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Cai F, Santiago S, Southworth E, Stephenson-Famy A, Fay E, Wang EY, Burns RN. Taking the Express Lane: Student Attitudes Towards Tracking in Ob/Gyn Residency. Clin Obstet Gynecol 2024; 67:465-473. [PMID: 38934565 DOI: 10.1097/grf.0000000000000873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
We sought to determine the subspecialty interests of fourth-year medical students (MS4s) matched to Ob/Gyn and evaluate their attitudes towards residency tracking. Matched MS4s completed a survey regarding subspecialization, confidence in that choice, and desire for tracking. A total of 922 MS4s completed the survey. Of these, 474 (51.4%) desired subspecialty training, but were less confident in their choice compared with those desiring generalist careers (60.0/100 vs. 64.9/100, P =0.003). Those seeking subspecialty training were more likely to desire tracking (15.2% vs. 39.5%, P <0.001). In conclusion, 51% of MS4s desired subspecialty training over generalist careers. Almost 40% of these students are interested in tracking.
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Affiliation(s)
- Fei Cai
- Division of Perinatology, Oregon Health & Sciences University, Portland, Oregon
| | - Sarah Santiago
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Elizabeth Southworth
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Alyssa Stephenson-Famy
- Division of Maternal Fetal Medicine, University of Washington Medical Center, Seattle, Washington
| | - Emily Fay
- Division of Maternal Fetal Medicine, University of Washington Medical Center, Seattle, Washington
| | - Eileen Y Wang
- Division of Maternal Fetal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ralph Nicholas Burns
- Division of Maternal Fetal Medicine, University of Texas Southwestern, Dallas, Texas
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2
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Hamilton A. The Future of Artificial Intelligence in Surgery. Cureus 2024; 16:e63699. [PMID: 39092371 PMCID: PMC11293880 DOI: 10.7759/cureus.63699] [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] [Accepted: 07/01/2024] [Indexed: 08/04/2024] Open
Abstract
Until recently, innovations in surgery were largely represented by extensions or augmentations of the surgeon's perception. This includes advancements such as the operating microscope, tumor fluorescence, intraoperative ultrasound, and minimally invasive surgical instrumentation. However, introducing artificial intelligence (AI) into the surgical disciplines represents a transformational event. Not only does AI contribute substantively to enhancing a surgeon's perception with such methodologies as three-dimensional anatomic overlays with augmented reality, AI-improved visualization for tumor resection, and AI-formatted endoscopic and robotic surgery guidance. What truly makes AI so different is that it also provides ways to augment the surgeon's cognition. By analyzing enormous databases, AI can offer new insights that can transform the operative environment in several ways. It can enable preoperative risk assessment and allow a better selection of candidates for procedures such as organ transplantation. AI can also increase the efficiency and throughput of operating rooms and staff and coordinate the utilization of critical resources such as intensive care unit beds and ventilators. Furthermore, AI is revolutionizing intraoperative guidance, improving the detection of cancers, permitting endovascular navigation, and ensuring the reduction in collateral damage to adjacent tissues during surgery (e.g., identification of parathyroid glands during thyroidectomy). AI is also transforming how we evaluate and assess surgical proficiency and trainees in postgraduate programs. It offers the potential for multiple, serial evaluations, using various scoring systems while remaining free from the biases that can plague human supervisors. The future of AI-driven surgery holds promising trends, including the globalization of surgical education, the miniaturization of instrumentation, and the increasing success of autonomous surgical robots. These advancements raise the prospect of deploying fully autonomous surgical robots in the near future into challenging environments such as the battlefield, disaster areas, and even extraplanetary exploration. In light of these transformative developments, it is clear that the future of surgery will belong to those who can most readily embrace and harness the power of AI.
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Affiliation(s)
- Allan Hamilton
- Artificial Intelligence Division for Simulation, Education, and Training, University of Arizona Health Sciences, Tucson, USA
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3
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Antony P, Kalkum E, Muller MK, Hager L, Probst P. The introduction of a 42 + 4 h work week for surgical residents in Switzerland - a stakeholder analysis. Langenbecks Arch Surg 2024; 409:197. [PMID: 38913126 DOI: 10.1007/s00423-024-03385-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 06/16/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND The Swiss national union of residents and attendings (VSAO) has voiced its desire for a transition from the current 48 h work week to a 42 + 4 h work week, in which 42 h be focused on patient care with the remaining 4 h be dedicated solely to training purposes. This could potentially result in a significant decrease in surgical education time. The current study seeks to address the issues involved in its implementation as well as possible compensatory mechanisms. METHODS This mixed methods study seeks to clearly underline the challenges associated with the implementation of a 42 + 4 h work week. First, the major stakeholders were identified and analysed via umbrella review. Thereafter, a classic stakeholder analysis was performed. Via morphological matrix, possible models for the implementation of a 42 + 4 h work week were developed and evaluated. Finally, representatives from the identified stakeholder groups were interviewed and given the opportunity to provide feedback. RESULTS A total of 26 articles were identified by the literature search and were used to identify the major stakeholders and issues involved in the implementation of the desired work hour regulation. Overall, these showed conflicting results with regard to the effect decreased working hours would have on surgical training and patient outcomes. In the end, the morphological matrix produced three feasible and desirable models for the implementation of a 42 + 4 h work week. Each included compensatory mechanisms like auxiliary staff, reduction in administrative tasks, and a switch to EPAs. In their interviews, the stakeholders generally supported these solutions. CONCLUSION Given the increasing emphasis on the importance of a positive work-life balance, it seems inevitable that the next few years will see the introduction of a 42 + 4 h work week in Switzerland. However, it is imperative that every effort be made to preserve the quality of training and patient care for the next generations. This will require the cooperation of all stakeholders in order to find workable solutions.
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Affiliation(s)
- P Antony
- Department of Surgery, Cantonal Hospital Thurgau, Pfaffenholzstrasse 4, Münsterlingen, 8501, Switzerland
| | - Eva Kalkum
- The Study Centre of the German Surgical Society (SDGC), University of Heidelberg, Heidelberg, Germany
| | - M K Muller
- Department of Surgery, Cantonal Hospital Thurgau, Pfaffenholzstrasse 4, Münsterlingen, 8501, Switzerland
| | | | - Pascal Probst
- Department of Surgery, Cantonal Hospital Thurgau, Pfaffenholzstrasse 4, Münsterlingen, 8501, Switzerland.
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Dall CP, Liu X, Faraj KS, Srivastava A, Kaufman SR, Shahinian VB, Hollenbeck BK. Teaching Hospitals and Textbook Outcomes After Major Urologic Cancer Surgery. Urology 2024:S0090-4295(24)00451-5. [PMID: 38878826 DOI: 10.1016/j.urology.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/22/2024] [Accepted: 06/04/2024] [Indexed: 06/30/2024]
Abstract
OBJECTIVE To assess textbook outcomes by hospital teaching status following major surgery for urologic cancers. METHODS We used 100% national Medicare Provider Analysis and Review files from 2017-2020 to assess rates of textbook outcomes in patients undergoing bladder (ie, radical cystectomy), kidney (ie, radical or partial nephrectomy), and prostate (ie, radical prostatectomy) surgery for genitourinary malignancies. The extent of integration of learners into each hospital's workforce-defined as major, minor, and non teaching hospitals-was the primary exposure. A textbook outcome, measured at the patient level, was defined as the absence of in-hospital mortality and mortality within 30days of surgery, no readmission 30days following discharge, no postoperative complication, and no prolonged length of stay. RESULTS Textbook outcomes were achieved in 51% (8564/16,786) of patients after bladder cancer surgery, 70% (39,938/57,300) of patients after kidney cancer surgery, and 82% (50,408/61,385) of patients after prostate cancer surgery. After adjusting for patient- and hospital-level characteristics, teaching hospitals had higher rates of textbook outcomes in those undergoing bladder (50.7% vs 44.0%; P = .001), kidney (72.0% vs 69.7%; P = .02), and prostate (85.3% vs 81.0%; P <.001) surgery. This effect was attenuated, but not eliminated, by surgical volume in additional sensitivity analyses for bladder (OR: 1.20, 95% CI: 1.00-1.42; P = .04) and prostate (OR: 1.15, 95% CI: 1.00-1.32; P = .04) surgery. There were no significant differences in kidney cancer surgery outcomes after adjusting for hospital volume (OR: 1.03, 95% CI: 0.93-1.14; P = .6). CONCLUSION Undergoing major cancer surgery at a teaching hospital was associated with an increased likelihood of achieving a textbook outcome. This effect was attenuated by volume but persisted for bladder and prostate surgery.
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Affiliation(s)
- Christopher P Dall
- Department of Urology, Massachusetts General Hospital, Boston, MA; Department of Urology, Brigham and Women's Hospital, Boston, MA.
| | - Xiu Liu
- Department of Urology, Massachusetts General Hospital, Boston, MA
| | - Kassem S Faraj
- Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Arnav Srivastava
- Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Samuel R Kaufman
- Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Vahakn B Shahinian
- Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI; Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Brent K Hollenbeck
- Department of Urology, Massachusetts General Hospital, Boston, MA; Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
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Podolsky DJ, Yasabala B, Wong Riff KW, Fisher DM. Evaluation of a high-fidelity cleft alveolar bone graft simulator. J Plast Reconstr Aesthet Surg 2024; 93:269-278. [PMID: 38728899 DOI: 10.1016/j.bjps.2024.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 03/03/2024] [Accepted: 04/05/2024] [Indexed: 05/12/2024]
Abstract
INTRODUCTION Cleft alveolar bone graft surgery is technically challenging to perform as well as difficult to learn and teach. A high-fidelity cleft alveolar bone graft simulator was previously developed. However, further evaluation of the simulator is necessary to assess its efficacy. METHODS Two cleft simulation workshops were conducted in which participants were led through a simulated cleft alveolar bone graft. The first simulation workshop involved six plastic surgery trainees. The second workshop involved 43 practicing cleft surgeons. The participants were provided with a Likert-type questionnaire assessing the simulators' features, realism, and value as a training tool. The change in self-reported confidence was assessed by providing each participant with a pre- and post-simulation confidence questionnaire. RESULTS There was overall agreement in the realism of the simulators' features (average score of 4.67 and 3.80 out of 5 for the trainees and surgeons, respectively). There was overall agreement to strong agreement in the simulators value as a training tool (average score of 5 and 4.43 out of 5 for the trainees and surgeons, respectively). The self-reported confidence increased for all questionnaire items for both the trainees and surgeons. This was significant (p < 0.05) for five out of eight and all questionnaire items for the trainees and surgeons, respectively. The magnitude of the confidence increase was generally greater for less experienced participants. CONCLUSION The cleft alveolar bone graft simulator was found to be realistic and valuable as a training platform. Use of the simulator improved self-reported confidence in cleft alveolar bone graft surgery.
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Affiliation(s)
- Dale J Podolsky
- Division of Plastic & Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada; Posluns Center for Image Guided Innovation and Therapeutic Intervention, Toronto, Ontario, Canada; Simulare Medical, Division of Smile Train, Toronto, Ontario, Canada.
| | | | - Karen W Wong Riff
- Division of Plastic & Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - David M Fisher
- Division of Plastic & Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
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Abdelmageed S, Horak VJ, Virtanen PS, Lam SK, Burchiel KJ, Raskin JS. A Well-Being Well-Check for Neurosurgery: Evidence-Based Suggestions for Our Specialty Based on a Systematic Review. World Neurosurg 2024; 185:351-358.e2. [PMID: 38403016 DOI: 10.1016/j.wneu.2024.02.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND The path through neurosurgery is rigorous. Many neurosurgeons may experience burnout, depression, or suicide throughout training and practice. We review the literature to help foster a culture of awareness and self-care and arm trainees with coping skills to reduce burnout and, thus, suicidality during all phases of their medical careers. METHODS A systematic search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using 4 databases. 7 studies were included. RESULTS Overlying themes of interventions were to increase balance, mindfulness, and physical fitness. The most common interventions included in programs were educational and physical activity. We suggest a comprehensive wellness program emphasizing interventions from 4 wellness dimensions-physical, spiritual, mental, and emotional. CONCLUSIONS Many neurosurgeons experience burnout, leading to a lack of satisfaction and early retirement; this necessitates a discipline-wide acknowledgment of endemic burnout among neurosurgeons. Systemic changes are needed to refine the training process and prioritize physician well-being- this cannot be left to chance.
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Affiliation(s)
- Sunny Abdelmageed
- Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois, USA; Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Victoria Jane Horak
- Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois, USA; Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Piiamaria S Virtanen
- Department of Neurological Surgery, Section of Pediatric Neurosurgery, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sandi K Lam
- Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois, USA; Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kim J Burchiel
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Jeffrey S Raskin
- Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois, USA; Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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Han ER, Chung EK. A qualitative study on the adoption of the new duty hour regulations among medical residents and faculty in Korea. PLoS One 2024; 19:e0301502. [PMID: 38603669 PMCID: PMC11008864 DOI: 10.1371/journal.pone.0301502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 03/15/2024] [Indexed: 04/13/2024] Open
Abstract
Duty hour regulations (DHRs) were enforced in 2017 in Korea to prevent the detrimental effects of excessively prolonged working hours among medical residents. We investigated the adoption of and implications of the new DHRs among medical residents and faculty members. Semi-structured interviews were conducted with 15 medical residents and 9 faculty members across general surgery, internal medicine, obstetrics-gynecology, and pediatrics departments at Chonnam National University Hospital. Based on the constructivist grounded theory, we developed themes from the data by concurrent coding and analysis with theoretical sampling until data saturation. In addition, respondent validation was used to ensure accuracy, and all authors remained reflexive throughout the study to improve validity. The methods of DHRs adoption among residents and faculty members included the following 4 themes: DHRs improved work schedule, residents have more time to learn on their own, clinical departments have come to distribute work, organization members have strived to improve patient safety. Residents have undertaken initial steps towards creating a balance between personal life and work. Teamwork and shift within the same team are the transitions that minimize discontinuity of patient care considering patient safety. Teaching hospitals, including faculty members, should ensure that residents' work and education are balanced with appropriate clinical experience and competency-based training.
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Affiliation(s)
- Eui-Ryoung Han
- Department of Medical Education, Chonnam National University Medical School, Gwangju, South Korea
| | - Eun-Kyung Chung
- Department of Medical Education, Chonnam National University Medical School, Gwangju, South Korea
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Morgan T, Torkian P, Awan OA. Mandatory Wellness Lectures and Exercises: Helpful or Harmful? Acad Radiol 2024; 31:747-749. [PMID: 38401991 DOI: 10.1016/j.acra.2023.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 01/16/2023] [Indexed: 02/26/2024]
Affiliation(s)
- Tyler Morgan
- Texas Tech University, Health Sciences Center School of Medicine, Lubbock, Texas
| | - Pooya Torkian
- Vascular and Interventional Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Omer A Awan
- University of Maryland School of Medicine, 655 W Baltimore Street, Baltimore, MD 21201.
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Keuning MC, Lambert B, Nieboer P, Huiskes M, Diemers AD. Perceptions and Guiding Strategies to Regulate Entrusted Autonomy of Residents in the Operating Room: A Systematic Literature Review. JOURNAL OF SURGICAL EDUCATION 2024; 81:93-105. [PMID: 37838573 DOI: 10.1016/j.jsurg.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 12/24/2022] [Accepted: 09/11/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVE To provide a systematic literature review of intraoperative entrusted autonomy for surgical residents. Specifically, perceptions from residents and supervising surgeons, supervising behavior and influencing factors on intraoperative teaching and learning are analyzed. BACKGROUND Increasing demands on surgical training and the need for effective development of technical skills, amplify the importance of making the most of intraoperative teaching and learning opportunities in the operating room. It is critical for residents to gain the greatest benefit from every surgical case and to achieve operative competence. METHODS A systematic literature search identified 921 articles from 2000 to 2022 that addressed surgical education/training, intraoperative supervision/teaching, autonomy and entrustment. 40 studies with heterogeneous designs and methodologies were included. RESULTS Four themes were established in the analysis: patient safety, learner, learning environment and supervising surgeon. The patient is identified as the primary responsibility during intraoperative teaching and learning. Supervisors continuously guard patient safety as well as the resident's learning process. Ideal intraoperative learning occurs when the resident has optimal entrusted autonomy during the procedure matching with the current surgical skills level. A safe learning environment with dedicated time for learning are prerequisites for both supervising surgeons and residents. Supervising surgeons' own preferences and confidence levels also play an important role. CONCLUSIONS This systematic literature review identifies patient safety as the overriding principle for supervising surgeons when regulating residents' entrusted autonomy. When the supervisor's responsibility toward the patient has been met, there is room for intraoperative teaching and learning. In this process the learner, the learning environment and the supervising surgeon's own preferences all intertwine, creating a triangular responsibility. This review outlines the challenge of establishing an equilibrium in this triangle and the broad arsenal of strategies supervising surgeons use to keep it in balance.
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Affiliation(s)
- Martine C Keuning
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, The Netherlands.
| | - Bart Lambert
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Patrick Nieboer
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Mike Huiskes
- Center for Language and Cognition Groningen, University of Groningen, Groningen, The Netherlands
| | - Agnes D Diemers
- Lifelong Learning, Education and Assessment Research Network (LEARN), University Medical Center Groningen, Groningen, The Netherlands
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Kostas JC, Sangho Lee A, Arunkumar A, Han C, Lee M, Goel AN, Alrassi J, Crosby T, Clark CM, Amin M, Abu-Ghanem S, Kirke D, Rameau A. Validation of a 3D-Printed Percutaneous Injection Laryngoplasty Simulator: A Randomized Controlled Trial. Laryngoscope 2024; 134:318-323. [PMID: 37466294 PMCID: PMC10796838 DOI: 10.1002/lary.30878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/12/2023] [Accepted: 06/19/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE Simulation may be a valuable tool in training laryngology office procedures on unsedated patients. However, no studies have examined whether existing awake procedure simulators improve trainee performance in laryngology. Our objective was to evaluate the transfer validity of a previously published 3D-printed laryngeal simulator in improving percutaneous injection laryngoplasty (PIL) competency compared with conventional educational materials with a single-blinded randomized controlled trial. METHODS Otolaryngology residents with fewer than 10 PIL procedures in their case logs were recruited. A pretraining survey was administered to participants to evaluate baseline procedure-specific knowledge and confidence. The participants underwent block randomization by postgraduate year to receive conventional educational materials either with or without additional training with a 3D-printed laryngeal simulator. Participants performed PIL on an anatomically distinct laryngeal model via trans-thyrohyoid and trans-cricothyroid approaches. Endoscopic and external performance recordings were de-identified and evaluated by two blinded laryngologists using an objective structured assessment of technical skill scale and PIL-specific checklist. RESULTS Twenty residents completed testing. Baseline characteristics demonstrate no significant differences in confidence level or PIL experience between groups. Senior residents receiving simulator training had significantly better respect for tissue during the trans-thyrohyoid approach compared with control (p < 0.0005). There were no significant differences in performance for junior residents. CONCLUSIONS In this first transfer validity study of a simulator for office awake procedure in laryngology, we found that a previously described low-cost, high-fidelity 3D-printed PIL simulator improved performance of PIL amongst senior otolaryngology residents, suggesting this accessible model may be a valuable educational adjunct for advanced trainees to practice PIL. LEVEL OF EVIDENCE NA Laryngoscope, 134:318-323, 2024.
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Affiliation(s)
- Julianna C. Kostas
- Sean Parker Institute for the Voice, Department of Otolaryngology – Head and Neck Surgery, Weill Cornell Medicine, New York, NY
| | - Andrew Sangho Lee
- Sean Parker Institute for the Voice, Department of Otolaryngology – Head and Neck Surgery, Weill Cornell Medicine, New York, NY
| | - Amit Arunkumar
- Sean Parker Institute for the Voice, Department of Otolaryngology – Head and Neck Surgery, Weill Cornell Medicine, New York, NY
| | - Catherine Han
- Sean Parker Institute for the Voice, Department of Otolaryngology – Head and Neck Surgery, Weill Cornell Medicine, New York, NY
| | - Mark Lee
- Sean Parker Institute for the Voice, Department of Otolaryngology – Head and Neck Surgery, Weill Cornell Medicine, New York, NY
| | - Alexander N. Goel
- Department of Otolaryngology – Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - James Alrassi
- Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, NY
| | - Tyler Crosby
- Department of Otolaryngology – Head and Neck Surgery, NYU Langone Health, New York, NY
| | - Christine M. Clark
- Sean Parker Institute for the Voice, Department of Otolaryngology – Head and Neck Surgery, Weill Cornell Medicine, New York, NY
| | - Milan Amin
- Department of Otolaryngology – Head and Neck Surgery, NYU Langone Health, New York, NY
| | - Sara Abu-Ghanem
- Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, NY
| | - Diana Kirke
- Department of Otolaryngology – Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Anaïs Rameau
- Sean Parker Institute for the Voice, Department of Otolaryngology – Head and Neck Surgery, Weill Cornell Medicine, New York, NY
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Gomar-Alba M, González-López P, Abarca-Olivas J, Martorell-Llobregat C, Gómez-Revuelta C, Masegosa-González J. Microneurosurgical training in the anatomical specimen: A structured plan for endoscopic and microsurgical skull base training during the residency. NEUROCIRUGIA (ENGLISH EDITION) 2024; 35:6-17. [PMID: 37453618 DOI: 10.1016/j.neucie.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/16/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND AND OBJECTIVE The development of a high level of competence and technical proficiency is one of the main objectives of any neurosurgical training program. Due to many factors, this progressive skill development can be complex during the residency. Despite its high cost and infrastructure requirements, there is renewed interest regarding the role of anatomy labs. The study and dissection of the human cadaver has been the environment where many surgeons have developed the necessary skills for microneurosurgery. We propose a structured endoscopic and microsurgical training dissection program to enable residents to maximize the benefits of their training in the lab. MATERIAL AND METHODS During the months of September, October and November 2021, a stay was done at the Microneurosurgery and Skull Base Laboratory of the Miguel Hernández University of Alicante. A total of 2 specimens were used. The first specimen underwent a first endoscopic endonasal dissection phase. After completing the endonasal part, a set of incisions were made to perform the transcranial part. In the second specimen, the transcranial part was performed first, leaving the endonasal endoscopic work for the last phase. RESULTS The results of the dissection program are presented. During the endonasal endoscopic phase, the transsphenoidal approach to the sella was simulated while focusing on the extended approaches in the sagittal plane. During the transcranial phase, right and left anterolateral approaches, a left anterior transcallosal interhemispheric approach, a left transcondylar posterolateral approach and a combined right lateral approach were performed. CONCLUSIONS The structured dissection of the specimen allowed both endonasal endoscopic and transcranial microsurgical training in the same specimen. This design facilitated the realization of the core skull base approaches in the same specimen. According to our initial experience, we believe that developing common dissection programs is a powerful tool to maximize the results of our residents' laboratory training.
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Affiliation(s)
- Mario Gomar-Alba
- Servicio de Neurocirugía, Hospital Universitario Torrecárdenas, Almería, Spain; Universidad de Almería, Almería, Spain.
| | - Pablo González-López
- Servicio de Neurocirugía, Hospital Universitario General de Alicante, Alicante, Spain
| | - Javier Abarca-Olivas
- Servicio de Neurocirugía, Hospital Universitario General de Alicante, Alicante, Spain
| | | | | | - José Masegosa-González
- Servicio de Neurocirugía, Hospital Universitario Torrecárdenas, Almería, Spain; Universidad de Almería, Almería, Spain
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Knfe G, Teshome H, Gama M, Abebe E, Kassahun M, Tekelwold B. Surgical residents' perceptions of the operating theatre educational environment at St. Paul's Hospital Millennium Medical College: A cross-sectional survey. Surg Open Sci 2024; 17:23-29. [PMID: 38274237 PMCID: PMC10809119 DOI: 10.1016/j.sopen.2023.12.011] [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: 09/04/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 01/27/2024] Open
Abstract
Background The educational environment refers to the "climate" that influences all aspects of learning in an educational context and the experience in the operating room is particularly crucial in surgical residents learning. Hence, this study aimed to assess surgical residents' perceptions of the operating theatre educational environment and associated factors in the surgical department at St. Paul's Hospital. Methods This cross-sectional study was conducted in March 2022 among surgical residents at St. Paul's Hospital Millennium Medical College to assess their perceptions of the operating room educational environment using the OREEM questionnaire. Descriptive statistics (mean, median, SD) were used to summarize demographic data and OREEM scores. The student t-test and one-way analysis of variance (ANOVA) testing followed by posthoc tests were used for comparison of quantitative data, with p-values < 0.05 considered significant. Results Of the participants, 103 (79.8%) were male and 26 (20.2%) were female with a mean age of 28 years. The overall mean score was 69% with subscale scores for teaching and training at 47.9/65.0 (73.7%), learning opportunities at 34.5/55.0 (62.7%), the atmosphere at 28.9/40.00 (72.4%) and workload/supervision/ support at 27.5/40.0 (68.7%). Male and female residents differed significantly in perceptions of "atmosphere" (t127 = 3.35, p < 0.001) and in junior versus senior residents' perceptions of the "learning opportunities" and "atmosphere" at p-values of 0.023 and 0.028 respectively. However, age, marital status, and specific surgical training programs did not have a significant effect on the scores. Conclusion Overall, residents had positive perceptions of their training and teaching, learning opportunities, the atmosphere in the operation theatre, and the supervision they received in the operation theatre. The operating room's "teaching and training" component received the highest score, while the operating room's "learning opportunities" component received the lowest. This indicates the importance of establishing a positive learning environment with sufficient "hands-on" experience, especially during emergencies. In addition, preoperative planning, case discussions, and feedback after the surgery should be routine.
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Affiliation(s)
- Goytom Knfe
- Department of Surgery, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Henok Teshome
- Department of Surgery, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Maru Gama
- Department of Surgery, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Engida Abebe
- Department of Surgery, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mulugeta Kassahun
- Department of Surgery, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Berhanetsehay Tekelwold
- Department of Surgery, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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McAdams RM. Fatigue and fallibility: the perils of prolonged shifts for neonatologists. J Perinatol 2023; 43:1530-1534. [PMID: 37422587 DOI: 10.1038/s41372-023-01718-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/16/2023] [Accepted: 06/29/2023] [Indexed: 07/10/2023]
Abstract
Sleep deprivation is a major challenge for neonatologists, who face increasing demands in the complex healthcare system. Current neonatal intensive care unit (NICU) schedule models often include extended shifts and overnight call, which can lead to sleep deprivation. This lack of sufficient sleep poses adverse health risks to neonatologists and can impair cognitive function, which increases the risk of medical errors and compromises patient safety. This paper proposes reducing shift durations and implementing policies and interventions to reduce fatigue among neonatologists and improve patient safety. The paper also offers policymakers, healthcare leaders, and NICU physicians valuable insights on potential ways to promote the health of the neonatologist workforce and safety in the NICU.
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Affiliation(s)
- Ryan M McAdams
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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14
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Yu Y, Oliver JB, Kunac A, Sehat AJ, Anjaria DJ. Declining Surgical Resident Operative Autonomy-All Trainees Are Not Created Equal. J Surg Res 2023; 292:330-338. [PMID: 37117092 DOI: 10.1016/j.jss.2023.02.038] [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: 03/03/2022] [Revised: 02/07/2023] [Accepted: 02/18/2023] [Indexed: 04/30/2023]
Abstract
INTRODUCTION We have previously shown that resident autonomy has decreased over time overall for all surgery residents. The purpose of this study is to examine changes in operative autonomy in general surgery residency within each postgraduate year (PGY) level. MATERIALS AND METHODS This is a retrospective analysis of the Veterans Association Surgical Quality Improvement Program database from July 1, 2004 to September 30, 2019. All general surgery, vascular surgery, and thoracic surgery procedures were analyzed and categorized by level of resident supervision as attending primary, attending operating with resident, or resident primary without attending scrubbed. Procedure work portion of relative value unit was used to capture procedure complexity. Changes in resident autonomy over time, procedure complexity, and outcomes were compared among PGY levels 1 to 5. RESULTS A total of 385,482 cases were analyzed. At each PGY level from 2014 to 2018, the relative decrease in resident primary cases ranged from -37.3% (PGY 4) to -75.5% (PGY 3). Mean work portion of relative value unit saw steady increase with PGY level (8.4 ± 3.5 in PGY 1 to 10.8 ± 5.7 in PGY 5, P < 0.001) and did not show a trend over time. CONCLUSIONS Surgical resident operative autonomy has markedly decreased over time across all PGY levels. This effect is most profound at the PGY 3 level, while more senior residents are affected to a lesser degree. Case complexity show PGY level-appropriate increase in resident autonomous cases. Decrease in resident autonomy over time is not associated with changes in case complexity.
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Affiliation(s)
- Yasong Yu
- Department of Surgery, VA New Jersey Healthcare System, East Orange, New Jersey; Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Joseph B Oliver
- Department of Surgery, VA New Jersey Healthcare System, East Orange, New Jersey; Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Anastasia Kunac
- Department of Surgery, VA New Jersey Healthcare System, East Orange, New Jersey; Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Alvand J Sehat
- Department of Surgery, VA New Jersey Healthcare System, East Orange, New Jersey
| | - Devashish J Anjaria
- Department of Surgery, VA New Jersey Healthcare System, East Orange, New Jersey; Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.
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Rogers-Vizena CR, Saldanha FYL, Sideridis GD, Allan CK, Livingston KA, Nussbaum L, Weinstock PH. High-Fidelity Cleft Simulation Maintains Improvements in Performance and Confidence: A Prospective Study. JOURNAL OF SURGICAL EDUCATION 2023; 80:1859-1867. [PMID: 37679288 DOI: 10.1016/j.jsurg.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/03/2023] [Accepted: 08/14/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE High-fidelity simulation has a growing role in plastic surgical education. This study tests the hypothesis that cleft lip repair simulation followed by structured debriefing improves performance and self-confidence and that gains are maintained. DESIGN Prospective, single-blinded interventional study with repeated measures. Trainees performed cleft lip repair on a high-fidelity simulator followed by debriefing, immediately completed a second repair, and returned 3 months later for a third session. Anonymized simulation videos were rated using the modified Objective Structured Assessment of Technical Skills (OSATS) and the Unilateral Cleft Lip Repair competency assessment tool (UCLR). Self-assessed cleft lip knowledge/confidence and procedural self-confidence were surveyed after each simulation. SETTING Boston Children's Hospital, a tertiary care academic hospital in Boston, MA, USA. PARTICIPANTS All trainees rotating through the study setting were eligible. Twenty-six participated; 21 returned for follow-up. RESULTS Significant improvements (p < 0.05) occurred between the first and second simulations for OSATS, UCLR, and procedural self-confidence. Significant improvement occurred between the second and third simulations cleft lip knowledge/confidence. Compared to the first simulation, improvements were maintained at the third simulation for all variables. Training level moderately correlated with score for UCLR for the first simulation (r = 0.55, p < 0.01), deteriorated somewhat with the second (r = 0.35, p = 0.08), and no longer corelated by the third (r = 0.02, p = 0.92). CONCLUSIONS Objective performance and subjective self-assessed knowledge and confidence improve with high-fidelity simulation plus structured debriefing and improvement is maintained. Differences in procedure-specific performance seen with increasing training level are reduced with simulation, suggesting it may accelerate knowledge and skill acquisition.
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Affiliation(s)
- Carolyn R Rogers-Vizena
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts; Boston Children's Hospital Immersive Design Systems, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Francesca Y L Saldanha
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Georgios D Sideridis
- Harvard Medical School, Boston, Massachusetts; Institutional Centers for Clinical & Translational Research, Boston Children's Hospital, Boston, Massachusetts
| | - Catherine K Allan
- Boston Children's Hospital Immersive Design Systems, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Katie A Livingston
- Boston Children's Hospital Immersive Design Systems, Boston, Massachusetts
| | - Lisa Nussbaum
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Peter H Weinstock
- Boston Children's Hospital Immersive Design Systems, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Anesthesia, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
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16
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Ore AS, Liu BS, Chen HW, Kent TS, Parsons CS, Narula N. General Surgery Trainee Cases Over Time: Postgraduate Year Matters. Am Surg 2023; 89:5325-5331. [PMID: 36564886 DOI: 10.1177/00031348221146932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Trainees and attending surgeons alike have concerns about resident and fellow operative volume/breadth, competency, and overall readiness for practice. This is an important topic within surgical graduate medical education. Our goal was to analyze the change in general surgery trainee operative experience over time by postgraduate year. METHODS Institutional operative records from two corresponding three-month time periods in 2009 and 2018 at the residency program's main hospital site were reviewed. Cases assisted on by general, vascular, or thoracic surgery trainees were included. The number of cases per level, combination of trainees in each case, and categories of cases were compared over time. RESULTS There were 1940 cases in 2009 and 1967 cases in 2018 over the respective time periods. The distribution of trainees was different (P < .001), with a similar number of PGY-1 and fellow cases, a decrease in PGY-2 and PGY-5 cases, and an increase in PGY-3 and PGY-4 cases. The number of cases with two trainees, double scrubbed cases, increased from 19.6% to 26.8% (P < .001). In addition, there were differences in the resident years that double scrubbed cases together, an increase in robotic and endovascular surgery, and a decrease in open cases. CONCLUSIONS This analysis of cases shows that resident operative volume over approximately a decade has been largely preserved, with some change in the distribution of cases based on trainee level, an increase in cases with more than one trainee, and a rise of minimally invasive surgery with a corresponding decrease in open cases.
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Affiliation(s)
- Ana Sofia Ore
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Betty S Liu
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Hao W Chen
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Tara S Kent
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Charles S Parsons
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Nisha Narula
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
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17
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Kostas JC, Lee M, Rameau A. A Novel Low-Cost, Open-Source, Three-Dimensionally Printed Thyroplasty Simulator. J Voice 2023:S0892-1997(23)00376-4. [PMID: 38036381 PMCID: PMC11133763 DOI: 10.1016/j.jvoice.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/14/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE Training of surgical procedures on awake patients, such as medialization thyroplasty, poses challenges to educators and trainees. Three-dimensionally (3D)-printed simulators provide opportunity to practice in low-stakes settings. We present the first 3D-printed thyroplasty simulator incorporating a cartilaginous framework, endolaryngeal soft tissue housed in a 3D-printed manikin with endoscopic visualization. METHODS Male and female laryngeal cartilages and endolarynx molds were 3D printed from an existing open-source design. Cartilage models were made of heat-treated polylactic acid (HTPLA), a material chosen for its thermal stability, allowing drilling. They were combined with molded silicone endolarynges modeling glottic insufficiency. Larynges were set in a 3D-printed head-and-neck manikin with an attached borescope for internal visualization similar to distal chip laryngoscopy. Eight laryngologists evaluated the simulator by drilling a thyroplasty window, inserting an implant for medialization, and rating the model using a modified Michigan Standard Simulation Experience Scale (1 = strongly disagree, 5 = strongly agree). RESULTS The model was well rated in educational value (mean 4.7, standard deviation [SD] 0.3), fidelity (mean 3.8, SD 0.2), and overall value (mean 4.8, SD 0.5). Qualitative assessment concluded the model was anatomically realistic and that HTPLA was a good approximation of the density and texture of thyroid cartilage. The materials for one larynx cost $4.09. CONCLUSION This high-fidelity 3D-printed simulator demonstrates educational value for thyroplasty training. The low-cost, open-source design has broad implications for universal access to this simulator platform.
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Affiliation(s)
- Julianna C Kostas
- Sean Parker Institute for the Voice, Department of Otolaryngology - Head and Neck Surgery, Weill Cornell Medicine, New York, New York
| | - Mark Lee
- Sean Parker Institute for the Voice, Department of Otolaryngology - Head and Neck Surgery, Weill Cornell Medicine, New York, New York
| | - Anaïs Rameau
- Sean Parker Institute for the Voice, Department of Otolaryngology - Head and Neck Surgery, Weill Cornell Medicine, New York, New York.
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18
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Nagasaki K, Kobayashi H. The effects of resident work hours on well-being, performance, and education: A review from a Japanese perspective. J Gen Fam Med 2023; 24:323-331. [PMID: 38025934 PMCID: PMC10646297 DOI: 10.1002/jgf2.649] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/20/2023] [Accepted: 08/31/2023] [Indexed: 12/01/2023] Open
Abstract
This article examines the impact of working-hour restrictions on the well-being, performance, and education of medical residents in Japan. Despite Japan's plan to introduce new regulations for resident working hours by 2024, there is still an ongoing debate regarding their appropriateness. This review provides a comprehensive overview of the current regulations of resident working hours worldwide, with a specific focus on weekly hours. The varying regulations are highlighted, including the 80-hour-per-week regulation in the United States and the 48-h-per-week regulation in the European Union influencing other regions. The article also discusses the effectiveness of working-hour restrictions on residents' mental health, with shorter working hours having potentially greater benefits. However, the impacts on medical safety and resident education are mixed, and further reduction in working hours must be carefully considered to avoid adverse effects. The planned changes to working-hour limits for residents in Japan offer a unique opportunity to gain new evidence on the impact of such regulations, which will be of interest to policymakers and researchers worldwide.
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Affiliation(s)
- Kazuya Nagasaki
- Department of Internal Medicine, Mito Kyodo General HospitalUniversity of TsukubaIbarakiJapan
| | - Hiroyuki Kobayashi
- Department of Internal Medicine, Mito Kyodo General HospitalUniversity of TsukubaIbarakiJapan
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19
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Gates RS, Kemp MT, Evans J, Liesman D, Pumiglia L, Matusko N, George BC, Sandhu G. The Demands of Surgery Residency: More Than Just Duty Hours? J Surg Res 2023; 290:293-303. [PMID: 37327639 DOI: 10.1016/j.jss.2023.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/24/2023] [Accepted: 04/15/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Efforts to improve surgical resident well-being could be accelerated with an improved understanding of resident job demands and resources. In this study, we sought to obtain a clearer picture of surgery resident job demands by assessing how residents distribute their time both inside and outside of the hospital. Furthermore, we aimed to elucidate residents' perceptions about current duty hour regulations. METHODS A cross-sectional survey was sent to 1098 surgical residents at 27 US programs. Responses regarding work hours, demographics, well-being (utilizing the physician well-being index), and perceptions of duty hours in relation to education and rest, were collected. Data were evaluated using descriptive statistics and content analysis. RESULTS A total of 163 residents (14.8% response rate) were included in the study. Residents reported a median total patient care hours per week of 78.0 h. Trainees spent 12.5 h on other professional activities. Greater than 40% of residents were "at risk" for depression and suicide based on physician well-being index scores. Four major themes associated with education and rest were identified: 1) duty hour definitions and reporting mechanisms do not completely reflect the amount of work residents perform, 2) quality patient care and educational opportunities do not fit neatly within the duty hour framework, 3) resident perceptions of duty hours are impacted the educational environment, and 4) long work hours and lack of adequate rest negatively affect well-being. CONCLUSIONS The breadth and depth of trainee job demands are not accurately captured by current duty hour reporting mechanisms, and residents do not believe that their current work hours allow for adequate rest or even completion of other clinical or academic tasks outside of the hospital. Many residents are unwell. Duty hour policies and resident well-being may be improved with a more holistic accounting of resident job demands and greater attention to the resources that residents have to offset those demands.
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Affiliation(s)
- Rebecca S Gates
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan.
| | - Michael T Kemp
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Julie Evans
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Daniel Liesman
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Luke Pumiglia
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Niki Matusko
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Brian C George
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Gurjit Sandhu
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan
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20
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Tatebe LC, Golisch KB, Janczewski LM, Krueger M, Halverson A. Autonomy Maps: Building a Shared Mental Model for Progressive Resident Operative Autonomy on the Road to Entrustable Professional Activities (EPAs). JOURNAL OF SURGICAL EDUCATION 2023; 80:1351-1354. [PMID: 37537103 DOI: 10.1016/j.jsurg.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/12/2023] [Accepted: 07/08/2023] [Indexed: 08/05/2023]
Abstract
Our residents expressed dissatisfaction with operative autonomy and faculty feedback regarding technical skills. They reported variability among faculty regarding allowed operative autonomy. Our goals were to establish a shared mental model among residents and faculty regarding intraoperative performance expectations. We asked faculty to assign a level of expected autonomy (Zwisch scale) for various steps of common procedures according to the resident post-graduate year. Through an iterative process, the maps were standardized across service lines. The resulting "Autonomy Maps" were distributed to the faculty and residents. We held educational sessions and set expectations for use. Selected benchmarks were incorporated into resident end-of-rotation assessment forms. Initial operative case mapping identified variability in faculty expectations for a given post-graduate year and procedure. Residents reported improved satisfaction with understanding expectations regarding operative performance. Establishing autonomy benchmarks facilitated more specific feedback regarding residents' technical skills. Faculty expectations for resident operative autonomy are variable. Autonomy Maps provide structure for a shared mental model between faculty and residents for progressive operative autonomy and serve as a framework for expectations that improve resident satisfaction. Case-specific technical benchmarks are useful tools for assessing residents' technical milestones.
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Affiliation(s)
- Leah C Tatebe
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
| | | | | | - Mackenzie Krueger
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Amy Halverson
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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21
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Shaban L, Mkandawire P, O'Flynn E, Mangaoang D, Mulwafu W, Stanistreet D. Quality Metrics and Indicators for Surgical Training: A Scoping Review. JOURNAL OF SURGICAL EDUCATION 2023; 80:1302-1310. [PMID: 37481412 DOI: 10.1016/j.jsurg.2023.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/17/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Surgical training quality is critical to ensure that trainees receive adequate preparation to perform surgical procedures independently and that patients receive safe, effective, and high-quality care. Numerous surgical training quality indicators have been proposed, investigated and implemented. However, the existing evidence base for these indicators is limited, with most studies originating from English-speaking, high-income countries. OBJECTIVES This scoping review aimed to identify the range of quality indicators that have been proposed and evaluated in the literature, and to critically evaluate the existing evidence base for these indicators. METHODS A systematic literature search was conducted using MEDLINE and Embase databases to identify studies reporting on surgical training quality indicators. A total of 68 articles were included in the review. RESULTS Operative volume is the most commonly cited indicator and has been investigated for its effects on trainee exam performance and career progression. Other indicators include operative diversity, workplace-based assessments, regular evaluation and feedback, academic achievements, formal teaching, and learning agreements, and direct observation of procedural skills. However, these indicators are largely based on qualitative analyses and expert opinions and have not been validated quantitatively using clear outcome measures for trainees and patients. CONCLUSIONS Future research is necessary to establish evidence-based indicators of high-quality surgical training, including in low-resource settings. Quantitative and qualitative studies are required to validate existing indicators and to identify new indicators that are relevant to diverse surgical training environments. Lastly, any approach to surgical training quality must prioritize the benefit to both trainees and patients, ensuring training success, career progression, and patient safety.
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Affiliation(s)
- Lawa Shaban
- Institute of Global Surgery, School of Population Health, RCSI, Dublin, Ireland.
| | - Payao Mkandawire
- Department of Surgery, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Eric O'Flynn
- Institute of Global Surgery, School of Population Health, RCSI, Dublin, Ireland
| | - Deirdre Mangaoang
- Institute of Global Surgery, School of Population Health, RCSI, Dublin, Ireland
| | - Wakisa Mulwafu
- Department of Surgery, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Debbi Stanistreet
- Department of Public Health and Epidemiology, School of Population Health, RCSI, Dublin, Ireland
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22
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Debets MPM, Tummers FHMP, Silkens MEWM, Huizinga CRH, Lombarts KMJMH, van der Bogt KEA. Doctors' alertness, contentedness and calmness before and after night shifts: a latent profile analysis. HUMAN RESOURCES FOR HEALTH 2023; 21:68. [PMID: 37605244 PMCID: PMC10441714 DOI: 10.1186/s12960-023-00855-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 08/08/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND While night shifts are crucial for patient care, they threaten doctors' well-being and performance. Knowledge of how the impact of night shifts differs for doctors is needed to attenuate the adverse effects of night shifts. This study aimed to obtain more precise insight into doctors' feelings surrounding night shift by: identifying profiles based on doctors' alertness, contentedness and calmness scores before and after night shifts (research question (RQ) 1); assessing how doctors' pre- and post-shift profiles change (RQ2); and determining associations of doctors' demographics and shift circumstances with alertness, contentedness and calmness change (RQ3). METHODS Latent Profile Analysis using doctors' pre- and post-shift self-rated alertness, contentedness and calmness scores was employed to identify pre- and post-shift profiles (RQ1). A cross-tabulation revealed pre- and post-shift profile changes (RQ2). Multiple regressions determined associations of demographics (i.e. age, sex, specialty) and night shift circumstances (i.e. hours worked pre-call, hours awake pre-call, shift duration, number of consecutive shifts, total hours of sleep) with alertness, contentedness and calmness change (RQ3). RESULTS In total, 211 doctors participated with a mean age of 39.8 ± 10 years; 47.4% was male. The participants included consultants (46.4%) and trainees (53.6%) of the specialties surgery (64.5%) and obstetrics/gynaecology (35.5%). Three pre-shift (Indifferent, Ready, Engaged) and four post-shift profiles (Lethargic, Tired but satisfied, Excited, Mindful) were found. Most doctors changed from Ready to Tired but satisfied, with alertness reducing most. Age, specialty, sleep, shift duration and the number of consecutive shifts associated with alertness, contentedness and calmness changes. CONCLUSIONS The results provided nuanced insight into doctors' feelings before and after night shifts. Future research may assess whether specific subgroups benefit from tailored interventions.
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Affiliation(s)
- Maarten P M Debets
- Research Group Professional Performance and Compassionate Care, Department of Medical Psychology, Amsterdam University Medical Centres, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - Fokkedien H M P Tummers
- Centre for Human Drug Research, Leiden, The Netherlands
- Department of Gyneacology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Milou E W M Silkens
- Department of Health Services Research and Management, City University of London, London, United Kingdom
| | - Coen R H Huizinga
- Centre for Human Drug Research, Leiden, The Netherlands
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Kiki M J M H Lombarts
- Research Group Professional Performance and Compassionate Care, Department of Medical Psychology, Amsterdam University Medical Centres, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Koen E A van der Bogt
- Centre for Human Drug Research, Leiden, The Netherlands
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Surgery, Haaglanden Medical Centre, The Hague, The Netherlands
- University Vascular Centre Leiden, The Hague, The Netherlands
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23
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McCloskey K, Turlip R, Ahmad HS, Ghenbot YG, Chauhan D, Yoon JW. Virtual and Augmented Reality in Spine Surgery: A Systematic Review. World Neurosurg 2023; 173:96-107. [PMID: 36812986 DOI: 10.1016/j.wneu.2023.02.068] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Augmented reality (AR) and virtual reality (VR) implementation in spinal surgery has expanded rapidly over the past decade. This systematic review summarizes the use of AR/VR technology in surgical education, preoperative planning, and intraoperative guidance. METHODS A search query for AR/VR technology in spine surgery was conducted through PubMed, Embase, and Scopus. After exclusions, 48 studies were included. Included studies were then grouped into relevant subsections. Categorization into subsections yielded 12 surgical training studies, 5 preoperative planning, 24 intraoperative usage, and 10 radiation exposure. RESULTS VR-assisted training significantly reduced penetration rates or increased accuracy rates compared to lecture-based groups in 5 studies. Preoperative VR planning significantly influenced surgical recommendations and reduced radiation exposure, operating time, and estimated blood loss. For 3 patient studies, AR-assisted pedicle screw placement accuracy ranged from 95.77% to 100% using the Gertzbein grading scale. Head-mounted display was the most common interface used intraoperatively followed by AR microscope and projector. AR/VR also had applications in tumor resection, vertebroplasty, bone biopsy, and rod bending. Four studies reported significantly reduced radiation exposure in AR group compared to fluoroscopy group. CONCLUSIONS AR/VR technologies have the potential to usher in a paradigm shift in spine surgery. However, the current evidence indicates there is still a need for 1) defined quality and technical requirements for AR/VR devices, 2) more intraoperative studies that explore usage outside of pedicle screw placement, and 3) technological advancements to overcome registration errors via the development of an automatic registration method.
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Affiliation(s)
- Kyle McCloskey
- Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Ryan Turlip
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hasan S Ahmad
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yohannes G Ghenbot
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daksh Chauhan
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jang W Yoon
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Tan DW, Pandit JJ, Hudson ME, Steinthorsson G, Tsai MH. Multivariable Cost Frontiers-Qualitative Financial Analyses Using Operational Metrics From the Implementation of a Surgery Fellowship. Ann Surg 2023; 277:e1169-e1175. [PMID: 34913889 DOI: 10.1097/sla.0000000000005328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We expand the application of cost frontiers and introduce a novel approach using qualitative multivariable financial analyses. SUMMARY BACKGROUND DATA With the creation of a 5 + 2-year fellowship program in July 2016, the Division of Vascular Surgery at the University of Vermont Medical Center altered the underlying operational structure of its inpatient services. METHOD Using WiseOR (Palo Alto, CA), a web-based OR management data system, we extracted the operating room metrics before and after August 1, 2016 service for each 4-week period spanning from September 2015 to July 2017. The cost per minute modeled after Childers et al's inpatient OR cost guidelines was multiplied by the after-hours utilization to determine variable cost. Zones with corresponding cutoffs were used to graphically represent cost efficiency trends. RESULTS Caseload/FTE for attending surgeons increased from 11.54 cases per month to 13.02 cases per month ( P = 0.0771). Monthly variable costs/FTE increased from $540.2 to $1873 ( P = 0.0138). Monthly revenue/FTE increased from $61,505 to $70,277 ( P = 0.2639). Adjusted monthly reve-nue/FTE increased from $60,965 to $68,403 ( P = 0.3374). Average monthly percent of adjusted revenue/FTE lost to variable costs increased from 0.85% to 2.77% ( P = 0.0078). Adjusted monthly revenue/case/FTE remained the same from $5309 to $5319 ( P = 0.9889). CONCLUSION In summary, we demonstrate that multivariable cost (or performance) frontiers can track a net increase in profitability associated with fellowship implementation despite diminishing returns at higher caseloads.
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Affiliation(s)
- Derek W Tan
- University of Vermont Larner College of Medicine, Burlington, VT
| | - Jaideep J Pandit
- Nuffield Department of Anesthesia, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Mark E Hudson
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh
| | - Georg Steinthorsson
- Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT; and
| | - Mitchell H Tsai
- Department of Anesthesiology, University of Vermont Larner College of Medicine, Burlington, VT
- Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT; and
- Department of Orthopedics and Rehabilitation (by courtesy), University of Vermont Larner College of Medicine, Burlington, VT
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Maoz Breuer R, Waitzberg R, Breuer A, Cram P, Bryndova L, Williams GA, Kasekamp K, Keskimaki I, Tynkkynen LK, van Ginneken V, Kovács E, Burke S, McGlacken-Byrne D, Norton C, Whiston B, Behmane D, Grike I, Batenburg R, Albreh T, Pribakovic R, Bernal-Delgado E, Estupiñan-Romero F, Angulo-Pueyo E, Rose AJ. Work like a Doc: A comparison of regulations on residents' working hours in 14 high-income countries. Health Policy 2023; 130:104753. [PMID: 36827717 DOI: 10.1016/j.healthpol.2023.104753] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/21/2023]
Abstract
BACKGROUND Medical residents work long, continuous hours. Working in conditions of extreme fatigue has adverse effects on the quality and safety of care, and on residents' quality of life. Many countries have attempted to regulate residents' work hours. OBJECTIVES We aimed to review residents' work hours regulations in different countries with an emphasis on night shifts. METHODS Standardized qualitative data on residents' working hours were collected with the assistance of experts from 14 high-income countries through a questionnaire. An international comparative analysis was performed. RESULTS All countries reviewed limit the weekly working hours; North-American countries limit to 60-80 h, European countries limit to 48 h. In most countries, residents work 24 or 26 consecutive hours, but the number of long overnight shifts varies, ranging from two to ten. Many European countries face difficulties in complying with the weekly hour limit and allow opt-out contracts to exceed it. CONCLUSIONS In the countries analyzed, residents still work long hours. Attempts to limit the shift length or the weekly working hours resulted in modest improvements in residents' quality of life with mixed effects on quality of care and residents' education.
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Affiliation(s)
- Rina Maoz Breuer
- The Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Israel
| | - Ruth Waitzberg
- The Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Israel; Department of Health Care Management, Faculty of Economics & Management, Technical University Berlin, Germany.
| | - Adin Breuer
- Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Peter Cram
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Canada
| | - Lucie Bryndova
- Center for Social and Economic Strategies, Faculty of Social Sciences, Charles University, Czechia
| | - Gemma A Williams
- European Observatory on Health Systems and Policies, London School of Economics and Political Science, Houghton Street, London United Kingdom
| | | | | | - Liina-Kaisa Tynkkynen
- Faculty of Social Sciences, Tampere University, Finland; Welfare State Research and Reform, Finnish Institute for Health and Welfare, Finland
| | - Verena van Ginneken
- Department of Psychiatry, Campus Benjamin Franklin, Charité - Universitätsmedizin, Germany
| | - Eszter Kovács
- Health Workforce Planning Knowledge Centre, Semmelweis University, Hungary
| | - Sara Burke
- Centre for Health Policy and Management, Trinity College Dublin, Ireland
| | | | | | | | - Daiga Behmane
- Faculty of Public Health and Social Welfare, Riga Stradins University, Latvia
| | - Ieva Grike
- Faculty of Residency Manager of Residency study process Riga Stradins University, Latvia
| | - Ronald Batenburg
- Netherlands institute for Health Services Research (Nivel), Radboud University Nijmegen, Faculty of Social Sciences, the Netherlands
| | - Tit Albreh
- Centre for Health Care National Institute of Public Health Trubarjeva, Slovenia
| | - Rade Pribakovic
- Centre for Health Care at the National Institute of Public Health of Slovenia, Slovenia
| | | | | | | | - Adam J Rose
- The Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Israel; School of Public Health, Hebrew University, Jerusalem, Israel
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Lu YM, Lin YT, Tsai CH, Pan CH, Chen HH, Lee MC. Prognostic Factors for Attempted Finger Replantation and Revascularisation after Traumatic Amputation: A 16-Year Retrospective Cohort Study. J Hand Surg Asian Pac Vol 2023; 28:149-155. [PMID: 37120311 DOI: 10.1142/s242483552350025x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Background: The aim of this study was to evaluate the impact of variant factors on finger replantation and revascularisation after traumatic amputation, which also included duty shift and the level of main operator. Methods: To determine the prognostic factors for the survival rate of finger replantation and revascularisation after traumatic finger amputation, we retrospectively reviewed the cases of finger replantation conducted from January 2001 to December 2017. Data collected consisted of the basic information of the patients, trauma-related factors, details of the operation and treatment outcomes. Descriptive statistics and data analysis was performed to assess outcomes. Results: In total, 150 patients with 198 replanted digits were enrolled in this study. The median age of the participants was 42.5 years, and 132 (88%) patients were men. The overall successful replantation rate was 86.4%. Seventy-three (36.9%) digits had Yamano type 1 injury; 110 (55.6%), Yamano type 2 injury and 15 (7.6%), Yamano type 3 injury. In total, 73 (36.9%) digits were completely amputated and 125 (63.1%) were not. Half of the replantation procedures (101, 51.0%) were performed during night shift (16:00-00:00), 69 (34.8%) during day shift (08:00-16:00) and 28 (14.1%) during graveyard shift (00:00-08:00). Multivariate logistic regression demonstrated that the trauma mechanism and type of amputation (complete vs. incomplete) significantly affect the survival rate of replantation. Conclusions: The trauma mechanism and type of amputation (complete vs. incomplete) significantly affect the survival rate of replantation. Other factors including duty shift and the level of operator did not reach statistically significance. Further studies must be conducted to validate the results of the current study. Level of Evidence: Level III (Prognostic).
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Affiliation(s)
- Yi-Min Lu
- TaoYuan General Hospital, Minister of Health and Welfare, Taoyuan, Taiwan
| | - Yu-Te Lin
- Chang Gung Memorial Hospital, Keelung, Taiwan
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Yun JJ, Jane JA. Editorial. Is the grass greener with night float? J Neurosurg 2023; 138:1114-1115. [PMID: 36087326 DOI: 10.3171/2022.6.jns22768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Karam JA, Tokarski A, Deirmengian C, Thalody H, Kwan SA, Mccahon J, Lutz R, Courtney PM, Deirmengian GK. A Video Teaching Tool Is Effective for Training Residents in Hip Arthroplasty Templating. Cureus 2023; 15:e35856. [PMID: 37033582 PMCID: PMC10078669 DOI: 10.7759/cureus.35856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2023] [Indexed: 03/09/2023] Open
Abstract
Work hour restrictions imposed on orthopedic surgery residents since the early 2000s have reduced educational opportunities at the workplace and encouraged alternative strategies for teaching outside the clinical setting. Preoperative templating is essential for safe and effective total hip arthroplasty (THA) and is accurate in predicting final implants. We sought to determine the effectiveness of a video tool for teaching orthopedic residents basic THA templating skills. We developed a video-based teaching tool with instructions on proper THA templating techniques. Ten cases were selected for testing, after excluding patients with severe hip deformities and poor-quality radiographs and only retaining those with concordance between templating by the senior authors and implanted components. The study subjects included three postgraduate year 1 (PGY-1), three PGY-2, and three PGY-5 residents, and three adult reconstruction fellows (PGY-6). Templating skills were assessed before and after watching the instructional video. The evaluation included the size and positioning of femoral and acetabular components, as well as the restoration of leg length. Each templating session was repeated twice. Variance was measured to evaluate consistency in measurements. A linear mixed model and F-test were used for statistical analyses. The number of years in training significantly affected performance prior to exposure to the instructional video. Post-exposure, there was a significant improvement in the accuracy of sizing and positioning of acetabular and femoral components for PGY-1, PGY-2, and PGY-5 residents. The results achieved were comparable to PGY-6 examiners, who did not gain substantial performance benefits from the instructional video. Limb length restoration was less affected by experience or exposure to the video. Component positioning and sizing, as well as leg length discrepancy (LLD), showed a significant decrease in variance after the intervention in all study groups. Video learning is reliable in teaching invaluable skills to orthopedic surgery residents without encroaching on work hours. We conceived a concise video to train orthopedic residents to perform THA templating with proper technique and demonstrated its efficiency and reproducibility.
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Sephien A, Reljic T, Jordan J, Prida X, Kumar A. Resident duty hours and resident and patient outcomes: Systematic review and meta-analysis. MEDICAL EDUCATION 2023; 57:221-232. [PMID: 36181404 DOI: 10.1111/medu.14943] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/18/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES The policies regarding resident physician work hours are constantly being evaluated and changed. However, the results of randomised control trials (RCTs) are mixed. This systematic review of RCTs aims to synthesise the evidence associated with resident duty hour restrictions and its impact on resident- and patient-based outcomes. METHODS A comprehensive search of the Cochrane Library, EMBASE and PubMed was conducted from inception until 31 July 2020. Any RCT evaluating the impact of longer resident physician work hours compared to shorter resident physician work hours on resident- and patient-based outcomes was eligible for inclusion. Two reviewers extracted data independently. The primary outcome was the impact of resident duty hour restrictions on emotional exhaustion, depersonalisation and personal accomplishment, as defined by the Maslach Burnout Inventory. The secondary patient-related outcomes were patient hospital length of stay, serious medical errors and preventable adverse events. Data were pooled using a random-effects model. RESULTS Of the 873 references, nine RCTs met the inclusion criteria. A shorter shift length compared with longer shift length was associated with significantly less emotional exhaustion (standardised mean difference [SMD] = -0.11, 95% CI = -0.21, -0.00) and less dissatisfaction with overall well-being (OR = 0.61, 95% CI 0.38, 0.99) but not with hospital length of stay (SMD = -0.01, 95% CI = -0.05, 0.02, p = 0.45) and serious medical errors per 1000 patient hours (OR = 1.07, 95% CI = 0.52, 2.21; p = 0.86). CONCLUSIONS Shorter resident duty hours is possibly associated with improvement in resident-based outcomes, specifically, emotional exhaustion, dissatisfaction with overall well-being, sleep duration and sleepiness. These findings may inform the policy change in support of reduced shift hours resulting in overall well-being for the residents with possible reduction in burnout without adverse impact on patient-based outcomes.
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Affiliation(s)
- Andrew Sephien
- Department of Internal Medicine, HCA Healthcare/USF Morsani GME Consortium: HCA Florida Citrus Hospital, Inverness, Florida, USA
| | - Tea Reljic
- Research Methodology and Biostatistics Core, Office of Research, Department of Internal Medicine, University of South Florida, Tampa, Florida, USA
| | - Jeffrey Jordan
- Department of Internal Medicine, HCA Healthcare/USF Morsani GME Consortium: HCA Florida Citrus Hospital, Inverness, Florida, USA
| | - Xavier Prida
- Department of Cardiovascular Sciences, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Ambuj Kumar
- Research Methodology and Biostatistics Core, Office of Research, Department of Internal Medicine, University of South Florida, Tampa, Florida, USA
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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.
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Evaluating the Impact of ACGME Resident Duty Hour Restrictions on Patient Outcomes for Bilateral Breast Reductions. Plast Reconstr Surg Glob Open 2023; 11:e4820. [PMID: 36761011 PMCID: PMC9904753 DOI: 10.1097/gox.0000000000004820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 12/28/2022] [Indexed: 02/11/2023]
Abstract
The Accreditation Council for Graduate Medical Education (ACGME) implemented duty-hour restrictions limiting residents to 80 hours per week in 2003 and further extended restrictions in 2011 to improve resident and patient well-being. Numerous studies have examined the effects of these restrictions on patient outcomes with inconclusive results. Few efforts have been made to examine the impact of this reform on the safety of common plastic surgery procedures. This study seeks to assess the influence of ACGME duty-hour restrictions on patient outcomes, using bilateral breast reduction mammoplasty as a marker for resident involvement and operative autonomy. Methods Bilateral breast reductions performed in the 3 years before and after each reform were collected from the National Inpatient Sample database: pre-duty hours (2000-2002), duty hours (2006-2008), and extended duty hours (2012-2014). Multivariable logistic regression models were constructed to investigate the association between ACGME duty hour restrictions on medical and surgical complications. Results Overall, 19,423 bilateral breast reductions were identified. Medical and surgical complication rates in these patients increased with each successive iteration of duty hour restrictions (P < 0.001). The 2003 duty-hour restriction independently associated with increased surgical (OR = 1.51, P < 0.001) and medical complications (OR = 1.85, P < 0.001). The 2011 extended duty-hour restriction was independently associated with increased surgical complications (OR = 1.39, P < 0.001). Conclusions ACGME duty-hour restrictions do not seem associated with better patient outcomes for bilateral breast reduction although there are multiple factors involved. These considerations and consequences should be considered in decisions that affect resident quality of life, education, and patient safety.
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Marder RS, Shah NV, Naziri Q, Maheshwari AV. The impact of surgical trainee involvement in total knee arthroplasty: a systematic review of surgical efficacy, patient safety, and outcomes. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:255-298. [PMID: 35022881 DOI: 10.1007/s00590-021-03179-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/27/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Trainee involvement in patient care has raised concerns about the potential risk of adverse outcomes and harming patients. We sought to analyze the impact and potential consequence of surgical trainee involvement in total knee arthroplasty (TKA) procedures in terms of surgical efficacy, patient safety, and functional outcomes. METHODS We systematically reviewed Medline/PubMed, EMBASE, the Cochrane library, and Scopus databases in April 2021. Eligible studies reported on the impact of trainee participation in TKA procedures performed with and without such involvement. RESULTS Twenty-three publications met our eligibility criteria and were included in our study. These studies reported on 132,624 surgeries completed on 132,416 patients. Specifically, 23,988 and 108,636 TKAs were performed with and without trainee involvement, respectively. The mean operative times for procedures with (n = 19,573) and without (n = 94,581) trainee involvement were 99.77 and 85.05 min, respectively. Both studies that reported data on cost of TKAs indicated a significant increase (p < 0.001) associated with procedures completed by teaching hospitals compared to private practices. Mean overall complication rates were 7.20% and 7.36% for TKAs performed with (n = 9,386) and without (n = 31,406) trainees. Lastly, the mean Knee Society Scale (KSS) knee scores for TKAs with (n = 478) and without (n = 806) trainee involvement were similar; 82.81 and 82.71, respectively. CONCLUSION Our systematic review concurred with previous studies that reported trainee involvement during TKAs increases the mean operative time. However, the overall complication rates and functional outcomes were similar. Larger studies with a better methodology and higher level of evidence are still needed for a resolute conclusion.
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Affiliation(s)
- Ryan S Marder
- Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Neil V Shah
- Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Qais Naziri
- Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Aditya V Maheshwari
- Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA.
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Neonatal intensive care unit occupancy rate and probability of discharge of very preterm infants. J Perinatol 2023; 43:490-495. [PMID: 36609482 DOI: 10.1038/s41372-022-01596-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/05/2022] [Accepted: 12/22/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To assess the association of NICU occupancy with probability of discharge and length of stay (LOS) among infants born <33 weeks gestational age (GA). STUDY DESIGN Retrospective study of 3388 infants born 23-32 weeks GA, admitted to five Level 3/4 NICUs (2014-2018) and discharged alive. Standardized ratios of observed-to-expected number of discharges were calculated for each quintile of unit occupancy. Multivariable linear regression models were used to assess the association between occupancy and LOS. RESULTS At the lowest unit occupancy quintiles (Q1 and Q2), infants were 12% and 11% less likely to be discharged compared to the expected number. At the highest unit occupancy quintile (Q5), infants were 20% more likely to be discharged. Highest occupancy (Q5) was also associated with a 4.7-day (95% CI 1.7, 7.7) reduction in LOS compared Q1. CONCLUSION NICU occupancy was associated with likelihood of discharge and LOS among infants born <33 weeks GA.
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Guerrero DT, Asaad M, Rajesh A, Hassan A, Butler CE. Advancing Surgical Education: The Use of Artificial Intelligence in Surgical Training. Am Surg 2023; 89:49-54. [PMID: 35570822 DOI: 10.1177/00031348221101503] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The technology of artificial intelligence (AI) has made significant in-roads into the field of medicine over the last decade. With surgery being a discipline where repetition is the key to mastery, the scope of AI presents enormous potential for resident education through the analysis of technique and delivery of structured feedback for performance improvement. In an era marred by a raging pandemic that has decreased exposure and opportunity, AI offers an attractive solution towards improving operating room efficiency, safe patient care in the hands of supervised residents and can ultimately culminate in reduced health care costs. Through this article, we elucidate the current adoption of the artificial intelligence technology and its prospects for advancing surgical education.
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Affiliation(s)
- David T Guerrero
- 12317University of Pittsburgh Medical School, Pittsburgh, PA, USA
| | - Malke Asaad
- Department of Plastic Surgery, 6595University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Aashish Rajesh
- 14742University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Abbas Hassan
- Department of Plastic Surgery, 571198The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Charles E Butler
- Department of Plastic Surgery, 571198The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Krishnaswami S, Polites SF, Dekany G, Gaines BA, Nwomeh BC, Huang EY, Finck CM, Lopushinsky SR, Puligandla PS, Feliz A, Mak GZ, Anderson SA, Fairbanks T, Alaish SM. The First Two Years of the Association of Pediatric Surgery Training Program Directors (APSTPD) Transition to Fellowship Course: Lessons Learned and Future Directions. JOURNAL OF SURGICAL EDUCATION 2023; 80:62-71. [PMID: 36085115 DOI: 10.1016/j.jsurg.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/08/2022] [Accepted: 08/13/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The first transition to fellowship course for incoming pediatric surgery fellows was held in the US in 2018 and the second in 2019. The course aimed to facilitate a successful transition in to fellowship by introduction of the professional, patient care, and technical aspects unique to pediatric surgery training. The purpose of this study was to evaluate the feasibility and effectiveness of the first two years of this course in the US and discuss subsequent evolution of this endeavor. DESIGN This is a descriptive and qualitative analysis of two years' experience with the Association of Pediatric Surgery Training Program Directors' (APSTPD) Transition to Fellowship course. Course development and curriculum, including clinical knowledge, soft skills, and hands-on skills labs, are presented. Participating incoming fellows completed multiple choice, boards-style pre- and post-tests. Scores were compared to determine if knowledge was effectively transferred. Participants also completed post-course evaluations and subsequent 3- or 12-month surveys inquiring on the lasting impact of the course on their transition into fellowship. Standard univariate statistics were used to present results. SETTING The first APSTPD Transition to Fellowship course was held at the Johns Hopkins Hospital in Baltimore, Maryland in 2018, and the second course was held at the Oregon Health and Science University in Portland, Oregon in 2019. PARTICIPANTS All fellows entering ACGME-certified Pediatric Surgery fellowships in the United States were invited to participate. Twenty fellows accepted and attended in 2018, and fourteen fellows participated in 2019. RESULTS There were 34 incoming pediatric surgery fellow participants over 2 years. Faculty represented more than 10 institutions each year. Pre- and post-test scores were similar between years, with a significant improvement of scores after completion of the course (67±10% vs 79±8%, p < 0.001). Feedback from participants was overwhelmingly positive, with skills labs being attendees' favorite component. When asked about usefulness of individual course sessions, more attendees found clinical sessions more useful than soft skills (93% vs 73%, p = 0.011). Almost all (90%) of participants reported the course met its stated purpose and would recommend the course to future fellows. This was further reflected on 3 and 12 month follow up surveys wherein 85% stated they found the course helpful during the first few months of fellowship and 90% would still recommend it. CONCLUSIONS A transition to fellowship course in the US for incoming pediatric surgery fellows is logistically feasible, effective in transfer of knowledge, and highly regarded among attendees. Feedback from each course has been used to improve the subsequent courses, ensuring that it remains a valuable addition to pediatric surgical training in the US.
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Affiliation(s)
- Sanjay Krishnaswami
- Department of Surgery, Oregon Health and Sciences University, Portland, Oregon; APSTPD Transition to Fellowship Task Force, Louisville, Kentucky
| | | | - Gabriela Dekany
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Barbara A Gaines
- APSTPD Transition to Fellowship Task Force, Louisville, Kentucky
| | | | - Eunice Y Huang
- APSTPD Transition to Fellowship Task Force, Louisville, Kentucky
| | | | | | | | - Alexander Feliz
- APSTPD Transition to Fellowship Task Force, Louisville, Kentucky
| | - Grace Z Mak
- APSTPD Transition to Fellowship Task Force, Louisville, Kentucky
| | - Scott A Anderson
- APSTPD Transition to Fellowship Task Force, Louisville, Kentucky
| | | | - Samuel M Alaish
- APSTPD Transition to Fellowship Task Force, Louisville, Kentucky; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Kaiser KA, Lench HC, Levine LJ. Medical residency match applicants undervalue factors that predict stress and burnout. MEDICAL EDUCATION ONLINE 2022; 27:2109243. [PMID: 35946069 PMCID: PMC9373742 DOI: 10.1080/10872981.2022.2109243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 06/15/2023]
Abstract
In the medical residency match process, applicants' ranking decisions are influenced by multiple factors related to training, geography, and lifestyle expectations. Ranking decisions directly impact match results, with implications for emotional outcomes such as happiness and stress. The present study explored the decision factors considered most important by applicants when creating rank order lists (ROLs), and how match outcomes and program factors predicted happiness, enthusiasm, stress, and life satisfaction. Senior medical students (n = 182) at a large public university in California completed surveys at three timepoints, spanning from shortly before Match Day to several months into PGY-1. Study findings support that both program-related (e.g., training quality, program size) and non-program-related (e.g., geography, work life balance) factors are important to applicants when making ROL decisions. Applicants who matched with their top choice program initially experienced emotional benefits, but these emotional differences did not persist into PGY-1, where all matched applicants had similar levels of emotion and life satisfaction. The emotional cost and benefits of matching with programs of different ROL positions (e.g., matching with top-choice program or not) were most apparent shortly after matching but in the long-term, a stronger predictor of PGY-1 emotions was perceived person-program alignment. Person-program alignment (e.g., call schedule, patient caseload) also predicted burnout in the first few months of a residency program. These findings show that, when applicants are making ranking decisions, they undervalue factors that predict stress and burnout during residency.
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Affiliation(s)
- Kaitlyn A. Kaiser
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas, USA
| | - Heather C. Lench
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas, USA
| | - Linda J. Levine
- Department of Psychological Science, and fellow, Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine, California, USA
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Sivakumar J, Chen Q, Hii MW, Cullinan M, Choi J, Steven M, Crosthwaite G. Learning curve of laparoscopic inguinal hernia repair: systematic review, meta-analysis, and meta-regression. Surg Endosc 2022; 37:2453-2475. [PMID: 36416945 DOI: 10.1007/s00464-022-09760-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 11/06/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Laparoscopic inguinal hernia repair has a long learning curve. It can be a technically challenging procedure and initially presents an unfamiliar view of inguinal anatomy. The aim of this review was to evaluate published literature relating to the learning curve of laparoscopic inguinal hernia repair and identify the number of cases required for proficiency. The secondary aim was to compare outcomes between surgeons before and after this learning curve threshold had been attained. METHODS A systematic literature search was conducted in databases of PubMed, Medline, Embase, Web of Science, and Cochrane Library, to identify studies that evaluated the learning curve of laparoscopic inguinal hernia repair. A meta-regression analysis was undertaken to identify the number of cases to achieve surgical proficiency, and a meta-analysis was performed to compare outcomes between cases that were undertaken during a surgeon's learning phase and experienced phase of the curve. RESULTS Twenty-two studies were included in this review, with 19 studies included in the meta-regression analysis, and 11 studies included in the meta-analysis. Mixed-effects Poisson regression demonstrated that there was a non-linear trend in the number of cases required to achieve surgical proficiency, with a 2.7% year-on-year decrease. The predicted number of cases to achieve surgical proficiency in 2020 was 32.5 (p < 0.01). The meta-analysis determined that surgeons in their learning phase may experience a higher rate of conversions to open (OR 4.43, 95% CI 1.65, 11.88), postoperative complications (OR 1.61, 95% CI 1.07, 2.42), and recurrences (OR 1.32, 95% CI 0.40, 4.30). CONCLUSION Laparoscopic inguinal hernia repair has a well-defined learning curve. While learning surgeons demonstrated reasonable outcomes, supervision during this period may be appropriate given the increased risk of conversion to open surgery. These data may benefit learning surgeons in the skill development of minimally invasive inguinal hernia repairs.
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Affiliation(s)
- Jonathan Sivakumar
- Clinical Institute General Surgery and Gastroenterology, Epworth Healthcare, Richmond, Australia.
- Department of General Surgery, Royal Melbourne Hospital, Melbourne, Australia.
- Department of Surgery, The University of Melbourne, Melbourne, Australia.
| | - Qianyu Chen
- Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Michael W Hii
- Clinical Institute General Surgery and Gastroenterology, Epworth Healthcare, Richmond, Australia
- Department of Surgery, The University of Melbourne, Melbourne, Australia
- Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Mark Cullinan
- Clinical Institute General Surgery and Gastroenterology, Epworth Healthcare, Richmond, Australia
- Department of Surgery, Monash University, Clayton, VIC, Australia
| | - Julian Choi
- Clinical Institute General Surgery and Gastroenterology, Epworth Healthcare, Richmond, Australia
- Department of Upper Gastrointestinal and Hepatobiliary Surgery, Western Health, Melbourne, Australia
| | - Mark Steven
- Clinical Institute General Surgery and Gastroenterology, Epworth Healthcare, Richmond, Australia
| | - Gary Crosthwaite
- Clinical Institute General Surgery and Gastroenterology, Epworth Healthcare, Richmond, Australia
- Department of Surgery, The University of Melbourne, Melbourne, Australia
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Khalil IA, Ibrahim T, Aldeeb M, Mohamed A, Ben Salah R, Aboumarzouk OM, Al-Naimi A. Urology Residents’ Perspectives on the In-House On-Call Systems: A Study in an Accredited Academic Center. Qatar Med J 2022; 2022:49. [PMCID: PMC9653301 DOI: 10.5339/qmj.2022.49] [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: 04/12/2022] [Accepted: 09/11/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction: Medical education and training are crucial in maintaining patients’ safety and improving patient care quality. Multiple studies have evaluated the effects of restrictive policies on the resident's quality of life and education. Due to the compiling data and the fact that these trials evaluated programs with a substantial number of residents, it remains uncertain whether these conclusions can be extended to urology programs with a small number of residents. Multiple on-call systems have been adopted in residency programs across the world. This study evaluated the residents’ quality of life, clinical experience, and education upon transitioning from 24-hour to 12-hour in-house on-call systems. Methods and materials: In this observational and questionnaire-based study, the effect of the transition from 24-hour to 12-hour in-house on-call systems was compared in terms of the resident's quality of life and education, surgical case volume, and working hours’ rules compliance. Quality of life and education: We adopted a validated survey based on a 5-point Likert scale to assess the residents’ perception of the transition to a 12-hour on-call system on their quality of life and education. Surgical case volume: We extracted the number of cases the residents operated on from the operating theater database at our institution. Working hours: compliance and violations: The weekly working hours, compliance, and violations per ACGME-I rules were collected from the MedHub platform. Results: Quality of life and education: Residents rated the 12-hour on-call system superior in terms of quality of life, education, and surgical case volume. Surgical case volume: There was a 45% increment in the surgical case volume (p = 0.04) with the 12-hour on-call system.
Working hours: compliance and violations
There was no significant difference in the mean weekly working hours (p = 0.1). However, the total number of duty hours violations decreased in the 12-hour on-call system. Conclusion: The 12-hour system is a better alternative to the 24-hour system in terms of the resident's quality of life, education, surgical case volume, and compliance with duty hour rules.
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Affiliation(s)
- Ibrahim A. Khalil
- Department of Urology, Hamad medical corporation, Doha, Qatar E-mail: ,E-mail:
| | - Tarek Ibrahim
- Department of Urology, Hamad medical corporation, Doha, Qatar E-mail:
| | - Maya Aldeeb
- Department of Medical Education, Family Medicine Residency Program, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Mohamed
- Department of Urology, Hamad medical corporation, Doha, Qatar E-mail:
| | - Rym Ben Salah
- Department of Urology, Hamad medical corporation, Doha, Qatar E-mail:
| | | | - Abdulla Al-Naimi
- Department of Urology, Hamad medical corporation, Doha, Qatar E-mail:
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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.
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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.
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Katiyar V, Sadhwani N, Sharma R, Tandon V, Raheja A, Goda R, Ganeshkumar A, Mishra S, Garg K, Prada F, Kale SS. A High-Fidelity Agar-Based Phantom for Ultrasonography-Guided Brain Biopsy Simulation: A Novel Training Prototype with Visual Feedback. World Neurosurg 2022; 167:e333-e343. [PMID: 35961586 DOI: 10.1016/j.wneu.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE A novel agar-based phantom was developed and assessed for ultrasonography (USG)-guided brain biopsy training. The phantom provides visual cues combined with sonologic cues, allowing multimodal training. Impact of multimodal training is evaluated through pretraining and posttraining trials. METHODS Twenty-five participants were divided based on experience with USG-based procedures into familiar (≥3 procedures performed in the past) (n = 14) and unfamiliar (<3 procedures performed) (n = 11). Agar phantoms with an opaque top and transparent middle layer were constructed in transparent glass bowls, each having 12 embedded targets. Participants underwent 2 supervised trials of USG-guided biopsy with aluminum foil covering the glass bowls, eliminating visual cues. Between 2 trials, participants underwent unsupervised self-training on a phantom without foil cover, providing visual cues. Performance was measured through insonation efficiency (EfI), biopsy efficiency (EfB), efficiency score (Ef), error score (Er), and performance score (PS). Scores were compared between and within the 2 groups before and after training. Impact of the self-training session on subjective comfort levels with the procedure was assessed through feedback forms. RESULTS Familiars had better pretraining EfB, Ef, Er, and PS (P < 0.001) compared with unfamiliars. After training, both performed similarly on all metrics. After training, familiars improved only in EfI (P = 0.001), with the unfamiliars showing significance in all metrics except EfI. CONCLUSIONS Simulation and phantom-based models can never supplant training through supervised skill application in vivo but our model supplements training by enabling technical skill acquisition, especially for beginners in USG-guided brain biopsy.
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Affiliation(s)
- Varidh Katiyar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Nidhisha Sadhwani
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ravi Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Tandon
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Amol Raheja
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Revanth Goda
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Akshay Ganeshkumar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shashwat Mishra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Francesco Prada
- Ultrasound NeuroImaging and Therapy (UNIT) Laboratory, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Shashank S Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Nagaraj MB, Meier J, Lefevre R, Farr DE, Abdelfattah KR. Educational Experience Impacts Wellness More than Hours Worked. JOURNAL OF SURGICAL EDUCATION 2022; 79:e137-e142. [PMID: 36253331 DOI: 10.1016/j.jsurg.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/19/2022] [Accepted: 09/10/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The Accreditation Council for Graduate Medical Education has focused its interests on resident wellbeing and the clinical work environment in recent years. Concerns regarding both duty hours as well as service obligations versus education resulted in programs nationwide receiving citations, including ours. This study aimed to evaluate the impact of those 2 factors on surgical residents' general wellbeing, hypothesizing that service obligations would be a stronger predictor. DESIGN We have previously reported on the use of a "Fuel Gauge" tool developed at our institution for monitoring resident wellbeing. We performed a retrospective comparison of prospectively collected cross-sectional survey data comparing the Fuel Gauge to a bimonthly "Service Versus Education" (SVE) report. This report used similar scaling and allowed residents to provide feedback on the balance of the educational quality of their current rotation in comparison to their perception of service obligation. Pearson's correlation was then used to compare those scores with duty hour logs to determine if a relationship could be identified between the 3 measurements. SETTING Academic institution of the University of Texas Southwestern in Dallas, Texas. PARTICIPANTS Active general surgery residents (n = 73). RESULTS During the study period, 73 residents filled out both a Fuel Gauge assessment and a SVE assessment at least once, with 273 complete data points available for analysis. Our program's Fuel Gauge median was 4, and our program's median SVE score was 4. Fuel Gauge assessment scores demonstrated a moderate positive correlation with SVE (r = 0.65, p < 0.001), while only a weakly negative association with increasing hours worked (r = -0.15, p = 0.015). SVE also demonstrated a weak negative correlation with hours logged (r = -0.225, p = 0.001). CONCLUSIONS While the Accreditation Council for Graduate Medical Education recognizes that multiple factors contribute to resident wellbeing issues, early efforts were focused on limiting excessive duty hours. Examining our institutional data regarding the previously understudied factor of SVE, we indeed found a stronger correlation with resident perception of low educational value rather than excessive work hours contributing to lower Fuel Gauge scores. These data, if verified, should guide program directors in identifying other institutional factors that may more strongly contribute to their own culture of resident wellness.
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Affiliation(s)
- Madhuri B Nagaraj
- Department of Surgery, University of Texas Southwestern, Dallas, Texas
| | - Jennie Meier
- Department of Surgery, University of Texas Southwestern, Dallas, Texas
| | - Rachael Lefevre
- Department of Surgery, University of Texas Southwestern, Dallas, Texas
| | - Deborah E Farr
- Department of Surgery, University of Texas Southwestern, Dallas, Texas
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Sawangkum P, Lockwood C, Brown HL, Louis J, Hoffman MS. The Role of Gynecologic Surgical Training for the Practicing Obstetrician. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2022.0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Peeraya Sawangkum
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Charles Lockwood
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Haywood L. Brown
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Judette Louis
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Mitchel S. Hoffman
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
- MCC GYN Program, Moffitt Cancer Center, Tampa, Florida, USA
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Dehmoobad Sharifabadi A, Clarkin C, Doja A. Trainee perceptions of resident duty hour restrictions: a qualitative study of online discussion forums. BMJ Open 2022; 12:e063104. [PMID: 36167374 PMCID: PMC9516167 DOI: 10.1136/bmjopen-2022-063104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Resident duty hour (RDH) restrictions in postgraduate medical education is a controversial yet important topic for study. There is limited literature on authentic trainee perceptions surrounding RDH restrictions to inform evaluation and future planning. Online forums are a widely accessible, yet underused resource, for insight into trainee perceptions. Our objective was to qualitatively assess trainee perceptions of RDH restrictions on online discussion forums. SETTING Online discussion forums; Premed101 (Canadian forum) and Student Doctor Network (SDN) (American forum). PARTICIPANTS 6630 posts from 161 discussion threads; comprising 429 posts in 14 threads from Premed101 and 6201 posts in 147 threads from SDN. Posters included medical students, residents and attending physicians. DESIGN Data were analysed inductively and iteratively to create themes and subthemes. Cocoding, consensus-based decision making and an audit trail were used to ensure trustworthiness. RESULTS Key findings distilled across both forums include: the relationship between hours worked and competence, the inapplicability of blanket RDH restrictions to all specialties and the inter-relationship between fatigue and patient safety. Discussions of RDH restriction compliance and perceived consequence for the reporting of violations were also featured on the American SDN forum. CONCLUSIONS The findings of this study reveal multiple themes pertinent to the implementation and revision of RDH restrictions. The most prominent theme was the inapplicability of blanket restrictions on duty hours theme due to the diversity of training needs across specialties and the environmental context of training programmes. Other discussions included the inter-relationship of patient safety and resident competence with duty hours. Lastly, concerns regarding the lack of transparency and psychological safety surrounding RDH violations, were discussed.
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Affiliation(s)
| | - Chantalle Clarkin
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Virtual Mental Health and Outreach, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Asif Doja
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
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The impact of surgical trainee involvement in total hip arthroplasty: a systematic review of surgical efficacy, patient safety, and outcomes. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:1365-1409. [PMID: 35662374 DOI: 10.1007/s00590-022-03290-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Concerns persist that trainee participation in surgical procedures may compromise patient care and potentiate adverse events and costs. We aimed to analyse the potential impact and consequences of surgical trainee involvement in total hip arthroplasty (THA) procedures in terms of surgical efficacy, patient safety, and functional outcomes. METHODS We systematically reviewed Medline/PubMed, EMBASE, the Cochrane library, and Scopus databases in October 2021. Eligible studies reported a direct comparison between THA cases performed with and without trainee involvement. RESULTS Eighteen publications met our eligibility criteria and were included in our study. The included studies reported on 142,450 THAs completed on 142,417 patients. Specifically, 48,155 and 94,295 surgeries were completed with and without trainee involvement, respectively. The mean operative times for procedures with (n = 5,662) and without (n = 14,763) trainee involvement were 106.20 and 91.41 min, respectively. Mean overall complication rates were 6.43% and 5.93% for THAs performed with (n = 4842) and without (n = 12,731) trainees. Lastly, the mean Harris Hip Scores (HHS) for THAs performed with (n = 442) and without (n = 750) trainee participation were 89.61 and 86.97, respectively. CONCLUSION Our systematic review confirmed previous studies' reports of increased operative time for THA cases with trainee involvement. However, based on the overall similar complication rates and functional hip scores obtained, patients should be reassured concerning the relative safety of trainee involvement in THA. Future prospective studies with higher levels of evidence are still needed to reinforce the existing evidence.
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Telehealth and Burn Care: From Faxes to Augmented Reality. Bioengineering (Basel) 2022; 9:bioengineering9050211. [PMID: 35621489 PMCID: PMC9137829 DOI: 10.3390/bioengineering9050211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 05/08/2022] [Accepted: 05/10/2022] [Indexed: 11/25/2022] Open
Abstract
Despite advances in telemedicine, practices remain diverse, ranging from telephonic to still images and video-based conferencing. We review the various modes of telemedicine in burn care and summarize relevant studies, including their contributions and limitations. We also review the role of a more recent technology, augmented reality, and its role in the triage and management of burn patients. Telemedicine in burn care remains diverse, with varied outcomes in accuracy and efficiency. Newer technologies such as augmented reality have not been extensively studied or implemented but show promise in immersive, real-time triage.
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Scharf VF, McPhetridge JB, Dickson R. Sleep patterns, fatigue, and working hours among veterinary house officers: a cross-sectional survey study. J Am Vet Med Assoc 2022; 260:1377-1385. [DOI: 10.2460/javma.21.05.0234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
OBJECTIVE
To describe the sleep patterns, working hours, and perceptions of fatigue among veterinary house officers and to identify potential areas for targeted intervention to improve well-being.
SAMPLE
303 house officers.
PROCEDURES
A 62-item questionnaire was generated by use of an online platform and sent to veterinary house officers at participating institutions via email. Responses were analyzed for trends and associations between variables of interest.
RESULTS
The mean age of respondents was 30 ± 3.7 years. Participants included 239 residents and 64 interns. House officers slept significantly less during times when they had clinical responsibilities compared to off-clinic time (6.0 hours vs 7.5 hours, respectively; P < 0.01). The majority of house officers reported working 11 to 13 hours on a typical weekday (58% [174/302]), and 32% reported clinical responsibilities 7 d/wk. Working hours were negatively related to sleep quantity (Pearson correlation coefficient, −0.54; P < 0.01), and perceived sleep quality was worse when on call (P < 0.01). The majority of house officers felt that fatigue negatively interfered with their technical skills, clinical judgment, and ability to empathize to some extent in the previous 4 weeks.
CLINICAL RELEVANCE
Most house officers fail to obtain sufficient sleep for optimal cognitive function and physical and mental health. Working hours and on call may be important factors contributing to the sleep patterns of veterinary house officers, and training program structure should be critically evaluated to promote protected time for sleep.
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Affiliation(s)
- Valery F. Scharf
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
| | - Jourdan B. McPhetridge
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
| | - Rachel Dickson
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA
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Nistor A, Jiga LP, Miclaus GD, Hoinoiu B, Matusz P, Ionac ME. Experimental swine models for perforator flap dissection in reconstructive microsurgery. PLoS One 2022; 17:e0266873. [PMID: 35404988 PMCID: PMC9000060 DOI: 10.1371/journal.pone.0266873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 03/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background Perforator flaps account for a fraction of reconstructive procedures despite their growing popularity. Specific microsurgical skills are required for successful harvesting of perforator flaps, which are difficult to attain through direct operating room training. Cadaver and small animal dissection cannot simulate human perforator dissection, lacking either bleeding and vessel feedback or providing too small calibers. Thus, we have developed and refined over the last ten years five perforator flaps models in living pig, described their harvesting technique and provided evidence for their effectiveness as perforator flap training models. Method CT angiography data from ten living pigs was used for detailed examination of the integument’s vascular anatomy. Microsurgical techniques were used to standardize and harvest the perforator flaps in acute models. The same operator-assistant team, with no prior perforator flap harvesting experience, raised all flaps in a sequential manner, one animal per day, during a 7 weeks timespan. Porcine flaps were compared to human counterparts in terms of vessel caliber, dissection times. Immediate flap survival was measured as duration of perforator pulsation after completion of flap harvesting, measured every 10 minutes for up to two hours. Results Five perforator flaps were standardized, based on the deep cranial epigastric, thoracodorsal, lateral intercostal, cranial gluteal and dorsal cervical arteries and the operative technique was described in detail. Mean pig perforator size was 1.24±0.36 mm and mean pedicle diameter was 2.78±0.8 mm, which matched closely the human calibers for each flap. Total harvesting time increased 22.4% between the first two experiments due to a more cautious approach following the lack of perforator pulsation in all flaps in the first experimental animal. A total decrease of 44.4% harvesting time between second and last experiment was observed, as expected with all repetitive surgical procedures. Post-operative perforator pulsation time revealed a steep learning curve, with no or short-term pulsatile perforators in the first five pigs, followed by a 275% increase in total perforator pulsation time between 5th and 6th experimental animal. Based on these findings we provide a description of the most common mistakes, their consequences and gestures which can be trained using the pig perforator flaps, in order to overcome these mistakes. Conclusion These five pig perforator flap models provide a fast and efficient learning tool to develop perforator flap harvesting skills safely. Surgical training using these five experimental models offers a similar hands-on perforator flap dissection experience as with human tissue, based on the similar sized calibers of both perforators and pedicles with their human counterparts.
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Affiliation(s)
- Alexandru Nistor
- Division of Microsurgery, Pius Branzeu Center for Laparoscopic Surgery and Microsurgery, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- * E-mail:
| | - Lucian P. Jiga
- Department of Plastic, Aesthetic, Reconstructive and Hand Surgery, Evangelisches Krankenhaus Oldenburg, University of Oldenburg, Oldenburg, Germany
| | | | - Bogdan Hoinoiu
- Division of Clinical Practical Skills, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Petru Matusz
- Department of Anatomy, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Mihai E. Ionac
- Division of Microsurgery, Pius Branzeu Center for Laparoscopic Surgery and Microsurgery, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
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Nagasaki K, Nishizaki Y, Shinozaki T, Kobayashi H, Shimizu T, Okubo T, Yamamoto Y, Konishi R, Tokuda Y. Impact of the resident duty hours on in-training examination score: A nationwide study in Japan. MEDICAL TEACHER 2022; 44:433-440. [PMID: 34818129 DOI: 10.1080/0142159x.2021.2003764] [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] [Indexed: 06/13/2023]
Abstract
PURPOSE The relationship between duty hours (DH) and the performance of postgraduate residents is needed to establish appropriate DH limits. This study explores their relationship using the General Medicine In-training Examination (GM-ITE). MATERIALS AND METHODS In this cross-sectional study, GM-ITE examinees of 2019 had participated. We analyzed data from the examination and questionnaire, including DH per week (eight categories). We examined the association between DH and GM-ITE score, using random-intercept linear models with and without adjustments. RESULTS Five thousand five hundred and ninety-three participants (50.7% PGY-1, 31.6% female, 10.0% university hospitals) were included. Mean GM-ITE scores were lower among residents in Category 2 (45-50 h; mean score difference, -1.05; p < 0.001) and Category 4 (55-60 h; -0.63; p = 0.008) compared with residents in Category 5 (60-65 h; Reference). PGY-2 residents in Categories 2-4 had lower GM-ITE scores compared to those in Category 5. University residents in Category 1 and Category 5 showed a large mean difference (-3.43; p = 0.01). CONCLUSIONS DH <60-65 h per week was independently associated with lower resident performance, but more DH did not improve performance. DH of 60-65 h per week may be the optimal balance for a resident's education and well-being.
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Affiliation(s)
- Kazuya Nagasaki
- Department of Internal Medicine, Mito Kyodo General Hospital, University of Tsukuba, Ibaraki, Japan
| | - Yuji Nishizaki
- Division Medical Education, Juntendo University School of Medicine, Tokyo, Japan
| | - Tomohiro Shinozaki
- Department of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science, Tokyo, Japan
| | - Hiroyuki Kobayashi
- Department of Internal Medicine, Mito Kyodo General Hospital, University of Tsukuba, Ibaraki, Japan
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Tomoya Okubo
- Research Division, National Center for University Entrance Examinations, Tokyo, Japan
| | - Yu Yamamoto
- Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Ryota Konishi
- Education Adviser Japan Organization of Occupational Health and Safety, Kanagawa, Japan
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Maheshwari AV, Garnett CT, Cheng TH, Buksbaum JR, Singh V, Shah NV. Does Resident Participation Influence Surgical Time and Clinical Outcomes? An Analysis on Primary Bilateral Single-Staged Sequential Total Knee Arthroplasty. Arthroplast Today 2022; 15:202-209.e4. [PMID: 35774880 PMCID: PMC9237261 DOI: 10.1016/j.artd.2022.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 02/08/2022] [Accepted: 02/26/2022] [Indexed: 12/01/2022] Open
Abstract
Background Although several studies have indirectly compared teaching and nonteaching hospitals, results are conflicting, and evaluation of the direct impact of trainee involvement is lacking. We investigated the direct impact of resident participation in primary total knee arthroplasties (TKAs). Material and methods Fifty patients undergoing single-staged sequential bilateral primary TKAs were evaluated. The more symptomatic side was performed by the attending surgeon first, followed by the contralateral side performed by a chief resident under direct supervision and assistance of the same attending surgeon. Surgery was subdivided into 8 critical steps on both sides. The overall time and critical stepwise surgical time and short-term clinical outcomes were then compared between the 2 sides. Results The attending surgeon completed the surgery (skin incision to dressing) significantly faster than the resident (70.2 vs 96.9 minutes) by a mean of 26.7 minutes (P < .05) and was also faster in all steps. The most significant differences in time were in “exposure” (9.5 vs 16.5 minutes) and “closure” steps (13.2 vs 24.9 minites), all P < .001. Adverse events occurred in 7 patients; 5 of these resolved uneventfully. There were no significant differences in surgical complications, objective outcome scores, or patient satisfaction scores between both sides. Conclusion Resident participation in TKA increased operative time without jeopardizing short-term patient clinical outcomes, satisfaction, and complications. This may alleviate concerns from patients and policymakers about TKA in an academic setting. Surgical “exposure” and “closure” were the most prolonged steps for the residents, and they may benefit with more focus and/or simulation studies during training.
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Coulshed A, Fernandes B, Hettige S. Overtime claiming among Australian doctors-in-training. AUST HEALTH REV 2022; 46:163-169. [PMID: 35314024 DOI: 10.1071/ah21323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 01/20/2022] [Indexed: 11/23/2022]
Abstract
ObjectiveTo quantify patterns of overtime among doctors-in-training in New South Wales and to explore the reasons doctors-in-training cite for not claiming overtime worked.MethodsA confidential online self-reporting survey was conducted of post-graduate doctors-in-training, working in hospitals in NSW, from post-graduate year 1 through to completion of specialist training. Questions sought to determine the average amount of overtime worked, overtime claiming patterns, and reasons why overtime was not claimed. Comparisons were made by level of training and specialty training pathway.ResultsA total of 1351 valid responses were received. Unrostered overtime was extremely common, as was underpayment for work completed. Though 73.5% of respondents reported working at least 5 h of unrostered overtime per fortnight, only 15.6% of respondents reported claiming all their unrostered overtime, and among those who did claim overtime, only 45.5% reported being paid the amount in full. Common reasons for not claiming overtime included workplace cultural expectations (37.0%), and overtime not falling under approved reasons (32.6%). There were statistically significant differences (P < 0.001) in all response categories between critical care, physician and surgical training pathways.ConclusionsThe survey data demonstrated a significant disconnect between expectations and reality of working hours among doctors-in-training. This is indicative of concerns regarding loss of income, impaired ability to plan workforce allocation due to hidden workload, and possibly impaired wellbeing.
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Affiliation(s)
- Andrew Coulshed
- Royal Prince Alfred Hospital, University of Sydney, 50 Missenden Road, Camperdown, NSW 2050, Australia
| | - Brian Fernandes
- Royal Prince Alfred Hospital, University of Sydney, 50 Missenden Road, Camperdown, NSW 2050, Australia
| | - Sanjay Hettige
- Nepean Hospital, University of Sydney, Derby Street, Kingswood, NSW 2747, Australia
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