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Wykowski JH, Kelly ME, Tong HH, Osobamiro OO, Albert TJ. An Opportunity for Change: Principles for Reforming Internal Medicine Inpatient Conferences. J Gen Intern Med 2024; 39:481-486. [PMID: 37989816 PMCID: PMC10897115 DOI: 10.1007/s11606-023-08399-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/24/2023] [Indexed: 11/23/2023]
Abstract
Inpatient educational conferences are a key part of internal medicine residency training. Many residencies made conferences virtual during the COVID-19 pandemic, and are now returning to in-person sessions. As we navigate this change, we can seize this opportunity to re-evaluate the role that inpatient conferences serve in resident education. In this paper, we briefly review the history of inpatient educational conferences before offering five recommendations for improvement. Our recommendations include grounding conference formats in educational theory, leveraging the expertise of all potential educators, broadening content to include health equity and justice throughout all curricula, and explicitly focusing on cultivating community among participants. Recognizing that each residency program is different, we anticipate that these recommendations may be implemented differently based on program size, available resources, and current institutional practices. We also include examples of prior successful curricular reforms aligned with our principles. We hope these recommendations ensure inpatient conferences continue to be a central part of residency education for future generations of internal medicine residents.
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Affiliation(s)
- James H Wykowski
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA.
| | - Molly E Kelly
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Hao H Tong
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | | | - Tyler J Albert
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA
- Veterans Affairs Puget Sound Healthcare System, Seattle, WA, USA
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Yuan JH, Huang Y, Rosgen BK, Donnelly S, Lan X, Katz SJ. Burnout and fatigue amongst internal medicine residents: A cross-sectional study on the impact of alternative scheduling models on resident wellness. PLoS One 2023; 18:e0291457. [PMID: 37708198 PMCID: PMC10501672 DOI: 10.1371/journal.pone.0291457] [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: 04/21/2023] [Accepted: 08/28/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Fatigue and burnout are prevalent among resident physicians across Canada. Shifts exceeding 24 hours are commonly purported as detrimental to resident health and performance. Residency training programs have employed strategies towards understanding and intervening upon the complex issue of resident fatigue, where alternative resident scheduling models have been an area of active investigation. This study sought to characterize drivers and outcomes of fatigue and burnout amongst internal medicine residents across different scheduling models. METHODS We conducted cross-sectional surveys were among internal medicine resident physicians at the University of Alberta. We collected anonymized socioeconomic demographics and medical education background, and estimated associations between demographic or work characteristics and fatigue and burnout outcomes. RESULTS Sixty-nine participants competed burnout questionnaires, and 165 fatigue questionnaires were completed (response rate of 48%). The overall prevalence of burnout was 58%. Lower burnout prevalence was noted among respondents with dependent(s) (p = 0.048), who identified as a racial minority (p = 0.018), or completed their medical degree internationally (p = 0.006). The 1-in-4 model was associated with the highest levels of fatigue, reported increased risk towards personal health (OR 4.98, 95%CI 1.77-13.99) and occupational or household harm (OR 5.69, 95%CI 1.87-17.3). Alternative scheduling models were not associated with these hazards. CONCLUSIONS The 1-in-4 scheduling model was associated with high rates of resident physician fatigue, and alternative scheduling models were associated with less fatigue. Protective factors against fatigue are best characterized as strong social supports outside the workplace. Further studies are needed to characterize the impacts of alternative scheduling models on resident education and patient safety.
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Affiliation(s)
- Jack H. Yuan
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Yiming Huang
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Brianna K. Rosgen
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sarah Donnelly
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Xiaoyang Lan
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Steven J. Katz
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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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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A Dual-Institutional Study on First Year Practice Outcomes of Pediatric Surgeons Who Trained in the Era of Work Hour Restrictions. Pediatr Surg Int 2022; 38:277-283. [PMID: 34709434 PMCID: PMC8742777 DOI: 10.1007/s00383-021-05037-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND In July 2003, an 80-h work week restriction for residencies was mandated. This was met with skepticism regarding its potential impact on operative training. We hypothesized no difference in outcomes for pediatric surgeons who trained under duty hour restrictions compared to historical complication rates. METHODS Dual-institutional review of pediatric patients who underwent five of the most common operations (2013-2018) by first-year pediatric surgeons who trained under duty hour restrictions was performed. Tests of proportions were used to compare complication rates to published rates on data collected prior to 2003. RESULTS Patient mean age was 10.1 years. No significant differences (p values > 0.05) were found in laparoscopic appendectomy rates of infection, bleeding or intra-abdominal abscess compared to previously published rates. Pyloromyotomy rates of infection or duodenal perforation were not different. No differences were detected in rates of infection, recurrence or testicular atrophy for inguinal hernia repair. Umbilical hernia rates of infection, bleeding, and recurrence were also not different. There was no difference in CVC rates of hemopneumothoraces; significantly more bleeding events were detected (1.2% vs. 0.1%; p value = 0.04). CONCLUSION In this study, first-year complication rates of pediatric surgeons who trained under duty hour restrictions were not significantly different when compared to published rates.
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Finn KM, Halvorsen AJ, Chaudhry S, Desai S, Dupras D, Reddy S, Wahi-Gururaj S, Willett L, Zaas AK. Does Increased Schedule Flexibility Lead to Change? A National Survey of Program Directors on 2017 Work Hours Requirements. J Gen Intern Med 2020; 35:3205-3209. [PMID: 32869195 PMCID: PMC7661583 DOI: 10.1007/s11606-020-06109-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 08/04/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The learning and working environment for resident physicians shifted dramatically over the past two decades, with increased focus on work hours, resident wellness, and patient safety. Following two multi-center randomized trials comparing 16-h work limits for PGY-1 trainees to more flexible rules, the ACGME implemented new flexible work hours standards in 2017. OBJECTIVE We sought to determine program directors' (PDs) support for the work hour changes and programmatic response. DESIGN In 2017, US Internal Medicine PDs were surveyed about their degree of support for extension of PGY-1 work hour limits, whether they adopted the new maximum continuous work hours permitted, and reasons for their decisions. KEY RESULTS The response rate was 70% (266/379). Fifty-seven percent of PDs (n = 151) somewhat/strongly support the new work hour rules for PGY-1 residents, while only 25% of programs (N = 66) introduced work periods greater than 16-h on any rotation. Higher rates of adopting change were seen in PDs who strongly/somewhat supported the change (56/151 [37%], P < 0.001), had tenure of 6+ years (33/93 [35%], P = 0.005), were of non-general internal medicine subspecialty (30/80 [38%], P = 0.003), at university-based programs (35/101 [35%], P = 0.009), and with increasing number of approved positions (< 38, 10/63 [16%]; 38-58, 13/69 [19%]; 59-100, 15/64 [23%]; > 100, 28/68 [41%], P = 0.005). Areas with the greatest influence for PDs not extending work hours were the 16-h rule working well (56%) and risk to PGY1 well-being (47%). CONCLUSIONS Although the majority of PDs support the ACGME 2017 work hours rules, only 25% of programs made immediate changes to extend hours. These data reveal that complex, often competing, forces influence PDs' decisions to change trainee schedules.
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Affiliation(s)
- Kathleen M Finn
- Internal Medicine Residency Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Andrew J Halvorsen
- Internal Medicine Residency Program, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Saima Chaudhry
- Office of Academic Affairs, Memorial Healthcare System, Hollywood, FL, USA
| | - Sanjay Desai
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Denise Dupras
- Internal Medicine Residency Program, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Shalini Reddy
- Internal Medicine Residency Program, John H. Stroger Hospital of Cook County Health, Chicago, IL, USA
| | - Sandhya Wahi-Gururaj
- Internal Medicine Residency, Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, NV, USA
| | - Lisa Willett
- Tinsley Harrison Internal Medicine Residency, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Aimee K Zaas
- Internal Medicine Residency Program, Duke University School of Medicine, Durham, NC, USA
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Kassam A, Cowan M, Topps M. Lessons Learned to Aid in Developing Fatigue Risk Management Plans for Resident Physicians. TEACHING AND LEARNING IN MEDICINE 2019; 31:136-145. [PMID: 30596293 DOI: 10.1080/10401334.2018.1542307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Phenomenon: Fatigue is a significant risk factor for deterioration in performance, which may lead to medical errors and reduced well-being in resident physicians (residents). Sleep deprivation, which has been studied extensively, is only one contributor to fatigue. Given the complexity of fatigue and its relationship with resident performance, the National Steering Committee on Resident Duty Hours in Canada recommends that all residency education programs develop a fatigue risk management plan (FRMP) for their residents. The purpose of this study was to explore the impact of residents' experiences of fatigue and the strategies they use to manage it. Approach: This single-site study investigated the perceptions of resident physicians. Residents were recruited through purposive sampling to ensure representation from a variety of programs, postgraduate year level, and gender. Recruitment was managed with support from the residency programs; however, data collection and analysis were conducted by the Office of Postgraduate Medical Education to ensure participant anonymity. Program directors and administrators assisted in relaying the information about the study to the residents; however, they were not made aware if their residents participated in the study. Interview and focus group data were collected all at once, then transcribed, and then subsequent thematic analysis of these data was conducted using a quasi-constant comparison approach until thematic saturation was reached. Two researchers coded the data using thematic content analysis. Findings: Fifty-seven residents participated in a focus group or interview. There was representation from more than half of the 58 residency programs and from 15 of 16 departments. Overall, there was consensus that fatigue impacts residents' physical, cognitive, and emotional states. These impacts were reported as influencing resident performance including those related to patient care. Residents reported that fatigue led them to be less productive in their personal and professional lives. Three major themes were identified for which strategies could be developed for fatigue risk management: self, program, and system. Together with self-, program-, and system-level strategies that complement and enhance each other, specific targeted FRMPs could be developed. Insights: Fatigue is a multifaceted phenomenon experienced by residents that requires management beyond extended duty hours and adequate amounts of sleep. FRMPs that encompass strategies used by the resident, the residency-training program, and the healthcare system in which they work could assist with managing fatigue in residents and support enhanced resident well-being and patient care.
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Affiliation(s)
- Aliya Kassam
- a Office of Postgraduate Medical Education , University of Calgary Cumming School of Medicine , Calgary , Alberta , Canada
| | - Michèle Cowan
- a Office of Postgraduate Medical Education , University of Calgary Cumming School of Medicine , Calgary , Alberta , Canada
| | - Maureen Topps
- a Office of Postgraduate Medical Education , University of Calgary Cumming School of Medicine , Calgary , Alberta , Canada
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Kopel JJ, Phy M. An interview with Sir William Osler on resident work hours and physician responsibility in the 21st century. Proc (Bayl Univ Med Cent) 2019; 32:159-162. [PMID: 30956618 DOI: 10.1080/08998280.2018.1533311] [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: 08/07/2018] [Revised: 09/28/2018] [Accepted: 10/04/2018] [Indexed: 10/27/2022] Open
Abstract
Since 2003, duty hour regulations (DHRs) imposed by the Accreditation Council on Graduate Medical Education (ACGME) have been a controversial issue in the medical community. The conflict touches upon the ethical principles of beneficence, nonmaleficence, justice, and the activities of every physician. However, the controversy concerning DHR presents opportunities for reevaluating a physician's roles, responsibilities, and work-life balance in the 21st century. In this article, the DHR controversy is discussed through the thoughts and ideas of Sir William Osler using an interview format. An internal medicine residency program director adds comments to this discussion based on his understanding of current ACGME regulations.
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Affiliation(s)
- Jonathan J Kopel
- Department of Internal Medicine, Texas Tech University Health Sciences CenterLubbockTexas
| | - Michael Phy
- Department of Internal Medicine, Texas Tech University Health Sciences CenterLubbockTexas
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Gaboury I, Ouellet K, Xhignesse M, St-Onge C. Strategies identified by program directors to improve adoption of the CanMEDS framework. CANADIAN MEDICAL EDUCATION JOURNAL 2018; 9:e26-e34. [PMID: 30498541 DOI: 10.36834/cmej.43049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Challenges associated with the use of the CanMEDS physician competency framework (CanMEDS) have been the subject of several studies. Most of these have focused on the adoption of specific roles in an Anglophone context. This study aims to investigate how Francophone postgraduate medical education (PGME) program directors have integrated the CanMEDS framework into their programs. METHODS We invited Francophone PGME program directors to participate in group interviews aimed at exploring their experiences using the CanMEDS framework. We used an open-ended interview guide and realized a thematic analysis of the transcripts. RESULTS We held five group interviews between February and December 2014 with 17 Francophone program directors representing 13 out of a maximum of 62 different specialties/subspecialties. Although program directors endorsed the framework, its integration was seen as challenging, particularly the assessment of non-medical expert roles. To overcome these challenges, they relied on common strategies including a longitudinal approach to the framework, improving inter-program collaboration, and subcontracting the teaching of certain roles. CONCLUSION While integrating the CanMEDS framework into their programs, Francophone program directors struggled with teaching and assessing non-medical expert roles and ensuring their longitudinal integration over time. Directors relied on various strategies, some of which (e.g., subcontracting) may ultimately limit the adoption of the framework as a whole. ___.
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Affiliation(s)
- Isabelle Gaboury
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Quebec, Canada
| | - Kathleen Ouellet
- Center for Health Profession Education, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Quebec, Canada
| | - Marianne Xhignesse
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Quebec, Canada
- Center for Health Profession Education, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Quebec, Canada
| | - Christina St-Onge
- Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Quebec, Canada
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Green JL, Suresh V, Bittar P, Ledbetter L, Mithani SK, Allori A. The Utilization of Video Technology in Surgical Education: A Systematic Review. J Surg Res 2018; 235:171-180. [PMID: 30691792 DOI: 10.1016/j.jss.2018.09.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/05/2018] [Accepted: 09/06/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The use of surgical video has great potential to enhance surgical education, but there exists limited information about how to effectively use surgical videos. We performed a systematic review of video technology in surgical training and provided evidence-based recommendations for its effective use. MATERIALS AND METHODS A systematic review of literature on surgical video in residency education was conducted. All articles meeting inclusion criteria were evaluated for technical characteristics pertaining to video usage. Included studies were critically appraised using a quality-scoring system. Recommendations were provided for the effective implementation of video in surgical education based on associations with improved training outcomes. RESULTS Twenty articles met inclusion criteria. In these studies, the source of video acquisition was primarily laparoscopy (40.0% of papers), and the main perspective of video was endoscopy (45.0%). Features of videos included supplementation with other educational tools (55.0%), schematic diagrams or images (50.0%), audio (40.0%), and narration (25.0%). Videos were primarily viewed preoperatively (60.0%) or postoperatively (50.0%). The intended viewer for videos was usually residents (70.0%) but also included attendings/faculty (30.0%). When compared with a nonvideo training group, video training was associated with improved resident knowledge (100%), improved operative performance (81.3%), and greater participant satisfaction (100%). CONCLUSIONS Based on this review, we recommend that surgical training programs incorporate schematics and imaging into video, supplement video with other education tools, and utilize audio in video. For video review, we recommend that residents review video preoperatively and postoperatively for learning and that attendings review video postoperatively for assessment.
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Affiliation(s)
- Jason L Green
- Duke University School of Medicine, Durham, North Carolina.
| | - Visakha Suresh
- Duke University School of Medicine, Durham, North Carolina
| | - Peter Bittar
- Duke University School of Medicine, Durham, North Carolina
| | - Leila Ledbetter
- Duke University Medical Center Library, Durham, North Carolina
| | - Suhail K Mithani
- Division of Plastic, Maxillofacial & Oral Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina; Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Alexander Allori
- Pediatric Plastic & Craniofacial Surgery, Division of Plastic, Maxillofacial & Oral Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
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Smink GM, Jeffe DB, Hayashi RJ, Al-Hammadi N, Fehr JJ. Pediatric-Oncology Simulation Training for Resident Education. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2018; 5:155-160. [PMID: 31485338 DOI: 10.1136/bmjstel-2018-000347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Introduction We sought to evaluate pediatric oncology simulations intended to improve pediatric residents' skills and comfort in caring for children with cancer. Method In a non-randomized trial, controls (the first three rotations) received a standard set of lectures, and the intervention arm received these lectures plus five simulation-training scenarios-fever/neutropenia, a new leukemia diagnosis, end-of-life care discussion, tumor lysis syndrome, and a mediastinal mass. All residents were tested after the rotation on the first three scenarios; management skills were evaluated independently by two raters. Before and after training, all residents completed an emotional-appraisal questionnaire evaluating each scenario as a perceived challenge or threat. Analysis of variance (ANOVA) measured differences by study arm in skills-checklist assessments and appraisals; repeated-measures ANOVA measured changes in emotional-appraisal scores. Results Forty-two residents (9 control, 33 intervention) participated. Inter-rater agreement for skills-checklist scores using average-measures intraclass correlation was high (0.847), and overall mean scores were significantly higher for the intervention than control group across both raters (P = 0.005). For all residents, perceived challenge increased in the end-of-life simulation, and perceived threat decreased in all three test scenarios. The intervention group, regardless of training year, evaluated the teaching scenarios favorably and felt that challenging oncology situations were addressed, skills were enhanced, and the simulations should be offered to other residents. Conclusions It was feasible to introduce residents to difficult pediatric oncology scenarios using simulation. The intervention group performed more skills than controls when tested, and perceive threat declined in all residents after their pediatric oncology rotation.
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Affiliation(s)
- Gayle M Smink
- Assistant Professor of Pediatrics, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Donna B Jeffe
- Professor of Medicine and director of the Health Behavior, Communication, and Outreach Core, Department of Medicine, and director of the Medical Education Research Unit, Office of Education, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Robert J Hayashi
- Professor of Pediatrics, Division of Pediatric Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Noor Al-Hammadi
- statistical data analyst, Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - James J Fehr
- Professor of Anesthesiology and Pediatrics, Departments of Anesthesiology and Pediatrics, Washington University School of Medicine, and medical director of the Saigh Pediatric Simulation Center at St. Louis Children's Hospital, St. Louis, Missouri, USA
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Healy JM, Maxfield MW, Solomon DG, Longo WE, Yoo PS. Beyond 250: A Comprehensive Strategy to Maximize the Operative Experience for Junior Residents. JOURNAL OF SURGICAL EDUCATION 2018; 75:541-545. [PMID: 29097172 DOI: 10.1016/j.jsurg.2017.08.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 07/25/2017] [Accepted: 08/27/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Among surgical educators, duty-hour restrictions led to concern regarding the adequacy of operative experience during residency, especially for junior residents. The American Board of Surgery recently instituted guidelines mandating "a minimum of 250 operations by the end of the PGY-2 year". A series of programmatic and institutional changes were implemented at our institution to augment the junior resident operative experience and to exceed compliance with this mandate. METHODS Operative data from Accreditation Council for Graduate Medical Education case logs for categorical and nondesignated preliminary interns from our large academic surgical residency were identified for 5 consecutive academic years, 2011 until 2016. American Board of Surgery In-Training Examination (ABSITE) scores were collected anonymously. The program systematically instituted the following changes: night float minimization, identification of new surgical opportunities, augmenting use of midlevel care providers, identification of rotations with suboptimal operative experiences, maximizing rotations with involvement of junior residents in the operating room, and systematic review of junior case logs. RESULTS After implementation, average total cases for residents completing postgraduate year (PGY)-2 increased from 176 to 330 (p < 0.001). Specifically, there was an 18% increase for interns (p = 0.059) and a 118% increase for PGY-2 residents (p < 0.001). There were statistically significant increases in skin and soft tissue cases, vascular cases, endoscopy, and complex laparoscopic cases. Average case volumes for senior residents did not change. Night float time was significantly decreased (5.7 vs 3.4 wk; p = 0.04). ABSITE scores were not significantly changed during this time. CONCLUSIONS Before implementation of these interventions, our program would have had 0% compliance with the 250 junior resident case rule. Within 12 months of implementation, total case volumes for residents completing PGY-2 increased by 88%-exceeding minimum standards. Overall, 100% programmatic compliance was achieved. Our program's experience exemplifies how mandates from the American Board of Surgery can lead to programmatic changes that improve the experience of surgical house officers.
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Affiliation(s)
- James M Healy
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
| | - Mark W Maxfield
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Daniel G Solomon
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Walter E Longo
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Peter S Yoo
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
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Jyot A, Baloul MS, Finnesgard EJ, Allen SJ, Naik ND, Gomez Ibarra MA, Abbott EF, Gas B, Cardenas-Lara FJ, Zeb MH, Cadeliña R, Farley DR. Surgery Website as a 24/7 Adjunct to a Surgical Curriculum. JOURNAL OF SURGICAL EDUCATION 2018; 75:811-819. [PMID: 29066315 DOI: 10.1016/j.jsurg.2017.09.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 09/17/2017] [Accepted: 09/18/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Successfully teaching duty hour restricted trainees demands engaging learning opportunities. Our surgical educational website and its associated assets were assessed to understand how such a resource was being used. DESIGN Our website was accessible to all Mayo Clinic employees via the internal web network. Website access data from April 2015 through October 2016 were retrospectively collected using Piwik. SETTING Academic, tertiary care referral center with a large general surgery training program. Mayo Clinic, Rochester, MN. PARTICIPANTS A total of 257 Mayo Clinic employees used the website. RESULTS The website had 48,794 views from 6313 visits by 257 users who spent an average of 14 ± 11 minutes on the website. Our website houses 295 videos, 51 interactive modules, 14 educational documents, and 7 flashcard tutorials. The most popular content type was videos, with a total of 30,864 views. The most popular visiting time of the day was between 8 pm and 9 pm with 6358 views (13%), and Thursday was the most popular day with 17,907 views (37%). A total of 78% of users accessed content beyond the homepage. Average visits peaked in relation to 2 components of our curriculum: a 240% increase one day before our biannual intern simulation assessments, and a 61% increase one day before our weekly conducted Friday simulation sessions. Interns who rotated on the service of the staff surgeon who actively endorses the website had 93% more actions per visit as compared to other users. The highest clicks were on the home banner for our weekly simulation session pre-emptive videos, followed by "groin anatomy," and "TEP hernia repair" videos. CONCLUSIONS Our website acted as a "just-in-time" accessible portal to reliable surgical information. It supplemented the time sensitive educational needs of our learners by serving as a heavily used adjunct to 3 components of our surgical education curriculum: weekly simulation sessions, biannual assessments, and clinical rotations.
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Affiliation(s)
- Apram Jyot
- Division of Subspecialty General Surgery, Rochester, Minnesota
| | | | | | - Samuel J Allen
- Division of Subspecialty General Surgery, Rochester, Minnesota
| | - Nimesh D Naik
- Division of Subspecialty General Surgery, Rochester, Minnesota
| | | | - Eduardo F Abbott
- Multidisciplinary Simulation Center, Mayo Clinic, Rochester, Minnesota; Department of Internal Medicine, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Becca Gas
- Division of Subspecialty General Surgery, Rochester, Minnesota
| | | | - Muhammad H Zeb
- Division of Subspecialty General Surgery, Rochester, Minnesota
| | - Rachel Cadeliña
- Division of Subspecialty General Surgery, Rochester, Minnesota
| | - David R Farley
- Division of Subspecialty General Surgery, Rochester, Minnesota.
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Kasten SJ, Cederna PS. Commentary on: Demystifying the "July Effect" in Plastic Surgery: A Multi-Institutional Study. Aesthet Surg J 2018; 38:225-227. [PMID: 29040371 DOI: 10.1093/asj/sjx158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Steven J Kasten
- Section of Plastic Surgery, University Michigan School of Medicine, Ann Arbor, MI
| | - Paul S Cederna
- Section of Plastic Surgery, University Michigan School of Medicine, Ann Arbor, MI
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Thériault B, Marceau-Grimard M, Blais AS, Fradet V, Moore K, Cloutier J. Urology residents on call: Investigating the workload and relevance of calls. Can Urol Assoc J 2018; 12:E71-E75. [PMID: 29381457 DOI: 10.5489/cuaj.4333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION On-call medical services assumed by residents represent many hours of hard work and no studies have documented what it really entails. As part of an effort to improve our on-call system, we examined phone calls received by residents on call. Our objectives were to evaluate the characteristics of phone calls received by residents on call (who, when, why, need to go to the hospital) and to determine residents' perception of these calls. We also looked into implementing strategies to reduce unnecessary calls. METHODS We prospectively collected information about calls using a standardized reporting form with the participation of all residents (10) from a single urology program over two periods of four weeks from November 2014 to March 2015. Residents answered pre- and post-collecting period questionnaires. RESULTS A total of 460 calls were recorded on 97 on-call days in two on-call lists. There was a mean of 3.5 (median 3, range 0-12) calls per weeknight and 7.7 (median 6, range 0-23) calls per weekend full day. Nintey-three calls (20%) led to the need for bedside evaluation and many of these were for new consultations (49%). The majority of calls originated from the clinical in-patient ward (49%) and emergency room (29%), and nurses (66%) and doctors (23%) most commonly initiated the calls. Calls between 11:00 pm and 8:00 am represented 13% of all calls. Most of the calls (77%) were perceived as relevant or very relevant. Most residents reported at least 80% of calls. CONCLUSIONS Although likely representing an underestimate of the reality, we provide a first effort in documenting the call burden of Canadian urology residents.
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Affiliation(s)
- Benoît Thériault
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Maryse Marceau-Grimard
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Anne-Sophie Blais
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Vincent Fradet
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Katherine Moore
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Jonathan Cloutier
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada
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Cowley DS, Markman JD, Best JA, Greenberg EL, Grodesky MJ, Murray SB, Corning KA, Levy MR, Greenberg WE. Understanding ownership of patient care: A dual-site qualitative study of faculty and residents from medicine and psychiatry. PERSPECTIVES ON MEDICAL EDUCATION 2017; 6:405-412. [PMID: 29209996 PMCID: PMC5732112 DOI: 10.1007/s40037-017-0389-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
INTRODUCTION With changes in duty hours and supervision requirements, educators have raised concerns about erosion of patient care ownership by resident physicians. However, the definition of ownership is unclear. This qualitative study investigated definitions of ownership in medicine and psychiatry faculty and residents. METHODS The authors distributed an anonymous online survey regarding definitions of ownership to faculty and residents at the psychiatry and internal medicine residency programs at the University of Washington and the Harvard Longwood psychiatry residency and conducted a qualitative analysis of free-text responses to identify emergent themes. RESULTS 225 faculty (48.6%) and 131 residents (43.8%) across the three programs responded. Responses yielded themes in five domains: Physician Actions, Physician Attitudes, Physician Identity, Physician Qualities, and Quality of Patient Care. All groups identified themes of advocacy, communication and care coordination, decision-making, follow through, knowledge, leadership, attitudes of going 'above and beyond' and 'the buck stops here', responsibility, serving as primary provider, demonstrating initiative, and providing the best care as central to ownership. Residents and faculty had differing perspectives on 'shift work' and transitions of care and on resident decision-making as elements of ownership. DISCUSSION This study expanded and enriched the definition of patient care ownership. There were more similarities than differences across groups, a reassuring finding for those concerned about a decreasing understanding of ownership in trainees. Findings regarding shared values, shift work, and the decision-making role can inform educators in setting clear expectations and fostering ownership despite changing educational and care models.
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Affiliation(s)
- Deborah S Cowley
- Department of Psychiatry and Behavioural Sciences, University of Washington, Seattle, WA, USA.
| | - Jesse D Markman
- Department of Psychiatry and Behavioural Sciences, University of Washington, Seattle, WA, USA
| | - Jennifer A Best
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Erica L Greenberg
- Department of Psychiatry, Harvard University, and Massachusetts General Hospital, Boston, MA, USA
| | - Michael J Grodesky
- Department of Psychosocial and Community Health, University of Washington, Seattle, WA, USA
| | - Suzanne B Murray
- Department of Psychiatry and Behavioural Sciences, University of Washington, Seattle, WA, USA
| | - Kelli A Corning
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Mitchell R Levy
- Department of Psychiatry and Behavioural Sciences, University of Washington, Seattle, WA, USA
| | - William E Greenberg
- Department of Psychiatry, Harvard University and Beth Israel Deaconess Medical Center, Boston, MA, USA
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Bommer C, Sullivan S, Campbell K, Ahola Z, Agarwal S, O'Rourke A, Jung HS, Gibson A, Leverson G, Liepert AE. Pre-simulation orientation for medical trainees: An approach to decrease anxiety and improve confidence and performance. Am J Surg 2017; 215:266-271. [PMID: 29174166 DOI: 10.1016/j.amjsurg.2017.09.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/02/2017] [Accepted: 09/07/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND We assessed the effect of basic orientation to the simulation environment on anxiety, confidence, and clinical decision making. METHODS Twenty-four graduating medical students participated in a two-week surgery preparatory curriculum, including three simulations. Baseline anxiety was assessed pre-course. Scenarios were completed on day 2 and day 9. Prior to the first simulation, participants were randomly divided into two groups. Only one group received a pre-simulation orientation. Before the second simulation, all students received the same orientation. Learner anxiety was reported immediately preceding and following each simulation. Confidence was assessed post-simulation. Performance was evaluated by surgical faculty. RESULTS The oriented group experienced decreased anxiety following the first simulation (p = 0.003); the control group did not. Compared to the control group, the oriented group reported less anxiety and greater confidence and received higher performance scores following all three simulations (all p < 0.05). CONCLUSIONS Pre-simulation orientation reduces anxiety while increasing confidence and improving performance.
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Affiliation(s)
- Cassidy Bommer
- University of Wisconsin School of Medicine and Public Health, Health Sciences Learning Center, Madison, WI, United States
| | - Sarah Sullivan
- University of Wisconsin Department of Surgery, Clinical Science Center, Madison, WI, United States
| | - Krystle Campbell
- University of Wisconsin Department of Surgery, Clinical Science Center, Madison, WI, United States
| | - Zachary Ahola
- University of Wisconsin School of Medicine and Public Health, Health Sciences Learning Center, Madison, WI, United States
| | - Suresh Agarwal
- University of Wisconsin Department of Surgery, Clinical Science Center, Madison, WI, United States
| | - Ann O'Rourke
- University of Wisconsin Department of Surgery, Clinical Science Center, Madison, WI, United States
| | - Hee Soo Jung
- University of Wisconsin Department of Surgery, Clinical Science Center, Madison, WI, United States
| | - Angela Gibson
- University of Wisconsin Department of Surgery, Clinical Science Center, Madison, WI, United States
| | - Glen Leverson
- University of Wisconsin Department of Surgery, Clinical Science Center, Madison, WI, United States
| | - Amy E Liepert
- University of Wisconsin Department of Surgery, Clinical Science Center, Madison, WI, United States.
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Middleton RM, Alvand A, Garfjeld Roberts P, Hargrove C, Kirby G, Rees JL. Simulation-Based Training Platforms for Arthroscopy: A Randomized Comparison of Virtual Reality Learning to Benchtop Learning. Arthroscopy 2017; 33:996-1003. [PMID: 28073670 DOI: 10.1016/j.arthro.2016.10.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 10/14/2016] [Accepted: 10/24/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether a virtual reality (VR) arthroscopy simulator or benchtop (BT) arthroscopy simulator showed superiority as a training tool. METHODS Arthroscopic novices were randomized to a training program on a BT or a VR knee arthroscopy simulator. The VR simulator provided user performance feedback. Individuals performed a diagnostic arthroscopy on both simulators before and after the training program. Performance was assessed using wireless objective motion analysis and a global rating scale. RESULTS The groups (8 in the VR group, 9 in the BT group) were well matched at baseline across all parameters (P > .05). Training on each simulator resulted in significant performance improvements across all parameters (P < .05). BT training conferred a significant improvement in all parameters when trainees were reassessed on the VR simulator (P < .05). In contrast, VR training did not confer improvement in performance when trainees were reassessed on the BT simulator (P > .05). BT-trained subjects outperformed VR-trained subjects in all parameters during final assessments on the BT simulator (P < .05). There was no difference in objective performance between VR-trained and BT-trained subjects on final VR simulator wireless objective motion analysis assessment (P > .05). CONCLUSIONS Both simulators delivered improvements in arthroscopic skills. BT training led to skills that readily transferred to the VR simulator. Skills acquired after VR training did not transfer as readily to the BT simulator. Despite trainees receiving automated metric feedback from the VR simulator, the results suggest a greater gain in psychomotor skills for BT training. Further work is required to determine if this finding persists in the operating room. CLINICAL RELEVANCE This study suggests that there are differences in skills acquired on different simulators and skills learnt on some simulators may be more transferable. Further work in identifying user feedback metrics that enhance learning is also required.
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Affiliation(s)
- Robert M Middleton
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Biomedical Research Unit, University of Oxford, Oxford, England.
| | - Abtin Alvand
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Biomedical Research Unit, University of Oxford, Oxford, England
| | - Patrick Garfjeld Roberts
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Biomedical Research Unit, University of Oxford, Oxford, England
| | - Caroline Hargrove
- McLaren Applied Technologies, McLaren Technology Centre, Woking, Surrey, England
| | - Georgina Kirby
- McLaren Applied Technologies, McLaren Technology Centre, Woking, Surrey, England
| | - Jonathan L Rees
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Biomedical Research Unit, University of Oxford, Oxford, England
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Caulley L, Quimby AE, Barrowman N, Moreau K, Vaccani JP. Effect of Home-Call on Otolaryngology Resident Education: A Pilot Study. JOURNAL OF SURGICAL EDUCATION 2017; 74:228-236. [PMID: 27717708 DOI: 10.1016/j.jsurg.2016.08.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 07/29/2016] [Accepted: 08/29/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To inform institutional policies regarding call encounters through an evaluation of the effect of home-call on academic experience and fatigue among surgical residents. This study conducted an assessment of the nature of resident call encounters premidnight and postmidnight and a comparative analysis of sleep deprivation and efficiency in residents during home-call and off call. DESIGN, SETTING, AND PARTICIPANTS All Otolaryngology-Head and Neck Surgery residents (n = 9) at single Canadian institution were asked to establish the time and nature of call encounters during home-call. Residents completed the Stanford Sleepiness Scale precall and postcall to measure sleepiness and wore an Actigraph device to measure sleep efficiency to establish fatigue in the setting of home-call as compared with residents off call. Home-call and off call patterns were studied using a random computer-generated selection of days for participants in both study groups. Analysis was conducted from December 1, 2013 to December 30, 2014. RESULTS Residents received on average 7 pages per night, of which 78.5% of pages were for nonurgent issues. On an average, change in sleep deprivation scores postcall was 3.0 points higher (95% CI: 2.48-3.57, p < 0.0001) in residents who were qualified for a postcall day compared with residents who did not qualify for a postcall day and residents off call according to the Stanford Sleepiness Scale. Postcall sleep deprivation was significantly associated with number of encounters managed after midnight, regardless of management through telephone or in-hospital (p = 0.01). The Actigraph device identified a significant decrease in sleep efficiency in residents who were qualified for a postcall day compared with residents off call (mean = -31.1; 95% CI: -38.9, -23.4; p < 0.001). CONCLUSIONS This is the first study to evaluate surgical residents' home-call experience. We identified a high proportion of nonurgent encounters that residents managed on call and increased postcall fatigue associated with postmidnight telephone encounters. This study highlights the detrimental effects of frequent sleep interruptions because of encounters on call and suggests the need for institutional guidelines to help minimize these interruptions.
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Affiliation(s)
- Lisa Caulley
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada; Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Alexandra E Quimby
- Department of Undergraduate Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Nick Barrowman
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Katherine Moreau
- Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada
| | - Jean-Philippe Vaccani
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada; Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
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Dietl CA, Russell JC. Effects of Technological Advances in Surgical Education on Quantitative Outcomes From Residency Programs. JOURNAL OF SURGICAL EDUCATION 2016; 73:819-830. [PMID: 27184181 DOI: 10.1016/j.jsurg.2016.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 03/27/2016] [Accepted: 03/28/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The purpose of this article is to review the literature on current technology for surgical education and to evaluate the effect of technological advances on the Accreditation Council of Graduate Medical Education (ACGME) Core Competencies, American Board of Surgery In-Training Examination (ABSITE) scores, and American Board of Surgery (ABS) certification. DESIGN A literature search was obtained from MEDLINE via PubMed.gov, ScienceDirect.com, and Google Scholar on all peer-reviewed studies published since 2003 using the following search queries: technology for surgical education, simulation-based surgical training, simulation-based nontechnical skills (NTS) training, ACGME Core Competencies, ABSITE scores, and ABS pass rate. RESULTS Our initial search list included the following: 648 on technology for surgical education, 413 on simulation-based surgical training, 51 on simulation-based NTS training, 78 on ABSITE scores, and 33 on ABS pass rate. Further, 42 articles on technological advances for surgical education met inclusion criteria based on their effect on ACGME Core Competencies, ABSITE scores, and ABS certification. Systematic review showed that 33 of 42 and 26 of 42 publications on technological advances for surgical education showed objective improvements regarding patient care and medical knowledge, respectively, whereas only 2 of 42 publications showed improved ABSITE scores, but none showed improved ABS pass rates. Improvements in the other ACGME core competencies were documented in 14 studies, 9 of which were on simulation-based NTS training. CONCLUSIONS Most of the studies on technological advances for surgical education have shown a positive effect on patient care and medical knowledge. However, the effect of simulation-based surgical training and simulation-based NTS training on ABSITE scores and ABS certification has not been assessed. Studies on technological advances in surgical education and simulation-based NTS training showing quantitative evidence that surgery residency program objectives are achieved are still needed.
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Affiliation(s)
- Charles A Dietl
- Division of Cardiothoracic Surgery, Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.
| | - John C Russell
- Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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20
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Dietl CA, Russell JC. Effect of Process Changes in Surgical Training on Quantitative Outcomes From Surgery Residency Programs. JOURNAL OF SURGICAL EDUCATION 2016; 73:807-818. [PMID: 27156139 DOI: 10.1016/j.jsurg.2016.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/22/2016] [Accepted: 03/22/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The purpose of this article is to review the literature on process changes in surgical training programs and to evaluate their effect on the Accreditation Council of Graduate Medical Education (ACGME) Core Competencies, American Board of Surgery In-Training Examination (ABSITE) scores, and American Board of Surgery (ABS) certification. DESIGN A literature search was obtained from MEDLINE via PubMed.gov, ScienceDirect.com, Google Scholar on all peer-reviewed studies published since 2003 using the following search queries: surgery residency training, surgical education, competency-based surgical education, ACGME core competencies, ABSITE scores, and ABS pass rate. RESULTS Our initial search list included 990 articles on surgery residency training models, 539 on competency-based surgical education, 78 on ABSITE scores, and 33 on ABS pass rate. Overall, 31 articles met inclusion criteria based on their effect on ACGME Core Competencies, ABSITE scores, and ABS certification. Systematic review showed that 5/31, 19/31, and 6/31 articles on process changes in surgical training programs had a positive effect on patient care, medical knowledge, and ABSITE scores, respectively. ABS certification was not analyzed. The other ACGME core competencies were addressed in only 6 studies. CONCLUSIONS Several publications on process changes in surgical training programs have shown a positive effect on patient care, medical knowledge, and ABSITE scores. However, the effect on ABS certification, and other quantitative outcomes from residency programs, have not been addressed. Studies on education strategies showing evidence that residency program objectives are being achieved are still needed. This article addresses the 6 ACGME Core Competencies.
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Affiliation(s)
- Charles A Dietl
- Division of Cardiothoracic Surgery, Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.
| | - John C Russell
- Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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Program Director Perceptions of Surgical Resident Training and Patient Care under Flexible Duty Hour Requirements. J Am Coll Surg 2016; 222:1098-105. [DOI: 10.1016/j.jamcollsurg.2016.03.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 03/16/2016] [Indexed: 11/23/2022]
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Nida AM, Googe BJ, Lewis AF, May WL. Resident fatigue in otolaryngology residents: a Web based survey. Am J Otolaryngol 2016; 37:210-6. [PMID: 27178510 DOI: 10.1016/j.amjoto.2016.01.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 01/22/2016] [Indexed: 11/18/2022]
Abstract
IMPORTANCE Resident fatigue has become a point of emphasis in medical education and its effects on otolaryngology residents and their patients require further study. OBJECTIVE The purpose of our study was to evaluate the prevalence and nature of fatigue in otolaryngology residents, evaluate various quality of life measures, and investigate associations of increased fatigue with resident safety. STUDY DESIGN Anonymous survey. SETTING Internet based. PARTICIPANTS United States allopathic otolaryngology residents. INTERVENTION None. MAIN OUTCOME(S) AND MEASURES The survey topics included demographics, residency structure, sleep habits and perceived stress. Responses were correlated with a concurrent Epworth Sleep Scale questionnaire to evaluate effects of fatigue on resident training and quality of life. RESULTS 190 residents responded to the survey with 178 completing the Epworth Sleep Scale questionnaire. Results revealed a mean Epworth Sleep Scale score of 9.9±5.1 with a median of 10.0 indicating a significant number of otolaryngology residents are excessively sleepy. Statistically significant correlations between Epworth Sleep Scale and sex, region, hours of sleep, and work hours were found. Residents taking in-house call had significantly fewer hours of sleep compared to home call (p=0.01). Residents on "head and neck" (typically consisting of a large proportion of head and neck oncologic surgery) rotations tended to have higher Epworth Sleep Scale and had significantly fewer hours of sleep (p=.003) and greater work hours (p<.001). Additionally, residents who reported no needle stick type incidents or near motor vehicle accidents had significantly lower mean Epworth Sleep Scale scores. Only 37.6% of respondents approve of the most recent Accreditation Council for Graduate Medical Education work hour restrictions and 14% reported averaging greater than 80hours of work/week. CONCLUSION AND RELEVANCE A substantial number of otolaryngology residents are excessively sleepy. Our data suggest that the effects of fatigue play a role in resident well-being and resident safety.
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Affiliation(s)
- Andrew M Nida
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, MS, USA.
| | - Benjamin J Googe
- University of Mississippi School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
| | - Andrea F Lewis
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, MS, USA.
| | - Warren L May
- University of Mississippi Medical Center, Jackson, MS, USA.
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Marwaha JS, Drolet BC, Maddox SS, Adams CA. The Impact of the 2011 Accreditation Council for Graduate Medical Education Duty Hour Reform on Quality and Safety in Trauma Care. J Am Coll Surg 2016; 222:984-91. [PMID: 26968321 DOI: 10.1016/j.jamcollsurg.2016.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 01/05/2016] [Accepted: 01/05/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND In 2011, the ACGME limited duty hours for residents. Although studies evaluating the 2011 policy have not shown improvements in general measures of morbidity or mortality, these outcomes might not reflect changes in specialty-specific practice patterns and secondary quality measures. STUDY DESIGN All trauma admissions from July 2009 through June 2013 at an academic Level I trauma center were evaluated for 5 primary outcomes (eg, mortality and length of stay), and 10 secondary quality measures and practice patterns (eg, operating room [OR] visits). All variables were compared before and after the reform (July 1, 2011). Piecewise regression was used to study temporal trends in quality. RESULTS There were 11,740 admissions studied. The reform was not strongly associated with changes in any primary outcomes except length of stay (7.98 to 7.36 days; p = 0.01). However, many secondary quality metrics changed. The total number of OR and bedside procedures per admission (6.72 to 7.34; p < 0.001) and OR visits per admission (0.76 to 0.91; p < 0.001) were higher in the post-reform group, representing an additional 9,559 procedures and 1,584 OR visits. Use of minor bedside procedures, such as laboratory and imaging studies, increased most significantly. CONCLUSIONS Although most major outcomes were unaffected, quality of care might have changed after the reform. Indeed, a consistent change in resource use patterns was manifested by substantial post-reform increases in measures such as bedside procedures and OR visits. No secondary quality measures exhibited improvements strongly associated with the reform. Several factors, including attending oversight, might have insulated major outcomes from change. Our findings show that some less-commonly studied quality metrics related to costs of care changed after the 2011 reform at our institution.
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Affiliation(s)
- Jayson S Marwaha
- Department of Surgery, Warren Alpert Medical School, Brown University, Providence, RI.
| | - Brian C Drolet
- Department of Surgery, Warren Alpert Medical School, Brown University, Providence, RI; Department of Surgery, Rhode Island Hospital, Providence, RI
| | - Suma S Maddox
- Department of Surgery, Warren Alpert Medical School, Brown University, Providence, RI; Department of Surgery, Rhode Island Hospital, Providence, RI
| | - Charles A Adams
- Department of Surgery, Warren Alpert Medical School, Brown University, Providence, RI; Department of Surgery, Rhode Island Hospital, Providence, RI
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Wingo MT, Halvorsen AJ, Beckman TJ, Johnson MG, Reed DA. Associations between attending physician workload, teaching effectiveness, and patient safety. J Hosp Med 2016; 11:169-73. [PMID: 26741703 DOI: 10.1002/jhm.2540] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 10/30/2015] [Accepted: 11/08/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND Prior studies suggest that high workload among attending physicians may be associated with reduced teaching effectiveness and poor patient outcomes, but these relationships have not been investigated using objective measures of workload and safety. OBJECTIVE To examine associations between attending workload, teaching effectiveness, and patient safety, hypothesizing that higher workload would be associated with lower teaching effectiveness and negative patient outcomes. DESIGN, SETTING, AND PARTICIPANTS We conducted a retrospective study of 69,386 teaching evaluation items submitted by 543 internal medicine residents for 107 attending physicians who supervised inpatient teaching services from July 2, 2005 to July 1, 2011. MEASUREMENTS Attending workload measures included hospital service census, patient length of stay, daily admissions, daily discharges, and concurrent outpatient duties. Teaching effectiveness was measured using residents' evaluations of attendings. Patient outcomes considered were applicable patient safety indicators (PSIs), intensive care unit transfers, cardiopulmonary resuscitation/rapid response team calls, and patient deaths. Mixed linear models and generalized linear regression models were used for statistical analysis. RESULTS Workload measures of midnight census and daily discharges were associated with lower teaching evaluation scores (both β = -0.026, P < 0.0001). The number of daily admissions was associated with higher teaching scores (β = 0.021, P = 0.001) and increased PSIs (odds ratio = 1.81, P = 0.0001). CONCLUSION Several measures of attending physician workload were associated with slightly lower teaching effectiveness, and patient safety may be compromised when teams are managing new admissions. Ongoing efforts by residency programs to optimize the learning environment should include strategies to manage the workload of supervising attendings.
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Affiliation(s)
- Majken T Wingo
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Andrew J Halvorsen
- Internal Medicine Residency Program, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Thomas J Beckman
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Matthew G Johnson
- Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Darcy A Reed
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
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Sun NZ, Gan R, Snell L, Dolmans D. Use of a Night Float System to Comply With Resident Duty Hours Restrictions: Perceptions of Workplace Changes and Their Effects on Professionalism. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:401-8. [PMID: 26488569 DOI: 10.1097/acm.0000000000000949] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
PURPOSE Although some evidence suggests that resident duty hours reforms can lead to shift-worker mentality and loss of patient ownership, other evidence links long hours and fatigue to poor work performance and loss of empathy, suggesting the restrictions could positively affect professionalism. The authors explored perceived impacts of a 16-hour duty restriction, achieved using a night float (NF) system, on the workplace and professionalism. METHOD In 2013, the authors conducted semistructured interviews with 18 residents, 9 staff physicians, and 3 residency program directors in the McGill University core internal medicine residency program regarding their perceptions of the program's 12-hour shift-based NF system. Interviews were transcribed and coded for common themes. The authors used a descriptive qualitative methodology. RESULTS Participants viewed implementation of the NF system as leading to decreased physical and mental exhaustion, more consistent interaction with patients, and more stable team structure within shifts compared with the previous 24-hour call system. These workplace changes were felt to improve teamwork and patient ownership within shifts, quality of work performed, and empathy. Across shifts, however, more frequent sign-overs, stricter application of shift time boundaries, and loose integration between daytime and NF teams were perceived as leading to emergence of shift-worker mentality around sign-over. Perceptions of optimal patient ownership changed from the traditional single-physician-24/7 model to team-based shared ownership. CONCLUSIONS Duty hours restrictions, as exemplified by an NF system, have both positive and negative impacts on professionalism. Interventions and training toward effective team-based care are needed to curb emergence of shift-worker mentality.
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Affiliation(s)
- Ning-Zi Sun
- N.-Z. Sun is assistant professor, Department of Medicine, and associate member, Centre for Medical Education, McGill University, Montreal, Quebec, Canada. R. Gan is a community internist, Department of Medicine, Anna-Laberge Hospital, Chateauguay, Quebec, Canada. L. Snell is professor of medicine and core faculty member, Centre for Medical Education, McGill University, Montreal, Quebec, Canada, and senior clinician-educator, Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada. D. Dolmans is professor and educational psychologist, Department of Educational Development and Research, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands
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Bilimoria KY, Chung JW, Hedges LV, Dahlke AR, Love R, Cohen ME, Hoyt DB, Yang AD, Tarpley JL, Mellinger JD, Mahvi DM, Kelz RR, Ko CY, Odell DD, Stulberg JJ, Lewis FR. National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training. N Engl J Med 2016; 374:713-27. [PMID: 26836220 DOI: 10.1056/nejmoa1515724] [Citation(s) in RCA: 301] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Concerns persist regarding the effect of current surgical resident duty-hour policies on patient outcomes, resident education, and resident well-being. METHODS We conducted a national, cluster-randomized, pragmatic, noninferiority trial involving 117 general surgery residency programs in the United States (2014-2015 academic year). Programs were randomly assigned to current Accreditation Council for Graduate Medical Education (ACGME) duty-hour policies (standard-policy group) or more flexible policies that waived rules on maximum shift lengths and time off between shifts (flexible-policy group). Outcomes included the 30-day rate of postoperative death or serious complications (primary outcome), other postoperative complications, and resident perceptions and satisfaction regarding their well-being, education, and patient care. RESULTS In an analysis of data from 138,691 patients, flexible, less-restrictive duty-hour policies were not associated with an increased rate of death or serious complications (9.1% in the flexible-policy group and 9.0% in the standard-policy group, P=0.92; unadjusted odds ratio for the flexible-policy group, 0.96; 92% confidence interval, 0.87 to 1.06; P=0.44; noninferiority criteria satisfied) or of any secondary postoperative outcomes studied. Among 4330 residents, those in programs assigned to flexible policies did not report significantly greater dissatisfaction with overall education quality (11.0% in the flexible-policy group and 10.7% in the standard-policy group, P=0.86) or well-being (14.9% and 12.0%, respectively; P=0.10). Residents under flexible policies were less likely than those under standard policies to perceive negative effects of duty-hour policies on multiple aspects of patient safety, continuity of care, professionalism, and resident education but were more likely to perceive negative effects on personal activities. There were no significant differences between study groups in resident-reported perception of the effect of fatigue on personal or patient safety. Residents in the flexible-policy group were less likely than those in the standard-policy group to report leaving during an operation (7.0% vs. 13.2%, P<0.001) or handing off active patient issues (32.0% vs. 46.3%, P<0.001). CONCLUSIONS As compared with standard duty-hour policies, flexible, less-restrictive duty-hour policies for surgical residents were associated with noninferior patient outcomes and no significant difference in residents' satisfaction with overall well-being and education quality. (FIRST ClinicalTrials.gov number, NCT02050789.).
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Affiliation(s)
- Karl Y Bilimoria
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University (K.Y.B., J.W.C., A.R.D., R.L., A.D.Y., D.M.M., D.D.O., J.J.S.), and the American College of Surgeons (K.Y.B., M.E.C., D.B.H., C.Y.K.), Chicago, the Department of Statistics, Northwestern University, Evanston (L.V.H.), and the Department of Surgery, Southern Illinois University, Springfield (J.D.M.) - all in Illinois; the Department of Surgery, Vanderbilt University, Nashville (J.L.T.); the Department of Surgery and the Center for Surgery and Health Economics, Perelman School of Medicine, University of Pennsylvania (R.R.K.), and the American Board of Surgery (F.R.L.) - both in Philadelphia; and the Department of Surgery, University of California, Los Angeles, School of Medicine, Los Angeles (C.Y.K.)
| | - Jeanette W Chung
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University (K.Y.B., J.W.C., A.R.D., R.L., A.D.Y., D.M.M., D.D.O., J.J.S.), and the American College of Surgeons (K.Y.B., M.E.C., D.B.H., C.Y.K.), Chicago, the Department of Statistics, Northwestern University, Evanston (L.V.H.), and the Department of Surgery, Southern Illinois University, Springfield (J.D.M.) - all in Illinois; the Department of Surgery, Vanderbilt University, Nashville (J.L.T.); the Department of Surgery and the Center for Surgery and Health Economics, Perelman School of Medicine, University of Pennsylvania (R.R.K.), and the American Board of Surgery (F.R.L.) - both in Philadelphia; and the Department of Surgery, University of California, Los Angeles, School of Medicine, Los Angeles (C.Y.K.)
| | - Larry V Hedges
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University (K.Y.B., J.W.C., A.R.D., R.L., A.D.Y., D.M.M., D.D.O., J.J.S.), and the American College of Surgeons (K.Y.B., M.E.C., D.B.H., C.Y.K.), Chicago, the Department of Statistics, Northwestern University, Evanston (L.V.H.), and the Department of Surgery, Southern Illinois University, Springfield (J.D.M.) - all in Illinois; the Department of Surgery, Vanderbilt University, Nashville (J.L.T.); the Department of Surgery and the Center for Surgery and Health Economics, Perelman School of Medicine, University of Pennsylvania (R.R.K.), and the American Board of Surgery (F.R.L.) - both in Philadelphia; and the Department of Surgery, University of California, Los Angeles, School of Medicine, Los Angeles (C.Y.K.)
| | - Allison R Dahlke
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University (K.Y.B., J.W.C., A.R.D., R.L., A.D.Y., D.M.M., D.D.O., J.J.S.), and the American College of Surgeons (K.Y.B., M.E.C., D.B.H., C.Y.K.), Chicago, the Department of Statistics, Northwestern University, Evanston (L.V.H.), and the Department of Surgery, Southern Illinois University, Springfield (J.D.M.) - all in Illinois; the Department of Surgery, Vanderbilt University, Nashville (J.L.T.); the Department of Surgery and the Center for Surgery and Health Economics, Perelman School of Medicine, University of Pennsylvania (R.R.K.), and the American Board of Surgery (F.R.L.) - both in Philadelphia; and the Department of Surgery, University of California, Los Angeles, School of Medicine, Los Angeles (C.Y.K.)
| | - Remi Love
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University (K.Y.B., J.W.C., A.R.D., R.L., A.D.Y., D.M.M., D.D.O., J.J.S.), and the American College of Surgeons (K.Y.B., M.E.C., D.B.H., C.Y.K.), Chicago, the Department of Statistics, Northwestern University, Evanston (L.V.H.), and the Department of Surgery, Southern Illinois University, Springfield (J.D.M.) - all in Illinois; the Department of Surgery, Vanderbilt University, Nashville (J.L.T.); the Department of Surgery and the Center for Surgery and Health Economics, Perelman School of Medicine, University of Pennsylvania (R.R.K.), and the American Board of Surgery (F.R.L.) - both in Philadelphia; and the Department of Surgery, University of California, Los Angeles, School of Medicine, Los Angeles (C.Y.K.)
| | - Mark E Cohen
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University (K.Y.B., J.W.C., A.R.D., R.L., A.D.Y., D.M.M., D.D.O., J.J.S.), and the American College of Surgeons (K.Y.B., M.E.C., D.B.H., C.Y.K.), Chicago, the Department of Statistics, Northwestern University, Evanston (L.V.H.), and the Department of Surgery, Southern Illinois University, Springfield (J.D.M.) - all in Illinois; the Department of Surgery, Vanderbilt University, Nashville (J.L.T.); the Department of Surgery and the Center for Surgery and Health Economics, Perelman School of Medicine, University of Pennsylvania (R.R.K.), and the American Board of Surgery (F.R.L.) - both in Philadelphia; and the Department of Surgery, University of California, Los Angeles, School of Medicine, Los Angeles (C.Y.K.)
| | - David B Hoyt
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University (K.Y.B., J.W.C., A.R.D., R.L., A.D.Y., D.M.M., D.D.O., J.J.S.), and the American College of Surgeons (K.Y.B., M.E.C., D.B.H., C.Y.K.), Chicago, the Department of Statistics, Northwestern University, Evanston (L.V.H.), and the Department of Surgery, Southern Illinois University, Springfield (J.D.M.) - all in Illinois; the Department of Surgery, Vanderbilt University, Nashville (J.L.T.); the Department of Surgery and the Center for Surgery and Health Economics, Perelman School of Medicine, University of Pennsylvania (R.R.K.), and the American Board of Surgery (F.R.L.) - both in Philadelphia; and the Department of Surgery, University of California, Los Angeles, School of Medicine, Los Angeles (C.Y.K.)
| | - Anthony D Yang
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University (K.Y.B., J.W.C., A.R.D., R.L., A.D.Y., D.M.M., D.D.O., J.J.S.), and the American College of Surgeons (K.Y.B., M.E.C., D.B.H., C.Y.K.), Chicago, the Department of Statistics, Northwestern University, Evanston (L.V.H.), and the Department of Surgery, Southern Illinois University, Springfield (J.D.M.) - all in Illinois; the Department of Surgery, Vanderbilt University, Nashville (J.L.T.); the Department of Surgery and the Center for Surgery and Health Economics, Perelman School of Medicine, University of Pennsylvania (R.R.K.), and the American Board of Surgery (F.R.L.) - both in Philadelphia; and the Department of Surgery, University of California, Los Angeles, School of Medicine, Los Angeles (C.Y.K.)
| | - John L Tarpley
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University (K.Y.B., J.W.C., A.R.D., R.L., A.D.Y., D.M.M., D.D.O., J.J.S.), and the American College of Surgeons (K.Y.B., M.E.C., D.B.H., C.Y.K.), Chicago, the Department of Statistics, Northwestern University, Evanston (L.V.H.), and the Department of Surgery, Southern Illinois University, Springfield (J.D.M.) - all in Illinois; the Department of Surgery, Vanderbilt University, Nashville (J.L.T.); the Department of Surgery and the Center for Surgery and Health Economics, Perelman School of Medicine, University of Pennsylvania (R.R.K.), and the American Board of Surgery (F.R.L.) - both in Philadelphia; and the Department of Surgery, University of California, Los Angeles, School of Medicine, Los Angeles (C.Y.K.)
| | - John D Mellinger
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University (K.Y.B., J.W.C., A.R.D., R.L., A.D.Y., D.M.M., D.D.O., J.J.S.), and the American College of Surgeons (K.Y.B., M.E.C., D.B.H., C.Y.K.), Chicago, the Department of Statistics, Northwestern University, Evanston (L.V.H.), and the Department of Surgery, Southern Illinois University, Springfield (J.D.M.) - all in Illinois; the Department of Surgery, Vanderbilt University, Nashville (J.L.T.); the Department of Surgery and the Center for Surgery and Health Economics, Perelman School of Medicine, University of Pennsylvania (R.R.K.), and the American Board of Surgery (F.R.L.) - both in Philadelphia; and the Department of Surgery, University of California, Los Angeles, School of Medicine, Los Angeles (C.Y.K.)
| | - David M Mahvi
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University (K.Y.B., J.W.C., A.R.D., R.L., A.D.Y., D.M.M., D.D.O., J.J.S.), and the American College of Surgeons (K.Y.B., M.E.C., D.B.H., C.Y.K.), Chicago, the Department of Statistics, Northwestern University, Evanston (L.V.H.), and the Department of Surgery, Southern Illinois University, Springfield (J.D.M.) - all in Illinois; the Department of Surgery, Vanderbilt University, Nashville (J.L.T.); the Department of Surgery and the Center for Surgery and Health Economics, Perelman School of Medicine, University of Pennsylvania (R.R.K.), and the American Board of Surgery (F.R.L.) - both in Philadelphia; and the Department of Surgery, University of California, Los Angeles, School of Medicine, Los Angeles (C.Y.K.)
| | - Rachel R Kelz
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University (K.Y.B., J.W.C., A.R.D., R.L., A.D.Y., D.M.M., D.D.O., J.J.S.), and the American College of Surgeons (K.Y.B., M.E.C., D.B.H., C.Y.K.), Chicago, the Department of Statistics, Northwestern University, Evanston (L.V.H.), and the Department of Surgery, Southern Illinois University, Springfield (J.D.M.) - all in Illinois; the Department of Surgery, Vanderbilt University, Nashville (J.L.T.); the Department of Surgery and the Center for Surgery and Health Economics, Perelman School of Medicine, University of Pennsylvania (R.R.K.), and the American Board of Surgery (F.R.L.) - both in Philadelphia; and the Department of Surgery, University of California, Los Angeles, School of Medicine, Los Angeles (C.Y.K.)
| | - Clifford Y Ko
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University (K.Y.B., J.W.C., A.R.D., R.L., A.D.Y., D.M.M., D.D.O., J.J.S.), and the American College of Surgeons (K.Y.B., M.E.C., D.B.H., C.Y.K.), Chicago, the Department of Statistics, Northwestern University, Evanston (L.V.H.), and the Department of Surgery, Southern Illinois University, Springfield (J.D.M.) - all in Illinois; the Department of Surgery, Vanderbilt University, Nashville (J.L.T.); the Department of Surgery and the Center for Surgery and Health Economics, Perelman School of Medicine, University of Pennsylvania (R.R.K.), and the American Board of Surgery (F.R.L.) - both in Philadelphia; and the Department of Surgery, University of California, Los Angeles, School of Medicine, Los Angeles (C.Y.K.)
| | - David D Odell
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University (K.Y.B., J.W.C., A.R.D., R.L., A.D.Y., D.M.M., D.D.O., J.J.S.), and the American College of Surgeons (K.Y.B., M.E.C., D.B.H., C.Y.K.), Chicago, the Department of Statistics, Northwestern University, Evanston (L.V.H.), and the Department of Surgery, Southern Illinois University, Springfield (J.D.M.) - all in Illinois; the Department of Surgery, Vanderbilt University, Nashville (J.L.T.); the Department of Surgery and the Center for Surgery and Health Economics, Perelman School of Medicine, University of Pennsylvania (R.R.K.), and the American Board of Surgery (F.R.L.) - both in Philadelphia; and the Department of Surgery, University of California, Los Angeles, School of Medicine, Los Angeles (C.Y.K.)
| | - Jonah J Stulberg
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University (K.Y.B., J.W.C., A.R.D., R.L., A.D.Y., D.M.M., D.D.O., J.J.S.), and the American College of Surgeons (K.Y.B., M.E.C., D.B.H., C.Y.K.), Chicago, the Department of Statistics, Northwestern University, Evanston (L.V.H.), and the Department of Surgery, Southern Illinois University, Springfield (J.D.M.) - all in Illinois; the Department of Surgery, Vanderbilt University, Nashville (J.L.T.); the Department of Surgery and the Center for Surgery and Health Economics, Perelman School of Medicine, University of Pennsylvania (R.R.K.), and the American Board of Surgery (F.R.L.) - both in Philadelphia; and the Department of Surgery, University of California, Los Angeles, School of Medicine, Los Angeles (C.Y.K.)
| | - Frank R Lewis
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University (K.Y.B., J.W.C., A.R.D., R.L., A.D.Y., D.M.M., D.D.O., J.J.S.), and the American College of Surgeons (K.Y.B., M.E.C., D.B.H., C.Y.K.), Chicago, the Department of Statistics, Northwestern University, Evanston (L.V.H.), and the Department of Surgery, Southern Illinois University, Springfield (J.D.M.) - all in Illinois; the Department of Surgery, Vanderbilt University, Nashville (J.L.T.); the Department of Surgery and the Center for Surgery and Health Economics, Perelman School of Medicine, University of Pennsylvania (R.R.K.), and the American Board of Surgery (F.R.L.) - both in Philadelphia; and the Department of Surgery, University of California, Los Angeles, School of Medicine, Los Angeles (C.Y.K.)
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Rajaram R, Saadat L, Chung J, Dahlke A, Yang AD, Odell DD, Bilimoria KY. Impact of the 2011 ACGME resident duty hour reform on hospital patient experience and processes-of-care. BMJ Qual Saf 2015; 25:962-970. [DOI: 10.1136/bmjqs-2015-004794] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 11/02/2015] [Accepted: 11/26/2015] [Indexed: 11/03/2022]
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Patel A. 50 Years Ago in The Journal of Pediatrics: A Comment on Pediatric Training Programs. J Pediatr 2015; 167:693. [PMID: 26319921 DOI: 10.1016/j.jpeds.2015.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Aarti Patel
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Anderson ML, Ogunwale A, Clark BA, Kilpatrick CC, Mach CM. Preferences and Outcomes for Chemotherapy Teaching in a Postgraduate Obstetrics and Gynecology Training Program. JOURNAL OF SURGICAL EDUCATION 2015; 72:936-941. [PMID: 26119096 DOI: 10.1016/j.jsurg.2015.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 01/30/2015] [Accepted: 04/13/2015] [Indexed: 06/04/2023]
Abstract
PURPOSE To determine whether chemotherapy teaching is a desired component of postgraduate training programs in obstetrics and gynecology and assess its effect on practicing clinicians. METHOD After obtaining institutional review board approval, 99 individuals who completed postgraduate training at a single academic medical center between 2005 and 2013 were invited to complete an online survey. Descriptive statistics were used to summarize responses. RESULTS Of the 99 individuals, 68 (68%) completed the survey. Respondents included physicians currently practicing in both academic medicine (n = 36, 52.9%) and private practice (n = 24, 35.2%). Most respondents (n = 60, 88.2%) indicated that chemotherapy teaching was a desired feature of their training and expressed a preference for both formal didactics and direct clinical involvement (n = 55, 80.2%). Benefits identified by respondents included improved insight into the management of symptoms commonly associated with chemotherapy (n = 55, 82.1%) and an enhanced ability to counsel patients referred for oncology care (n = 48, 70.5%). All respondents who pursued training in gynecologic oncology following residency (n = 6) indicated that chemotherapy teaching favorably affected their fellowship experience. Of the 6 gynecologic oncologists, 3 (50%) who responded also indicated that chemotherapy teaching during residency improved their performance in fellowship interviews. CONCLUSION Chemotherapy teaching was a desired feature of postgraduate training in general obstetrics and gynecology at the institution studied. Consideration should be given to creating curricula that incorporate the principles and practice of chemotherapy and address the needs of obstetrics and gynecology trainees who intend to pursue both general and subspecialty practice.
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Affiliation(s)
- Matthew L Anderson
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
| | - Abayomi Ogunwale
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Brian A Clark
- Department of Clinical Sciences and Administration, University of Houston, Houston, Texas
| | - Charlie C Kilpatrick
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Claire M Mach
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas; Department of Clinical Sciences and Administration, University of Houston, Houston, Texas
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Sabri N, Sun NZ, Cummings BA, Jayaraman D. The Perceived Effect of Duty Hour Restrictions on Learning Opportunities in the Intensive Care Unit. J Grad Med Educ 2015; 7:48-52. [PMID: 26217422 PMCID: PMC4507927 DOI: 10.4300/jgme-d-14-00180.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 08/29/2014] [Accepted: 10/20/2014] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Many countries have reduced resident duty hours in an effort to promote patient safety and enhance resident quality of life. There are concerns that reducing duty hours may impact residents' learning opportunities. OBJECTIVES We (1) evaluated residents' perceptions of their current learning opportunities in a context of reduced duty hours, and (2) explored the perceived change in resident learning opportunities after call length was reduced from 24 continuous hours to 16 hours. METHODS We conducted an anonymous, cross-sectional online survey of 240 first-, second-, and third-year residents rotating through 3 McGill University-affiliated intensive care units (ICUs) in Montreal, Quebec, Canada, between July 1, 2012, and June 30, 2013. The survey investigated residents' perceptions of learning opportunities in both the 24-hour and 16-hour systems. RESULTS Of 240 residents, 168 (70%) completed the survey. Of these residents, 63 (38%) had been exposed to both 24-hour and 16-hour call schedules. The majority of respondents (83%) reported that didactic teaching sessions held by ICU staff physicians were useful. However, of the residents trained in both approaches to overnight call, 44% reported a reduction in learner attendance at didactic teaching sessions, 48% reported a reduction in attendance at midday hospital rounds, and 40% reported a perceived reduction in self-directed reading after the implementation of the new call schedule. CONCLUSIONS A substantial proportion of residents perceived a reduction in the attendance of instructor-directed and self-directed reading after the implementation of a 16-hour call schedule in the ICU.
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Nadler A, Ashamalla S, Escallon J, Ahmed N, Wright FC. Career plans and perceptions in readiness to practice of graduating general surgery residents in Canada. JOURNAL OF SURGICAL EDUCATION 2015; 72:205-211. [PMID: 25457941 DOI: 10.1016/j.jsurg.2014.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 09/06/2014] [Accepted: 10/06/2014] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Overall, 25% of American general surgery residents identified as not feeling confident operating independently at graduation, which may contribute to 70% pursuing further training. This study was undertaken to identify intended career plans of general surgery graduates in Canada on a national level, and perceived strengths and weaknesses of training that would affect transition to early practice. METHODS Questionnaires were distributed to graduating general surgery residents at a Canadian national review course in 2012 and 2013. Data were analyzed for overall trends. RESULTS Overall, 75% (78/104) of graduating residents responded in 2012 and 53% (50/95) in 2013. Greater than 60% of respondents were entering a fellowship program upon graduation (49/78 in 2012 and 37/50 in 2013); the most common fellowship choices were minimally invasive surgery (24% in 2012 and 39% in 2013) or surgical oncology (16% in 2012). Most residents reported that they were completing subspecialty training to meet career goals (64/85 overall) rather than feeling unprepared for practice (0/85 overall). Most residents planned on practicing in urban centers (54%) and academic hospitals (73%). Residents perceived a need for assistance for laparoscopic adrenalectomy, neck dissection, laparoscopic splenectomy, laparoscopic low anterior resection, groin dissection, and thyroidectomy. CONCLUSIONS An overwhelming majority of general surgery graduates plan to pursue fellowship training to meet career goals of working in urban, academic centers, rather than a perceived lack of competence. It is vital to describe operative competency expectations for residents and to promote a variety of practice opportunities following graduation.
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Affiliation(s)
- Ashlie Nadler
- Division of General Surgery, University of Toronto, Toronto, Ontario, Canada.
| | - Shady Ashamalla
- Division of Surgical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jaime Escallon
- Division of Surgical Oncology, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Najma Ahmed
- Division of General Surgery, St Michael's Hospital, Toronto, Ontario, Canada
| | - Frances C Wright
- Division of Surgical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Osman NY, Walling JL, Mitchell VG, Alexander EK. Length of attending-student and resident-student interactions in the inpatient medicine clerkship. TEACHING AND LEARNING IN MEDICINE 2015; 27:130-137. [PMID: 25893934 DOI: 10.1080/10401334.2015.1011655] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED PHENOMENON: Changes in the medical education milieu have led away from the apprenticeship model resulting in shorter physician-student interactions. Faculty and student feedback suggests that supervisor/student interactions may now be more cursory with increasing numbers of supervisors per student, and shorter duration of interaction. This may affect both education and student assessment. APPROACH We compared inpatient attending and resident daily schedules with those of 3rd- and 4th-year medical students rotating on medicine clerkships at Brigham and Women's Hospital during academic years 2009-11 to determine the number of days of overlap. We used evaluation forms to determine the extent of evaluator's self-reported knowledge of the student. FINDINGS We correlated the daily schedules of 199 students and 204 resident and 187 attending physicians, which resulted in 558 resident-student pairings and 680 attending-student pairings over 2 years. During a 4-week block, students averaged 3.7 attending physicians (M = 4, range = 2-7), with 49.7% supervised by 4 or more. Attending-student overlap averaged 9 days (M = 9, range = 2-23), though 40% were 7 days or less. Students overlapped with an average 3.4 residents (M = 3, range = 1-6). Resident-student overlap averaged 12 days (M = 11, range = 3-26). There were 824 student assessment forms analyzed. Resident and attending physician supervisors describing knowledge of their student as "good/average" overlapped with students for 14 and 11 days respectively compared to resident and physician supervisors who described their knowledge as "poor" (11 days, p < .01; 6 days, p < .01). Insights: On the inpatient medicine clerkship, students have multiple supervising physicians with wide variability in the period of overlap. This leads to a disrupted apprenticeship model with fragmentation of supervision and concomitant effects on assessment, feedback, role modeling, and clerkship education.
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Affiliation(s)
- Nora Y Osman
- a Department of Medicine , Brigham and Women's Hospital and Harvard Medical School , Boston , Massachusetts , USA
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Chung J, Obi A, Chen R, Lin W, Sun S, Chen Z, Gulati A, Xu X, Pozehl W, Jacob Seagull F, Cohn AM, Daskin MS, Reddy RM. Estimating minimum program volume needed to train surgeons: when 4 × 15 really equals 90. JOURNAL OF SURGICAL EDUCATION 2015; 72:61-67. [PMID: 25441261 DOI: 10.1016/j.jsurg.2014.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 06/19/2014] [Accepted: 07/22/2014] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Work-hour restrictions have decreased flexibility in scheduling and reduced exposure to certain operative cases. These restrictions may affect a resident's ability to meet certification requirements, particularly for rare, unscheduled cases (e.g., cardiothoracic transplants). We developed a computer-based simulation model using variables such as case volume and program size to demonstrate the influence of these factors on the likelihood of certifying a set of residents on rare cases. METHODS We built a simulator to predict the probability of attaining certification for surgical residents, using cardiothoracic transplants as a test case. Inputs to the model included operating times, call schedules, and procurement travel times, as well as information on the distribution of times between transplants. RESULTS We simulated 100 years of schedules using our current system parameters of an average of 33 heart and 31 lung transplants per year, and assuming an Accreditation Council for Graduate Medical Education-compliant daily-rotating call schedule. Despite having enough transplants to certify all residents for lungs if all opportunities were distributed equally among residents, the certification rate achieved when constrained by arrival time (and call schedules) and work restrictions was only 55%. Our calculations show that meeting minimum transplant-certification requirements for all residents would require at least 1.5 times the expected number of annual transplants. CONCLUSIONS Our model enables analysis of a given program's ability to certify its residents based on program size and volume. These results could be used to design alternative scheduling paradigms to improve certification rates, without requiring reductions in certification requirements or program size.
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Affiliation(s)
- Jennifer Chung
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Andrea Obi
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Ryan Chen
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan
| | - Wandi Lin
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan
| | - Siyuan Sun
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan
| | - Zixiao Chen
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan
| | - Anurag Gulati
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan
| | - Xun Xu
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan
| | - William Pozehl
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan
| | | | - Amy M Cohn
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan; Center for Healthcare Engineering and Patient Safety, Ann Arbor, Michigan
| | - Mark S Daskin
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan
| | - Rishindra M Reddy
- University of Michigan Medical School, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan.
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Jamal MH, Wong S, Whalen TV. Effects of the reduction of surgical residents' work hours and implications for surgical residency programs: a narrative review. BMC MEDICAL EDUCATION 2014; 14 Suppl 1:S14. [PMID: 25560685 PMCID: PMC4304271 DOI: 10.1186/1472-6920-14-s1-s14] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND The widespread implementation of resident work hour restrictions has led to significant alterations in surgical training and the postgraduate educational experience. We evaluated the experience of surgical residency programs as reflected in the literature from 2008 onward in order to summarize current challenges and identify key areas in need of further research. METHODS We searched MEDLINE and EMBASE for English-language articles published from January 2008 to December 2011 related to work hour restrictions in surgical residency programs, including those pertaining to personal well-being, education and training, patient care, and faculty experiences. RESULTS We retrieved 240 unique abstracts and included 24 studies in the current review. Of the 10 studies examining effects on operating room experience, 4 reported negative or mixed outcomes and 6 reported neutral outcomes, although non-compliance was demonstrated in 2 of these studies. Effects on surgical faculty perceptions were consistently reported as negative, while the effect on patient outcomes and professionalism were found to be neutral and unchanged. CONCLUSIONS Further studies are needed to characterize operative experience at varying levels of training, particularly in the context of strict adherence to new work hours. Research that examines the effect of the work hour limitations on professionalism and non-operative educational activities, such as reading and simulation-based training, as well as sign-over practices, would also be of benefit.
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Affiliation(s)
- Mohammad H Jamal
- Department of General Surgery, McGill University Health Centre, Montreal, Canada
- Department of Surgery, College of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Stephanie Wong
- Department of General Surgery, McGill University Health Centre, Montreal, Canada
| | - Thomas V Whalen
- Department of Surgery, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
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Sun NZ, Maniatis T. Scheduling in the context of resident duty hour reform. BMC MEDICAL EDUCATION 2014; 14 Suppl 1:S18. [PMID: 25561221 PMCID: PMC4304277 DOI: 10.1186/1472-6920-14-s1-s18] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Fuelled by concerns about resident health and patient safety, there is a general trend in many jurisdictions toward limiting the maximum duration of consecutive work to between 14 and 16 hours. The goal of this article is to assist institutions and residency programs to make a smooth transition from the previous 24- to 36-hour call system to this new model. We will first give an overview of the main types of coverage systems and their relative merits when considering various aspects of patient care and resident pedagogy. We will then suggest a practical step-by-step approach to designing, implementing, and monitoring a scheduling system centred on clinical and educational needs in the context of resident duty hour reform. The importance of understanding the impetus for change and of assessing the need for overall workflow restructuring will be explored throughout this process. Finally, as a practical example, we will describe a large, university-based teaching hospital network's transition from a traditional call-based system to a novel schedule that incorporates the new 16-hour duty limit.
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Affiliation(s)
- Ning-Zi Sun
- Division of General Internal Medicine, McGill University Health Centre; Department of Medicine, McGill University, QC, Canada
| | - Thomas Maniatis
- Division of General Internal Medicine, McGill University Health Centre; Department of Medicine, McGill University, QC, Canada
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Litofsky NS, Farooqui A, Tanaka T, Norregaard T. Use of the Electronic Health Record to Track Continuity of Care in Neurological Surgery Residency. J Grad Med Educ 2014; 6:507-11. [PMID: 26279776 PMCID: PMC4535215 DOI: 10.4300/jgme-d-13-00294.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 01/13/2014] [Accepted: 04/21/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Continuity of care in neurological surgery includes preoperative planning, technical and cognitive operative experience, and postoperative follow-up. Determining the extent of continuity of care with duty hour limits is problematic. OBJECTIVE We used electronic health record data to track continuity of care in a neurological surgery program and to assess changes in rotation requirements. METHODS The electronic health record was surveyed for all dictated resident-neurological surgery patient encounters (excluding progress notes), discharge summaries, and bedside procedures (July 2009-November 2011). Encounters were designated as preoperative, operative, or postoperative and were grouped by postgraduate year (PGY)-1 through PGY-6. RESULTS A total of 6382 dictations were reviewed, with 5231 (82.0%) pertinent to neurological surgery. Of the 1469 operative notes, 303 (20.6%) had a record of an encounter with the operating resident in either a postoperative or preoperative setting. Preoperative encounters totaled 10.1% (148 of 1469); postoperative, 5.1% (75 of 1469); and encounters with both were 5.4% (80 of 1469). Continuity of care was as follows: PGY-1, 13.8% (4 of 29); PGY-2, 17.4% (26 of 149); PGY-3, 29.0% (36 of 124); PGY-4, 24.8% (73 of 294); PGY-5, 28.8% (109 of 379); and PGY-6, 11.1% (55 of 494). One of the highest continuity rates was observed in a rotation specifically constructed to enhance continuity of care. CONCLUSIONS The electronic health record can be used to track resident continuity of care in neurological surgery. The primary operating resident saw the patient in nonoperative settings, such as general admission, clinic visitation, or consultation in 20.6% (303 of 1469) of cases.
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Ahmed N, Devitt KS, Keshet I, Spicer J, Imrie K, Feldman L, Cools-Lartigue J, Kayssi A, Lipsman N, Elmi M, Kulkarni AV, Parshuram C, Mainprize T, Warren RJ, Fata P, Gorman MS, Feinberg S, Rutka J. A systematic review of the effects of resident duty hour restrictions in surgery: impact on resident wellness, training, and patient outcomes. Ann Surg 2014; 259:1041-53. [PMID: 24662409 PMCID: PMC4047317 DOI: 10.1097/sla.0000000000000595] [Citation(s) in RCA: 325] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND In 2003, the Accreditation Council for Graduate Medical Education (ACGME) mandated 80-hour resident duty limits. In 2011 the ACGME mandated 16-hour duty maximums for PGY1 (post graduate year) residents. The stated goals were to improve patient safety, resident well-being, and education. A systematic review and meta-analysis were performed to evaluate the impact of resident duty hours (RDH) on clinical and educational outcomes in surgery. METHODS A systematic review (1980-2013) was executed on CINAHL, Cochrane Database, Embase, Medline, and Scopus. Quality of articles was assessed using the GRADE guidelines. Sixteen-hour shifts and night float systems were analyzed separately. Articles that examined mortality data were combined in a random-effects meta-analysis to evaluate the impact of RDH on patient mortality. RESULTS A total of 135 articles met the inclusion criteria. Among these, 42% (N = 57) were considered moderate-high quality. There was no overall improvement in patient outcomes as a result of RDH; however, some studies suggest increased complication rates in high-acuity patients. There was no improvement in education related to RDH restrictions, and performance on certification examinations has declined in some specialties. Survey studies revealed a perception of worsened education and patient safety. There were improvements in resident wellness after the 80-hour workweek, but there was little improvement or negative effects on wellness after 16-hour duty maximums were implemented. CONCLUSIONS Recent RDH changes are not consistently associated with improvements in resident well-being, and have negative impacts on patient outcomes and performance on certification examinations. Greater flexibility to accommodate resident training needs is required. Further erosion of training time should be considered with great caution.
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Affiliation(s)
- Najma Ahmed
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Itay Keshet
- Department of Internal Medicine, Mount Sinai Hospital, New York City, NY
| | - Jonathan Spicer
- Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Kevin Imrie
- Department of Internal Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Liane Feldman
- Department of Surgery, McGill University, Montreal, Quebec, Canada
| | | | - Ahmed Kayssi
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Nir Lipsman
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Maryam Elmi
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Chris Parshuram
- Department of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Todd Mainprize
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Richard J. Warren
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Paola Fata
- Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - M. Sean Gorman
- Department of Surgery, Royal Inland Hospital, Kamloops, British Columbia, Canada
| | - Stan Feinberg
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - James Rutka
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Lifchez SD, Redett RJ. A standardized patient model to teach and assess professionalism and communication skills: the effect of personality type on performance. JOURNAL OF SURGICAL EDUCATION 2014; 71:297-301. [PMID: 24797843 DOI: 10.1016/j.jsurg.2013.09.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 08/10/2013] [Accepted: 09/05/2013] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Teaching and assessing professionalism and interpersonal communication skills can be more difficult for surgical residency programs than teaching medical knowledge or patient care, for which many structured educational curricula and assessment tools exist. Residents often learn these skills indirectly, by observing the behavior of their attendings when communicating with patients and colleagues. The purpose of this study was to assess the results of an educational curriculum we created to teach and assess our residents in professionalism and communication. METHODS We assessed resident and faculty prior education in delivering bad news to patients. Residents then participated in a standardized patient (SP) encounter to deliver bad news to a patient's family regarding a severe burn injury. Residents received feedback from the encounter and participated in an education curriculum on communication skills and professionalism. As a part of this curriculum, residents underwent assessment of communication style using the Myers-Briggs type inventory. The residents then participated in a second SP encounter discussing a severe pulmonary embolus with a patient's family. RESULTS Resident performance on the SP evaluation correlated with an increased comfort in delivering bad news. Comfort in delivering bad news did not correlate with the amount of prior education on the topic for either residents or attendings. Most of our residents demonstrated an intuitive thinking style (NT) on the Myers-Briggs type inventory, very different from population norms. DISCUSSION The lack of correlation between comfort in delivering bad news and prior education on the subject may indicate the difficulty in imparting communication and professionalism skills to residents effectively. Understanding communication style differences between our residents and the general population can help us teach professionalism and communication skills more effectively. With the next accreditation system, residency programs would need to demonstrate that residents are acquiring these skills in their training. SP encounters are effective in teaching and assessing these skills.
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Affiliation(s)
- Scott D Lifchez
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Richard J Redett
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Hoskote SS, Nadkarni GN, Annapureddy N, Shetty AA, Fried ED. Internal medicine residents' perspectives on effects of 2011 ACGME work hour regulations on patient care. TEACHING AND LEARNING IN MEDICINE 2014; 26:274-278. [PMID: 25010239 DOI: 10.1080/10401334.2014.910458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND The Accreditation Council for Graduate Medical Education (ACGME) introduced new work hour limitations in July 2011. PURPOSES The aim is to assess internal medicine residents' perspectives on the impact of these limitations on their ability to discharge patient care duties. METHODS An anonymous survey was administered to 158 medicine residents in an urban university-affiliated internal medicine residency program. Residents' perspectives on various aspects of patient care were recorded on a 5-point Likert-type scale. RESULTS The response rate was 62%. The majority of residents (80%) agreed that patients had adequate continuity of care. Most residents agreed that they had enough time to follow up on consult notes (64% agreed) and investigations (80% agreed) daily. Most PGY-1 residents (59%) reported having enough time to prepare sign-outs. Most (60%) residents felt that reducing handoffs would improve patient care. CONCLUSIONS Most residents believe that the new work hour limitations would continue to uphold patient safety, but handoffs in care must be restricted.
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Affiliation(s)
- Sumedh S Hoskote
- a Department of Medicine, St. Luke's-Roosevelt Hospital Center , Columbia University College of Physicians and Surgeons , New York , New York , USA
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Osborne R, Parshuram CS. Delinking resident duty hours from patient safety. BMC MEDICAL EDUCATION 2014; 14 Suppl 1:S2. [PMID: 25561349 PMCID: PMC4304278 DOI: 10.1186/1472-6920-14-s1-s2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Patient safety is a powerful motivating force for change in modern medicine, and is often cited as a rationale for reducing resident duty hours. However, current data suggest that resident duty hours are not significantly linked to important patient outcomes. We performed a narrative review and identified four potential explanations for these findings. First, we question the relevance of resident fatigue in the creation of harmful errors. Second, we discuss factors, including workload, experience, and individual characteristics, that may be more important determinants of resident fatigue than are duty hours. Third, we describe potential adverse effects that may arise from--and, therefore, counterbalance any potential benefits of--duty hour reductions. Fourth, we explore factors that may mitigate any risks to patient safety associated with using the services of resident trainees. In summary, it may be inappropriate to justify a reduction in working hours on the grounds of a presumed linkage between patient safety and resident duty hours. Better understanding of resident-related factors associated with patient safety will be essential if improvements in important patient safety outcomes are to be realized through resident-focused strategies.
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Affiliation(s)
- Roisin Osborne
- Center for Safety Research, Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health and Evaluation Sciences Program, The Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
- Centre for Patient Safety, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Christopher S Parshuram
- Center for Safety Research, Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health and Evaluation Sciences Program, The Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
- Centre for Patient Safety, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Critical Care Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Oristrell J, Oliva J, Casanovas A, Comet R, Jordana R, Navarro M. The Computer Book of The Internal Medicine Resident: Competence acquisition and achievement of learning objectives. Rev Clin Esp 2014. [DOI: 10.1016/j.rceng.2013.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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East J, Cator A, Burns E, O'Gara TL, Card J, Cohn A, Macy M. Rounding frequency and hospital length of stay for children with respiratory illnesses: a simulation study. J Hosp Med 2013; 8:678-83. [PMID: 24222573 DOI: 10.1002/jhm.2097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 09/27/2013] [Accepted: 09/27/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND Patient discharge from the hospital is linked to physician-led rounds, whereas discharge from the emergency department (ED) is more fluid. The relationship between rounding and length of stay (LOS) has not been quantitatively described. OBJECTIVES To describe the arrival and discharge patterns in the ED and inpatient settings for children with respiratory illnesses and to explore how the timing and frequency of rounding could impact LOS. DESIGN/SETTING Retrospective administrative data analyses of visits for respiratory illnesses to a tertiary care pediatric ED from May 2007 to April 2010. METHODS ED visits for common respiratory conditions were selected based on International Classification of Diseases, 9th Revision, Clinical Modification codes, excluding complex comorbid conditions, severe illness, and intensive care unit admission. Discharge time was plotted against arrival time for the ED and inpatient unit. LOS was calculated. A Monte Carlo simulation model was developed to explore the influence of additional rounds on inpatient LOS. RESULTS Of the 5503 included visits, 1285 (23.4%) resulted in inpatient care. Discharges from the ED typically occurred 2 to 5 hours after arrival, whereas most inpatient discharges occurred between 11 am and 6 pm regardless of admission time. Simulating 1 additional rounding session decreased predicted inpatient LOS by approximately 5 hours. CONCLUSIONS In contrast to ED discharges that occurred around the clock, inpatient discharges for children with respiratory illnesses were concentrated during afternoon hours. Increasing rounding frequency may improve hospital efficiency but could result in unintended consequences such as fewer opportunities for patient education.
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Affiliation(s)
- Joseph East
- Industrial and Operations Engineering Department, University of Michigan, Ann Arbor, Michigan; Health Management and Policy Department, School of Public Health, University of Michigan, Ann Arbor, Michigan
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The Computer Book of the Internal Medicine Resident: competence acquisition and achievement of learning objectives. Rev Clin Esp 2013; 214:8-16. [PMID: 24035662 DOI: 10.1016/j.rce.2013.07.010] [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: 05/24/2013] [Revised: 07/23/2013] [Accepted: 07/28/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND The Computer Book of the Internal Medicine resident (CBIMR) is a computer program that was validated to analyze the acquisition of competences in teams of Internal Medicine residents. OBJECTIVES To analyze the characteristics of the rotations during the Internal Medicine residency and to identify the variables associated with the acquisition of clinical and communication skills, the achievement of learning objectives and resident satisfaction. METHODS All residents of our service (n=20) participated in the study during a period of 40 months. The CBIMR consisted of 22 self-assessment questionnaires specific for each rotation, with items on services (clinical workload, disease protocolization, resident responsibilities, learning environment, service organization and teamwork) and items on educational outcomes (acquisition of clinical and communication skills, achievement of learning objectives, overall satisfaction). Associations between services features and learning outcomes were analyzed using bivariate and multivariate analysis. RESULTS An intense clinical workload, high resident responsibilities and disease protocolization were associated with the acquisition of clinical skills. High clinical competence and teamwork were both associated with better communication skills. Finally, an adequate learning environment was associated with increased clinical competence, the achievement of educational goals and resident satisfaction. CONCLUSIONS Potentially modifiable variables related with the operation of clinical services had a significant impact on the acquisition of clinical and communication skills, the achievement of educational goals, and resident satisfaction during the specialized training in Internal Medicine.
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Rakinic J. Teaching and Assessing Colorectal Surgery Residents in the Age of ACGME Competencies: Pieces of the Whole. Clin Colon Rectal Surg 2013; 25:143-50. [PMID: 23997669 DOI: 10.1055/s-0032-1322527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Educators have struggled with teaching and evaluation of the six Accreditation Council for Graduate Medical Education (ACGME) core competencies since their introduction in 1999. In addition, many authors have questioned the construct validity of the competencies. Concern has also arisen regarding the educational effects of the competencies and the subsequent limitation of resident duty hours, the combination of which have forced unprecedented changes in American graduate medical education. This article attempts to present an understanding of how these events have had direct and indirect effects on the education of residents in colon and rectal surgery, and to provide a framework for educators in colon and rectal surgery to adapt in their curricula.
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Affiliation(s)
- Jan Rakinic
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
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Abstract
BACKGROUND Surgery resident education is based on experiential training, which is influenced by changes in clinical management strategies, technical and technologic advances, and administrative regulations. Trauma care has been exposed to each of these factors, prompting concerns about resident experience in operative trauma. The current study analyzed the reported volume of operative trauma for the last two decades; to our knowledge, this is the first evaluation of nationwide trends during such an extended time line. METHODS The Accreditation Council for Graduate Medical Education (ACGME) database of operative logs was queried from academic year (AY) 1989-1990 to 2009-2010 to identify shifts in trauma operative experience. Annual case log data for each cohort of graduating surgery residents were combined into approximately 5-year blocks, designated Period I (AY1989-1990 to AY1993-1994), Period II (AY1994-1995 to AY1998-1999), Period III (AY1999-2000 to AY2002-2003), and Period IV (AY2003-2004 to AY2009-2010). The latter two periods were delineated by the year in which duty hour restrictions were implemented. RESULTS Overall general surgery caseload increased from Period I to Period II (p < 0.001), remained stable from Period II to Period III, and decreased from Period III to Period IV (p < 0.001). However, for ACGME-designated trauma cases, there were significant declines from Period I to Period II (75.5 vs. 54.5 cases, p < 0.001) and Period II to Period III (54.5 vs. 39.3 cases, p < 0.001) but no difference between Period III and Period IV (39.3 vs. 39.4 cases). Graduating residents in Period I performed, on average, 31 intra-abdominal trauma operations, including approximately five spleen and four liver operations. Residents in Period IV performed 17 intra-abdominal trauma operations, including three spleen and approximately two liver operations. CONCLUSION Recent general surgery trainees perform fewer trauma operations than previous trainees. The majority of this decline occurred before implementation of work-hour restrictions. Although these changes reflect concurrent changes in management of trauma, surgical educators must meet the challenge of training residents in procedures less frequently performed. LEVEL OF EVIDENCE Epidemiologic study, level III; therapeutic study, level IV.
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Cordero L, Hart BJ, Hardin R, Mahan JD, Nankervis CA. Deliberate practice improves pediatric residents' skills and team behaviors during simulated neonatal resuscitation. Clin Pediatr (Phila) 2013; 52:747-52. [PMID: 23671270 DOI: 10.1177/0009922813488646] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To evaluate the skills and team behavior of pediatric residents during resuscitation with a high-fidelity mannequin before and after a deliberate practice intervention. METHODS Each month residents participate in two 90-minute videorecorded sessions (2-3 weeks apart) in an "off-site" delivery room during their neonatal ICU rotation. Teams responded to a scenario that required 5 skills (positive pressure ventilation, chest compressions, endotracheal intubation, umbilical vein catheterization, and epinephrine administration). Skills were scored for technique and timeliness and team behaviors for communication, management, and leadership. A 2-hour focused intervention was given between sessions. RESULTS In all, 33 residents (11 teams) completed the sessions. Gaps in procedural skills noted during the first session were corrected. Timeliness for completion of skills remained below expectations. Improvements in team behaviors were noted. CONCLUSIONS Deliberate practice improved procedural skills and team performance. Lack of improvement in timeliness suggests that a different educational paradigm is required.
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Affiliation(s)
- Leandro Cordero
- Department of Pediatrics, The Wexner Medical Center, Ohio State University, Columbus, OH 43210-1228, USA.
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Gow KW, Drake FT, Aarabi S, Waldhausen JH. The ACGME case log: general surgery resident experience in pediatric surgery. J Pediatr Surg 2013; 48:1643-9. [PMID: 23932601 PMCID: PMC4235999 DOI: 10.1016/j.jpedsurg.2012.09.027] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 08/19/2012] [Accepted: 09/05/2012] [Indexed: 10/26/2022]
Abstract
BACKGROUND General surgery (GS) residents in ACGME programs log cases performed during their residency. We reviewed designated pediatric surgery (PS) cases to assess for changes in performed cases over time. METHODS The ACGME case logs for graduating GS residents were reviewed from academic year (AY) 1989-1990 to 2010-2011 for designated pediatric cases. Overall and designated PS cases were analyzed. Data were combined into five blocks: Period I (AY1989-90 to AY1993-94), Period II (AY1994-95 to AY1998-99), Period III (AY1999-00 to AY2002-03), Period IV (AY2003-04 to AY2006-07), and Period V (AY2007-08 to AY2010-11). Periods IV and V were delineated by implementation of duty hour restrictions. Student t-tests compared averages among the time periods with significance at P < .05. RESULTS Overall GS case load remained relatively stable. Of total cases, PS cases accounted for 5.4% in Period I and 3.7% in Period V. Designated pediatric cases declined for each period from an average of 47.7 in Period I to 33.8 in Period V. These changes are due to a decline in hernia repairs, which account for half of cases. All other cases contributed only minimally to the pediatric cases. The only laparoscopic cases in the database were anti-reflux procedures, which increased over time. CONCLUSIONS GS residents perform a diminishing number of designated PS cases. This decline occurred before the onset of work-hour restrictions. These changes have implications on the capabilities of the current graduating workforce. However, the case log does not reflect all cases trainees may be exposed to, so revision of this list is recommended.
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Affiliation(s)
- Kenneth W. Gow
- Corresponding author. 4800 Sand Point Way NE, Seattle, WA 98105. Tel.: +1 206 987 1177; fax: +1 206 987 3925. (K.W. Gow)
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Nakayama DK, Taylor SM. SESC Practice Committee Survey: Surgical Practice in the Duty-hour Restriction Era. Am Surg 2013. [DOI: 10.1177/000313481307900716] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Debate continues as to the relevance of Accreditation Council for Graduate Medical Education (ACGME) duty-hour restrictions in actual practice and the adequacy of resident training in surgery. A survey of the membership of the Southeastern Surgical Congress using an Internet-based questionnaire was conducted: adherence to duty-hour restrictions, evidence of sleepiness and fatigue, opinions regarding the training, and clinical performance of surgeons who had trained after the institution of duty-hour restrictions in 2003 (termed “recently trained surgeons”). One hundred seventy-seven members respondents out of 1008 (18%). Most (101 of 170 [59%]) worked more than 80 hours in a week and half (86 of 174 [49%]) more than 24 hours consecutively once or more a month. Falling asleep inappropriately was reported by 6 to 12 per cent. Forty per cent (71 of 176) thought that graduates of residencies today are prepared for clinical practice. Those who had hired a recently trained surgeon believed the latter was sufficiently trained (61 of 123 [50%]) more often than those who had not hired one (10 of 51 [20%]; P = 0.006). Those with a new colleague gave first assistant help in 75 per cent (91 of 121) during the first year. Surgeons in practice regularly violate ACGME duty-hour restrictions. Many surgeons have doubts whether new graduates of residency training programs have adequate training to practice surgery. Those who have hired a new surgeon trained under duty-hour restrictions are more likely to be satisfied with the latter's training. Most new trainees receive direct assistance from their practice partners, continuing their training beyond residency.
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Affiliation(s)
- Don K. Nakayama
- Department of Surgery, the Mercer University School of Medicine and the Medical Center of Central Georgia, Macon, Georgia
| | - Spence M. Taylor
- University of South Carolina School of Medicine, Greenville Hospital System, Greenville, South Carolina
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Choma NN, Vasilevskis EE, Sponsler KC, Hathaway J, Kripalani S. Effect of the ACGME 16-hour rule on efficiency and quality of care: duty hours 2.0. JAMA Intern Med 2013; 173:819-21. [PMID: 23545839 PMCID: PMC3690764 DOI: 10.1001/jamainternmed.2013.3014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Neesha N. Choma
- Department of Medicine, Vanderbilt University, Nashville, TN
| | | | | | - Jacob Hathaway
- Department of Medicine, Vanderbilt University, Nashville, TN
| | - Sunil Kripalani
- Department of Medicine, Vanderbilt University, Nashville, TN
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