Investigation of divergent thinking among surgeons and surgeon trainees in Canada (IDEAS): a mixed-methods study

OBJECTIVE

To assess the creative potential of surgeons and surgeon trainees, as measured by divergent thinking. The secondary objectives were to identify factors associated with divergent thinking, assess confidence in creative problem-solving and the perceived effect of surgical training on creative potential, and explore the value of creativity in surgery.

DESIGN

We used a mixed-methods design, conducting a survey of divergent thinking ability using a validated questionnaire followed by two semi-structured interviews with top-scoring participants.

PARTICIPANTS & SETTING

Surgeons and surgeon trainees in the Department of Surgery at McMaster University.

OUTCOMES

The primary outcome was divergent thinking, assessed with the Abbreviated Torrance Test for Adults. Participants also self-assessed their confidence in creative problem-solving and the effect of surgical training on their creative potential. We performed descriptive analyses and multivariable linear regression to identify factors associated with divergent thinking. We conducted a thematic analysis of the interview responses.

RESULTS

82 surgeons and surgeon trainees were surveyed; 43 were junior trainees and 28 were senior trainees. General surgery, orthopaedic surgery and plastic surgery represented 71.9% of the participants. The median participant age was 28 years (range 24-73), 51.2% of whom were female. Participants demonstrated levels of divergent thinking that were higher but not meaningfully different from the adult norm (62.39 (95% CI 61.25, 63.53), p<0.001). While participants scored significantly higher than the average adult on fluency (the ability to produce quantities of ideas) and flexibility (the ability to process information in different ways) (p<0.001 for both), they scored below average on originality (the ability to produce uncommon, new or unique ideas) (p<0.001). Regression analysis identified higher divergent thinking scores among females (estimated β=-3.58 (95% CI -6.25 to -0.90), p=0.010).

CONCLUSIONS

The divergent thinking ability among surgeons and surgeon trainees was not meaningfully different from the adult normative score; however, their ability to generate original ideas was below average.

Standardization and Visualization of the Surgical Time-Out

INTRODUCTION

The time-out (TO) can prevent adverse events but is subject to TO engagement. We hypothesize transforming the TO to an auditable, active process will improve compliance and engagement.

METHODS

The passive nature of the current TO was identified as a potential safety issue on staff patient safety culture surveys. Subsequently, the Time Out Engagement and Standardization quality improvement initiative was developed and included a whiteboard checklist to be used in the operating room. As a baseline, 11 TOs were audited concerning engagement and content. Key stakeholders were engaged to determine potential interventions. A TO consisting of 15 elements using a TO whiteboard checklist with role-specific objectives was developed. Plan, Do, Study, Act cycles commenced. After implementation, 17 TOs were audited based on engagement and content.

RESULTS

Before intervention, engagement varied with nurse participating in 100% compared with anesthesia provider or surgeon participating in 18%. No TO included all 15 elements and only 13% of elements included in all TOs. After implementation of Time Out Engagement and Standardization, anesthesia and surgeon who participated increased to 100% and 76.5%, respectively (P < 0.0001, P = 0.006). The 15 standardized elements of the TO were discussed in 90% of cases. Overall, preintervention 88 elements (57.1%) were completed across all TOs, while postintervention 243 elements (98.8%) were completed (P < 0.001).

CONCLUSIONS

We identified a need for increased engagement of the TO based on staff concerns, which were verified through auditing. Implementation of a team-driven intervention and 3 rapid Plan, Do, Study, Act cycles led to measurable improvement of the surgical TO.

Perceived human factors from the perspective of paramedics – a qualitative interview study

Background

The work environment in prehospital emergency medical care setting is dynamic and complex and includes many stressors. However, little is known about the perceived human factors from the perspective of paramedics. In this study, we investigated, from the perspective of paramedics, what are the human factors, and how are they linked to prehospital emergency medical care?

Methods

Data were collected through semi-structured interviews (n = 15) with Finnish paramedics. The material was analyzed using inductive content analysis.

Results

Three main categories of human factors were identified. The first main category consisted of factors related to work which were divided into two generic categories: “Challenging organizational work environment” and “Changing external work environment.” The second main category comprised factors related to paramedics themselves and were divided into three generic categories: “Issues linked to personality,” “Personal experiences”, and “Factors resulting from personal features.” The third main category described that paramedics have difficulties in understanding and describing human factors.

Conclusion

This study revealed numerous factors that can affect paramedics’ work in the EMS setting. Increased knowledge about human factors in the EMS setting provides organizations with the opportunity to develop procedures that can support paramedics’ cognitive and physical work. Human factors in different situations can be addressed to improve occupational and patient safety.

Does standardisation improve post-operative anaesthesia handoffs? Meta-analyses on provider, patient, organisational, and handoff outcomes

Anaesthesia handoffs are associated with negative outcomes (e.g. inappropriate treatments, post-operative complications, and in-hospital mortality). To minimise these adverse outcomes, federal bodies (e.g. Joint Commission) have mandated handoff standardisation. Due to the proliferation of handoff interventions and research, there is a need to meta-analyze anaesthesia handoffs. Therefore, we performed meta-analyses on the provider, patient, organisational, and handoff outcomes related to post-operative anaesthesia handoff protocols. We meta-analysed 41 articles with post-operative anaesthesia handoffs that implemented a standardised handoff protocol. Compared to no standardisation, a standardised post-operative anaesthesia handoff changed provider outcomes with an OR of 4.03 (95% CI 3.20-5.08), patient outcomes with an OR of 1.49 (95% CI 1.32-1.69), organisational outcomes with an OR of 4.25 (95% CI 2.51-7.19), handoff outcomes with an OR of 8.52 (95% CI 7.05-10.31). Our meta-analyses demonstrate that standardised post-operative anaesthesia handoffs altered patient, provider, organisational, and handoff outcomes. Practitioner Summary: We conducted meta-analyses to assess the effects of post-operative anaesthesia handoff standardisation on provider, patient, organisational, and handoff outcomes. Our findings suggest that standardised post-operative anaesthesia handoffs changed all listed outcomes in a positive direction. We discuss the implications of these findings as well as notable limitations in this literature base.

Simulation-based randomized trial of medical emergency cognitive aids

BACKGROUND

Medical emergencies are complex and stressful, especially for the young and inexperienced. Cognitive aids (CA) have been shown to facilitate management of simulated medical emergencies by experienced teams. In this randomized trial we evaluated guideline adherence and treatment efficacy in simulated medical emergencies managed by residents with and without CA.

METHODS

Physicians attending educational courses executed simulated medical emergencies. Teams were randomly assigned to manage emergencies with or without CA. Primary outcome was risk reduction of essential working steps. Secondary outcomes included prior experience in emergency medicine and CA, perceptions of usefulness, clinical relevance, acceptability, and accuracy in CA selection. Participants were grouped as "medical" (internal medicine and neurology) and "perioperative" (anesthesia and surgery) regarding their specialty. The study was designed as a prospective randomized single-blind study that was approved by the ethical committee of the University Duisburg-Essen (19-8966-BO).

TRIAL REGISTRATION

DRKS, DRKS00024781. Registered 16 March 2021-Retrospectively registered, http://www.drks.de/DRKS00024781 .

RESULTS

Eighty teams participated in 240 simulated medical emergencies. Cognitive aid usage led to 9% absolute and 15% relative risk reduction. Per protocol analysis showed 17% absolute and 28% relative risk reduction. Wrong CA were used in 4%. Cognitive aids were judged as helpful by 94% of the participants. Teams performed significantly better when emergency CA were available (p < 0.05 for successful completion of critical work steps). Stress reduction using CA was more likely in "medical" than in "perioperative" subspecialties (3.7 ± 1.2 vs. 2.9 ± 1.2, p < 0.05).

CONCLUSIONS

In a high-fidelity simulation study, CA usage was associated with significant reduction of incorrect working steps in medical emergencies management and was characterized by high acceptance. These findings suggest that CA for medical emergencies may have the potential to improve emergency care.

Establishing Institutional Scores With the Rigor and Transparency Index: Large-scale Analysis of Scientific Reporting Quality

BACKGROUND

Improving rigor and transparency measures should lead to improvements in reproducibility across the scientific literature; however, the assessment of measures of transparency tends to be very difficult if performed manually.

OBJECTIVE

This study addresses the enhancement of the Rigor and Transparency Index (RTI, version 2.0), which attempts to automatically assess the rigor and transparency of journals, institutions, and countries using manuscripts scored on criteria found in reproducibility guidelines (eg, Materials Design, Analysis, and Reporting checklist criteria).

METHODS

The RTI tracks 27 entity types using natural language processing techniques such as Bidirectional Long Short-term Memory Conditional Random Field-based models and regular expressions; this allowed us to assess over 2 million papers accessed through PubMed Central.

RESULTS

Between 1997 and 2020 (where data were readily available in our data set), rigor and transparency measures showed general improvement (RTI 2.29 to 4.13), suggesting that authors are taking the need for improved reporting seriously. The top-scoring journals in 2020 were the Journal of Neurochemistry (6.23), British Journal of Pharmacology (6.07), and Nature Neuroscience (5.93). We extracted the institution and country of origin from the author affiliations to expand our analysis beyond journals. Among institutions publishing >1000 papers in 2020 (in the PubMed Central open access set), Capital Medical University (4.75), Yonsei University (4.58), and University of Copenhagen (4.53) were the top performers in terms of RTI. In country-level performance, we found that Ethiopia and Norway consistently topped the RTI charts of countries with 100 or more papers per year. In addition, we tested our assumption that the RTI may serve as a reliable proxy for scientific replicability (ie, a high RTI represents papers containing sufficient information for replication efforts). Using work by the Reproducibility Project: Cancer Biology, we determined that replication papers (RTI 7.61, SD 0.78) scored significantly higher (P<.001) than the original papers (RTI 3.39, SD 1.12), which according to the project required additional information from authors to begin replication efforts.

CONCLUSIONS

These results align with our view that RTI may serve as a reliable proxy for scientific replicability. Unfortunately, RTI measures for journals, institutions, and countries fall short of the replicated paper average. If we consider the RTI of these replication studies as a target for future manuscripts, more work will be needed to ensure that the average manuscript contains sufficient information for replication attempts.

A Checklist for Reproducible Computational Analysis in Clinical Metabolomics Research

Clinical metabolomics emerged as a novel approach for biomarker discovery with the translational potential to guide next-generation therapeutics and precision health interventions. However, reproducibility in clinical research employing metabolomics data is challenging. Checklists are a helpful tool for promoting reproducible research. Existing checklists that promote reproducible metabolomics research primarily focused on metadata and may not be sufficient to ensure reproducible metabolomics data processing. This paper provides a checklist including actions that need to be taken by researchers to make computational steps reproducible for clinical metabolomics studies. We developed an eight-item checklist that includes criteria related to reusable data sharing and reproducible computational workflow development. We also provided recommended tools and resources to complete each item, as well as a GitHub project template to guide the process. The checklist is concise and easy to follow. Studies that follow this checklist and use recommended resources may facilitate other researchers to reproduce metabolomics results easily and efficiently.

Implementing a Standardized Cardiac Protocol for the Adolescent Preparticipation Sports Examination

INTRODUCTION

To evaluate adolescent athletes for cardiovascular (CV) abnormalities before engaging in competitive sports, the American Heart Association guidelines recommend preparticipation screening. The initiative aimed to implement a standardized protocol to increase the identification of CV abnormalities during athletic physical examinations.

METHOD

A rapid-cycle model with four Plan-Do-Study-Act cycles was implemented in two urgent care clinics. Providers used a CV-specific screening checklist; parents were engaged in a discussion about the importance of this screening, and team engagement activities were used. Outcomes were measured with chart audits and surveys.

RESULTS

Because of the intervention, 62% of athletes were screened, with 29% identified as having a CV risk. The satisfaction of the patients and the team increased by 3% and 62.5%, respectively.

DISCUSSION

Despite competing foci in the clinics, athletes were properly screened using a standardized checklist, which is easily sustainable and can be duplicated in other settings.

A Fundamental Cognitive Taxonomy for Cognition Aids

OBJECTIVE

This study aimed to organize the literature on cognitive aids to allow comparison of findings across studies and link the applied work of aid development to psychological constructs and theories of cognition.

BACKGROUND

Numerous taxonomies have been developed, all of which label cognitive aids via their surface characteristics. This complicates integration of the literature, as a type of aid, such as a checklist, can provide many different forms of support (cf. prospective memory for steps and decision support for alternative diagnoses).

METHOD

In this synthesis of the literature, we address the disparate findings and organize them at their most basic level: Which cognitive processes does the aid need to support? Which processes do they support? Such processes include attention, perception, decision making, memory, and declarative knowledge.

RESULTS

Cognitive aids can be classified into the processes they support. Some studies focused on how an aid supports the cognitive processes demanded by the task (aid function). Other studies focused on supporting the processes needed to utilize the aid (aid usability).

CONCLUSION

Classifying cognitive aids according to the processes they support allows comparison across studies in the literature and a formalized way of planning the design of new cognitive aids. Once the literature is organized, theory-based guidelines and applied examples can be used by cognitive aid researchers and designers.

APPLICATION

Aids can be designed according to the cognitive processes they need to support. Designers can be clear about their focus, either examining how to support specific cognitive processes or improving the usability of the aid.