Teaching assistant cases in general surgery training - A literature review

BACKGROUND

There is a lack of understanding of the scope and purpose of teaching assistant cases, impact on patients and safety, as well as the facilitators or barriers to resident participation in these cases.

METHODS

Four databases (PubMed, Embase, Web of Science, and the Education Resources Information Center), were searched. The references of identified resources were additionally hand-searched. 10 articles were identified and considered in the literature review.

RESULTS

The TA case literature focuses on case numbers and safety. The discussions of papers allude to perceived benefits of TA cases. The literature review reveals that residents are more likely to be granted TA opportunities if they show themselves worthy of entrustment.

CONCLUSIONS

The work elucidates aspects of TA cases that have not previously been emphasized or highlighted. The literature review can serve to inform attending surgeons and trainees how to optimize the opportunities teaching assistant cases can afford.

Efficacy of a resident-as-teacher program (RATP) for general surgery residents: An evaluation of 3 Years of implementation

BACKGROUND

Teaching is a responsibility of general surgery residents and formal teaching instruction is mandated. This study examines the efficacy of a formal RATP incorporated into our general surgery residency curriculum.

METHODS

The RATP was developed locally and delivered longitudinally over the course of the academic year, starting in 2017. Self-assessment surveys were distributed to residents before and after completion of the program each academic year. Medical students were surveyed regarding their impression of teaching on the surgical clerkship.

RESULTS

RATP data was collected annually. All sessions were highly rated. Residents reported improved teaching self-efficacy after participation. Medical student agreement with the statement 'Residents provided effective teaching during the [surgery] clerkship' increased from 68.6% prior to RATP implementation to 79.7% in the following years (p < 0.05).

CONCLUSIONS

Incorporation of a locally developed RATP improved residents' self-perceptions and medical student perception of residents as teachers. RATPs should be adopted widely.

Perspectives on virtual interviews-A follow-up study of the Comprehensive Endocrine Surgery Fellowship interview process

BACKGROUND

The American Association of Endocrine Surgeons Comprehensive Endocrine Surgery Fellowship interview stakeholders previously favored in-person interviews, despite time and expense. This study assessed perception changes given mandated virtual interviews because of coronavirus disease 2019.

METHODS

Immediately after the 2020 Match, anonymous surveys were distributed to applicants (n = 37) and program directors (n = 22). Mixed-methods analyses were used to evaluate responses. Results were compared to data from a prior study of the 2013 to 2018 in-person interview process.

RESULTS

Response rates were 82% (program directors) and 60% (applicants). Compared with prior applicants, 2020 applicants attended similar numbers of interviews (1-10, 32% vs 37%; P = .61), used fewer vacation days (23% vs 56%; P = .01), and most reported 0 expenses. Burdens included lack of protected time for interviews. The virtual format did not compromise applicant ability to meet faculty (mean rank = 6.8/10) or make favorable impressions (mean rank = 6.8/10). Program directors reported equivalent or improved assessments of applicants. Program directors (72%) and applicants (77%) indicated that future interviews should be partially or completely virtual.

CONCLUSION

In contrast to prior survey data, applicants and program directors now express interest in virtual or hybrid interview processes. Virtual interviews were less costly, less time-consuming, and met goals effectively. Integrating virtual interview components will require innovative strategies to reduce redundancies and promote equitable access.

The role of racial segregation in treatment and outcomes among patients with hepatocellular carcinoma

BACKGROUND

There is a long history of segregation in the U.S.A with enduring impacts on cancer outcomes today. We evaluated the impact of segregation on racial disparities in Hepatocellular Carcinoma (HCC) treatment and outcomes.

METHODS

We obtained data on black and white patients with HCC from the SEER program (2005-2015) within the 100 most populous participating counties. Our exposure was the index of dissimilarity (IoD), a validated measure of segregation. Outcomes were overall survival, advanced stage at diagnosis (Stage III/IV) and surgery for localized disease (Stage I/II). Cancer-specific survival was assessed using Kaplan-Meier estimates.

RESULTS

Black patients had a 1.18 times increased risk (95%CI 1.14,1.22) of presenting at advanced stage as compared to white patients and these disparities disappeared at low levels of segregation. In the highest quartile of IoD, black patients had a significantly lower survival than white (17 months vs 27 months, p < 0.001), and this difference disappeared at the lowest quartile of IoD.

CONCLUSIONS

Our data illustrate that structural racism in the form racial segregation has a significant impact on racial disparities in the treatment of HCC. Urban and health policy changes can potentially reduce disparities in HCC outcomes.

Novel Low-Cost, Low-Fidelity Hemorrhoidectomy Task Trainers

OBJECTIVE

Develop and describe a set of low-cost hemorrhoidectomy task trainer prototypes in the setting of inadequate junior resident surgical skill preparation for anorectal cases.

DESIGN

This is a study comparing expert and novice performance and opinions. Three task trainers were developed to simulate dissecting, knot-tying, and suturing in a confined space, like the anus. Participants were asked to dissect the peel off of an orange, tie seven 2-handed knots on a weight, and close a defect in a piece of felt with a running stitch. An 8-oz mason jar was used to simulate the confined space. Participants were asked to fill out a 5-point Likert-based evaluation regarding the skills. The primary outcome was time to complete each task in seconds. Secondary outcome measures were number of errors associated with each task, subjective achievability of tasks, and utility of tasks for improving surgical skills.

SETTING

General surgery residency program at a safety-net academic center.

PARTICIPANTS

Forty subjects participated in this study. There were 20 experts (7 attending surgeons, 13 PGY-1-PGY-5 surgical residents) and 20 novices (11 third- and 9 fourth-year medical students).

RESULTS

Experts knot-tied (59s vs 140s, p < 0.001) and sutured (219s vs 295s, p < 0.001) faster than novices. Experts were able to tie 7 knots in fewer attempts than novices (p < 0.001). There was no significant difference in speed of orange dissection between groups. There were no significant differences in the number or frequency of other errors. All participants felt the tasks were achievable (4.90/5) and would be useful in improving skills (4.93/5).

CONCLUSIONS

This study demonstrated that a set of low-cost, low-fidelity prototypical hemorrhoidectomy task trainers can discriminate between experts and novices. Simulation models such as these can offer useful practice opportunities for junior general surgery trainees.

Resident involvement in minimally-invasive vs. open procedures

BACKGROUND

The objective of this study was to evaluate the impact of resident involvement on surgical outcomes in laparoscopic compared to open procedures.

METHODS

The American College of Surgeons National Surgical Quality Improvement Program 2007-2012 was queried for open and laparoscopic ventral hernia repair (VHR), inguinal hernia repair (IHR), splenectomy, colectomy, or cholecystectomy (CCY). Multivariable regression analyses were performed to assess the impact of resident involvement on surgical outcomes.

RESULTS

In total, 88,337 VHR, 20,586 IHR, 59,254 colectomies, 3301 splenectomies, and 95,900 CCY were identified. Resident involvement was predictive for major complication during open VHR (AOR, 1.29; p < 0.001), but not during any other procedure. Resident participation significantly prolonged operative time for open, as well as laparoscopic VHR, IHR, colectomy, splenectomy, and CCY (all p < 0.01).

CONCLUSIONS

The results of this study suggest that resident participation has a similar impact on surgical outcomes during laparoscopic and open surgery, and is generally safe.

Resident-as-Teacher Programs in General Surgery Residency: Context and Characterization

OBJECTIVE

Teaching medical students and junior residents are key components of a surgical resident's role. How surgical residents are formally prepared for their teaching role is not well described. The aim of this study was to characterize the status of formal Resident-as-Teacher Programs (RATPs) in U.S. general surgery residency programs. We also sought to understand current attitudes towards teaching by residents.

DESIGN

A survey regarding the presence of RATPs and attitudes toward teaching by residents was sent through the Association of Program Directors in Surgery (APDS) to general surgery program directors (PDs).

SETTING

The study was conducted using an electronically distributed survey.

PARTICIPANTS

Program directors of general surgery residencies were contacted through the APDS.

RESULTS

Program directors from 105 institutions completed the survey; one did not respond to the question about RATPs. 27 (26%) indicated they utilized a RATP. Of these programs the majority, 25 (93%), were developed at the institution and only 2 (6%) used a published curriculum. For the programs without a RATP, 47 (61%) of PDs indicated they were interested in establishing one. Respondents not interested most often cited other resident obligations and time constraints as limiting factors.

CONCLUSIONS

Fewer than one third of responding programs have an established RATP; of those programs that do not have a RATP, the majority are interested in establishing one. Residents clearly play an important role teaching and PDs acknowledge teaching is an important part of residents' daily job, thus formal preparing residents for their teaching role is important. Development and dissemination of a RATP that can be easily incorporated in to general surgery programs would meet an identified need in general surgery training.