic aids to highlight anatomy (71.6%) and postprocedural outcomes (68.9%). LAP-VEGaS scores were greater in videos originating from US surgeons compared to non-US surgeons (12.4 ± 3.4 vs 8.0 ± 3.5; P < .001). Our study highlights that otolaryngology trainees may experience difficulty finding high-EQ cholesteatoma surgery videos on YouTube. Areas for improved EQ content are discussed. Level of evidence: IV.
Collapse
Affiliation(s)
- Matthew J. Wu
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA,Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA,Elliott D. Kozin, MD, Department of Otolaryngology, Massachusetts Eye and Ear, 243 Charles St, Boston, MA 02114, USA.
| | - Renata M. Knoll
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Karim Bouhadjer
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Aaron K. Remenschneider
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA,Department of Otolaryngology, University of Massachusetts Medical Center, Worcester, Massachusetts, USA
| | - Elliott D. Kozin
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
6
|
How are Patient Order and Shift Timing Associated With Imaging Choices in the Emergency Department? Evidence From Niagara Health Administrative Data. Ann Emerg Med 2022; 80:392-400. [PMID: 35953385 DOI: 10.1016/j.annemergmed.2022.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 06/03/2022] [Accepted: 06/03/2022] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE We assessed whether the timing and order of patients over emergency shifts are associated with receiving diagnostic imaging in the emergency department and characterized whether changes in imaging are associated with changes in patients returning to the ED. METHODS In this retrospective study, we used multivariate and instrumental variable regressions to examine how the timing and order of patients are associated with the use of diagnostic imaging. Outcomes include whether a patient receives a radiograph, a computed tomography (CT) scan, an ultrasound, and 7-day bouncebacks to the ED. The variables of interest are time and order during a physician's shift in which a patient is seen. RESULTS A total of 841,683 ED visits were examined from an administrative database of all ED visits to Niagara Health. Relative to the first patient, the probability of receiving a radiograph, CT, and ultrasound decreases by 6.4%, 9.1%, and 3.8% if a patient is the 15th patient seen during a shift. Relative to the first minute, the probability of receiving a radiograph, CT, or ultrasound increases by 1.9%, 2.7%, and 1.1% if a patient is seen in the 180th minute. Seven-day bounceback rates are not consistently associated with patient order or timing in a shift and imaging orders. CONCLUSION Imaging in the ED is associated with shift length and especially patient order, suggesting that physicians make different imaging decisions over the course of their shifts. Additional imaging does not translate into reductions in subsequent bouncebacks to the hospital.
Collapse
|
7
|
Lee S, Kim YS, Park K, Lee M, Jang JY. Impact of Enforcement of the Act to Improve Training Conditions and the Status of Medical Residents in Emergency Abdominal Surgery. Yonsei Med J 2022; 63:751-758. [PMID: 35914757 PMCID: PMC9344275 DOI: 10.3349/ymj.2022.63.8.751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/04/2022] [Accepted: 05/10/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE In 2018, the Act to Improve Training Conditions and the Status of Medical Residents (AITR) was fully implemented in South Korea. This study aimed to investigate the effects of AITR implementation on the clinical outcomes of patients who underwent emergency abdominal surgery. MATERIALS AND METHODS A total of 2571 patients who underwent emergency abdominal surgery after visiting the emergency room (ER) between 2015 and 2019 was included. Electronic medical records were retrospectively reviewed. In addition, a comparative analysis was performed for patient groups treated before and after AITR implementation. RESULTS The median patient age was 48.0 years, and 49.2% of them were male. Appendicitis was the most common diagnosis (82.6%), followed by major abdominal emergencies (9.9%) and cholecystitis (7.5%). The median time from arrival to surgery was 439 min, and 52 (2.0%) patients died. A comparison of patients who underwent surgery before (pre-AITR; 1453, 56.5%) and after (post-AITR; 1118, 43.5%) AITR implementation revealed a significant difference in age, number of residents on a 24-h shift, and diagnosis. The time from ER arrival to surgery was not significantly longer after AITR implementation than before AITR implementation (434 min vs. 443 min, p=0.230). AITR was not a significant risk factor for mortality (p=0.225). CONCLUSION The time from ER arrival to emergency surgery did not increase significantly after AITR implementation, and there was no difference in the patients' clinical outcomes.
Collapse
Affiliation(s)
- Sungho Lee
- Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Yeon Su Kim
- Department of Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
| | - Kwanhoon Park
- Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - MiWoo Lee
- Department of Social Welfare, Hanyang Woman's University, Seoul, Korea
| | - Ji Young Jang
- Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
| |
Collapse
|
8
|
Do obstetrics trainees working hours affect caesarean section rates in normal risk women? Eur J Obstet Gynecol Reprod Biol 2021; 258:358-361. [PMID: 33535147 DOI: 10.1016/j.ejogrb.2021.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/17/2021] [Accepted: 01/20/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The rate of caesarean section (CS) is increasing globally. The nulliparous, term, singleton, vertex presentation, spontaneously labouring woman (Robson Group 1/RG1) is considered low risk for CS. It has been hypothesized that more CS occur at nighttime or at weekends due to doctor fatigue. The European Working Time Directive (EWTD) was implemented in our institution in 2013 to limit doctor working hours, which aimed at reducing fatigue but arguably fractures continuity of care. This study aimed to determine the effect of nocturnal hours and weekend on-call as well as the implementation of EWTD on our RG1 CS rates. STUDY DESIGN This was a population-based study in a tertiary referral centre from 2008-2017. The inclusion criteria for our study were limited to RG1. Data were analysed from an established clinical database, including mode and time of delivery. Descriptive statistics are presented as number and percent for categorical variables. Relative frequencies were tested using chi-squared test. All statistical analyses were performed using SPSS Version 26. Statistical significance was defined as p < .05. RESULTS There were 86,473 deliveries over the 10-year study period. There were 18,761 women in RG1. Overall the RG1 CS rate was 12.9 % (n = 2415). Rates of CS in the RG1 were not statistically different between those delivering on weekdays (12.9 %, n = 1726/13,430) and weekends (12.9 %, n = 689/5,331, OR 0.99, 95 % CI = 0.90-1.09, p = .89). During daytime hours the CS rate was 12.1 % (n = 777/6411) and at nighttime was 13.3 % (n = 1638/12,350, OR 1.10, 95 % CI = 1.01-1.21, p = .03). Comparing the time periods pre and post EWTD implementation, there was a significant increase in CS rates (12.1 % n = 1319/10,873 V 13.9 % n = 1096/7,888, OR 1.17, 95 % CI = 1.07-1.27 p < .001). With respect to other modes of delivery in RG1 pre and post EWTD, there was a statistically significant decrease in operative vaginal delivery (OVD) rates (40.1%, n=4,360 V 37.7%, n=2,973, OR 0.90, 95% CI = 0.85-0.95, p = .001) CONCLUSION: This study shows an association between obstetric trainee working practices, RG1 CS and OVD rates; this is most pronounced at night and after the introduction of the EWTD. It is unlikely that obstetric trainee working practices are the only factor related to the increasing CS rate and reduced OVD rate. Consideration should be giving to addressing the needs of obstetric trainees in relation to achieving their competencies with now reduced labour ward exposure. Further study is required to see if alternate arrangements in relation to simulation training could increase the OVD rate and reduce the CS rate.
Collapse
|
9
|
Hategeka C, Ruton H, Karamouzian M, Lynd LD, Law MR. Use of interrupted time series methods in the evaluation of health system quality improvement interventions: a methodological systematic review. BMJ Glob Health 2020; 5:e003567. [PMID: 33055094 PMCID: PMC7559052 DOI: 10.1136/bmjgh-2020-003567] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/07/2020] [Accepted: 09/10/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND When randomisation is not possible, interrupted time series (ITS) design has increasingly been advocated as a more robust design to evaluating health system quality improvement (QI) interventions given its ability to control for common biases in healthcare QI. However, there is a potential risk of producing misleading results when this rather robust design is not used appropriately. We performed a methodological systematic review of the literature to investigate the extent to which the use of ITS has followed best practice standards and recommendations in the evaluation of QI interventions. METHODS We searched multiple databases from inception to June 2018 to identify QI intervention studies that were evaluated using ITS. There was no restriction on date, language and participants. Data were synthesised narratively using appropriate descriptive statistics. The risk of bias for ITS studies was assessed using the Cochrane Effective Practice and Organisation of Care standard criteria. The systematic review protocol was registered in PROSPERO (registration number: CRD42018094427). RESULTS Of 4061 potential studies and 2028 unique records screened for inclusion, 120 eligible studies assessed eight QI strategies and were from 25 countries. Most studies were published since 2010 (86.7%), reported data using monthly interval (71.4%), used ITS without a control (81%) and modelled data using segmented regression (62.5%). Autocorrelation was considered in 55% of studies, seasonality in 20.8% and non-stationarity in 8.3%. Only 49.2% of studies specified the ITS impact model. The risk of bias was high or very high in 72.5% of included studies and did not change significantly over time. CONCLUSIONS The use of ITS in the evaluation of health system QI interventions has increased considerably over the past decade. However, variations in methodological considerations and reporting of ITS in QI remain a concern, warranting a need to develop and reinforce formal reporting guidelines to improve its application in the evaluation of health system QI interventions.
Collapse
Affiliation(s)
- Celestin Hategeka
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Hinda Ruton
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- School of Public Health, University of Rwanda, Kigali, Rwanda
| | - Mohammad Karamouzian
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- HIV/STI Surveillance Research Centre, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
- Center for Health Evaluation and Outcome Sciences, Providence Health Research Institute, Vancouver, British Columbia, Canada
| | - Michael R Law
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
10
|
Koo JK, Moyer L, Castello MA, Arain Y. Improving Accuracy of Handoff by Implementing an Electronic Health Record–generated Tool: An Improvement Project in an Academic Neonatal Intensive Care Unit. Pediatr Qual Saf 2020; 5:e329. [PMID: 32766500 PMCID: PMC7360222 DOI: 10.1097/pq9.0000000000000329] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/13/2020] [Indexed: 01/22/2023] Open
|
11
|
Friedman ND. Junior doctor training: has the pendulum swung too far? Intern Med J 2020; 49:1546-1549. [PMID: 31808259 DOI: 10.1111/imj.14657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/27/2019] [Accepted: 05/16/2019] [Indexed: 11/29/2022]
Abstract
The current Australian Medical Association doctors in training enterprise agreement dictates that hours beyond 38 or 43 ordinary hours per week incur overtime. Costly overtime has led to strict adherence to ordinary hours with dramatically reduced rostered and unrostered overtime. The stringent regulation over ordinary hours may protect doctors at a cost to training and potentially patient safety. Reduced shift duration adds to the number of clinical handovers, while reduced exposure to patients and training opportunities may prolong training time. Now is the time for renegotiation of working hours, which are most favourable for doctor training and well-being.
Collapse
Affiliation(s)
- N Deborah Friedman
- Department of Infectious Diseases, Barwon Health, Geelong, Victoria, Australia.,Department of General Medicine, Barwon Health, Geelong, Victoria, Australia
| |
Collapse
|
12
|
Ciechanski P, Cheng A, Damji O, Lopushinsky S, Hecker K, Jadavji Z, Kirton A. Effects of transcranial direct-current stimulation on laparoscopic surgical skill acquisition. BJS Open 2018; 2:70-78. [PMID: 29951631 PMCID: PMC5989997 DOI: 10.1002/bjs5.43] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 12/13/2017] [Indexed: 02/05/2023] Open
Abstract
Background Changes in medical education may limit opportunities for trainees to gain proficiency in surgical skills. Transcranial direct-current stimulation (tDCS) can augment motor skill learning and may enhance surgical procedural skill acquisition. The aim of this study was to determine the effects of tDCS on simulation-based laparoscopic surgical skill acquisition. Methods In this double-blind, sham-controlled randomized trial, participants were randomized to receive 20 min of anodal tDCS or sham stimulation over the dominant primary motor cortex, concurrent with Fundamentals of Laparoscopic Surgery simulation-based training. Primary outcomes of laparoscopic pattern-cutting and peg transfer tasks were scored at baseline, during repeated performance over 1 h, and again at 6 weeks. Intent-to-treat analysis examined the effects of treatment group on skill acquisition and retention. Results Of 40 participants, those receiving tDCS achieved higher mean(s.d.) final pattern-cutting scores than participants in the sham group (207·6(30·0) versus 186·0(32·7) respectively; P = 0·022). Scores were unchanged at 6 weeks. Effects on peg transfer scores were not significantly different (210·2(23·5) in the tDCS group versus 201·7(18·1) in the sham group; P = 0·111); the proportion achieving predetermined proficiency levels was higher for tDCS than for sham stimulation. Procedures were well tolerated with no serious adverse events and no decreases in motor measures. Conclusion The addition of tDCS to laparoscopic surgical training may enhance skill acquisition. Trials of additional skills and translation to non-simulated performance are required to determine the potential value in medical education and impact on patient outcomes. Registration number: NCT02756052 (https://clinicaltrials.gov/).
Collapse
Affiliation(s)
- P Ciechanski
- Department of Neuroscience University of Calgary Calgary Alberta Canada
| | - A Cheng
- Department of Pediatrics University of Calgary Calgary Alberta Canada
| | - O Damji
- Department of Cumming School of Medicine University of Calgary Calgary Alberta Canada
| | - S Lopushinsky
- Department of Surgery University of Calgary Calgary Alberta Canada
| | - K Hecker
- Department of Veterinary Medicine University of Calgary Calgary Alberta Canada.,Department of Community Health Sciences University of Calgary Calgary Alberta Canada
| | - Z Jadavji
- Department of Neuroscience University of Calgary Calgary Alberta Canada
| | - A Kirton
- Department of Pediatrics University of Calgary Calgary Alberta Canada.,Department of Clinical Neurosciences University of Calgary Calgary Alberta Canada
| |
Collapse
|
13
|
Ciechanski P, Cheng A, Lopushinsky S, Hecker K, Gan LS, Lang S, Zareinia K, Kirton A. Effects of Transcranial Direct-Current Stimulation on Neurosurgical Skill Acquisition: A Randomized Controlled Trial. World Neurosurg 2017; 108:876-884.e4. [DOI: 10.1016/j.wneu.2017.08.123] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 08/17/2017] [Accepted: 08/18/2017] [Indexed: 11/29/2022]
|
14
|
Anderson-Montoya BL, Scerbo MW, Ramirez DE, Hubbard TW. Running Memory for Clinical Handoffs: A Look at Active and Passive Processing. HUMAN FACTORS 2017; 59:393-406. [PMID: 27793979 DOI: 10.1177/0018720816672514] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The goal of the present study was to examine the effects of domain-relevant expertise on running memory and the ability to process handoffs of information. In addition, the role of active or passive processing was examined. BACKGROUND Currently, there is little research that addresses how individuals with different levels of expertise process information in running memory when the information is needed to perform a real-world task. METHOD Three groups of participants differing in their level of clinical expertise (novice, intermediate, and expert) performed an abstract running memory span task and two tasks resembling real-world activities, a clinical handoff task and an air traffic control (ATC) handoff task. For all tasks, list length and the amount of information to be recalled were manipulated. RESULTS Regarding processing strategy, all participants used passive processing for the running memory span and ATC tasks. The novices also used passive processing for the clinical task. The experts, however, appeared to use more active processing, and the intermediates fell in between. CONCLUSION Overall, the results indicated that individuals with clinical expertise and a developed mental model rely more on active processing of incoming information for the clinical task while individuals with little or no knowledge rely on passive processing. APPLICATION The results have implications about how training should be developed to aid less experienced personnel identify what information should be included in a handoff and what should not.
Collapse
Affiliation(s)
| | | | - Dana E Ramirez
- Children's Hospital of the King's Daughters, Norfolk, Virginia
| | | |
Collapse
|
15
|
Wen T, Attenello FJ, Cen SY, Khalessi AA, Kim-Tenser M, Sanossian N, Giannotta SL, Amar AP, Mack WJ. Impact of the 2003 ACGME Resident Duty Hour Reform on Hospital-Acquired Conditions: A National Retrospective Analysis. J Grad Med Educ 2017; 9:215-221. [PMID: 28439356 PMCID: PMC5398152 DOI: 10.4300/jgme-d-16-00055.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 08/07/2016] [Accepted: 12/17/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The Accreditation Council for Graduate Medical Education reforms in 2003 instituted an 80-hour weekly limit for resident physicians. Critics argue that these restrictions have increased handoffs among residents and the potential for a decline in patient safety. "Never events" hospital-acquired conditions (HACs) are a set of preventable events used as a quality metric in hospital safety analyses. OBJECTIVE This analysis evaluated post-work hour reform effects on HAC incidence for US hospital inpatients, using the National Inpatient Sample. METHODS Data were collected from 2000-2002 (pre-2003) and 2004-2006 (post-2003) time periods. HAC incidence in academic and non-academic centers was evaluated in multivariate analysis assessing for likelihood of HAC occurrence, prolonged length of stay (pLOS), and increased total charges. RESULTS The data encompassed approximately 111 million pre-2003 and 117 million post-2003 admissions. Patients were 10% more likely to incur a HAC in the post-2003 versus pre-2003 era (odds ratio [OR] = 1.10; 95% confidence interval [CI] 1.06-1.14; P < .01). Teaching hospitals exhibited an 18% (OR = 1.18; 95% CI 1.11-1.27; P < .01) increase in HAC likelihood, with no change in nonteaching settings (OR = 1.03; 95% CI 1.00-1.06; P > .05). Patients with ≥ 1 HAC were associated with a 60% likelihood of elevated charges (OR = 1.60; 95% CI 1.50-1.72; P < .01) and 65% likelihood of pLOS (OR = 1.65; 95% CI 1.60-1.70; P < .01). CONCLUSIONS Post-2003 era patients were associated with 10% increased likelihood of HAC, with effects noted primarily at teaching hospitals.
Collapse
|
16
|
Heitkamp DE, Ruchman RB, Rozenshtein A. Lessons From Flexner: The Struggle of Small Radiology Residency Programs in the United States. J Am Coll Radiol 2017; 14:675-677. [PMID: 28169178 DOI: 10.1016/j.jacr.2016.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 12/09/2016] [Accepted: 12/12/2016] [Indexed: 01/12/2023]
Affiliation(s)
- Darel E Heitkamp
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indiana University Hospital, Indianapolis, Indiana.
| | - Richard B Ruchman
- Department of Radiology, Monmouth Medical Center, Long Branch, New Jersey
| | - Anna Rozenshtein
- Department of Radiology, Westchester Medical Center, New York Medical College, Valhalla, New York
| |
Collapse
|
17
|
Linville MD, Bates JE. Graduate Medical Education—Accelerated Change. Am J Med Sci 2017; 353:126-131. [DOI: 10.1016/j.amjms.2016.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 11/28/2016] [Accepted: 12/02/2016] [Indexed: 11/25/2022]
|
18
|
Kreutzer L, Dahlke AR, Love R, Ban KA, Yang AD, Bilimoria KY, Johnson JK. Exploring Qualitative Perspectives on Surgical Resident Training, Well-Being, and Patient Care. J Am Coll Surg 2017; 224:149-159. [DOI: 10.1016/j.jamcollsurg.2016.10.041] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/10/2016] [Indexed: 10/20/2022]
|
19
|
Operative Autonomy among Senior Surgical Trainees during Infrainguinal Bypass Operations Is Not Associated with Worse Long-term Patient Outcomes. Ann Vasc Surg 2017; 38:42-53. [DOI: 10.1016/j.avsg.2016.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 09/09/2016] [Accepted: 09/29/2016] [Indexed: 11/20/2022]
|
20
|
Rush R. Post-call delirium. MEDICAL EDUCATION 2016; 50:1200-1203. [PMID: 27873419 DOI: 10.1111/medu.13076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 12/17/2015] [Accepted: 01/12/2016] [Indexed: 06/06/2023]
Abstract
Although frequently diagnosed in hospital in-patients, delirium is often recognised but under-reported in the housestaff population. It is estimated that more than 90% of housestaff will experience regular episodes of post-call delirium. This paper identifies diagnostic criteria and discusses approaches to treatment.
Collapse
Affiliation(s)
- Raphael Rush
- Department of Rheumatology, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
21
|
Philibert I. What Is Known: Examining the Empirical Literature in Resident Work Hours Using 30 Influential Articles. J Grad Med Educ 2016; 8:795-805. [PMID: 28018556 PMCID: PMC5180546 DOI: 10.4300/jgme-d-16-00642.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Examining influential, highly cited articles can show the advancement of knowledge about the effect of resident physicians' long work hours, as well as the benefits and drawbacks of work hour limits. OBJECTIVE A narrative review of 30 articles, selected for their contribution to the literature, explored outcomes of interest in the research on work hours-including patient safety, learning, and resident well-being. METHODS Articles were selected from a comprehensive review. Citation volume, quality, and contribution to the evolving thinking on work hours and to the Accreditation Council for Graduate Medical Education standards were assessed. RESULTS Duty hour limits are supported by the scientific literature, particularly limits on weekly hours and reducing the frequency of overnight call. The literature shows declining hours and call frequency over 4 decades of study, although the impact on patient safety, learning, and resident well-being is not clear. The review highlighted limitations of the scientific literature on resident hours, including small samples and reduced generalizability for intervention studies, and the inability to rule out confounders in large studies using administrative data. Key areas remain underinvestigated, and accepted methodology is challenged when assessing the impact of interventions on the multiple outcomes of interest. CONCLUSIONS The influential literature, while showing the beneficial effect of work hour limits, does not answer all questions of interest in determining optimal limits on resident hours. Future research should use methods that permit a broader, collective examination of the multiple, often competing attributes of the learning environment that collectively promote patient safety and resident learning and well-being.
Collapse
Affiliation(s)
- Ingrid Philibert
- Corresponding author: Ingrid Philibert, PhD, MBA, Accreditation Council for Graduate Medical Education, 401 N Michigan Avenue, Suite 2000, Chicago, IL 60611, 312.755.5003,
| |
Collapse
|
22
|
Program Director Perceptions of Surgical Resident Training and Patient Care under Flexible Duty Hour Requirements. J Am Coll Surg 2016; 222:1098-105. [DOI: 10.1016/j.jamcollsurg.2016.03.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 03/16/2016] [Indexed: 11/23/2022]
|
23
|
|
24
|
Bilimoria KY, Chung JW, Hedges LV, Dahlke AR, Love R, Cohen ME, Hoyt DB, Yang AD, Tarpley JL, Mellinger JD, Mahvi DM, Kelz RR, Ko CY, Odell DD, Stulberg JJ, Lewis FR. National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training. N Engl J Med 2016; 374:713-27. [PMID: 26836220 DOI: 10.1056/nejmoa1515724] [Citation(s) in RCA: 301] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Concerns persist regarding the effect of current surgical resident duty-hour policies on patient outcomes, resident education, and resident well-being. METHODS We conducted a national, cluster-randomized, pragmatic, noninferiority trial involving 117 general surgery residency programs in the United States (2014-2015 academic year). Programs were randomly assigned to current Accreditation Council for Graduate Medical Education (ACGME) duty-hour policies (standard-policy group) or more flexible policies that waived rules on maximum shift lengths and time off between shifts (flexible-policy group). Outcomes included the 30-day rate of postoperative death or serious complications (primary outcome), other postoperative complications, and resident perceptions and satisfaction regarding their well-being, education, and patient care. RESULTS In an analysis of data from 138,691 patients, flexible, less-restrictive duty-hour policies were not associated with an increased rate of death or serious complications (9.1% in the flexible-policy group and 9.0% in the standard-policy group, P=0.92; unadjusted odds ratio for the flexible-policy group, 0.96; 92% confidence interval, 0.87 to 1.06; P=0.44; noninferiority criteria satisfied) or of any secondary postoperative outcomes studied. Among 4330 residents, those in programs assigned to flexible policies did not report significantly greater dissatisfaction with overall education quality (11.0% in the flexible-policy group and 10.7% in the standard-policy group, P=0.86) or well-being (14.9% and 12.0%, respectively; P=0.10). Residents under flexible policies were less likely than those under standard policies to perceive negative effects of duty-hour policies on multiple aspects of patient safety, continuity of care, professionalism, and resident education but were more likely to perceive negative effects on personal activities. There were no significant differences between study groups in resident-reported perception of the effect of fatigue on personal or patient safety. Residents in the flexible-policy group were less likely than those in the standard-policy group to report leaving during an operation (7.0% vs. 13.2%, P<0.001) or handing off active patient issues (32.0% vs. 46.3%, P<0.001). CONCLUSIONS As compared with standard duty-hour policies, flexible, less-restrictive duty-hour policies for surgical residents were associated with noninferior patient outcomes and no significant difference in residents' satisfaction with overall well-being and education quality. (FIRST ClinicalTrials.gov number, NCT02050789.).
Collapse
Affiliation(s)
- Karl Y Bilimoria
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University (K.Y.B., J.W.C., A.R.D., R.L., A.D.Y., D.M.M., D.D.O., J.J.S.), and the American College of Surgeons (K.Y.B., M.E.C., D.B.H., C.Y.K.), Chicago, the Department of Statistics, Northwestern University, Evanston (L.V.H.), and the Department of Surgery, Southern Illinois University, Springfield (J.D.M.) - all in Illinois; the Department of Surgery, Vanderbilt University, Nashville (J.L.T.); the Department of Surgery and the Center for Surgery and Health Economics, Perelman School of Medicine, University of Pennsylvania (R.R.K.), and the American Board of Surgery (F.R.L.) - both in Philadelphia; and the Department of Surgery, University of California, Los Angeles, School of Medicine, Los Angeles (C.Y.K.)
| | - Jeanette W Chung
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University (K.Y.B., J.W.C., A.R.D., R.L., A.D.Y., D.M.M., D.D.O., J.J.S.), and the American College of Surgeons (K.Y.B., M.E.C., D.B.H., C.Y.K.), Chicago, the Department of Statistics, Northwestern University, Evanston (L.V.H.), and the Department of Surgery, Southern Illinois University, Springfield (J.D.M.) - all in Illinois; the Department of Surgery, Vanderbilt University, Nashville (J.L.T.); the Department of Surgery and the Center for Surgery and Health Economics, Perelman School of Medicine, University of Pennsylvania (R.R.K.), and the American Board of Surgery (F.R.L.) - both in Philadelphia; and the Department of Surgery, University of California, Los Angeles, School of Medicine, Los Angeles (C.Y.K.)
| | - Larry V Hedges
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University (K.Y.B., J.W.C., A.R.D., R.L., A.D.Y., D.M.M., D.D.O., J.J.S.), and the American College of Surgeons (K.Y.B., M.E.C., D.B.H., C.Y.K.), Chicago, the Department of Statistics, Northwestern University, Evanston (L.V.H.), and the Department of Surgery, Southern Illinois University, Springfield (J.D.M.) - all in Illinois; the Department of Surgery, Vanderbilt University, Nashville (J.L.T.); the Department of Surgery and the Center for Surgery and Health Economics, Perelman School of Medicine, University of Pennsylvania (R.R.K.), and the American Board of Surgery (F.R.L.) - both in Philadelphia; and the Department of Surgery, University of California, Los Angeles, School of Medicine, Los Angeles (C.Y.K.)
| | - Allison R Dahlke
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University (K.Y.B., J.W.C., A.R.D., R.L., A.D.Y., D.M.M., D.D.O., J.J.S.), and the American College of Surgeons (K.Y.B., M.E.C., D.B.H., C.Y.K.), Chicago, the Department of Statistics, Northwestern University, Evanston (L.V.H.), and the Department of Surgery, Southern Illinois University, Springfield (J.D.M.) - all in Illinois; the Department of Surgery, Vanderbilt University, Nashville (J.L.T.); the Department of Surgery and the Center for Surgery and Health Economics, Perelman School of Medicine, University of Pennsylvania (R.R.K.), and the American Board of Surgery (F.R.L.) - both in Philadelphia; and the Department of Surgery, University of California, Los Angeles, School of Medicine, Los Angeles (C.Y.K.)
| | - Remi Love
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University (K.Y.B., J.W.C., A.R.D., R.L., A.D.Y., D.M.M., D.D.O., J.J.S.), and the American College of Surgeons (K.Y.B., M.E.C., D.B.H., C.Y.K.), Chicago, the Department of Statistics, Northwestern University, Evanston (L.V.H.), and the Department of Surgery, Southern Illinois University, Springfield (J.D.M.) - all in Illinois; the Department of Surgery, Vanderbilt University, Nashville (J.L.T.); the Department of Surgery and the Center for Surgery and Health Economics, Perelman School of Medicine, University of Pennsylvania (R.R.K.), and the American Board of Surgery (F.R.L.) - both in Philadelphia; and the Department of Surgery, University of California, Los Angeles, School of Medicine, Los Angeles (C.Y.K.)
| | - Mark E Cohen
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University (K.Y.B., J.W.C., A.R.D., R.L., A.D.Y., D.M.M., D.D.O., J.J.S.), and the American College of Surgeons (K.Y.B., M.E.C., D.B.H., C.Y.K.), Chicago, the Department of Statistics, Northwestern University, Evanston (L.V.H.), and the Department of Surgery, Southern Illinois University, Springfield (J.D.M.) - all in Illinois; the Department of Surgery, Vanderbilt University, Nashville (J.L.T.); the Department of Surgery and the Center for Surgery and Health Economics, Perelman School of Medicine, University of Pennsylvania (R.R.K.), and the American Board of Surgery (F.R.L.) - both in Philadelphia; and the Department of Surgery, University of California, Los Angeles, School of Medicine, Los Angeles (C.Y.K.)
| | - David B Hoyt
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University (K.Y.B., J.W.C., A.R.D., R.L., A.D.Y., D.M.M., D.D.O., J.J.S.), and the American College of Surgeons (K.Y.B., M.E.C., D.B.H., C.Y.K.), Chicago, the Department of Statistics, Northwestern University, Evanston (L.V.H.), and the Department of Surgery, Southern Illinois University, Springfield (J.D.M.) - all in Illinois; the Department of Surgery, Vanderbilt University, Nashville (J.L.T.); the Department of Surgery and the Center for Surgery and Health Economics, Perelman School of Medicine, University of Pennsylvania (R.R.K.), and the American Board of Surgery (F.R.L.) - both in Philadelphia; and the Department of Surgery, University of California, Los Angeles, School of Medicine, Los Angeles (C.Y.K.)
| | - Anthony D Yang
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University (K.Y.B., J.W.C., A.R.D., R.L., A.D.Y., D.M.M., D.D.O., J.J.S.), and the American College of Surgeons (K.Y.B., M.E.C., D.B.H., C.Y.K.), Chicago, the Department of Statistics, Northwestern University, Evanston (L.V.H.), and the Department of Surgery, Southern Illinois University, Springfield (J.D.M.) - all in Illinois; the Department of Surgery, Vanderbilt University, Nashville (J.L.T.); the Department of Surgery and the Center for Surgery and Health Economics, Perelman School of Medicine, University of Pennsylvania (R.R.K.), and the American Board of Surgery (F.R.L.) - both in Philadelphia; and the Department of Surgery, University of California, Los Angeles, School of Medicine, Los Angeles (C.Y.K.)
| | - John L Tarpley
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University (K.Y.B., J.W.C., A.R.D., R.L., A.D.Y., D.M.M., D.D.O., J.J.S.), and the American College of Surgeons (K.Y.B., M.E.C., D.B.H., C.Y.K.), Chicago, the Department of Statistics, Northwestern University, Evanston (L.V.H.), and the Department of Surgery, Southern Illinois University, Springfield (J.D.M.) - all in Illinois; the Department of Surgery, Vanderbilt University, Nashville (J.L.T.); the Department of Surgery and the Center for Surgery and Health Economics, Perelman School of Medicine, University of Pennsylvania (R.R.K.), and the American Board of Surgery (F.R.L.) - both in Philadelphia; and the Department of Surgery, University of California, Los Angeles, School of Medicine, Los Angeles (C.Y.K.)
| | - John D Mellinger
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University (K.Y.B., J.W.C., A.R.D., R.L., A.D.Y., D.M.M., D.D.O., J.J.S.), and the American College of Surgeons (K.Y.B., M.E.C., D.B.H., C.Y.K.), Chicago, the Department of Statistics, Northwestern University, Evanston (L.V.H.), and the Department of Surgery, Southern Illinois University, Springfield (J.D.M.) - all in Illinois; the Department of Surgery, Vanderbilt University, Nashville (J.L.T.); the Department of Surgery and the Center for Surgery and Health Economics, Perelman School of Medicine, University of Pennsylvania (R.R.K.), and the American Board of Surgery (F.R.L.) - both in Philadelphia; and the Department of Surgery, University of California, Los Angeles, School of Medicine, Los Angeles (C.Y.K.)
| | - David M Mahvi
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University (K.Y.B., J.W.C., A.R.D., R.L., A.D.Y., D.M.M., D.D.O., J.J.S.), and the American College of Surgeons (K.Y.B., M.E.C., D.B.H., C.Y.K.), Chicago, the Department of Statistics, Northwestern University, Evanston (L.V.H.), and the Department of Surgery, Southern Illinois University, Springfield (J.D.M.) - all in Illinois; the Department of Surgery, Vanderbilt University, Nashville (J.L.T.); the Department of Surgery and the Center for Surgery and Health Economics, Perelman School of Medicine, University of Pennsylvania (R.R.K.), and the American Board of Surgery (F.R.L.) - both in Philadelphia; and the Department of Surgery, University of California, Los Angeles, School of Medicine, Los Angeles (C.Y.K.)
| | - Rachel R Kelz
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University (K.Y.B., J.W.C., A.R.D., R.L., A.D.Y., D.M.M., D.D.O., J.J.S.), and the American College of Surgeons (K.Y.B., M.E.C., D.B.H., C.Y.K.), Chicago, the Department of Statistics, Northwestern University, Evanston (L.V.H.), and the Department of Surgery, Southern Illinois University, Springfield (J.D.M.) - all in Illinois; the Department of Surgery, Vanderbilt University, Nashville (J.L.T.); the Department of Surgery and the Center for Surgery and Health Economics, Perelman School of Medicine, University of Pennsylvania (R.R.K.), and the American Board of Surgery (F.R.L.) - both in Philadelphia; and the Department of Surgery, University of California, Los Angeles, School of Medicine, Los Angeles (C.Y.K.)
| | - Clifford Y Ko
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University (K.Y.B., J.W.C., A.R.D., R.L., A.D.Y., D.M.M., D.D.O., J.J.S.), and the American College of Surgeons (K.Y.B., M.E.C., D.B.H., C.Y.K.), Chicago, the Department of Statistics, Northwestern University, Evanston (L.V.H.), and the Department of Surgery, Southern Illinois University, Springfield (J.D.M.) - all in Illinois; the Department of Surgery, Vanderbilt University, Nashville (J.L.T.); the Department of Surgery and the Center for Surgery and Health Economics, Perelman School of Medicine, University of Pennsylvania (R.R.K.), and the American Board of Surgery (F.R.L.) - both in Philadelphia; and the Department of Surgery, University of California, Los Angeles, School of Medicine, Los Angeles (C.Y.K.)
| | - David D Odell
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University (K.Y.B., J.W.C., A.R.D., R.L., A.D.Y., D.M.M., D.D.O., J.J.S.), and the American College of Surgeons (K.Y.B., M.E.C., D.B.H., C.Y.K.), Chicago, the Department of Statistics, Northwestern University, Evanston (L.V.H.), and the Department of Surgery, Southern Illinois University, Springfield (J.D.M.) - all in Illinois; the Department of Surgery, Vanderbilt University, Nashville (J.L.T.); the Department of Surgery and the Center for Surgery and Health Economics, Perelman School of Medicine, University of Pennsylvania (R.R.K.), and the American Board of Surgery (F.R.L.) - both in Philadelphia; and the Department of Surgery, University of California, Los Angeles, School of Medicine, Los Angeles (C.Y.K.)
| | - Jonah J Stulberg
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University (K.Y.B., J.W.C., A.R.D., R.L., A.D.Y., D.M.M., D.D.O., J.J.S.), and the American College of Surgeons (K.Y.B., M.E.C., D.B.H., C.Y.K.), Chicago, the Department of Statistics, Northwestern University, Evanston (L.V.H.), and the Department of Surgery, Southern Illinois University, Springfield (J.D.M.) - all in Illinois; the Department of Surgery, Vanderbilt University, Nashville (J.L.T.); the Department of Surgery and the Center for Surgery and Health Economics, Perelman School of Medicine, University of Pennsylvania (R.R.K.), and the American Board of Surgery (F.R.L.) - both in Philadelphia; and the Department of Surgery, University of California, Los Angeles, School of Medicine, Los Angeles (C.Y.K.)
| | - Frank R Lewis
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University (K.Y.B., J.W.C., A.R.D., R.L., A.D.Y., D.M.M., D.D.O., J.J.S.), and the American College of Surgeons (K.Y.B., M.E.C., D.B.H., C.Y.K.), Chicago, the Department of Statistics, Northwestern University, Evanston (L.V.H.), and the Department of Surgery, Southern Illinois University, Springfield (J.D.M.) - all in Illinois; the Department of Surgery, Vanderbilt University, Nashville (J.L.T.); the Department of Surgery and the Center for Surgery and Health Economics, Perelman School of Medicine, University of Pennsylvania (R.R.K.), and the American Board of Surgery (F.R.L.) - both in Philadelphia; and the Department of Surgery, University of California, Los Angeles, School of Medicine, Los Angeles (C.Y.K.)
| |
Collapse
|
25
|
Matsushima K, Inaba K, Skiada D, Esparza M, Cho J, Lee T, Strumwasser A, Magee G, Grabo D, Lam L, Benjamin E, Belzberg H, Demetriades D. A high-volume trauma intensive care unit can be successfully staffed by advanced practitioners at night. J Crit Care 2016; 33:4-7. [PMID: 26928304 DOI: 10.1016/j.jcrc.2016.01.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 12/21/2015] [Accepted: 01/18/2016] [Indexed: 12/01/2022]
Abstract
PURPOSE It remains unknown whether critically ill trauma patients can be successfully managed by advanced practitioners (APs). The purpose of this study was to examine the impact of night coverage by APs in a high-volume trauma intensive care unit (ICU) on patient outcomes and care processes. MATERIALS AND METHODS During the study period, our ICU was staffed by APs during the night shift (7 pm-7 am) from Sunday to Wednesday and by resident physicians (RPs) from Thursday to Saturday. On-call trauma fellows and attending surgeons in house supervised both APs and RPs. Patient outcomes and care processes by APs was compared with those admitted by RPs. RESULTS A total of 289 patients were identified between July 2013 and February 2014. Median lactate clearance rate within 24 hours of admission was similar between study groups (10.0% vs 9.1%; P = .39). Advanced practitioners and RPs transfused patients requiring massive transfusion with a similar blood product ratio (packed red blood cell:fresh frozen plasma) (2.1:1 vs 1.7:1; P = .32). In a multiple logistic regression analysis, AP coverage was not associated with any clinical outcome differences. CONCLUSIONS Our data suggest that, with adequate supervision, a high-volume trauma ICU can be safely staffed by APs overnight.
Collapse
Affiliation(s)
- Kazuhide Matsushima
- Division of Acute Care Surgery, University of Southern California, Los Angeles, CA.
| | - Kenji Inaba
- Division of Acute Care Surgery, University of Southern California, Los Angeles, CA
| | - Dimitra Skiada
- Division of Acute Care Surgery, University of Southern California, Los Angeles, CA
| | - Michael Esparza
- Division of Acute Care Surgery, University of Southern California, Los Angeles, CA
| | - Jayun Cho
- Division of Acute Care Surgery, University of Southern California, Los Angeles, CA
| | - Tim Lee
- Division of Acute Care Surgery, University of Southern California, Los Angeles, CA
| | - Aaron Strumwasser
- Division of Acute Care Surgery, University of Southern California, Los Angeles, CA
| | - Gregory Magee
- Division of Acute Care Surgery, University of Southern California, Los Angeles, CA
| | - Daniel Grabo
- Division of Acute Care Surgery, University of Southern California, Los Angeles, CA
| | - Lydia Lam
- Division of Acute Care Surgery, University of Southern California, Los Angeles, CA
| | - Elizabeth Benjamin
- Division of Acute Care Surgery, University of Southern California, Los Angeles, CA
| | - Howard Belzberg
- Division of Acute Care Surgery, University of Southern California, Los Angeles, CA
| | | |
Collapse
|
26
|
Lin H, Lin E, Auditore S, Fanning J. A Narrative Review of High-Quality Literature on the Effects of Resident Duty Hours Reforms. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:140-50. [PMID: 26445081 DOI: 10.1097/acm.0000000000000937] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
PURPOSE To summarize current high-quality studies evaluating the effect and efficacy of resident duty hours reforms (DHRs) on patient safety and resident education and well-being. METHOD The authors searched PubMed and Medline in August 2012 and again in May 2013 for literature (1987-2013) about the effects of DHRs. They assessed the quality of articles using the Medical Education Research Study Quality Instrument (MERSQI) scoring system. They considered randomized controlled trials (RCTs), partial RCTs, and all studies with a MERSQI score ≥ 14 to be "high-quality" methodology studies. RESULTS A total of 72 high-quality studies met inclusion criteria. Most studies showed no change or slight improvement in mortality and complication rates after DHRs. Resident well-being was generally improved, but there was a perceived negative impact on education (knowledge acquisition, skills, and cognitive performance) following DHRs. Eleven high-quality studies assessed the impact of DHR interventions; all reported a neutral to positive impact. Seven high-quality studies assessed costs associated with DHRs and demonstrated an increase in hospital costs. CONCLUSIONS The results of most studies that allow enough time for DHR interventions to take effect suggest a benefit to patient safety and resident well-being, but the effect on the quality of training remains unknown. Additional methodologically sound studies on the impact of DHRs are necessary. Priorities for future research include approaches to optimizing education and clinical proficiency and studies on the effect of intervention strategies on both education and patient safety. Such studies will provide additional information to help improve duty hours policies.
Collapse
Affiliation(s)
- Henry Lin
- H. Lin is a pediatric gastroenterologist, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. E. Lin is a gastroenterology fellow, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. S. Auditore is market segment development manager, American Medical Association, Chicago, Illinois. J. Fanning is chief of membership and resident fellow member-early career psychiatrist officer, American Psychiatric Association, Arlington, Virginia
| | | | | | | |
Collapse
|
27
|
Wong RH, Smieliauskas F, Pan IW, Lam SK. Interrupted time-series analysis: studying trends in neurosurgery. Neurosurg Focus 2015; 39:E6. [DOI: 10.3171/2015.9.focus15374] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Neurosurgery studies traditionally have evaluated the effects of interventions on health care outcomes by studying overall changes in measured outcomes over time. Yet, this type of linear analysis is limited due to lack of consideration of the trend’s effects both pre- and postintervention and the potential for confounding influences. The aim of this study was to illustrate interrupted time-series analysis (ITSA) as applied to an example in the neurosurgical literature and highlight ITSA’s potential for future applications.
METHODS
The methods used in previous neurosurgical studies were analyzed and then compared with the methodology of ITSA.
RESULTS
The ITSA method was identified in the neurosurgical literature as an important technique for isolating the effect of an intervention (such as a policy change or a quality and safety initiative) on a health outcome independent of other factors driving trends in the outcome. The authors determined that ITSA allows for analysis of the intervention’s immediate impact on outcome level and on subsequent trends and enables a more careful measure of the causal effects of interventions on health care outcomes.
CONCLUSIONS
ITSA represents a significant improvement over traditional observational study designs in quantifying the impact of an intervention. ITSA is a useful statistical procedure to understand, consider, and implement as the field of neurosurgery evolves in sophistication in big-data analytics, economics, and health services research.
Collapse
Affiliation(s)
- Ricky H. Wong
- 1Department of Neurosurgery, University of South Florida, Tampa, Florida
| | | | - I-Wen Pan
- 3Department of Neurosurgery, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas
| | - Sandi K. Lam
- 3Department of Neurosurgery, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas
| |
Collapse
|
28
|
Lee MJ. On Patient Safety: Have The ACGME Resident Work Hour Reforms Improved Patient Safety? Clin Orthop Relat Res 2015; 473:3364-7. [PMID: 26349439 PMCID: PMC4586212 DOI: 10.1007/s11999-015-4547-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 08/26/2015] [Indexed: 01/31/2023]
Affiliation(s)
- Michael J. Lee
- University of Chicago Medical Center, 5841 S Maryland Ave, MC 3079, Chicago, IL 606037 USA
| |
Collapse
|
29
|
Archuleta S, Ibrahim H, Stadler DJ, Shah NG, Chew NW, Cofrancesco J. Perceptions of Leaders and Clinician Educators on the Impact of International Accreditation. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:S83-S90. [PMID: 26505107 DOI: 10.1097/acm.0000000000000906] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Graduate medical education (GME) is responding to calls for reform by adopting competency-based frameworks and, in some countries, by rapidly implementing external accreditation systems. The Accreditation Council for Graduate Medical Education International (ACGME-I) began accrediting institutions in 2009. This study aimed to describe ACGME-I-accredited institutions and explore perceptions of their leaders and clinician educators (CEs) regarding preparedness, challenges, and initial impact of accreditation. METHOD Cross-sectional surveys of all ACGME-I-accredited institutions' leaders and CEs were conducted from June 2013 to June 2014. Eligible participants were identified through institution Web sites and GME offices. Combinations of Web- and paper-based surveys were employed. RESULTS Completed surveys were received from 24 (70.6%) of 34 institutional leaders and 274 (76.3%) of 359 CEs, representing 3 countries, 8 academic medical centers, 2 affiliated teaching hospitals, and 47 residency programs. Leaders and CEs felt prepared in the domains of knowledge and implementation of the competencies. Top challenges were excessive "demands on faculty time" and "bureaucratic procedures." The majority of both groups perceived a positive impact of accreditation on all learner, faculty, institution, and patient outcomes; most perceived no impact on patient satisfaction. Overall, 79.2% of leaders and 75.8% of CEs agreed or strongly agreed that seeking ACGME-I accreditation was worthwhile. CONCLUSIONS This study indicates that despite the challenges identified, initial perceptions of the impact of ACGME-I accreditation are positive. Findings from this study may be useful to institutions and countries considering similar GME reform, though long-term outcome data are needed.
Collapse
|
30
|
Bina RW, Lemole GM, Dumont TM. On resident duty hour restrictions and neurosurgical training: review of the literature. J Neurosurg 2015; 124:842-8. [PMID: 26473789 DOI: 10.3171/2015.3.jns142796] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Within neurosurgery, the national mandate of the 2003 duty hour restrictions (DHR) by the Accreditation Council for Graduate Medical Education (ACGME) has been controversial. Ensuring the proper education and psychological well-being of residents while fulfilling the primary purpose of patient care has generated much debate. Most medical disciplines have developed strategies that address service needs while meeting educational goals. Additionally, there are numerous studies from those disciplines; however, they are not specifically relevant to the needs of a neurosurgical residency. The recent implementation of the 2011 DHR specifically aimed at limiting interns to 16-hour duty shifts has proven controversial and challenging across the nation for neurosurgical residencies--again bringing education and service needs into conflict. In this report the current literature on DHR is reviewed, with special attention paid to neurosurgical residencies, discussing resident fatigue, technical training, and patient safety. Where appropriate, other specialty studies have been included. The authors believe that a one-size-fits-all approach to residency training mandated by the ACGME is not appropriate for the training of neurosurgical residents. In the authors' opinion, an arbitrary timeline designed to limit resident fatigue limits patient care and technical training, and has not improved patient safety.
Collapse
Affiliation(s)
- Robert W Bina
- Department of Surgery, Division of Neurosurgery, The University of Arizona College of Medicine, Tucson, Arizona
| | - G Michael Lemole
- Department of Surgery, Division of Neurosurgery, The University of Arizona College of Medicine, Tucson, Arizona
| | - Travis M Dumont
- Department of Surgery, Division of Neurosurgery, The University of Arizona College of Medicine, Tucson, Arizona
| |
Collapse
|
31
|
Kensinger CD, McMaster WG, Vella MA, Sexton KW, Snyder RA, Terhune KP. Residents as Educators: A Modern Model. JOURNAL OF SURGICAL EDUCATION 2015; 72:949-956. [PMID: 26143515 PMCID: PMC4831619 DOI: 10.1016/j.jsurg.2015.04.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 03/31/2015] [Accepted: 04/06/2015] [Indexed: 06/01/2023]
Abstract
Education during surgical residency has changed significantly. As part of the shifting landscape, the importance of an organized and structured curriculum has increased. However, establishing this is often difficult secondary to clinical demands and pressure both on faculty and residents. We present a peer-assisted learning model for academic institutions without professional non-clinical educations. The "resident as educator" (RAE) model empowers residents to be the organizers of the education curriculum. RAE is built on a culture of commitment to education, skill development and team building, allowing the upper level residents to develop and execute the curriculum. Several modules designed to address junior level residents and medical students' educational needs have been implemented, including (1) intern boot camp, (2) summer school, (3) technical skill sessions, (4) trauma orientation, (5) weekly teaching conferences, and (4) a fourth year medical student surgical preparation course. Promoting residents as educators leads to an overall benefit for the program by being cost-effective and time-efficient, while simultaneously promoting professional development of residents and a culture of education.
Collapse
Affiliation(s)
- Clark D. Kensinger
- Vanderbilt University Medical Center, Department of General Surgery. 1161 21st Avenue South, D4313 MCN. Nashville, TN 37232, United States of America
| | - William G. McMaster
- Vanderbilt University Medical Center, Department of General Surgery. 1161 21st Avenue South, D4313 MCN. Nashville, TN 37232, United States of America
| | - Michael A. Vella
- Vanderbilt University Medical Center, Department of General Surgery. 1161 21st Avenue South, D4313 MCN. Nashville, TN 37232, United States of America
| | - Kevin W. Sexton
- Vanderbilt University Medical Center, Department of General Surgery. 1161 21st Avenue South, D4313 MCN. Nashville, TN 37232, United States of America
| | - Rebecca A. Snyder
- Vanderbilt University Medical Center, Department of General Surgery. 1161 21st Avenue South, D4313 MCN. Nashville, TN 37232, United States of America
| | - Kyla P. Terhune
- Vanderbilt University Medical Center, Department of General Surgery. 1161 21st Avenue South, D4313 MCN. Nashville, TN 37232, United States of America
| |
Collapse
|
32
|
Schroeppel TJ, Sharpe JP, Magnotti LJ, Weinberg JA, Croce MA, Fabian TC. How to Further Decrease the Efficiency of Care at a Level I Trauma Center: Implement the Amended Resident Work Hours. Am Surg 2015. [DOI: 10.1177/000313481508100719] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Work-hour restrictions were amended in 2011 to limit interns to 16 continuous duty hours, essentially requiring a night float system of 12-hour shifts. We hypothesize that there has been no improvement in outcomes after implementation of the amended work-hour restrictions. Outcomes from trauma admissions were queried from the trauma registry from 2009 to 2011 (PRE) and 2011 to 2013 (POST). The primary outcome was mortality with secondary outcomes intensive care unit length of stay (LOS) and LOS. Patients were stratified based on age, mechanism, gender, blood pressure, heart rate, and injury severity (Injury Severity Score, Glasgow Coma Scale, Base Deficit). Outcomes were then compared from admissions PRE to POST. A total of 9178 patients were included in the study population. The mean age was 42 with most being male (72%) and blunt mechanism (81%). Patient populations were well matched except patients in the POST period were slightly older (43 vs 42 years; P = 0.01). Intensive care unit LOS and LOS were higher in the POST period. After adjusted analysis, admission in the POST period was not a predictor of mortality (odds ratio 0.857; confidence interval 0.655–1.12). The POST period was an independent predictor for LOS (β = 0.74; P = 0.002). This study adds to the mounting evidence that the implementation of the amended limits on work hours leads to furthermore decreased efficiency of care.
Collapse
Affiliation(s)
- Thomas J. Schroeppel
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - John P. Sharpe
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Louis J. Magnotti
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Jordan A. Weinberg
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Martin A. Croce
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Timothy C. Fabian
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| |
Collapse
|
33
|
Pattani R, Wu PE, Dhalla IA. Other consequences of reduced duty hours. The authors respond. CMAJ 2015; 187:207. [PMID: 25691795 PMCID: PMC4330147 DOI: 10.1503/cmaj.115-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Reena Pattani
- Department of Medicine (Pattani, Dhalla), St. Michael's Hospital; Department of Medicine, (Pattani, Wu, Dhalla), University of Toronto; Department of Medicine (Wu), Toronto General Hospital; Institute of Health Policy, Management and Evaluation (Dhalla), University of Toronto, Toronto, Ont
| | - Peter E Wu
- Department of Medicine (Pattani, Dhalla), St. Michael's Hospital; Department of Medicine, (Pattani, Wu, Dhalla), University of Toronto; Department of Medicine (Wu), Toronto General Hospital; Institute of Health Policy, Management and Evaluation (Dhalla), University of Toronto, Toronto, Ont
| | - Irfan A Dhalla
- Department of Medicine (Pattani, Dhalla), St. Michael's Hospital; Department of Medicine, (Pattani, Wu, Dhalla), University of Toronto; Department of Medicine (Wu), Toronto General Hospital; Institute of Health Policy, Management and Evaluation (Dhalla), University of Toronto, Toronto, Ont
| |
Collapse
|
34
|
Blackmore C, Austin J, Lopushinsky SR, Donnon T. Effects of Postgraduate Medical Education "Boot Camps" on Clinical Skills, Knowledge, and Confidence: A Meta-Analysis. J Grad Med Educ 2014; 6:643-52. [PMID: 26140112 PMCID: PMC4477555 DOI: 10.4300/jgme-d-13-00373.1] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 04/28/2014] [Accepted: 07/21/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Throughout their medical education, learners face multiple transition periods associated with increased demands, producing stress and concern about the adequacy of their skills for their new role. OBJECTIVE We evaluated the effectiveness of boot camps in improving clinical skills, knowledge, and confidence during transitions into postgraduate or discipline-specific residency programs. METHODS Boot camps are in-training courses combining simulation-based practice with other educational methods to enhance learning and preparation for individuals entering new clinical roles. We performed a search of MEDLINE, CINAHL, PsycINFO, EMBASE, and ERIC using boot camp and comparable search terms. Inclusion criteria included studies that reported on medical education boot camps, involved learners entering new clinical roles in North American programs, and reported empirical data on the effectiveness of boot camps to improve clinical skills, knowledge, and/or confidence. A random effects model meta-analysis was performed to combined mean effect size differences (Cohen's d) across studies based on pretest/posttest or comparison group analyses. RESULTS The search returned 1096 articles, 15 of which met all inclusion criteria. Combined effect size estimates showed learners who completed boot camp courses had significantly "large" improvements in clinical skills (d = 1.78; 95% CI 1.33-2.22; P < .001), knowledge (d = 2.08; 95% CI 1.20-2.96; P < .001), and confidence (d = 1.89; 95% CI 1.63-2.15; P < .001). CONCLUSIONS Boot camps were shown as an effective educational strategy to improve learners' clinical skills, knowledge, and confidence. Focus on pretest/posttest research designs limits the strength of these findings.
Collapse
|
35
|
Lachance S, Latulippe JF, Valiquette L, Langlois G, Douville Y, Fried GM, Richard C. Perceived effects of the 16-hour workday restriction on surgical specialties: Quebec's experience. JOURNAL OF SURGICAL EDUCATION 2014; 71:707-715. [PMID: 24818538 DOI: 10.1016/j.jsurg.2014.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 12/01/2013] [Accepted: 01/17/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Quebec was the first Canadian province to implement a 16-hour workday restriction. Our aim was to assess and compare Quebec's surgical residents' and professors' perception regarding the effects on the educational environment, quality of care, and quality of life. DESIGN The Surgical Theater Educational Environment Measure, the Postgraduate Hospital Educational Environment Measure, quality of the medical act, and quality-of-life questionnaires were administered 6 months after the work-hour restrictions. SETTING Université de Montréal Surgery Department, Montréal, Québec, Canada; Université de Sherbrooke Surgery Department, Sherbrooke, Québec, Canada; Université Laval Surgery Department, Québec, Québec, Canada; and McGill University Surgery Department, Montréal, Québec, Canada. PARTICIPANTS Surgical residents and professors of all specialties within the 4 university surgery departments in Quebec through a voluntary web-based survey. RESULTS A total of 280 questionnaires were analyzed with response rates of 29.7% and 16.4% for residents and professors, respectively. Data were coded on a scale from 2 (strong improvement perception) to -2 (strong deterioration perception). The professors perceived a higher negative effect than the residents did on the educational environment, i.e., role of autonomy (-0.399 vs. -0.577, p < 0.001), teaching (-0.496 vs. -0.540, p < 0.001), social support (-0.345 vs. -0.535, p < 0.001), and surgical learning (-0.409 vs. -0.626, p < 0.001). The professors also observed a higher negative effect on patients' safety (-0.199 vs. -0.595, p = 0.003) and quality of care (-0.077 vs. -0.421, p = 0.014). The latter was even perceived as unchanged by residents (-0.077, 95% CI: -0.249 to 0.095). The residents perceived a negative effect on their quality of life, whereas the professors believed the contrary (0.500 vs -0.496, p < 0.001). More professors than residents believed residency should be prolonged (80.8% vs. 50.6%, p < 0.001). CONCLUSIONS Residents and professors perceive a mild negative effect on the educational environment and quality of care, whereas their perception on quality of life is opposite. The professors seem concerned about adequate training to the point of considering increasing training length.
Collapse
Affiliation(s)
- Sébastien Lachance
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Quebec, Canada; Département de chirurgie, Université de Montréal, Quebec, Canada.
| | - Jean-François Latulippe
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Quebec, Canada; Département de chirurgie, Université de Montréal, Quebec, Canada
| | - Luc Valiquette
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Quebec, Canada; Département de chirurgie, Université de Montréal, Quebec, Canada
| | - Gaétan Langlois
- Département de chirurgie, Université de Sherbrooke, Quebec, Canada
| | - Yvan Douville
- Département de chirurgie, Université Laval, Quebec, Canada
| | - Gerald M Fried
- Department of Surgery, McGill University, Montreal, Canada
| | - Carole Richard
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Quebec, Canada; Département de chirurgie, Université de Montréal, Quebec, Canada
| |
Collapse
|
36
|
Affiliation(s)
- Reena Pattani
- Department of Medicine (Pattani, Dhalla), St. Michael's Hospital, Toronto, Ont.; Department of Medicine (Pattani, Wu, Dhalla), University of Toronto, Toronto, Ont.; Department of Medicine (Wu), Toronto General Hospital, Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Dhalla), University of Toronto, Toronto, Ont.
| | - Peter E Wu
- Department of Medicine (Pattani, Dhalla), St. Michael's Hospital, Toronto, Ont.; Department of Medicine (Pattani, Wu, Dhalla), University of Toronto, Toronto, Ont.; Department of Medicine (Wu), Toronto General Hospital, Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Dhalla), University of Toronto, Toronto, Ont
| | - Irfan A Dhalla
- Department of Medicine (Pattani, Dhalla), St. Michael's Hospital, Toronto, Ont.; Department of Medicine (Pattani, Wu, Dhalla), University of Toronto, Toronto, Ont.; Department of Medicine (Wu), Toronto General Hospital, Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Dhalla), University of Toronto, Toronto, Ont
| |
Collapse
|
37
|
Shelton J, Kummerow K, Phillips S, Arbogast PG, Griffin M, Holzman MD, Nealon W, Poulose BK. Patient safety in the era of the 80-hour workweek. JOURNAL OF SURGICAL EDUCATION 2014; 71:551-559. [PMID: 24776874 PMCID: PMC4852697 DOI: 10.1016/j.jsurg.2013.12.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 12/13/2013] [Accepted: 12/30/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE In 2003, duty-hour regulations (DHR) were initially implemented for residents in the United States to improve patient safety and protect resident's well-being. The effect of DHR on patient safety remains unclear. The study objective was to evaluate the effect of DHR on patient safety. DESIGN Using an interrupted time series analysis, we analyzed selected patient safety indicators (PSIs) for 376 million discharges in teaching (T) vs nonteaching (NT) hospitals before and after implementation of DHR in 2003 that restricted resident work hours to 80 hours per week. The PSIs evaluated were postoperative pulmonary embolus or deep venous thrombosis (PEDVT), iatrogenic pneumothorax (PTx), accidental puncture or laceration, postoperative wound dehiscence (WD), postoperative hemorrhage or hematoma, and postoperative physiologic or metabolic derangement. Propensity scores were used to adjust for differences in patient comorbidities between T and NT hospitals and between discharge quarters. The primary outcomes were differences in the PSI rates before and after DHR implementation. The PSI differences between T and NT institutions were the secondary outcome. SETTING T and NT hospitals in the United States. PARTICIPANTS Participants were 376 million patient discharges from 1998 to 2007 in the Nationwide Inpatient Sample. RESULTS Declining rates of PTx in both T and NT hospitals preintervention slowed only in T hospitals postintervention (p = 0.04). Increasing PEDVT rates in both T and NT hospitals increased further only in NT hospitals (p = 0.01). There were no differences in the PSI rates over time for hemorrhage or hematoma, physiologic or metabolic derangement, accidental puncture or laceration, or WD. T hospitals had higher rates than NT hospitals both preintervention and postintervention for all the PSIs except WD. CONCLUSIONS Trends in rates for 2 of the 6 PSIs changed significantly after DHR implementation, with PTx rates worsening in T hospitals and PEDVT rates worsening in NT hospitals. Lack of consistent patterns of change suggests no measurable effect of the policy change on these PSIs.
Collapse
Affiliation(s)
- Julia Shelton
- Division of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kristy Kummerow
- Division of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Sharon Phillips
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Patrick G Arbogast
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marie Griffin
- Department of Preventive Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Geriatric Research Education and Clinical Center, Tennessee Valley Healthcare System, VA Medical Center, Nashville, Tennessee
| | - Michael D Holzman
- Division of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - William Nealon
- Division of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Benjamin K Poulose
- Division of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
38
|
Norby K, Siddiq F, Adil MM, Haines SJ. The effect of duty hour regulations on outcomes of neurological surgery in training hospitals in the United States: duty hour regulations and patient outcomes. J Neurosurg 2014; 121:247-61. [PMID: 24888763 DOI: 10.3171/2014.4.jns131191] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The effects of sleep deprivation on performance have been well documented and have led to changes in duty hour regulation. New York State implemented stricter duty hours in 1989 after sleep deprivation among residents was thought to have contributed to a patient's death. The goal of this study was to determine if increased regulation of resident duty hours results in measurable changes in patient outcomes. METHODS Using the Nationwide Inpatient Sample (NIS), patients undergoing neurosurgical procedures at hospitals with neurosurgery training programs were identified and screened for in-hospital complications, in-hospital procedures, discharge disposition, and in-hospital mortality. Comparisons in the above outcomes were made between New York hospitals and non-New York hospitals before and after the Accreditation Council for Graduate Medical Education (ACGME) regulations were put into effect in 2003. RESULTS Analysis of discharge disposition demonstrated that 81.9% of patients in the New York group 2000-2002 were discharged to home compared with 84.1% in the non-New York group 2000-2002 (p = 0.6, adjusted multivariate analysis). In-hospital mortality did not significantly differ (p = 0.7). After the regulations were implemented, there was a nonsignificant decrease in patients discharged to home in the non-New York group: 84.1% of patients in the 2000-2002 group compared with 81.5% in the 2004-2006 group (p = 0.6). In-hospital mortality did not significantly change (p = 0.9). In New York there was no significant change in patient outcomes with the implementation of the regulations; 81.9% of patients in the 2000-2002 group were discharged to home compared with 78.0% in the 2004-2006 group (p = 0.3). In-hospital mortality did not significantly change (p = 0.4). After the regulations were in place, analysis of discharge disposition demonstrated that 81.5% of patients in the non-New York group 2004-2006 were discharged to home compared with 78.0% in the New York group 2004-2006 (p = 0.01). In-hospital mortality was not significantly different (p = 0.3). CONCLUSIONS Regulation of resident duty hours has not resulted in significant changes in outcomes among neurosurgical patients.
Collapse
|
39
|
Ahmed N, Devitt KS, Keshet I, Spicer J, Imrie K, Feldman L, Cools-Lartigue J, Kayssi A, Lipsman N, Elmi M, Kulkarni AV, Parshuram C, Mainprize T, Warren RJ, Fata P, Gorman MS, Feinberg S, Rutka J. A systematic review of the effects of resident duty hour restrictions in surgery: impact on resident wellness, training, and patient outcomes. Ann Surg 2014; 259:1041-53. [PMID: 24662409 PMCID: PMC4047317 DOI: 10.1097/sla.0000000000000595] [Citation(s) in RCA: 325] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND In 2003, the Accreditation Council for Graduate Medical Education (ACGME) mandated 80-hour resident duty limits. In 2011 the ACGME mandated 16-hour duty maximums for PGY1 (post graduate year) residents. The stated goals were to improve patient safety, resident well-being, and education. A systematic review and meta-analysis were performed to evaluate the impact of resident duty hours (RDH) on clinical and educational outcomes in surgery. METHODS A systematic review (1980-2013) was executed on CINAHL, Cochrane Database, Embase, Medline, and Scopus. Quality of articles was assessed using the GRADE guidelines. Sixteen-hour shifts and night float systems were analyzed separately. Articles that examined mortality data were combined in a random-effects meta-analysis to evaluate the impact of RDH on patient mortality. RESULTS A total of 135 articles met the inclusion criteria. Among these, 42% (N = 57) were considered moderate-high quality. There was no overall improvement in patient outcomes as a result of RDH; however, some studies suggest increased complication rates in high-acuity patients. There was no improvement in education related to RDH restrictions, and performance on certification examinations has declined in some specialties. Survey studies revealed a perception of worsened education and patient safety. There were improvements in resident wellness after the 80-hour workweek, but there was little improvement or negative effects on wellness after 16-hour duty maximums were implemented. CONCLUSIONS Recent RDH changes are not consistently associated with improvements in resident well-being, and have negative impacts on patient outcomes and performance on certification examinations. Greater flexibility to accommodate resident training needs is required. Further erosion of training time should be considered with great caution.
Collapse
Affiliation(s)
- Najma Ahmed
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Itay Keshet
- Department of Internal Medicine, Mount Sinai Hospital, New York City, NY
| | - Jonathan Spicer
- Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Kevin Imrie
- Department of Internal Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Liane Feldman
- Department of Surgery, McGill University, Montreal, Quebec, Canada
| | | | - Ahmed Kayssi
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Nir Lipsman
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Maryam Elmi
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Chris Parshuram
- Department of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Todd Mainprize
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Richard J. Warren
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Paola Fata
- Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - M. Sean Gorman
- Department of Surgery, Royal Inland Hospital, Kamloops, British Columbia, Canada
| | - Stan Feinberg
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - James Rutka
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
40
|
|
41
|
|
42
|
Imrie K, Frank JR, Ahmed N, Gorman L, Harris KA. A new era for resident duty hours in surgery calls for greater emphasis on resident wellness. Can J Surg 2013; 56:295-6. [PMID: 24067513 DOI: 10.1503/cjs.017713] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Kevin Imrie
- From the Royal College of Physicians and Surgeons of Canada, Ottawa, Ont., and the University of Toronto Faculty of Medicine, Toronto, Ont
| | | | | | | | | |
Collapse
|
43
|
Rakinic J. Teaching and Assessing Colorectal Surgery Residents in the Age of ACGME Competencies: Pieces of the Whole. Clin Colon Rectal Surg 2013; 25:143-50. [PMID: 23997669 DOI: 10.1055/s-0032-1322527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Educators have struggled with teaching and evaluation of the six Accreditation Council for Graduate Medical Education (ACGME) core competencies since their introduction in 1999. In addition, many authors have questioned the construct validity of the competencies. Concern has also arisen regarding the educational effects of the competencies and the subsequent limitation of resident duty hours, the combination of which have forced unprecedented changes in American graduate medical education. This article attempts to present an understanding of how these events have had direct and indirect effects on the education of residents in colon and rectal surgery, and to provide a framework for educators in colon and rectal surgery to adapt in their curricula.
Collapse
Affiliation(s)
- Jan Rakinic
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| |
Collapse
|
44
|
Hussey PS, Burns RM, Weinick RM, Mayer L, Cerese J, Farley DO. Using a hospital quality improvement toolkit to improve performance on the AHRQ quality indicators. Jt Comm J Qual Patient Saf 2013; 39:177-84. [PMID: 23641537 DOI: 10.1016/s1553-7250(13)39024-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
45
|
Twenty-year analysis of surgical resident operative trauma experiences. J Surg Res 2013; 180:191-5. [DOI: 10.1016/j.jss.2012.04.061] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 04/09/2012] [Accepted: 04/26/2012] [Indexed: 11/18/2022]
|
46
|
Ruutiainen AT, Durand DJ, Scanlon MH, Itri JN. Increased error rates in preliminary reports issued by radiology residents working more than 10 consecutive hours overnight. Acad Radiol 2013; 20:305-11. [PMID: 23452475 DOI: 10.1016/j.acra.2012.09.028] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 09/10/2012] [Accepted: 09/20/2012] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES To determine if the rate of major discrepancies between resident preliminary reports and faculty final reports increases during the final hours of consecutive 12-hour overnight call shifts. MATERIALS AND METHODS Institutional review board exemption status was obtained for this study. All overnight radiology reports interpreted by residents on-call between January 2010 and June 2010 were reviewed by board-certified faculty and categorized as major discrepancies if they contained a change in interpretation with the potential to impact patient management or outcome. Initial determination of a major discrepancy was at the discretion of individual faculty radiologists based on this general definition. Studies categorized as major discrepancies were secondarily reviewed by the residency program director (M.H.S.) to ensure consistent application of the major discrepancy designation. Multiple variables associated with each report were collected and analyzed, including the time of preliminary interpretation, time into shift study was interpreted, volume of studies interpreted during each shift, day of the week, patient location (inpatient or emergency department), block of shift (2-hour blocks for 12-hour shifts), imaging modality, patient age and gender, resident identification, and faculty identification. Univariate risk factor analysis was performed to determine the optimal data format of each variable (ie, continuous versus categorical). A multivariate logistic regression model was then constructed to account for confounding between variables and identify independent risk factors for major discrepancies. RESULTS We analyzed 8062 preliminary resident reports with 79 major discrepancies (1.0%). There was a statistically significant increase in major discrepancy rate during the final 2 hours of consecutive 12-hour call shifts. Multivariate analysis confirmed that interpretation during the last 2 hours of 12-hour call shifts (odds ratio (OR) 1.94, 95% confidence interval (CI) 1.18-3.21), cross-sectional imaging modality (OR 5.38, 95% CI 3.22-8.98), and inpatient location (OR 1.81, 95% CI 1.02-3.20) were independent risk factors for major discrepancy. CONCLUSIONS In a single academic medical center, major discrepancies in resident preliminary reports increased significantly during the final 2 hours of consecutive 12-hour overnight call shifts. This finding could be related to either fatigue or circadian desynchronization. Discrimination of these two potential etiologies requires additional investigation as major discrepancies in resident reports have the potential to negatively impact patient care/outcome. Cross-sectional imaging modalities including computed tomography and ultrasound (versus conventional radiography), as well as inpatient location (versus Emergency Department location), were also associated with significantly higher major discrepancy rates.
Collapse
|
47
|
Petrucci AM, Nouh T, Boutros M, Gagnon R, Meterissian SH. Assessing clinical judgment using the Script Concordance test: the importance of using specialty-specific experts to develop the scoring key. Am J Surg 2013; 205:137-40. [DOI: 10.1016/j.amjsurg.2012.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 06/15/2012] [Accepted: 09/02/2012] [Indexed: 11/16/2022]
|
48
|
Surgical Residents' Perception of the 16-Hour Work Day Restriction: Concern for Negative Impact on Resident Education and Patient Care. J Am Coll Surg 2012; 215:868-77. [DOI: 10.1016/j.jamcollsurg.2012.08.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Revised: 08/05/2012] [Accepted: 08/07/2012] [Indexed: 10/27/2022]
|
49
|
Philibert I, Nasca T, Brigham T, Shapiro J. Duty-hour limits and patient care and resident outcomes: can high-quality studies offer insight into complex relationships? Annu Rev Med 2012; 64:467-83. [PMID: 23121182 DOI: 10.1146/annurev-med-120711-135717] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Long hours are an accepted component of resident education, yet data suggest they contribute to fatigue that may compromise patient safety. A systematic review confirms that limiting duty hours increases residents' hours of sleep and improves objective measures of alertness. Most studies of operative experience for surgical residents found no effect, and there is evidence of a limited positive effect on residents' mood. We find a mixed effect on patient safety, although problems with supervision, rather than the limits, may be responsible or contibute; evidence of reduced continuity of care and reduced continuity in residents' clinical education; and evidence that increased workload under the limits has a negative effect on patient and resident outcomes. We highlight specific areas for research and offer recommendations for national policy.
Collapse
Affiliation(s)
- Ingrid Philibert
- Accreditation Council for Graduate Medical Education, Chicago, Illinois 60654, USA.
| | | | | | | |
Collapse
|
50
|
Hoh BL, Neal DW, Kleinhenz DT, Hoh DJ, Mocco J, Barker FG. Higher Complications and No Improvement in Mortality in the ACGME Resident Duty-Hour Restriction Era. Neurosurgery 2012; 70:1369-81; discussion 1381-2. [DOI: 10.1227/neu.0b013e3182486a75] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|