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Mikhail D, Margolin EJ, Sfakianos J, Clifton M, Sorenson M, Thavaseelan S, Haleblian G, Kavoussi L, Badalato GM, Richstone L. Changing the Status Quo: Developing a Virtual Sub-Internship in the Era of COVID-19. JOURNAL OF SURGICAL EDUCATION 2021; 78:1544-1555. [PMID: 33896734 PMCID: PMC8419923 DOI: 10.1016/j.jsurg.2021.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 05/10/2023]
Abstract
PROBLEM Subinternships are integral to medical education as tools for teaching and assessing fourth-year medical students. Social distancing due to COVID-19 has precluded the ability to offer in-person subinternships - negatively impacting medical education and creating uncertainty surrounding the residency match. With no precedent for the development and implementation of virtual subinternships, the Society of Academic Urologists (SAU) developed an innovative and standardized curriculum for the Virtual Subinternship in Urology (vSIU). METHODS The vSIU committee's mandate was to create a standardized curriculum for teaching foundational urology and assessing student performance. Thirty-three members from 23 institutions were divided into working groups and given 3 weeks to develop 10 modules based on urologic subspecialties, Accreditation Council for Graduate Medical Education core competencies, technical skills training and student assessment. Working groups were encouraged to develop innovative learning approaches. The final curriculum was assembled into the "vSIU Guidebook." RESULTS The vSIU Guidebook contains 212 pages - 64 pages core content and 2 appendices (patient cases and evaluations). It outlines a detailed 4-week curriculum with a sufficient volume of resources to offer a completely adaptable virtual course with the same rigor as a traditional subinternship. Modules contain curated teaching resources including journal articles, lectures, surgical videos and simulated clinical scenarios. Innovative learning tools include reflective writing, mentorship guidelines, videoconference-based didactics, surgical simulcasting and virtual technical skills training. The guidebook was disseminated to program directors nationally. NEXT STEPS The vSIU is the first virtual subinternship in any specialty to be standardized and offered nationally, and it was implemented by at least 19 urology programs. This curriculum serves as a template for other specialties looking to develop virtual programs and feedback from educators and students will allow the curriculum to evolve. As the pandemic continues to challenge our paradigm, this rapid and innovative response exemplifies that the medical community will continue to meet the needs of an ever-changing educational landscape.
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Affiliation(s)
- David Mikhail
- Department of Urology, Northwell Health, New York, New York.
| | - Ezra J Margolin
- Department of Urology, Columbia University Irving Medical Center, New York, New York
| | | | - Marisa Clifton
- Department of Urology, Johns Hopkins, Baltimore, Maryland
| | - Mathew Sorenson
- Department of Urology, University of Washington, Seattle, Washington
| | | | - George Haleblian
- Division of Urology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Louis Kavoussi
- Department of Urology, Northwell Health, New York, New York
| | - Gina M Badalato
- Department of Urology, Columbia University Irving Medical Center, New York, New York
| | - Lee Richstone
- Department of Urology, Northwell Health, New York, New York
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Program Director Perceptions of Usefulness of the Accreditation Council for Graduate Medical Education Milestones System for Urology Resident Evaluation. Urology 2019; 124:28-32. [DOI: 10.1016/j.urology.2018.10.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/05/2018] [Accepted: 10/11/2018] [Indexed: 11/18/2022]
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Conti SL, Brubaker W, Chung BI, Sofer M, Hsi RS, Shinghal R, Elliott CS, Caruso T, Leppert JT. Crowdsourced Assessment of Ureteroscopy with Laser Lithotripsy Video Feed Does Not Correlate with Trainee Experience. J Endourol 2018; 33:42-49. [PMID: 30450963 DOI: 10.1089/end.2018.0534] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES We sought to validate the use of crowdsourced surgical video assessment in the evaluation of urology residents performing flexible ureteroscopic laser lithotripsy. METHODS We collected video feeds from 30 intrarenal ureteroscopic laser lithotripsy cases where residents, postgraduate year (PGY) two through six, handled the ureteroscope. The video feeds were annotated to represent overall performance and to contain parts of the procedure being scored. Videos were submitted to a commercially available surgical video evaluation platform (Crowd-Sourced Assessment of Technical Skills). We used a validated ureteroscopic laser lithotripsy global assessment tool that was modified to include only those domains that could be evaluated on the captured video. Videos were evaluated by crowd workers recruited using Amazon's Mechanical Turk platform as well as five endourology-trained experts. Mean scores were calculated and intraclass correlation coefficients (ICCs) were computed for the expert domain and total scores. ICCs were estimated using a linear mixed-effects model. Spearman rank correlation coefficients were calculated as a measure of the strength of the relationships between the crowd mean and expert average scores. RESULTS A total of 30 videos were reviewed 2488 times by 487 crowd workers and five expert endourologists. ICCs between expert raters were all below accepted levels of correlation (0.30), with the overall score having an ICC of <0.001. For individual domains, the crowd scores did not correlate with expert scores, except for the stone retrieval domain (0.60 p = 0.015). In addition, crowdsourced scores had a negative correlation with the PGY level (0.44, p = 0.019). CONCLUSIONS There is poor agreement between experts and poor correlation between expert and crowd scores when evaluating video feeds of ureteroscopic laser lithotripsy. The use of an intraoperative video of ureteroscopy with laser lithotripsy for assessment of resident trainee skills does not appear reliable. This is further supported by the lack of correlation between crowd scores and advancing PGY level.
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Affiliation(s)
- Simon L Conti
- 1 Department of Urology, Stanford University School of Medicine , Stanford, California.,2 Veterans Affairs Palo Alto Health Care System , Palo Alto, California.,3 Johns Hopkins School of Education , Baltimore, Maryland
| | - William Brubaker
- 1 Department of Urology, Stanford University School of Medicine , Stanford, California
| | - Benjamin I Chung
- 1 Department of Urology, Stanford University School of Medicine , Stanford, California
| | - Mario Sofer
- 4 Tel Aviv Sourasky Medical Center , Tel Aviv, Israel
| | - Ryan S Hsi
- 5 Department of Urologic Surgery, Vanderbilt University Medical Center , Nashville, Tennessee
| | | | - Christopher S Elliott
- 1 Department of Urology, Stanford University School of Medicine , Stanford, California.,7 Division of Urology, Santa Clara Valley Medical Center , Santa Clara, California
| | - Thomas Caruso
- 3 Johns Hopkins School of Education , Baltimore, Maryland.,8 Department of Anesthesia, Stanford University School of Medicine , Stanford, California
| | - John T Leppert
- 1 Department of Urology, Stanford University School of Medicine , Stanford, California.,2 Veterans Affairs Palo Alto Health Care System , Palo Alto, California
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Educational Resources for Resident Training in Quality Improvement: A National Survey of Urology Residency Program Directors. UROLOGY PRACTICE 2018. [DOI: 10.1016/j.urpr.2017.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ziemba JB, Ziemba TM, Pietzak EJ, Guzzo TJ, Canning DA, Wein AJ. Integrating Leadership Education into Urology Residency Training. UROLOGY PRACTICE 2018. [DOI: 10.1016/j.urpr.2016.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Justin B. Ziemba
- Division of Urology, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Eugene J. Pietzak
- Division of Urology, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thomas J. Guzzo
- Division of Urology, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Douglas A. Canning
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Alan J. Wein
- Division of Urology, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Maddox MM, Lopez A, Mandava SH, Boonjindasup A, Viriyasiripong S, Silberstein JL, Lee BR. Electroencephalographic Monitoring of Brain Wave Activity During Laparoscopic Surgical Simulation to Measure Surgeon Concentration and Stress: Can the Student Become the Master? J Endourol 2015; 29:1329-33. [PMID: 26414353 DOI: 10.1089/end.2015.0239] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To measure gamma and alpha brain wave activity as a measurement of concentration and stress levels during surgical simulator performance of laparoscopic tasks to determine if expert surgeons have different brain activity patterns compared with intermediate and novice surgeons. MATERIALS AND METHODS After obtaining Institutional Review Board approval, 1st and 2nd year medical students, urology residents (PGY2-PGY5), and attending urologists from one institution were recruited. Participants were stratified by level of experience and performed laparoscopic tasks on the EDGE laparoscopic simulator. Subjects were evaluated for concentration and stress levels using the electroencephalography (EEG) data extracted from the MUSE(™) headband. The MUSE software developer kit (SDK) allowed quantification of gamma and alpha waves during each task. An analysis of variance was used to compare concentration and stress levels between groups. RESULTS A total of 19 participants were recruited for the study and stratified by surgical experience into novice, intermediate, and expert laparoscopy groups: 6 medical students, 9 urology residents, and 4 attending urologists, respectively. Concentration and stress were quantified by calculating the area under the curve of the gamma and alpha EEG wave tracings. Stress was significantly lower in the attending urologists compared with the residents and medical students during the laparoscopic suturing and trended toward significance in the peg transfer task (P = 0.0003, P = 0.069). Concentration was significantly higher in the expert group compared with the less experienced groups during both the peg and suture tasks (P = 0.036, P = 0.0039). CONCLUSIONS EEG brain activity in more experienced surgeons reveals a significant increase in concentration levels with a decrease in stress during simulated laparoscopic tasks compared with novices. This information may correlate with increased proficiency as well as provide objective feedback of progress along the learning curve with the MUSE SDK.
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Affiliation(s)
- Michael M Maddox
- 1 Department of Urology, Tulane University School of Medicine , New Orleans, Louisiana
| | - Asis Lopez
- 2 Department of Biomedical Engineering, Tulane University School of Science and Engineering , New Orleans, Louisiana
| | - Sree Harsha Mandava
- 1 Department of Urology, Tulane University School of Medicine , New Orleans, Louisiana
| | - Aaron Boonjindasup
- 1 Department of Urology, Tulane University School of Medicine , New Orleans, Louisiana
| | | | | | - Benjamin R Lee
- 1 Department of Urology, Tulane University School of Medicine , New Orleans, Louisiana
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Guy C. Genetic Counseling Milestones: A Framework for Student Competency Evaluation. J Genet Couns 2015; 25:635-43. [PMID: 26462934 DOI: 10.1007/s10897-015-9895-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 09/23/2015] [Indexed: 11/25/2022]
Abstract
Graduate medical education has recently increased focus on the development of medical specialty competency milestones to provide a targeted tool for medical resident evaluation. Milestones provide developmental assessment of the attainment of competencies over the course of an educational program. An educational framework is described to explore the development of Genetic Counseling Milestones for the evaluation of the development of genetic counseling competencies by genetic counseling students. The development of Genetic Counseling Milestones may provide a valuable tool to assess genetic counseling students across all program activities. Historical educational context, current practices, and potential benefits and challenges in the development of Genetic Counseling Milestones are discussed.
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Affiliation(s)
- Carrie Guy
- Department of Pediatrics, Division of Genetics, Masters in Genetic Counseling Program, University of Oklahoma Health Science Center, 1200 Children's Ave, Ste 12100, Oklahoma City, OK, 73104, USA.
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Allard CB, Meyer CP, Gandaglia G, Chang SL, Chun FKH, Gelpi-Hammerschmidt F, Hanske J, Kibel AS, Preston MA, Trinh QD. The Effect of Resident Involvement on Perioperative Outcomes in Transurethral Urologic Surgeries. JOURNAL OF SURGICAL EDUCATION 2015; 72:1018-1025. [PMID: 26003818 DOI: 10.1016/j.jsurg.2015.04.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 04/13/2015] [Accepted: 04/14/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To conduct the first study of intra- and postoperative outcomes related to intraoperative resident involvement in transurethral resection procedures for benign prostatic hyperplasia and bladder cancer in a large, multi-institutional database. DESIGN Relying on the American College of Surgeons National Surgical Quality Improvement Program Participant User Files (2005-2012), we abstracted all cases of endoscopic prostate surgery (EPS) for benign prostatic hyperplasia and transurethral resection of bladder tumors (TURBTs). Multivariable logistic regression models were constructed to assess the effect of trainee involvement (postgraduate year [PGY] 1-2: junior, PGY 3-4: senior, PGY ≥ 5: chief or fellow) vs attending only on operative time and length of hospital stay, as well as 30-day complication, reoperation, and readmission rates. RESULTS In all, 5093 EPS and 3059 TURBTs for a total of 8152 transurethral resection procedures were performed during the study period for which data on resident involvement were available. In multivariable analyses, resident involvement in EPS or TURBT was associated with increased odds of prolonged operative times and hospital readmissions in 30 days independent of resident level of training. Resident involvement was not associated with overall complications or reoperation rates. CONCLUSIONS Resident involvement in lower urinary tract surgeries is associated with increased readmissions. Strategies to optimize resident teaching of these common urologic procedures in order to minimize possible risks to patients should be explored.
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Affiliation(s)
- Christopher B Allard
- Division of Urology, Brigham and Women's Hospital, Boston, Massachusetts; Division of Urology, Massachusetts General Hospital, Boston, Massachusetts.
| | - Christian P Meyer
- Division of Urology, Brigham and Women's Hospital, Boston, Massachusetts; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | - Steven L Chang
- Division of Urology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Felix K H Chun
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Francisco Gelpi-Hammerschmidt
- Division of Urology, Brigham and Women's Hospital, Boston, Massachusetts; Division of Urology, Massachusetts General Hospital, Boston, Massachusetts
| | - Julian Hanske
- Center for Surgery and Public Health and Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany
| | - Adam S Kibel
- Division of Urology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Mark A Preston
- Division of Urology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Quoc-Dien Trinh
- Division of Urology, Brigham and Women's Hospital, Boston, Massachusetts
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Ruhotina N, Dagenais J, Gandaglia G, Sood A, Abdollah F, Chang SL, Leow JJ, Olugbade K, Rai A, Sammon JD, Schmid M, Varda B, Zorn KC, Menon M, Kibel AS, Trinh QD. The impact of resident involvement in minimally-invasive urologic oncology procedures. Can Urol Assoc J 2014; 8:334-40. [PMID: 25408800 DOI: 10.5489/cuaj.2170] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Robotic and laparoscopic surgical training is an integral part of resident education in urology, yet the effect of resident involvement on outcomes of minimally-invasive urologic procedures remains largely unknown. We assess the impact of resident participation on surgical outcomes using a large multi-institutional prospective database. METHODS Relying on the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participant User Files (2005-2011), we abstracted the 3 most frequently performed minimally-invasive urologic oncology procedures. These included radical prostatectomy, radical nephrectomy and partial nephrectomy. Multivariable logistic regression models were constructed to assess the impact of trainee involvement (PGY 1-2: junior, PGY 3-4: senior, PGY ≥5: chief) versus attending-only on operative time, length-of-stay, 30-day complication, reoperation and readmission rates. RESULTS A total of 5459 minimally-invasive radical prostatectomies, 1740 minimally-invasive radical nephrectomies and 786 minimally-invasive partial nephrectomies were performed during the study period, for which data on resident surgeon involvement was available. In multivariable analyses, resident involvement was not associated with increased odds of overall complications, reoperation, or readmission rates for minimally-invasive prostatectomy, radical and partial nephrectomy. However, operative time was prolonged when residents were involved irrespective of the type of procedure. Length-of-stay was decreased with senior resident involvement in minimally-invasive partial nephrectomies (odds ratio [OR] 0.49, p = 0.04) and prostatectomies (OR 0.68, p = 0.01). The major limitations of this study include its retrospective observational design, inability to adjust for the case complexity and surgeon/hospital characteristics, and the lack of information regarding the minimally-invasive approach utilized (whether robotic or laparoscopic). CONCLUSIONS Resident involvement is associated with increased operative time in minimally-invasive urologic oncology procedures. However, it does not adversely affect the complication, reoperation or readmission rates, as well as length-of-stay.
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Affiliation(s)
- Nedim Ruhotina
- Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Julien Dagenais
- Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Giorgio Gandaglia
- Cancer Prognostics and Health Outcomes Unit, Centre Hospitalier de l'Université de Montréal, Montreal, QC
| | - Akshay Sood
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA; ; Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI
| | - Firas Abdollah
- Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI
| | - Steven L Chang
- Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; ; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
| | - Jeffrey J Leow
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
| | - Kola Olugbade
- Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Arun Rai
- Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jesse D Sammon
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA; ; Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI
| | - Marianne Schmid
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
| | - Briony Varda
- Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Kevin C Zorn
- Cancer Prognostics and Health Outcomes Unit, Centre Hospitalier de l'Université de Montréal, Montreal, QC
| | - Mani Menon
- Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI
| | - Adam S Kibel
- Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Quoc-Dien Trinh
- Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; ; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
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