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Al-Halabi B, Madani A, Alabdulkarim A, Vassiliou M, Gilardino M. Defining Cognitive Competencies for Breast Augmentation Surgery. JOURNAL OF SURGICAL EDUCATION 2023; 80:873-883. [PMID: 37105861 DOI: 10.1016/j.jsurg.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 03/17/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Breast augmentation is the most performed aesthetic procedure in the United States yet one that surgical trainees have limited exposure to. This creates a lack of confidence in performing this key procedure among graduates. It is imperative to develop novel curricula and objective measures to standardize acquiring competency. OBJECTIVE This qualitative study establishes various cognitive competencies and pitfalls in augmentation mammoplasty. METHODS Using a priori established task analysis, literary sources and operative observations, a total of 20 cognitive vignettes were developed to conduct cognitive task analyses (CTA) for breast augmentation through semistructured interviews of experts. Interviews were itemized, and verbal data were recorded, transcribed verbatim, and thematically analyzed by reviewers. RESULTS Eight experts were interviewed (median age 39 years, 87.5% males, with a median of 7 years in practice). A conceptual framework for breast augmentation was developed and divided into 5 operative stages containing 208 competencies and 41 pitfalls. Pitfalls were mapped to deficits in shared decision making, proper informed consent, prospective hemostasis, and awareness of anatomical landmarks and markings. CONCLUSIONS This work provided an inclusive framework of cognitive competencies in breast augmentation surgery to facilitate their assessment. This model guides the analysis of other procedures to transfer cognitive competencies to learners. In a transition toward competency-based education, this provides a primer to assessments that include all aspects of a surgeon's skill set.
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Affiliation(s)
- Becher Al-Halabi
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Quebec, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Amin Madani
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montreal, Quebec, Canada; Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Abdulaziz Alabdulkarim
- Plastic Surgery, Surgery Department, College of Medicine, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Melina Vassiliou
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montreal, Quebec, Canada; Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Mirko Gilardino
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Quebec, Canada
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Purdy AC, Smith BR, Amersi F, Calhoun KE, Tolles J, Dauphine C, Holloway J, Roy M, Jarman BT, Han AY, Neville AL, Dickinson KJ, Salcedo ES, Shields Frey E, Poola VP, Murayama KM, Chen F, Wu E, Fleischman RJ, de Virgilio C. Characteristics Associated With Outstanding General Surgery Residency Graduate Performance, as Rated by Surgical Educators. JAMA Surg 2022; 157:918-924. [PMID: 35947371 PMCID: PMC9366653 DOI: 10.1001/jamasurg.2022.3340] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/17/2022] [Indexed: 11/14/2022]
Abstract
Importance Characteristics of outstanding graduating surgical residents are currently undefined. Identifying these qualities may be important in guiding resident selection and resident education. Objective To determine characteristics that are most strongly associated with being rated as an outstanding graduating surgical resident. Design, Setting, and Participants The multi-institutional study had 3 phases. First, an expert panel developed a list of characteristics embodied by top graduating surgical residents. Second, groups of faculty from 14 US general-surgery residency programs ranked 2017 through 2020 graduates into quartiles of overall performance. Third, faculty evaluated their graduates on each characteristic using a 5-point Likert scale. Data were analyzed using Spearman rank-order correlation to identify which individual characteristics were associated with overall graduate performance. A least absolute shrinkage and selection operator (LASSO) ordinal regression was performed to select a parsimonious model to predict the outcome of overall performance rating from individual characteristic scores. Main Outcome and Measures Surgical educators' rankings of general surgery residency graduates' overall performance. Results Fifty faculty from 14 US residency programs with a median of 13 (range, 5-30) years of surgical education experience evaluated 297 general surgery residency graduates. Surgical educators identified 21 characteristics that they believed outstanding graduating surgical residents possessed. Two hundred ninety-seven surgical residency graduates were evaluated. Higher scores in every characteristic correlated with better overall performance. Characteristics most strongly associated with higher overall performance scores were surgical judgment (r = 0.728; P < .001), leadership (r = 0.726; P < .001), postoperative clinical skills (r = 0.715; P < .001), and preoperative clinical skills (r = 0.707; P < .001). The remainder of the characteristics were moderately associated with overall performance. The LASSO regression model identified 3 characteristics from which overall resident performance could be accurately predicted without measuring other qualities: surgical judgment (odds ratio [OR] per 1 level of 5-level Likert scale OR, 1.27; 95% CI, 1.03-1.51), leadership (OR, 1.27; 95% CI, 1.06-1.48), and medical knowledge (OR, 1.16; 95% CI, 1.01-1.33). Conclusions and Relevance All individual characteristics identified by surgical educators as being qualities of outstanding graduating surgical residents were positively associated with overall graduate performance. Surgical judgment and leadership skills had the strongest individual associations. Assessment of only 3 qualities (surgical judgment, leadership, and medical knowledge) were required to predict overall resident performance ratings. These findings highlight the importance of developing specific surgical judgment and leadership skills curricula and assessments during surgical residency.
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Affiliation(s)
- Amanda C. Purdy
- Department of Surgery, Harbor-University of California, Los Angeles Medical Center, Torrance
| | - Brian R. Smith
- Department of Surgery, University of California, Irvine Medical Center, Orange
| | - Farin Amersi
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Juliana Tolles
- Department of Emergency Medicine, Harbor-University of California, Los Angeles Medical Center, Torrance
- The Lundquist Institute, Torrance, California
| | - Christine Dauphine
- Department of Surgery, Harbor-University of California, Los Angeles Medical Center, Torrance
| | - Janell Holloway
- Department of Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Mayank Roy
- Department of Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Benjamin T. Jarman
- Department of Surgery, Gunderson Medical Foundation, La Crosse, Wisconsin
| | - Amy Y. Han
- Department of Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Angela L. Neville
- Department of Surgery, Harbor-University of California, Los Angeles Medical Center, Torrance
| | - Karen J. Dickinson
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock
| | - Edgardo S. Salcedo
- Department of Surgery, University of California, Davis, School of Medicine, Sacramento
| | - Edgar Shields Frey
- Department of Surgery, Brookwood Baptist Medical Center, Birmingham, Alabama
| | - V. Prasad Poola
- Department of Surgery, Southern Illinois School of Medicine, Springfield
| | | | - Formosa Chen
- Department of Surgery, University of California, Los Angeles
| | - Esther Wu
- Department of Surgery, Loma Linda University, California
| | - Ross J. Fleischman
- Department of Emergency Medicine, Harbor-University of California, Los Angeles Medical Center, Torrance
- The Lundquist Institute, Torrance, California
| | - Christian de Virgilio
- Department of Surgery, Harbor-University of California, Los Angeles Medical Center, Torrance
- The Lundquist Institute, Torrance, California
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Teaching and Assessing Cognitive Competencies in Aesthetic and Plastic Surgery. Plast Reconstr Surg 2022; 150:455e-464e. [PMID: 35687398 DOI: 10.1097/prs.0000000000009295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cognition, part of surgical competence, employs forward planning, error prevention, and orchestrating technical skills. Thus, an understanding of mental processes used by experts throughout patient care is essential to teaching such competencies. This study aims to analyze and compare mental models of two distinct procedures in plastic surgery, breast augmentation and flexor tendon repair, to develop a framework to define cognitive competencies in plastic surgery aided by a review of the literature. METHODS Based on data from a-priori cognitive task analyses, literary sources, and field observations of breast augmentation surgery and flexor tendon repair, task-lists were produced for each procedure. Two mental models were developed using fuzzy logic cognitive maps to visually illustrate and analyze cognitive processes employed in either procedure. A comparison of the models aided by literature was used to define the cognitive competencies employed, identify differences in the decision-making process, and provide a guiding framework for understanding cognitive competencies. RESULTS Five distinct cognitive competency domains were identified from the literature applicable to plastic surgery, namely situation awareness, decision-making, task management, leadership, and communication and teamwork. Differences in processes of decision-making employed between an elective and a trauma setting were identified. A framework to map cognitive competencies within a generic mental model in surgical care was synthesized and methods were suggested for training on such competencies. CONCLUSION Cognitive competencies in different settings in plastic surgery are introduced using a comparative study of two mental models of distinct procedures to guide the teaching and assessment of such competencies.
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Al-Halabi B, Abi-Rafeh J, Jaberi M, Gilardino M. Preliminary Validation of a Stimulator for Markings in Surgery. Surg Innov 2021; 29:464-465. [PMID: 34461771 DOI: 10.1177/15533506211041910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Becher Al-Halabi
- Division of Plastic & Reconstructive Surgery, 54473McGill University Health Centre, Montreal, QC, Canada
| | - Jad Abi-Rafeh
- Division of Plastic & Reconstructive Surgery, 54473McGill University Health Centre, Montreal, QC, Canada
| | - Mehrad Jaberi
- Division of Plastic & Reconstructive Surgery, 54473McGill University Health Centre, Montreal, QC, Canada
| | - Mirko Gilardino
- Division of Plastic & Reconstructive Surgery, 54473McGill University Health Centre, Montreal, QC, Canada
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Abstract
BACKGROUND Time-based training models in plastic surgery vary in exposure, resulting in low confidence levels among graduates. The evolution of postgraduate medical education into a competency-based model to address these issues requires an understanding of interventions described in the plastic surgery literature to identify gaps and guide creation of assessments to demonstrate competence. METHODS A systematic search of the MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, PubMed, and Cochrane databases from inception until December of 2017 was conducted using search terms and synonyms of educational interventions reported in plastic surgery. Full texts were retrieved following filtering and data extracted were related to intervention design and execution, involvement of competency assessment, and educational objectives and alignment to Accreditation Council for Graduate Medical Education competencies and Royal College of Physicians and Surgeons of Canada Canadian Medical Education Directives for Specialists roles. Study quality was assessed using Kirkpatrick's levels of learning evaluation, validity evidence, and the Medical Education Research Study Quality Instrument score. RESULTS Of the initial 4307 results, only 36 interventions met the inclusion criteria. Almost all interventions aligned to medical knowledge and patient care Accreditation Council for Graduate Medical Education competencies. One-fifth of the interventions involved no assessment of competency, whereas most displayed assessment at the level of design as opposed to outcomes. Quality assessment revealed low levels of learning evaluation and evidence of validity; the average Medical Education Research Study Quality Instrument score was 10.9 of 18. CONCLUSION A systematic review of educational literature in plastic surgery was conducted to assess the quality of reported educational interventions, and to help guide creating tools that ensure competency acquirement among trainees.
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Agrawal N, Turner A, Grome L, Abu-Ghname A, Davis MJ, Reece EM, Buchanan EP, Winocour S. Use of Simulation in Plastic Surgery Training. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2896. [PMID: 32802639 PMCID: PMC7413819 DOI: 10.1097/gox.0000000000002896] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/14/2020] [Indexed: 12/18/2022]
Abstract
The nationwide focus on patient safety and the health of residents has increased the demand for educational tools outside the operating room. Simulation is a valuable tool for assessing and developing surgical skills in a controlled and safe environment. The use of simulation as a formal component of training has been increasing in various surgical subspecialties. In general surgery, simulation examinations such as the Fundamentals of Laparoscopic Surgery and Fundamentals of Endoscopic Surgery have become a prerequisite to board certification. Although formal simulation examinations in plastic surgery are not universal, there has been an increase in the use of simulation to increase resident competency in the operating room. For now, we will review the current state of simulation in craniofacial, hand, microvascular, and esthetic surgery and discuss applications for the future. We will also discuss the evolving role of artificial intelligence, virtual reality, and augmented reality in plastic surgery training and testing.
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Affiliation(s)
- Nikhil Agrawal
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Acara Turner
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Luke Grome
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Amjed Abu-Ghname
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
- Division of Plastic Surgery, Department of Surgery, Texas Children’s Hospital, Houston, Tex
| | - Matthew J. Davis
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
- Division of Plastic Surgery, Department of Surgery, Texas Children’s Hospital, Houston, Tex
| | - Edward M. Reece
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
- Division of Plastic Surgery, Department of Surgery, Texas Children’s Hospital, Houston, Tex
| | - Edward P. Buchanan
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
- Division of Plastic Surgery, Department of Surgery, Texas Children’s Hospital, Houston, Tex
| | - Sebastian Winocour
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
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Silvestre J, Caruso VA, Hernandez JM, Serletti JM, Chang B. The Impact of Training Pathway on Breast Surgery Cases Performed during Plastic Surgery Residency. Aesthetic Plast Surg 2019; 43:1663-1668. [PMID: 31218380 DOI: 10.1007/s00266-019-01424-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 06/06/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Operative volume is a critical component of surgical resident education. This study compares reported breast surgery case volume between resident training pathways in plastic surgery. METHODS This retrospective cohort study reviewed case logs of plastic surgery residents in the independent/combined and integrated training pathways. Breast surgery case volume was compared via t tests across two major categories: reconstructive and aesthetic. Differences in intra-pathway variability were compared with F tests. Five consecutive cohorts of plastic surgery residents (n = 818): independent/combined (n = 526, 64%) and integrated (n = 292, 36%) at Accreditation Council for Graduate Medical Education (ACGME) accredited residency programs, were included (2011-2015). RESULTS Independent/combined residents reported significantly more aesthetic cases than integrated residents, but similar reconstructive cases. Independent/combined residents reported more breast augmentations, mastopexy, cosmetic breast fat grafting, and other cosmetic breast cases. Within the reconstructive category, independent residents reported more breast reconstruction fat grafting cases while integrated residents reported more breast reconstruction with pedicle flap, other breast reconstruction, and breast reduction cases. Independent residents had greater intra-pathway variability in five case subcategories, while integrated residents had greater variability in one case subcategory. CONCLUSIONS Disparities in breast surgery case volume exist by plastic surgery residency training pathway. Given the importance of case volume to residents and faculty, these disparities may warrant greater attention. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Jason Silvestre
- The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
- Hospital of the University of Pennsylvania, 3400 Spruce St, 10 Penn Tower, Philadelphia, PA, 19104, USA.
| | - Vincenza A Caruso
- The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Hospital of the University of Pennsylvania, 3400 Spruce St, 10 Penn Tower, Philadelphia, PA, 19104, USA
| | - Jade M Hernandez
- The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Hospital of the University of Pennsylvania, 3400 Spruce St, 10 Penn Tower, Philadelphia, PA, 19104, USA
| | - Joseph M Serletti
- The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Hospital of the University of Pennsylvania, 3400 Spruce St, 10 Penn Tower, Philadelphia, PA, 19104, USA
| | - Benjamin Chang
- The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Hospital of the University of Pennsylvania, 3400 Spruce St, 10 Penn Tower, Philadelphia, PA, 19104, USA
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Firdouse M, Devon K, Kayssi A, Goldfarb J, Rossos P, Cil TD. Using Texting for Clinical Communication in Surgery: A Survey of Academic Staff Surgeons. Surg Innov 2018. [PMID: 29537349 DOI: 10.1177/1553350618761980] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Text messaging has become ubiquitous and is being increasingly used within the health care system. The purpose of this study was to understand texting practices for clinical communication among staff surgeons at a large academic institution. METHODS Staff surgeons in 4 subspecialties (vascular, plastics, urology, and general surgery) were surveyed electronically. RESULTS A total of 62 surgeons from general surgery (n = 33), vascular surgery (n = 6), plastic surgery (n = 13), and urology (n = 10) completed the study (response rate 30%). When conveying urgent patient-related information, staff surgeons preferred directly calling other staff surgeons (61.5%) and trainees (58.8%). When discussing routine patient information, staff surgeons used email to reach other staff surgeons (54.9%) but preferred texting (62.7%) for trainees. The majority of participants used texting because it is fast (65.4%), convenient (69.2%) and allows transmitting information to multiple recipients simultaneously (63.5%). Most felt that texting enhances patient care (71.5%); however, only half believed that it enhanced trainees' educational experiences. The majority believed that texting identifiable patient information breaches patient confidentiality. CONCLUSIONS Our data showed high adoption of text messaging for clinical communication among surgeons, particularly with trainees. The majority of surgeons acknowledge security concerns inherent in texting for patient care. Existing mobile communication platforms fail to meet the needs of academic surgeons. Further research should include guidelines related to texting in clinical practice, educational implications of texting, and technologies to better meet the needs of clinicians working in an academic surgical settings.
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Affiliation(s)
| | - Karen Devon
- 1 University of Toronto, ON, Canada.,2 University Health Network, Toronto, ON, Canada
| | | | | | - Peter Rossos
- 1 University of Toronto, ON, Canada.,2 University Health Network, Toronto, ON, Canada
| | - Tulin D Cil
- 1 University of Toronto, ON, Canada.,2 University Health Network, Toronto, ON, Canada
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Khelemsky R, Hill B, Buchbinder D. Validation of a Novel Cognitive Simulator for Orbital Floor Reconstruction. J Oral Maxillofac Surg 2016; 75:775-785. [PMID: 28012843 DOI: 10.1016/j.joms.2016.11.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/20/2016] [Accepted: 11/24/2016] [Indexed: 01/22/2023]
Abstract
PURPOSE The increasing focus on patient safety in current medical practice has promoted the development of surgical simulation technology in the form of virtual reality (VR) training designed largely to improve technical skills and less so for nontechnical aspects of surgery such as decision making and material knowledge. The present study investigated the validity of a novel cognitive VR simulator called Touch Surgery for a core maxillofacial surgical procedure: orbital floor reconstruction (OFR). MATERIALS AND METHODS A cross-sectional study was carried out on 2 groups of participants with different experience levels. Novice graduate dental students and expert surgeons were recruited from a local dental school and academic residency programs, respectively. All participants completed the OFR module on Touch Surgery. The primary outcome variable was simulator performance score. Post-module questionnaires rating specific aspects of the simulation experience were completed by the 2 groups and served as the secondary outcome variables. The age and gender of participants were considered additional predictor variables. From these data, conclusions were made regarding 3 types of validity (face, content, and construct) for the Touch Surgery simulator. Dependent-samples t tests were used to explore the consistency in simulation performance scores across phases 1 and 2 by experience level. Two multivariate ordinary least-squares regression models were fit to estimate the relation between experience and phase 1 and 2 scores. RESULTS Thirty-nine novices and 10 experts who were naïve to Touch Surgery were recruited for the study. Experts outperformed novices on phases 1 and 2 of the OFR module (P < .001), which provided the measurement of construct validation. Responses to the questionnaire items used to assess face validity were favorable from the 2 groups. Positive questionnaire responses also were recorded from experts alone on items assessing the content validity for the module. Participant age and gender were not relevant predictors of performance scores. CONCLUSION Construct, content, and face validities were observed for the OFR module on a novel cognitive simulator, Touch Surgery. Therefore, OFR simulation on the smart device platform could serve as a useful cognitive training and assessment tool in maxillofacial surgery residency programs.
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Affiliation(s)
- Renata Khelemsky
- Resident, Department of Otolaryngology-Head and Neck Surgery, Division of Oral and Maxillofacial Surgery, Mount Sinai Beth Israel and Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Brianna Hill
- Medical Student, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Daniel Buchbinder
- Chief, Division of Oral and Maxillofacial Surgery, Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Beth Israel and Icahn School of Medicine at Mount Sinai, New York, NY
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