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Rigberg D, Smith BK, Sun T, Pearce B, Humphries M, Sheahan M, Coleman D, Lee J. Vascular In-person for Students In the match Trial: An investigation of post-interview site visits to address the limitations of virtual interviews. J Vasc Surg 2024:S0741-5214(24)00926-1. [PMID: 38556041 DOI: 10.1016/j.jvs.2024.03.439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 03/03/2024] [Accepted: 03/11/2024] [Indexed: 04/02/2024]
Abstract
PURPOSE The graduate medical education community implemented virtual residency interviews in response to travel restrictions during the COVID-19 pandemic, and this approach has persisted. Although many residency applicants wish to visit in person prospective training sites, such opportunities could bias programs toward those who are able to meet this financial burden, exacerbating equity concerns. One proposed solution is to offer applicants the opportunity to visit only after a program's rank list is "locked," avoiding favoritism to applicants who visit, but allowing applicants to experience some of the camaraderie, geography, and local effects of an in-person visit. As debate about the optimal format of residency interviews continues, it is important to investigate whether in-person program visits, completed after program rank list certification, provide meaningful benefits to applicants in the residency match process. METHODS All vascular programs entering the 2023 integrated vascular surgery residency match were invited to participate. Programs agreed to certify their National Resident Matching Program (NRMP) rank lists by February 1, 2023. Applicants then had the opportunity to visit the programs at which they interviewed. The particulars of the visit were determined by the individual programs. Applicants completed their standard rank list and locked on the standard March 1, 2023, date. Applicants then completed a survey regarding the impact of the visits on their rank order list decision-making. Program Directors completed a survey regarding their experiences as well. Data were collected using REDCap. RESULTS Twenty-one of the 74 programs participated (28%). 19 PDs completed the post-interview site visit survey (response rate 90%). Applicants interviewing at the participating programs (n = 112) were informed of the study, offered the opportunity to attend post-interview site visits, and received the survey. 47 applicants responded (response rate 42%). 86% of applicants stated the visit impacted their rank list. Most important factors were esprit de corps of the program (86%), the faculty/trainees/staff (81%), and the physical setting (62%). 71 percent of those participating spent <$800 on their visit. 81 percent were satisfied with the process. 21 percent of PDs would have changed their rank list if they could have based on the applicants' in-person visit. 63 percent of the visit sessions cost the programs<$500, and 63% were satisfied with the process. CONCLUSIONS This study is the first to document the impact of in-person site visits by applicants on a graduate medical education match process in one specialty. Our results suggest that this process provides meaningful data to applicants that helped them with their decision-making evidenced by most altering their rank lists, while avoiding some of the critical equity issues that accompany traditional in person interviews. This may provide a model for future interview processes for residency programs.
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Affiliation(s)
| | - Brigitte K Smith
- Division of Vascular Surgery, Department of Surgery, University of Utah, School of Medicine, Salt Lake City, UT
| | - Ting Sun
- Division of Vascular Surgery, Department of Surgery, University of Utah, School of Medicine, Salt Lake City, UT
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Moore E, Wohlauer MV, Dorosh J, Kabeil M, Malgor RD, O'Banion LA, Lopez-Pena G, Gillette R, Colborn K, Cuff RF, Lucero L, Ali A, Koleilat I, Batarseh P, Talathi S, Rivera A, Humphries MD, Ly K, Harroun N, Smith BK, Darelli-Anderson AM, Choudhry A, Hammond E, Costanza M, Khetarpaul V, Cosentino A, Watson J, Afifi R, Mouawad NJ, Tan TW, Sharafuddin M, Quevedo JP, Nkansah R, Shibale P, Shalhub S, Lin JC. Impact of COVID-19 on patients undergoing scheduled procedures for chronic venous disease. Vascular 2024:17085381241240679. [PMID: 38520224 DOI: 10.1177/17085381241240679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Abstract
OBJECTIVE The COVID-19 pandemic has drastically altered the medical landscape. Various strategies have been employed to preserve hospital beds, personal protective equipment, and other resources to accommodate the surges of COVID-19 positive patients, hospital overcapacities, and staffing shortages. This has had a dramatic effect on vascular surgical practice. The objective of this study is to analyze the impact of the COVID-19 pandemic on surgical delays and adverse outcomes for patients with chronic venous disease scheduled to undergo elective operations. METHODS The Vascular Surgery COVID-19 Collaborative (VASCC) was founded in March 2020 to evaluate the outcomes of patients with vascular disease whose operations were delayed. Modules were developed by vascular surgeon working groups and tested before implementation. A data analysis of outcomes of patients with chronic venous disease whose surgeries were postponed during the COVID-19 pandemic from March 2020 through February 2021 was performed for this study. RESULTS A total of 150 patients from 12 institutions in the United States were included in the study. Indications for venous intervention were: 85.3% varicose veins, 10.7% varicose veins with venous ulceration, and 4.0% lipodermatosclerosis. One hundred two surgeries had successfully been completed at the time of data entry. The average length of the delay was 91 days, with a median of 78 days. Delays for venous ulceration procedures ranged from 38 to 208 days. No patients required an emergent intervention due to their venous disease, and no patients experienced major adverse events following their delayed surgeries. CONCLUSIONS Interventions may be safely delayed for patients with venous disease requiring elective surgical intervention during the COVID-19 pandemic. This finding supports the American College of Surgeons' recommendations for the management of elective vascular surgical procedures. Office-based labs may be safe locations for continued treatment when resources are limited. Although the interventions can be safely postponed, the negative impact on quality of life warrants further investigation.
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Affiliation(s)
- Ethan Moore
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Max V Wohlauer
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - James Dorosh
- Deparment of Surgery, McLaren Greater Lansing at Michigan State University, East Lansing, MI, USA
| | - Mahmood Kabeil
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Rafael D Malgor
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Leigh A O'Banion
- Department of Surgery, University of California San Francisco Fresno, Fresno, CA, USA
| | - Gabriel Lopez-Pena
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Riley Gillette
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kathryn Colborn
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Robert F Cuff
- Department of Surgery, Spectrum Health/Michigan State University, Grand Rapids, MI, USA
| | - Leah Lucero
- Department of Surgery, University of California San Francisco Fresno, Fresno, CA, USA
| | - Amna Ali
- Department of Surgery, University of California San Francisco Fresno, Fresno, CA, USA
| | - Issam Koleilat
- Department of Surgery, RWJ/Barnabas Health, Toms River, NJ, USA
| | - Paola Batarseh
- Department of Surgery, Jacobi Medical Center, Albert Einstein School of Medicine, Bronx, NY, USA
| | - Sonia Talathi
- Department of Surgery, Jacobi Medical Center, Albert Einstein School of Medicine, Bronx, NY, USA
| | - Aksim Rivera
- Department of Surgery, Jacobi Medical Center, Albert Einstein School of Medicine, Bronx, NY, USA
| | - Misty D Humphries
- Department of Surgery, University of California Davis Health, Sacramento, CA, USA
| | - Kevin Ly
- Department of Surgery, University of California Davis Health, Sacramento, CA, USA
| | - Nikolai Harroun
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Brigitte K Smith
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Asad Choudhry
- Department of Surgery, SUNY Upstate University Hospital, Syracuse, NY, USA
| | - Eric Hammond
- Department of Surgery, SUNY Upstate University Hospital, Syracuse, NY, USA
| | - Michael Costanza
- Department of Surgery, SUNY Upstate University Hospital, Syracuse, NY, USA
| | - Vipul Khetarpaul
- Department of Surgery, Barnes Jewish Hospital, Washington University School of Medicine, St. Louis, MO, USA
| | - Ashley Cosentino
- Department of Surgery, Barnes Jewish Hospital, Washington University School of Medicine, St. Louis, MO, USA
| | - Jacob Watson
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Rana Afifi
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Nicolas J Mouawad
- Department of Vascular and Endovascular Surgery, McLaren Center for Research and Innovation, Bay City, MI, USA
| | - Tze-Woei Tan
- Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Mel Sharafuddin
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Judith P Quevedo
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Reggie Nkansah
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Palcah Shibale
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Sherene Shalhub
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Judith C Lin
- Deparment of Surgery, McLaren Greater Lansing at Michigan State University, East Lansing, MI, USA
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Weaver ML, Sun T, Shickel B, Cox ML, Carter TM, Steinl GK, Johnson CE, Amankwah KS, Cardella JA, Loftus TJ, Smith BK. Gender differences in autonomy and performance assessments in a national cohort of vascular surgery trainees. J Vasc Surg 2024:S0741-5214(24)00498-1. [PMID: 38493897 DOI: 10.1016/j.jvs.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/22/2024] [Accepted: 03/09/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE Gender disparities in surgical training and assessment are described in the general surgery literature. Assessment disparities have not been explored in vascular surgery. We sought to investigate gender disparities in operative assessment in a national cohort of vascular surgery integrated residents (VIRs) and fellows (VSFs). METHODS Operative performance and autonomy ratings from the Society for Improving Medical Professional Learning (SIMPL) application database were collected for all vascular surgery participating institutions from 2018 to 2023. Logistic generalized linear mixed models were conducted to examine the association of faculty and trainee gender on faculty and self-assessment of autonomy and performance. Data were adjusted for post-graduate year and case complexity. Random effects were included to account for clustering effects due to participant, program, and procedure. RESULTS One hundred three trainees (n = 63 VIRs; n = 40 VSFs; 63.1% men) and 99 faculty (73.7% men) from 17 institutions (n = 12 VIR and n = 13 VSF programs) contributed 4951 total assessments (44.4% by faculty, 55.6% by trainees) across 235 unique procedures. Faculty and trainee gender were not associated with faculty ratings of performance (faculty gender: odds ratio [OR], 0.78; 95% confidence interval [CI], 0.27-2.29; trainee gender: OR, 1.80; 95% CI, 0.76-0.43) or autonomy (faculty gender: OR, 0.99; 95% CI, 0.41-2.39; trainee gender: OR, 1.23; 95% CI, 0.62-2.45) of trainees. All trainees self-assessed at lower performance and autonomy ratings as compared with faculty assessments. However, women trainees rated themselves significantly lower than men for both autonomy (OR, 0.57; 95% CI, 0.43-0.74) and performance (OR, 0.40; 95% CI, 0.30-0.54). CONCLUSIONS Although gender was not associated with differences in faculty assessment of performance or autonomy among vascular surgery trainees, women trainees perceive themselves as performing with lower competency and less autonomy than their male colleagues. These findings suggest utility for exploring gender differences in real-time feedback delivered to and received by trainees and targeted interventions to align trainee self-perception with actual operative performance and autonomy to optimize surgical skill acquisition.
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Affiliation(s)
- M Libby Weaver
- Division of Vascular and Endovascular Surgery, University of Virginia School of Medicine, Charlottesville, VA.
| | - Ting Sun
- Division of Vascular Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Benjamin Shickel
- Department of Medicine, University of Florida Health, Gainesville, FL
| | - Morgan L Cox
- Division of Vascular Surgery, Piedmont Healthcare, Atlanta, GA
| | - Taylor M Carter
- Department of Surgery, University of North Carolina School of Medicine, Raleigh, NC
| | - Gabrielle K Steinl
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - Cali E Johnson
- Division of Vascular Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Kwame S Amankwah
- Division of Vascular and Endovascular Surgery, University of Connecticut School of Medicine, Farmington, CT
| | - Jonathan A Cardella
- Division of Vascular Surgery and Endovascular Therapy, Yale School of Medicine, New Haven, CT
| | - Tyler J Loftus
- Department of Surgery, University of Florida Health, Gainesville, FL
| | - Brigitte K Smith
- Division of Vascular Surgery, University of Utah School of Medicine, Salt Lake City, UT
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Smith BK, Yamazaki K, Tekian A, Brooke BS, Mitchell EL, Park YS, Holmboe ES, Hamstra SJ. Accreditation Council for Graduate Medical Education Milestone Training Ratings and Surgeons' Early Outcomes. JAMA Surg 2024:2816274. [PMID: 38477914 PMCID: PMC10938242 DOI: 10.1001/jamasurg.2024.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/08/2023] [Indexed: 03/14/2024]
Abstract
Importance National data on the development of competence during training have been reported using the Accreditation Council for Graduate Medical Education (ACGME) Milestones system. It is now possible to consider longitudinal analyses that link Milestone ratings during training to patient outcomes data of recent graduates. Objective To evaluate the association of in-training ACGME Milestone ratings in a surgical specialty with subsequent complication rates following a commonly performed operation, endovascular aortic aneurysm repair (EVAR). Design, Setting, and Participants This study of patient outcomes followed EVAR in the Vascular Quality Initiative (VQI) registry (4213 admissions from 208 hospitals treated by 327 surgeons). All surgeons included in this study graduated from ACGME-accredited training programs from 2015 through 2019 and had Milestone ratings 6 months prior to graduation. Data were analyzed from December 1, 2021, through September 15, 2023. Because Milestone ratings can vary with program, they were corrected for program effect using a deviation score from the program mean. Exposure Milestone ratings assigned to individual trainees 6 months prior to graduation, based on judgments of surgical competence. Main Outcomes and Measures Surgical complications following EVAR for patients treated by recent graduates during the index hospitalization, obtained using the nationwide Society for Vascular Surgery Patient Safety Organization's VQI registry, which includes 929 participating centers in 49 US states. Results The study included outcomes for 4213 patients (mean [SD] age, 73.25 [8.74] years; 3379 male participants [80.2%]). Postoperative complications included 9.5% major (400 of 4213 cases) and 30.2% minor (1274 of 4213 cases) complications. After adjusting for patient risk factors and site of training, a significant association was identified between individual Milestone ratings of surgical trainees and major complications in early surgical practice in programs with lower mean Milestone ratings (odds ratio, 0.50; 95% CI; 0.27-0.95). Conclusions and Relevance In this study, Milestone assessments of surgical trainees were associated with subsequent clinical outcomes in their early career. Although these findings represent one surgical specialty, they suggest Milestone ratings can be used in any specialty to identify trainees at risk for future adverse patient outcomes when applying the same theory and methodology. Milestones data should inform data-driven educational interventions and trainee remediation to optimize future patient outcomes.
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Affiliation(s)
| | - Kenji Yamazaki
- Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Ara Tekian
- Department of Medical Education, University of Illinois College of Medicine, Chicago
| | - Benjamin S Brooke
- Division of Vascular Surgery, Department of Surgery, School of Medicine, University of Utah, Salt Lake City
| | | | - Yoon Soo Park
- Department of Medical Education, University of Illinois College of Medicine, Chicago
| | - Eric S Holmboe
- Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Stanley J Hamstra
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Holland Bone and Joint Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Fereydooni A, Fisher AT, Mullis DM, Smith BK, Sgroi MD. Impact of Integrated Vascular Surgery Residency Training Pathway and Professional Development Time on Career Choice and Research Productivity. J Surg Educ 2024; 81:295-303. [PMID: 38105151 DOI: 10.1016/j.jsurg.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 08/24/2023] [Accepted: 10/13/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE The limited availability of academic surgery positions has led to increased competition for these jobs. Integrated vascular surgery residency (IVSR) allows for earlier specialization, with some programs providing professional development time (PDT). We hypothesized that IVSR and PDT lead to academic employment and increased research productivity. DESIGN This is a retrospective study of vascular surgery fellowship (VSF) and IVSR graduates. SETTING Training, number of publications, H-index, NIH funding, and employment history were collected using institutional websites, Doximity, Scopus, PubMed, and NIH Research Portfolio Reporting. PARTICIPANTS After a review of the research protocol, the Association of Program Directors in Vascular Surgery (APDVS) provided a list of vascular surgery fellowship (VSF) and IVSR graduates. METHODS After review of the research protocol, the Association of Program Directors in Vascular Surgery (APDVS) provided a list of vascular surgery fellowship (VSF) and IVSR graduates. Training, number of publications, H-index, NIH funding, and employment history were collected using institutional websites, Doximity, Scopus, PubMed, and NIH Research Portfolio Reporting. RESULTS From 2013-2017, comparison of IVSR (n=131) to VSF (n=603) graduates showed that IVSR graduates were more likely to be women (38.17% vs 28.19%; p = 0.024), be MD graduates (99.24% vs 93.37%; p = 0.008), attended programs in the northeast (41.98% vs 27.5%; p < 0.001), have advanced degrees (13.74% vs 6.97%; p = 0.01) and graduate from larger programs (median 15 vs 14 faculty; p = 0.013). There was no significant difference in number of publications per trainee by the end of training (median 4 vs 3; P=0.61) or annual trend in average number of publications. After training, there was no significant difference in the type of practice, academic affiliation, practice region, publication number, H-index, NIH funding, level of academic appointment, or leadership positions. From 2013-2019, a comparison of IVSR graduates with (n=32) and without PDT (n=190) demonstrated that those with PDT were more likely to be women (53.13% vs 34.74%; p = 0.038), have advanced degrees (28.12% vs 8.95%; p = 0.002), be at larger programs (median 14 vs 9 faculty; p < 0.001), train at a top 10 NIH funded program (65.62% vs 21.58%; p < 0.001) and publish more by the end of IVSR (median 9 vs 3; p < 0.001). Graduates with PDT were more likely to have academic employment and affiliation, a higher yearly publication rate, and greater H-index. CONCLUSION IVSR and VSF graduates have comparable academic employment and research productivity. However, PDT during IVSR correlates with an eventual academic career and greater research productivity. This study supports the importance of PDT in developing academic vascular surgeons. It remains necessary to continue both IVSR and VSF training paradigms as healthcare needs of the population are met through both academic and non-academic surgeons.
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Affiliation(s)
- Arash Fereydooni
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California.
| | - Andrea T Fisher
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Danielle M Mullis
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Brigitte K Smith
- Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Michael D Sgroi
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California.
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Weaver ML, Carter T, Yamazaki K, Hamstra SJ, Holmboe E, Chaer R, Park YS, Smith BK. The Association of ACGME Milestones With Performance on American Board of Surgery Assessments: A National Investigation of Surgical Trainees. Ann Surg 2024; 279:180-186. [PMID: 37436889 DOI: 10.1097/sla.0000000000005998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
OBJECTIVE To determine the relationship between, and predictive utility of, milestone ratings and subsequent American Board of Surgery (ABS) vascular surgery in-training examination (VSITE), vascular qualifying examination (VQE), and vascular certifying examination (VCE) performance in a national cohort of vascular surgery trainees. BACKGROUND Specialty board certification is an important indicator of physician competence. However, predicting future board certification examination performance during training continues to be challenging. METHODS This is a national longitudinal cohort study examining relational and predictive associations between Accreditation Council for Graduate Medical Education (ACGME) Milestone ratings and performance on VSITE, VQE, and VCE for all vascular surgery trainees from 2015 to 2021. Predictive associations between milestone ratings and VSITE were conducted using cross-classified random-effects regression. Cross-classified random-effects logistic regression was used to identify predictive associations between milestone ratings and VQE and VCE. RESULTS Milestone ratings were obtained for all residents and fellows(n=1,118) from 164 programs during the study period (from July 2015 to June 2021), including 145,959 total trainee assessments. Medical knowledge (MK) and patient care (PC) milestone ratings were strongly predictive of VSITE performance across all postgraduate years (PGYs) of training, with MK ratings demonstrating a slightly stronger predictive association overall (MK coefficient 17.26 to 35.76, β = 0.15 to 0.23). All core competency ratings were predictive of VSITE performance in PGYs 4 and 5. PGY 5 MK was highly predictive of VQE performance [OR 4.73, (95% CI, 3.87-5.78), P <0.001]. PC subcompetencies were also highly predictive of VQE performance in the final year of training [OR 4.14, (95% CI, 3.17-5.41), P <0.001]. All other competencies were also significantly predictive of first-attempt VQE pass with ORs of 1.53 and higher. PGY 4 ICS ratings [OR 4.0, (95% CI, 3.06-5.21), P <0.001] emerged as the strongest predictor of VCE first-attempt pass. Again, all subcompetency ratings remained significant predictors of first-attempt pass on CE with ORs of 1.48 and higher. CONCLUSIONS ACGME Milestone ratings are highly predictive of future VSITE performance, and first-attempt pass achievement on VQE and VCE in a national cohort of surgical trainees.
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Affiliation(s)
- M Libby Weaver
- Division of Vascular and Endovascular Surgery, University of Virginia, Charlottesville, VA
| | - Taylor Carter
- Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Kenji Yamazaki
- Accreditation Council for Graduate Medical Education, Chicago, IL
| | - Stanley J Hamstra
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Eric Holmboe
- Accreditation Council for Graduate Medical Education, Chicago, IL
| | - Rabih Chaer
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Yoon Soo Park
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Brigitte K Smith
- Division of Vascular Surgery, University of Utah, Salt Lake City, UT
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Fisher AT, Fereydooni A, Mullis DM, Smith BK, Sgroi MD. Individual and Program-Related Predictors of Academic Vascular Surgery Practice. Ann Vasc Surg 2023; 97:121-128. [PMID: 37454896 DOI: 10.1016/j.avsg.2023.06.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/23/2023] [Accepted: 06/30/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Several studies have explored factors affecting academic employment in surgical subspecialties; however, vascular surgery has not yet been investigated. We examined which elements of surgical training predict future academic productivity and studied characteristics of NIH-funded vascular surgery attendings. METHODS With approval from the Association of Program Directors in Vascular Surgery (APDVS), the database of recent vascular surgery fellowship (VSF) and integrated vascular surgery residency (IVSR) graduates was obtained, and public resources (Doximity, Scopus, PubMed, NIH, etc.) were queried for research output during and after training, completion of dedicated research years, individual and program NIH funding, current practice setting, and academic rank. Adjusted multivariate regression analyses were conducted for postgraduate academic productivity. RESULTS From 2013 to 2017, there were 734 graduates. Six hundred three completed VSF and 131 IVSR; 220 (29%) were female. Academic employment was predicted by MD degree, advanced degree, training at a top NIH-funded program, number publications by end of training, and H-index. Dedicated research time before or during vascular training, advanced degree, or graduating from a top NIH-funded program were predictors of publishing >1 paper/year. Number of publications by end of training and years in practice were predictive of H-index ≥5. VSF versus IVSR pathway did not have an impact on future academic employment, annual publication rate as an attending, or H-index. Characterization of NIH-funded attendings showed that they often completed dedicated research time (72%) and trained at a top NIH-funded program (79%). Mean publications by graduation among this group was 15.82 ± 11.3, and they averaged 4.31 ± 4.2 publications/year as attendings. CONCLUSIONS Research output during training, advanced degrees, and training at a top NIH-funded program predict an academic vascular surgery career. VSF and IVSR constitute equally valid paths to productive academic careers.
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Affiliation(s)
- Andrea T Fisher
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stanford University, School of Medicine, Stanford, CA.
| | - Arash Fereydooni
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stanford University, School of Medicine, Stanford, CA
| | - Danielle M Mullis
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stanford University, School of Medicine, Stanford, CA
| | - Brigitte K Smith
- Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Michael D Sgroi
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stanford University, School of Medicine, Stanford, CA
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Cox ML, Weaver ML, Johnson C, Chen X, Carter T, Yee CC, Coleman DM, Sgroi MD, George BC, Smith BK. Early findings and strategies for successful implementation of SIMPL workplace-based assessments within vascular surgery residency and fellowship programs. J Vasc Surg 2023; 78:806-814.e2. [PMID: 37164236 DOI: 10.1016/j.jvs.2023.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/13/2023] [Accepted: 04/30/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE As medical education systems increasingly move toward competency-based training, it is important to understand the tools available to assess competency and how these tools are utilized. The Society for Improving Medical Professional Learning (SIMPL) offers a smart phone-based assessment system that supports workplace-based assessment of residents' and fellows' operative autonomy, performance, and case complexity. The purpose of this study was to characterize implementation of the SIMPL app within vascular surgery integrated residency (0+5) and fellowship (5+2) training programs. METHODS SIMPL operative ratings recorded between 2018 and 2022 were collected from all participating vascular surgery training institutions (n = 9 institutions with 5+2 and 0+5 programs; n = 4 institutions with 5+2 program only). The characteristics of programs, trainees, faculty, and SIMPL operative assessments were evaluated using descriptive statistics. RESULTS Operative assessments were completed for 2457 cases by 85 attendings and 86 trainees, totaling 4615 unique operative assessment ratings. Attendings included dictated feedback in 52% of assessments. Senior-level residents received more assessments than junior-level residents (postgraduate year [PGY]1-3, n = 439; PGY4-5, n = 551). Performance ratings demonstrated increases from junior to senior trainees for both resident and fellow cohorts with "performance-ready" or "exceptional performance" ratings increasing by nearly two-fold for PGY1 to PGY5 residents (28.1% vs 40.6%), and from first- to second-year fellows (PGY6, 46.7%; PGY7, 60.3%). Similar gains in autonomy were demonstrated as trainees progressed through training. Senior residents were more frequently granted autonomy with "supervision only" than junior residents (PGY1, 8.7%; PGY5, 21.6%). "Supervision only" autonomy ratings were granted to 21.8% of graduating fellows. Assessment data included a greater proportion of complex cases for senior compared with junior fellows (PGY6, 20.9% vs PGY7, 26.5%). Program Directors felt that faculty and trainee buy-in were the main barriers to implementation of the SIMPL assessment app. CONCLUSIONS This is the first description of the SIMPL app as an operative assessment tool within vascular surgery that has been successfully implemented in both residency and fellowship programs. The assessment data demonstrates expected progressive gains in trainees' autonomy and performance, as well as increasing case complexity, across PGY years. Given the selection of SIMPL as the assessment platform for required American Board of Surgery and Vascular Surgery Board Entrustable Professional Activities assessments, understanding facilitators and barriers to implementation of workplace-based assessments using this app is imperative, particularly as we move toward competency-based medical education.
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Affiliation(s)
- Morgan L Cox
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Florida, Gainesville, FL.
| | - M Libby Weaver
- Vascular and Endovascular Surgery Division, University of Virginia Department of Surgery, University of Virginia, Charlottesville, VA
| | - Cali Johnson
- Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Xilin Chen
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Taylor Carter
- Division of General Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Chia Chye Yee
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Dawn M Coleman
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC
| | - Michael D Sgroi
- Division of Vascular and Endovascular Surgery, Stanford University, Stanford, CA
| | - Brian C George
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Brigitte K Smith
- Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
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Bleicher J, Johnson JE, Cain BT, Shaw RD, Acher AA, Gleason L, Barth RJ, Chu DI, Jung S, Melnick D, Kaphingst KA, Smith BK, Huang LC. Surgical Trainee Perspectives on the Opioid Crisis: The Influence of Explicit and Hidden Curricula. J Surg Educ 2023; 80:786-796. [PMID: 36890045 DOI: 10.1016/j.jsurg.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 02/16/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE In order to effectively create and implement an educational program to improve opioid prescribing practices, it is important to first consider the unique perspectives of residents on the frontlines of the opioid epidemic. We sought to better understand resident perspectives on opioid prescribing, current practices in pain management, and opioid education as a needs assessment for designing future educational interventions. DESIGN This is a qualitative study using focus groups of surgical residents at 4 different institutions. SETTING We conducted focus groups using a semistructured interview guide in person or over video conferencing. The residency programs selected for participation represent a broad geographic range and varying residency sizes. PARTICIPANTS We used purposeful sampling to recruit general surgery residents from the University of Utah, University of Wisconsin, Dartmouth-Hitchcock Medical Center, and the University of Alabama at Birmingham. All general surgery residents at these locations were eligible for inclusion. Participants were assigned to focus groups by residency site and their status as junior (PGY-2, PGY-3) or senior resident (PGY-4, PGY-5). RESULTS We completed 8 focus groups with a total of 35 residents included. We identified 4 main themes. First, residents relied on clinical and nonclinical factors when making decisions about opioid prescribing. However, hidden curricula based on unique institutional cultures and attending preferences heavily influenced residents' prescribing practices. Second, residents acknowledged that stigma and biases towards certain patient groups influenced opioid prescribing practices. Third, residents encountered barriers within their health systems to evidence-based opioid prescribing. Fourth, residents did not routinely receive formal education on pain management or opioid prescribing. Residents recommended several interventions to improve the current state of opioid prescribing, including standardized prescribing guidelines, improved patient education, and formal training during the first year of residency. CONCLUSIONS Our study highlighted several areas of opioid prescribing that can be improved upon through educational interventions. These findings can be used to develop programs aimed at improving residents' opioid prescribing practices, both during and after training, and ultimately the safe care of surgical patients. ETHICS STATEMENT This project was approved by the University of Utah Institutional Review Board, ID # 00118491. All participants provided written informed consent.
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Affiliation(s)
- Josh Bleicher
- Department of Surgery, University of Utah, Salt Lake City, Utah.
| | | | - Brian T Cain
- Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Robert D Shaw
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Alexandra A Acher
- Department of Surgery, University of Utah, Salt Lake City, Utah; Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Lauren Gleason
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Richard J Barth
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Daniel I Chu
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Sarah Jung
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - David Melnick
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Kimberly A Kaphingst
- Department of Communication, Unversity of Utah and Huntsman Cancer Institute, Salt Lake City, Utah
| | | | - Lyen C Huang
- Department of Surgery, University of Utah, Salt Lake City, Utah; Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah
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Smith BK, Mitchell EL. Challenges and opportunities for evidence-based training in vascular surgery. J Vasc Surg 2023; 77:1531-1532. [PMID: 37087150 DOI: 10.1016/j.jvs.2023.01.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 04/24/2023]
Affiliation(s)
| | - Erica L Mitchell
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN
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Alnahhal KI, Lyden SP, Caputo FJ, Sorour AA, Rowe VL, Colglazier JJ, Smith BK, Shames ML, Kirksey L. The USMLE® STEP 1 Pass or Fail Era of the Vascular Surgery Residency Application Process: Implications for Structural Bias and Recommendations. Ann Vasc Surg 2023:S0890-5096(23)00239-X. [PMID: 37120072 DOI: 10.1016/j.avsg.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 05/01/2023]
Abstract
MOTIVES BEHIND THE SHIFT USMLE® STEP 1 score reporting has been changed to a binary pass/fail format since January 26, 2022. The motives behind this change were (1) the questionable validity of using USMLE® STEP 1 as a screening tool during the candidate selection process and (2) the negative impact of using standardized examination scores as an initial gatekeeping threshold for the underrepresented in medicine (URiM) candidates applying to GME programs, given their generally lower mean standardized exams scores compared to non-URiM students. The USMLE® administrators justified this change as a tactic to enhance the overall educational experience for all students and to increase the representation of URiM groups. Moreover, they advised the program directors (PDs) to give more attention to other important qualities and components such as the applicant's personality traits, leadership roles and other extracurricular accomplishments, as part of a holistic evaluation strategy. IMPACT OF USMLE® STEP 1 PASS/FAIL: At this early stage, it is unclear how this change will impact Vascular Surgery Integrated residency (VSIR) programs. Several questions are outstanding, most importantly, how VSIR PDs will evaluate applicants absent the variable which heretofore was the primary screening tool. Our previously published survey showed that VSIR PDs will move their attention to other measures such as USMLE® STEP 2CK and letters of recommendation during the VSIR selection process. Furthermore, more emphasis on subjective measures such as the applicant's medical school rank and extracurricular student activities is expected. Given the expected higher weight of USMLE® STEP 2CK in the selection process than ever, many anticipate that medical students will dedicate more of their limited time to its preparation at the expense of both clinical and non-clinical activities. Potentially leaving less time to explore specialty pathways and to determine whether VS is the appropriate career for them. A FRAMEWORK FOR CANDIDATE EVALUATION The critical juncture in the VSIR candidate evaluation paradigm presents an opportunity to thoughtfully transform the process via current (Standardized Letter of Recommendation, USMLE® STEP 2CK, and clinical research) and future (Emotional Intelligence, Structure Interview and Personality Assessment) measures which constitute a framework to follow in the USMLE® STEP 1 pass/fail era.
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Affiliation(s)
- Khaled I Alnahhal
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland
| | - Sean P Lyden
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland
| | - Francis J Caputo
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland
| | - Ahmed A Sorour
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland
| | - Vincent L Rowe
- Division of Vascular and Endovascular Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles
| | - Jill J Colglazier
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester
| | - Brigitte K Smith
- Department of Surgery, Division of Vascular Surgery, University of Utah, Salt Lake City
| | - Murray L Shames
- Division of Vascular Surgery, University of South Florida School of Medicine, Tampa
| | - Lee Kirksey
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland.
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Smith BK, Yamazaki K, Tekian A, Holmboe E, Hamstra SJ, Mitchell EL, Park YS. The Use of Learning Analytics to Enable Detection of Underperforming Trainees: An Analysis of National Vascular Surgery Trainee ACGME Milestones Assessment Data. Ann Surg 2023; 277:e971-e977. [PMID: 35129524 DOI: 10.1097/sla.0000000000005243] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aims to investigate at-risk scores of semiannual Accreditation Council for Graduate Medical Education (ACGME) Milestone ratings for vascular surgical trainees' final achievement of competency targets. SUMMARY BACKGROUND DATA ACGME Milestones assessments have been collected since 2015 for Vascular Surgery. It is unclear whether milestone ratings throughout training predict achievement of recommended performance targets upon graduation. METHODS National ACGME Milestones data were utilized for analyses. All trainees completing 2-year vascular surgery fellowships in June 2018 and 5-year integrated vascular surgery residencies in June 2019 were included. A generalized estimating equations model was used to obtain at-risk scores for each of the 31 subcompetencies by semiannual review periods, to estimate the probability of trainees achieving the recommended graduation target based on their previous ratings. RESULTS A total of 122 vascular surgery fellows (VSFs) (95.3%) and 52 integrated vascular surgery residents (IVSRs) (100%) were included. VSFs and IVSRs did not achieve level 4.0 competency targets at a rate of 1.6% to 25.4% across subcompetencies, which was not significantly different between the 2 groups for any of the subcompetencies ( P = 0.161-0.999). Trainees were found to be at greater risk of not achieving competency targets when lower milestone ratings were assigned, and at later time-points in training. At a milestone rating of 2.5, with 1 year remaining before graduation, the at-risk score for not achieving the target level 4.0 milestone ranged from 2.9% to 77.9% for VSFs and 33.3% to 75.0% for IVSRs. CONCLUSION The ACGME Milestones provide early diagnostic and predictive information for vascular surgery trainees' achievement of competence at completion of training.
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Affiliation(s)
- Brigitte K Smith
- Division of Vascular Surgery, Department of Surgery, University of Utah, School of Medicine, Salt Lake City, UT
| | - Kenji Yamazaki
- Accreditation Council for Graduate Medical Education, Chicago, IL
| | - Ara Tekian
- University of Illinois-Chicago Department of Medical Education, Chicago, IL
| | - Eric Holmboe
- Accreditation Council for Graduate Medical Education, Chicago, IL
| | - Stanley J Hamstra
- Accreditation Council for Graduate Medical Education, Chicago, IL
- University of Toronto, Department of Surgery
| | - Erica L Mitchell
- Department of Surgery, University of Tennessee Health & Science Center, Vascular and Endovascular Surgery, Regional One Health Medical Center, Memphis, TN
| | - Yoon Soo Park
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
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13
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Fereydooni A, Fisher AT, Mullis DM, Smith BK, Sgroi MD. Impact of Integrated Vascular Surgery Residency Training Pathway and Professional Development Time on Career Choice and Research Productivity. J Vasc Surg 2023. [DOI: 10.1016/j.jvs.2022.12.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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DeAngelo MM, Holeman TA, Peacock JB, Smith BK, Kraiss LW, Hales JB, Maloney M, Brooke BS. Impact of frailty on risk of long-term functional decline following vascular surgery. J Vasc Surg 2023; 77:515-522. [PMID: 36007843 PMCID: PMC9868047 DOI: 10.1016/j.jvs.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/06/2022] [Accepted: 08/13/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Frailty is a clinical syndrome associated with slow recovery after vascular surgery. However, the degree and length of functional impairment frail patients experience after surgery is unclear. The objective of this study was to prospectively measure changes in functional status among frail and non-frail patients undergoing a spectrum of different vascular surgery procedures. METHODS Patients consented to undergo elective minor and major vascular surgery procedures at an academic medical center between May 2018 and March 2019 were prospectively identified. Prior to surgery, all patients underwent provider assessment of frailty using the validated Clinical Frailty Scale (CFS), as well as baseline assessment of functional status using the Katz Activities of Daily Living (ADL) index and the Lawton Instrumental Activities of Daily Living (iADL) index. These same instruments were used to evaluate each patient's functional status at 2-weeks, 1-month, 1-year, and 2-year time points following surgery. Changes in iADL and ADL scores among frail (CFS ≥5) and non-frail patients were compared using paired Wilcoxon signed-rank tests and logistic regression models. RESULTS A total of 126 patients were assessed before and after minor (55%) and major (45%) vascular procedures, of which 43 patients (34%) were determined to be frail prior to surgery. Frail patients were older and more likely than non-frail patients to have medical comorbidities including chronic kidney disease, chronic obstructive pulmonary disease, or diabetes (all P < .05). When compared with the non-frail cohort, frail patients had significantly lower ADL and iADL scores before surgery and experienced a greater decline in ability to independently complete ADL and iADL activities after surgery that was sustained at 2 years (P < .05 and P < .001, respectively). After risk-adjustment, frailty was associated with an increased likelihood of decline in ADLs (odds ratio, 5.4; 95% confidence interval, 1.9-15.4; P < .05) and iADLs (odds ratio, 6.3; 95% confidence interval, 2.6-15.1; P < .001) at 2 years following surgery. CONCLUSIONS Frail patients experience a significant decline in ability to perform ADL and iADLs that persists 2 years following vascular surgery. These data highlight the degree of functional decline occurring immediately following surgery, as well as risk for long-term, sustained impairment that should be shared with frail patients before undergoing a procedure.
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Affiliation(s)
- Madeline M DeAngelo
- Division of Vascular Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Teryn A Holeman
- Division of Vascular Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Jordan B Peacock
- Division of Vascular Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Brigitte K Smith
- Division of Vascular Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Larry W Kraiss
- Division of Vascular Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Julie B Hales
- Division of Vascular Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Maria Maloney
- Division of Vascular Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Benjamin S Brooke
- Division of Vascular Surgery, University of Utah School of Medicine, Salt Lake City, UT.
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Mitzman B, Smith BK, Varghese TK. Resident Training in Robotic Thoracic Surgery. Thorac Surg Clin 2023; 33:25-32. [DOI: 10.1016/j.thorsurg.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Sorour AA, Kirksey L, Caputo FJ, Dehaini H, Bena J, Rowe VL, Colglazier JJ, Smith BK, Shames ML, Lyden SP. Vascular surgery integrated resident selection criteria in the pass or fail era. J Vasc Surg 2023; 77:625-631.e8. [PMID: 36007844 DOI: 10.1016/j.jvs.2022.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/12/2022] [Accepted: 08/15/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Vascular surgery integrated residency (VSIR) programs are highly competitive; however, criteria for resident selection remain opaque and non-standardized. The already unclear selection criteria will be further impacted by the impending transition of the United States Medical Licensing Examination (USMLE) Step 1 from numeric scores to a binary pass/fail outcome. The purpose of this study was to investigate the historical and anticipated selection criteria of VSIR applicants. METHODS This was a cross-sectional, nationwide, 59-item survey that was sent to all VSIR program directors (PDs). Data was analyzed using the Fisher exact test if categorical and the Mann-Whitney U test and the Kruskal-Wallis test if ordinal. RESULTS Forty of 69 PDs (58%) responded to the survey. University-based programs constituted 85% of responders. Most VSIR PDs (65%) reported reviewing between 101 to 150 applications for 1 to 2 positions annually. Forty-two percent of the responding PDs reported sole responsibility for inviting applicants to interview, whereas 50% had a team of faculty responsible for reviewing applications. On a five-point Likert scale, letters of recommendation (LOR) from vascular surgeons or colleagues (a person the PD knows) were the most important objective criteria. Work within a team structure was rated highest among subjective criteria. The majority of respondents (72%) currently use the Step 1 score as a primary method to screen applicants. Regional differences in use of Step 1 score as a primary screening method were: Midwest (100%), Northeast (76%), South (43%), and West (40%) (P = .01). PDs responded that that they will use USMLE Step 2 score (42%) and LOR (10%) to replace USMLE Step 1 score. The current top ranked selection criteria are letters from a vascular surgeon, USMLE Step 1 score and overall LOR. The proposed top ranked selection criteria after transition of USMLE Step 1 to pass/fail include LOR overall followed by Step 2 score. CONCLUSIONS This is the first study to evaluate the selection criteria used by PDs for VSIR. The landscape of VSIR selection criteria is shifting and increasing transparency is essential to applicants' understanding of the selection process. The transition of USMLE Step 1 to a pass/fail report will shift the attention to Step 2 scores and elevate the importance of other relatively more subjective criteria. Defining VSIR program selection criteria is an important first step toward establishing holistic review processes that are transparent and equitable.
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Affiliation(s)
- Ahmed A Sorour
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Aortic Center, Cleveland Clinic, Cleveland, OH
| | - Levester Kirksey
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Aortic Center, Cleveland Clinic, Cleveland, OH.
| | - Francis J Caputo
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Aortic Center, Cleveland Clinic, Cleveland, OH
| | - Hassan Dehaini
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Aortic Center, Cleveland Clinic, Cleveland, OH
| | - James Bena
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Aortic Center, Cleveland Clinic, Cleveland, OH
| | - Vincent L Rowe
- Keck School of Medicine at the University of Southern California, Department of Vascular Surgery, Los Angeles, CA
| | - Jill J Colglazier
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Brigitte K Smith
- Department of Surgery, Division of Vascular Surgery, University of Utah, Salt Lake City, UT
| | - Murray L Shames
- Division of Vascular Surgery, University of South Florida School of Medicine, Tampa, FL
| | - Sean P Lyden
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Aortic Center, Cleveland Clinic, Cleveland, OH
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Fisher AT, Fereydooni A, Mullis DM, Smith BK, Sgroi MD. Individual And Program-related Predictors Of Academic Vascular Surgery Practice. Ann Vasc Surg 2023. [DOI: 10.1016/j.avsg.2022.12.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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He JJ, Horns JJ, Kraiss LW, Smith BK, Griffin CL, DeMartino RR, Sarfati MR, Brooke BS. High-intensity statin therapy reduces risk of amputation and reintervention among patients undergoing lower extremity bypass for chronic limb-threatening ischemia. Eur J Vasc Endovasc Surg 2023. [DOI: 10.1016/j.ejvs.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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He JJ, Horns JJ, Kraiss LW, Smith BK, Griffin CL, DeMartino RR, Sarfati MR, Brooke BS. High-intensity statin therapy reduces risk of amputation and reintervention among patients undergoing lower extremity bypass for chronic limb-threatening ischemia. J Vasc Surg 2023; 77:497-505. [PMID: 36115522 DOI: 10.1016/j.jvs.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/29/2022] [Accepted: 09/06/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Statins are considered standard-of-care medical therapy for patients undergoing lower extremity bypass (LEB) procedures for chronic limb-threatening ischemia (CLTI). It is unclear, however, whether up-titrating and maintaining patients on higher-intensity statin medications following LEB improves limb salvage outcomes. This study was designed to evaluate whether high-intensity statin therapy impacts the risk of amputation and reintervention following LEB for patients with CLTI. METHODS The IBM MarketScan database was used to identify adult patients (18-99 years old) who underwent a LEB for CLTI between 2008 and 2017. Patients lacking insurance covering drug reimbursement or those who already had undergone amputation before time of bypass were excluded. Using pharmacy claims and national drug codes to define statin intensity, patients were stratified into three groups: high-intensity, low-intensity, and limited statin therapy. The association between intensity of statin therapy and need for reintervention and/or major amputation after LEB was analyzed using Kaplan-Meier curves and risk-adjusted Cox proportional hazard models. RESULTS A total of 25,907 patients who underwent LEB for CLTI were identified, of which 6696 (26%) were maintained on high-dose statins, 9297 (36%) were on low-dose statins, and 9914 (38%) had inconsistent pharmacy claims for statin therapy after surgery. Patients on high-intensity statins were, on average, younger and more likely to be male with comorbid disease (diabetes, hypertension, hyperlipidemia, obesity, renal insufficiency, ischemic heart disease, cerebrovascular disease, and tobacco abuse) than patients on low-intensity statins or limited statin therapy (P < .001 for all comparisons). Following LEB, 6649 patients (25.6%) required a reintervention, and 2550 patients (9.8%) went on to have a major amputation during follow-up. Patients maintained on high-intensity statins after LEB had a significantly lower likelihood of requiring a reintervention (hazard ratio [HR], 0.48; 95% confidence interval [CI], 0.45-0.51; P < .001) or amputation (HR, 0.27; 95% CI, 0.24-0.30; P < .001) as compared with patients on limited statin therapy. Further, there was a dose-dependent effect for these outcomes relative to patients on low-intensity statins in risk-adjusted models, and it was independent of whether an autologous vein graft was used for the LEB. Finally, among patients who underwent a reintervention, high-dose statin therapy also significantly reduced the HR for subsequent amputation (HR, 0.21; 95% CI, 0.18-0.25; P < .001). CONCLUSIONS Patients with CLTI on high-intensity therapy following LEB had a significantly lower risk of requiring subsequent reintervention and amputation when compared with patients on low-intensity statins or with limited statin use. These data suggest that patients with CLTI should be up-titrated and/or maintained on high-intensity statins following revascularization whenever possible.
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Affiliation(s)
- Jane J He
- Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Joshua J Horns
- Department of Surgery, Surgical Population Analysis Research Core (SPARC), University of Utah School of Medicine, Salt Lake City, UT
| | - Larry W Kraiss
- Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Brigitte K Smith
- Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Claire L Griffin
- Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Randall R DeMartino
- Division of Vascular and Endovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Mark R Sarfati
- Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Benjamin S Brooke
- Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT; Department of Surgery, Surgical Population Analysis Research Core (SPARC), University of Utah School of Medicine, Salt Lake City, UT; Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT.
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Smith BK, Yamazaki K, Luman A, Tekian A, Holmboe E, Mitchell EL, Park YS, Hamstra SJ. Predicting Performance at Graduation From Early ACGME Milestone Ratings: Longitudinal Learning Analytics in Professionalism and Communication in Vascular Surgery. J Surg Educ 2023; 80:235-246. [PMID: 36182635 DOI: 10.1016/j.jsurg.2022.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/14/2022] [Accepted: 09/08/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Program directors in surgical disciplines need more tools from the ACGME to help them use Milestone ratings to improve trainees' performance. This is especially true in competencies that are notoriously difficult to measure, such as professionalism (PROF) and interpersonal and communication skills (ICS). It is now widely understood that skills in these two areas have direct impact on patient care outcomes. This study investigated the potential for generating early predictors of final Milestone ratings within the PROF and ICS competency categories. DESIGN This retrospective cohort study utilized Milestone ratings from all ACGME-accredited vascular surgery training programs, covering residents and fellows who completed training in June 2019. The outcome measure studied was the rate of achieving the recommended graduation target of Milestone Level 4 (possible range: 1-5), while the predictors were the Milestone ratings attained at earlier stages of training. Predictive probability values (PPVs) were calculated for each of the 3 PROF and two ICS sub-competencies to estimate the probability of trainees not reaching the recommended graduation target based on their previous Milestone ratings. SETTING All ACGME-accredited vascular surgery training programs within the United States. PARTICIPANTS All trainees completing a 2 year vascular surgery fellowship (VSF) in June 2019 (n = 119) or a 5 year integrated vascular surgery residency (IVSR) in June 2019 (n = 52) were included in the analyses. RESULTS The overall rate of failing to achieve the recommended graduation target across all PROF and ICS sub-competencies ranged from 7.7% to 21.8% of all trainees. For trainees with a Milestone rating at ≤ 2.5 with 1 year remaining in their training program, the predictive probability of not achieving the recommended graduation target ranged from 37.0% to 71.5% across sub-competencies, with the highest risks observed under PROF for "Administrative Tasks" (71.5%) and under ICS for "Communication with the Healthcare Team" (56.7%). CONCLUSIONS As many as 1 in 4 vascular surgery trainees did not achieve the ACGME vascular surgery Milestones targets for graduation in at least one of the PROF and ICS sub-competencies. Biannual ACGME Milestone assessment ratings of PROF and ICS during early training can be used to predict achievement of competency targets at time of graduation. Early clues to problems in PROF and ICS enable programs to address potential deficits early in training to ensure competency in these essential non-technical skills prior to entering unsupervised practice.
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Affiliation(s)
- Brigitte K Smith
- University of Utah, Department of Surgery, Division of Vascular Surgery, Salt Lake City, Utah.
| | - Kenji Yamazaki
- Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Abigail Luman
- University of Utah, School of Medicine, Salt Lake City, Utah
| | - Ara Tekian
- University of Illinois, Chicago, Department of Medical Education, Chicago, Illinois
| | - Eric Holmboe
- Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Erica L Mitchell
- University of Tennessee Health and Science Center, Vascular and Endovascular Surgery, Regional One Health Medical Center, Memphis, Tennessee
| | - Yoon Soo Park
- University of Illinois, Chicago, Department of Medical Education, Chicago, Illinois
| | - Stanley J Hamstra
- University of Toronto, Department of Surgery, Toronto, Ontario, Canada
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21
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McKinley SK, Altieri MS, Sheppard O, Hendershot K, Williams K, Smith BK. Designing the "match of the future": challenges and proposed solutions in the interview and match phase of the UME-GME transition. Global Surg Educ 2022; 1:69. [PMID: 38013709 PMCID: PMC9670067 DOI: 10.1007/s44186-022-00073-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 11/29/2023]
Abstract
This review focuses on the interview and match process with the purpose of broadly reviewing challenges in the current surgical residency selection process, detailing potential solutions, and identifying future avenues of investigation.
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Affiliation(s)
- Sophia K. McKinley
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - Maria S. Altieri
- Department of Surgery, University of Pennsylvania, Philadelphia, PA USA
| | - Olabisi Sheppard
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE USA
| | | | - Keneeshia Williams
- Department of Surgery, Emory University School of Medicine, Atlanta, GA USA
| | | | - the ASE Graduate Surgical Education Committee
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
- Department of Surgery, University of Pennsylvania, Philadelphia, PA USA
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE USA
- Department of Surgery, University of Alabama, Birmingham, AL USA
- Department of Surgery, Emory University School of Medicine, Atlanta, GA USA
- Department of Surgery, University of Utah, Salt Lake City, UT USA
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22
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Abstract
Psychological safety is known to improve team performance and organizational learning. The related concept of "educational safety" has recently emerged to describe an environment in which learners can unreservedly focus on learning and professional growth, without worrying about the potential repercussions of interpersonal risk-taking. Educational safety is crucial for optimal learning in clinical environments, and yet is difficult to establish due to constant performance assessment, fear of failure, and pervasive hierarchies. In this perspective, we propose a framework for conceptualizing educational safety in surgical learning environments, and explore current threats to educational safety. We also discuss strategies for combating these threats, as well as the importance of further research to evaluate the impact of educational safety on surgical learning outcomes.
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Affiliation(s)
| | - Rachel M Jensen
- Department of Surgery, Stanford University, Stanford, California
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23
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Smith BK, Hamstra SJ, Yamazaki K, Tekian A, Brooke BS, Holmboe E, Mitchell EL, Park YS. Expert Consensus on the Conceptual Alignment of ACGME Competencies with Patient Outcomes After Common Vascular Surgical Procedures. J Vasc Surg 2022; 76:1388-1397. [DOI: 10.1016/j.jvs.2022.06.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/20/2022] [Accepted: 06/28/2022] [Indexed: 10/31/2022]
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24
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Sorour AA, Kirksey L, Caputo FJ, Dehaini H, Rowe VL, Colglazier JJ, Smith BK, Shames ML, Lyden SP. Vascular Surgery Integrated Resident Selection Criteria in the Step 1 Pass/Fail Era: A National Survey of Program Directors. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2022.03.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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25
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He J, Horns JJ, Kraiss LW, Smith BK, Sarfati M, Griffin CL, DeMartino RR, Paudel N, Brooke BS. High-Intensity Statin Therapy Reduces Risk of Amputation and Reintervention Among Patients Undergoing Lower Extremity Bypass for Chronic Limb-Threatening Ischemia. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2022.03.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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26
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Shaw RD, Eid MA, Bleicher J, Broecker J, Caesar B, Chin R, Meyer C, Mitsakos A, Stolarksi AE, Theiss L, Smith BK, Ivatury SJ. Current Barriers in Robotic Surgery Training for General Surgery Residents. J Surg Educ 2022; 79:606-613. [PMID: 34844897 DOI: 10.1016/j.jsurg.2021.11.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/01/2021] [Accepted: 11/06/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To assess the current barriers in robotic surgery training for general surgery residents. DESIGN Multi-institutional web-based survey. SETTING 9 academic medical centers with a general surgery residency. PARTICIPANTS General surgery residents of at least PGY-3 training level. RESULTS 163 general surgery residents were contacted with 80 responses (49.1%). The most common responders were PGY-3s (38.8%) followed by PGY-5s (27.5%). The Northeast represented 42.5% of responses. Colorectal cases were the most common robotic case residents were involved in (51.3%). Residents' typical roles were assisting at the bedside (31.3%) and splitting time between assisting at the bedside and operating at the surgeon console (31.3%). 43% report to be either extremely or somewhat dissatisfied with their robotic surgery experience. 62.5% report they do not intend to integrate robotic surgery into their future practice. 93.8% of residents have a standardized robotic curriculum. 47.5% report using the simulator only during required didactic time with 52.5% having the robotic simulator conveniently located. The majority of residents report that the presence of dual consoles and first-assists in robotic cases enhance their robotic training (93% - 62%, respectively). 72.5% felt like they had more autonomy during laparoscopic cases and 96.8% of residents felt that an attendings' lack of experience impacted their time operating at the surgeon console. CONCLUSIONS General surgery residents report lack of effective OR teaching, real clinical experience, and simulated experience as main barriers in their robotic surgery training. Dual consoles and first-assistants are favorably looked upon. Lack of attending experience and comfort were universally negatively associated with resident participation. For residents interested in robotic surgery, advocating for more robust investment in dual consoles, first-assistants, and faculty development would likely improve their robotic surgery training experience. However, residency programs should consider whether robotic surgery should be a core competency of an already time restricted training paradigm.
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Affiliation(s)
- Robert D Shaw
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
| | - Mark A Eid
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; VA Outcomes Group, VA Quality Scholars Program; Geisel School of Medicine, Hanover, New Hampshire
| | - Josh Bleicher
- Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Justine Broecker
- Department of Surgery, Mayo-Clinic Florida, Jacksonville, Florida
| | - Ben Caesar
- Department of Surgery, Maine Medical Center, Portland, Maine
| | - Ryan Chin
- Department of Surgery, Montefiore Medical Center, New York, New York
| | - Courtney Meyer
- Department of Surgery, Emory University, Atlanta, Georgia
| | | | - Allan E Stolarksi
- Department of Surgery, Boston University | Boston Medical Center, Boston, Massachusetts
| | - Lauren Theiss
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Srinivas J Ivatury
- Department of Surgery and Perioperative Care, The University of Texas at Austin Dell Medical School, Austin, Taxas
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27
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Smith BK, Wilson TW, Perler BA, Allen CM, Presson AP, Brooke BS. Does training paradigm matter? A comparison of outcomes of frail patients treated by integrated vascular surgery residency and vascular surgery fellowship-trained surgeons. Am J Surg 2022; 224:881-887. [DOI: 10.1016/j.amjsurg.2022.04.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 04/08/2022] [Accepted: 04/30/2022] [Indexed: 11/01/2022]
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28
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Smith BK, Yamazaki K, Tekian A, Brooke BS, Holmboe E, Hamstra SJ, Mitchell EL, Park YS. Expert Consensus on the Accreditation Council for Graduate Medical Education Competencies That Align With Vascular Quality Initiative Surgical Outcomes. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2021.12.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Neuberger K, McCrary H, Beckstrom J, Darelli‐Anderson AM, Farrell TW, Brooke BS, Smith BK, Brownson KE. Improving healthcare transitions of surgical care through an
interprofessional
education elective. J Am Geriatr Soc 2022; 70:E11-E14. [DOI: 10.1111/jgs.17670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/09/2021] [Accepted: 12/22/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Kaden Neuberger
- University of Utah School of Medicine Salt Lake City Utah USA
| | - Hilary McCrary
- Division of Otolaryngology – Head and Neck Surgery University of Utah School of Medicine Salt Lake City Utah USA
| | - Julie Beckstrom
- Division of Vascular Surgery University of Utah School of Medicine Salt Lake City Utah USA
| | | | - Timothy W. Farrell
- Division of Geriatrics University of Utah School of Medicine Salt Lake City Utah USA
- VA Salt Lake City Geriatric Research, Education, and Clinical Center Salt Lake City Utah USA
- University of Utah Health Interprofessional Education Program Salt Lake City Utah USA
| | - Benjamin S. Brooke
- Division of Vascular Surgery University of Utah School of Medicine Salt Lake City Utah USA
| | - Brigitte K. Smith
- Division of Vascular Surgery University of Utah School of Medicine Salt Lake City Utah USA
- Office of Surgical Education University of Utah School of Medicine Salt Lake City Utah USA
| | - Kirstyn E. Brownson
- Division of General Surgery University of Utah School of Medicine Salt Lake City Utah USA
- Huntsman Cancer Institute Salt Lake City Utah USA
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30
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DeAngelo M, Hakim A, Darelli-Anderson AM, Harding JP, Smith BK. Medical Student Perspectives on Choosing a Career in Vascular Surgery. Ann Vasc Surg 2021; 83:152-157. [PMID: 34936893 DOI: 10.1016/j.avsg.2021.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/07/2021] [Accepted: 11/17/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Vascular surgery is facing an impending workforce shortage as the population ages and the demand for vascular surgical services increases. The integrated vascular surgery residency (0+5) paradigm is well-established and provides a mechanism to increase the number of board-certified vascular surgeons. Recruitment of medical students to these programs has proven challenging with unfilled positions in each of the past two years. The aim of this study is to explore factors that influence medical students' interest in vascular surgery and their decision to ultimately pursue a career in the field. METHODS Medical students listed on the Society for Vascular Surgery "Find a VSIG (Vascular Surgery Interest Group)" webpage were contacted via email to participate in the study. A snowball sampling technique was employed to recruit additional participants, including recent medical school graduates who had matched into a 0+5 program. Fifteen students participated in 5 focus groups. Directed content analysis was employed to qualitatively analyze focus group transcripts. RESULTS Five domains were identified as influencing students' decision to pursue vascular surgery. Experiential learning facilitated early exploration of the field. The intellectuality of the specialty was a feature that attracted students to vascular surgery. In addition, the professional identify of vascular surgeons as comprehensive care providers was appealing. Students identified with their mentors' relationships as observed during clinical encounters. Long-term mentorship was important in sustaining students' interest. CONCLUSION Medical students pursue a career in vascular surgery based on early exposure to the specialty, experiential learning through hands-on VSIG events, clinical experiences, and longitudinal faculty mentorship. The unique aspects of the specialty, including professional identity and intellectuality, should be highlighted to both attract and maintain students' interest in the field. These findings can be used by national vascular surgery leaders, practicing vascular surgeons, and faculty and student leadership of VSIGs to optimize recruitment programs and increase the vascular surgery workforce.
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Affiliation(s)
| | | | | | | | - Brigitte K Smith
- University of Utah, Department of Surgery, Division of Vascular Surgery.
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31
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Glasgow RE, Mulvihill SJ, Pettit JC, Young J, Smith BK, Vargo DJ, Ray DM, Finlayson SRG. Value Analysis of Methods of Inguinal Hernia Repair. Ann Surg 2021; 274:572-580. [PMID: 34506312 DOI: 10.1097/sla.0000000000005063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Value is defined as health outcomes important to patients relative to cost of achieving those outcomes: Value = Quality/Cost. For inguinal hernia repair, Level 1 evidence shows no differences in long-term functional status or recurrence rates when comparing surgical approaches. Differences in value reside within differences in cost. The aim of this study is to compare the value of different surgical approaches to inguinal hernia repair: Open (Open-IH), Laparoscopic (Lap-IH), and Robotic (R-TAPP). METHODS Variable and fixed hospital costs were compared among consecutive Open-IH, Lap-IH, and R-TAPP repairs (100 each) performed in a university hospital. Variable costs (VC) including direct materials, labor, and variable overhead ($/min operating room [OR] time) were evaluated using Value Driven Outcomes, an internal activity-based costing methodology. Variable and fixed costs were allocated using full absorption costing to evaluate the impact of surgical approach on value. As cost data is proprietary, differences in cost were normalized to Open-IH cost. RESULTS Compared to Open-IH, VC for Lap-IH were 1.02X higher (including a 0.81X reduction in cost for operating room [OR] time). For R-TAPP, VC were 2.11X higher (including 1.36X increased costs for OR time). With allocation of fixed cost, a Lap-IH was 1.03X more costly, whereas R-TAPP was 3.18X more costly than Open-IH. Using equivalent recurrence as the quality metric in the value equation, Lap-IH decreases value by 3% and R-TAPP by 69% compared to Open-IH. CONCLUSIONS Use of higher cost technology to repair inguinal hernias reduces value. Incremental health benefits must be realized to justify increased costs. We expect payors and patients will incorporate value into payment decisions.
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Affiliation(s)
| | | | - Jacob C Pettit
- Department of Decision Support, University of Utah, Salt Lake City, Utah
| | - Jeffrey Young
- Department of Decision Support, University of Utah, Salt Lake City, Utah
| | | | - Daniel J Vargo
- Department of Surgery, University of Utah, Salt Lake City, Utah
| | - David M Ray
- Department of Surgery, University of Utah, Salt Lake City, Utah
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32
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Tang W, Tonna JE, Smith BK, Kraiss LW, Sarfati MR, Griffin CL, Brooke BS. Arterial Duplex Ultrasound Criteria for Predicting Limb Ischemia and Amputation Among Patients Undergoing Femoral Cannulation for Extracorporeal Membrane Oxygenation. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.06.396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Smith BK, Sheahan MG, Sgroi M, Weis T, Singh N, Rigberg D, Coleman DM, Lee JT, Shames ML, Mitchell EL. Addressing Contemporary Management of Vascular Trauma: Optimization of Patient Care Through Collaboration. Ann Surg 2021; 273:e171-e172. [PMID: 33824252 DOI: 10.1097/sla.0000000000004861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Brigitte K Smith
- Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Malachi G Sheahan
- Division of Vascular and Endovascular Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Michael Sgroi
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stanford University, Palo Alto, CA
| | - Tahlia Weis
- Vascular Surgery at Marshfield Clinic Health System, Marshfield, WI
| | - Niten Singh
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Washington, Seattle, WA
| | - David Rigberg
- Division of Vascular Surgery, Department of Surgery, University of California - Los Angeles, Los Angeles, CA
| | - Dawn M Coleman
- Division of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Jason T Lee
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stanford University, Palo Alto, CA
| | - Murray L Shames
- Division of Vascular Surgery, Department of Surgery, University of South Florida, Tampa, FL
| | - Erica L Mitchell
- Academic Sabbatical, Masters in Healthcare Delivery Science, Dartmouth, Hanover, NH
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Zemela MS, Malgor RD, Smith BK, Smeds MR. Feasibility and acceptability of virtual mock oral examinations for senior vascular surgery trainees and implications for the certifying exam. Ann Vasc Surg 2021; 76:28-37. [PMID: 33838232 PMCID: PMC8579692 DOI: 10.1016/j.avsg.2021.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/12/2021] [Accepted: 03/12/2021] [Indexed: 11/06/2022]
Abstract
Objectives The COVID-19 pandemic resulted in the cancellation of in-person testing across the country. We sought to understand the feasibility of conducting virtual oral examinations as well as solicit opinions of vascular surgery program directors (PD) regarding the use of virtual platforms to conduct both low stakes mock oral examinations with their trainees and potentially “real” high stakes certifying examinations (CE) moving forward. Methods Forty-four senior vascular surgery trainees from 17 institutions took part in a virtual mock oral examination conducted by 38 practicing vascular surgeons via Zoom. Each examination lasted 30 minutes with four clinical scenarios. An anonymous survey pertaining to the conduct of the examination and opinions on feasibility of using virtual examinations for the vascular surgery CE was sent to all examiners and examinees. A similar survey was sent to all vascular surgery program directors. Results The overall pass rate was 82% (36/44 participants) with no correlation with training paradigm. 32/44 (73%) of trainees, 29/38 (76%) of examiners and 49/103 (48%) of PDs completed the surveys. Examinees and examiners thought the experience was beneficial and PDs also thought the experience would be beneficial for their trainees. While the majority of trainees and examiners believed they were able to communicate and express (or evaluate) knowledge and confidence as easily virtually as in person, PDs were less likely to agree confidence could be assessed virtually. The majority of respondents thought the CE of the Vascular Surgery Board of the American Board of Surgery could be offered virtually, although no groups thought virtual exams were superior to in person exams. While cost benefit was perceived in virtual examinations, the security of the examination was a concern. Conclusions Performing virtual mock oral examinations for vascular surgery trainees is feasible. Both vascular surgery trainees as well as PDs feel that virtual CEs should be considered by the Vascular Surgery Board.
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Affiliation(s)
- Mark S Zemela
- Saint Louis University School of Medicine, Saint Louis, MO
| | - Rafael D Malgor
- Division of Vascular Surgery and Endovascular Therapy, University of Colorado, Aurora, CO
| | - Brigitte K Smith
- Division of Vascular Surgery, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Matthew R Smeds
- Division of Vascular and Endovascular Surgery, Saint Louis University, Saint Louis, MO.
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Smith BK, Rectenwald J, Yudkowsky R, Hirshfield LE. A Framework for Understanding the Association Between Training Paradigm and Trainee Preparedness for Independent Surgical Practice. JAMA Surg 2021; 156:535-540. [PMID: 33759997 DOI: 10.1001/jamasurg.2021.0031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The sociopolitical and cultural context of graduate surgical education has changed considerably over the past 2 decades. Although new structures of graduate surgical training programs have been developed in response and the comparative value of formats are continually debated, it remains unclear how different time-based structural paradigms are preparing trainees for independent practice after program completion. Objective To investigate the factors associated with trainees' and program directors' perception of trainee preparedness for independent surgical practice. Design, Setting, and Participants This qualitative study used an instrumental case study approach and obtained information through semistructured interviews, which were analyzed using open-and-focused coding. Participants were recent graduates and program directors of vascular surgery training programs in the United States. The 2 training paradigms analyzed were the integrated vascular surgery residency program (0 + 5, with 0 indicating that the general surgery training experiences are fully integrated into the 5 years of overall training and 5 indicating the total number of years of training) and the traditional vascular surgery fellowship program (5 + 2, with 5 indicating the number of years of general surgery training and 2 indicating the number of years of vascular surgery training). All graduates completed their training in 2018. All interviews were conducted between July 1, 2018, and September 30, 2018. Main Outcomes and Measures A conceptual framework to inform current and ongoing efforts to optimize graduate surgical training programs across specialties. Results A total of 22 semistructured interviews were completed, involving 7 graduates of 5 + 2 programs, 9 graduates of 0 + 5 programs, and 6 vascular surgery program directors. Of the 22 participants, 15 were men (68%). Participants described 4 interconnected domains that were associated with trainees' perceived preparedness for practice: structural, individual, relational, and organizational. Structural factors included the overall and vascular surgery-specific time spent in training, whereas individual factors included innate technical skills, confidence, maturity, and motivation. Faculty-trainee relationships (or relational factors) were deemed important for building trust and granting of autonomy. Organizational factors included features of the local organization, including patient population, case volume, and case mix. Conclusions and Relevance Findings suggest that restructuring training paradigms alone is insufficient to address the issue of trainees' perceived preparedness for practice. A framework was created from the results for evaluating and improving residency and fellowship programs as well as for developing graduate surgical training paradigms that incorporate all 4 domains associated with preparedness.
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Affiliation(s)
- Brigitte K Smith
- Division of Vascular Surgery, Department of Surgery, University of Utah, Salt Lake City
| | - John Rectenwald
- Division of Vascular Surgery, Department of Surgery, University of Wisconsin, Madison
| | - Rachel Yudkowsky
- Department of Medical Education, University of Illinois at Chicago, Chicago
| | - Laura E Hirshfield
- Department of Medical Education, University of Illinois at Chicago, Chicago
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McCrary HC, Colbert-Getz JM, Poss WB, Smith BK. A Systematic Review of the Relationship Between In-Training Examination Scores and Specialty Board Examination Scores. J Grad Med Educ 2021; 13:43-57. [PMID: 33680301 PMCID: PMC7901636 DOI: 10.4300/jgme-d-20-00111.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/04/2020] [Accepted: 10/23/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND In-training examinations (ITEs) are intended for low-stakes, formative assessment of residents' knowledge, but are increasingly used for high-stake purposes, such as to predict board examination failures. OBJECTIVE The aim of this review was to investigate the relationship between performance on ITEs and board examination performance across medical specialties. METHODS A search of the literature for studies assessing the strength of the relationship between ITE and board examination performance from January 2000 to March 2019 was completed. Results were categorized based on the type of statistical analysis used to determine the relationship between ITE performance and board examination performance. RESULTS Of 1407 articles initially identified, 89 articles underwent full-text review, and 32 articles were included in this review. There was a moderate-strong relationship between ITE and board examination performance, and ITE scores significantly predict board examination scores for the majority of studies. Performing well on an ITE predicts a passing outcome for the board examination, but there is less evidence that performing poorly on an ITE will result in failing the associated specialty board examination. CONCLUSIONS There is a moderate to strong correlation between ITE performance and subsequent performance on board examinations. That the predictive value for passing the board examination is stronger than the predictive value for failing calls into question the "common wisdom" that ITE scores can be used to identify "at risk" residents. The graduate medical education community should continue to exercise caution and restraint in using ITE scores for moderate to high-stakes decisions.
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Hayek S, Woo B, Darelli-Anderson A, Dove J, Fluck M, Stefanidis D, Shabahang MM, Smith BK. Disparate opinions on the value of Vice Chairs of education in Departments of Surgery: A national survey of Department Chairs and other surgical education stakeholders. Am J Surg 2020; 221:381-387. [PMID: 33288225 DOI: 10.1016/j.amjsurg.2020.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 10/28/2020] [Accepted: 11/15/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The position of Vice Chair of Education (VCE) is increasingly common in Surgery Departments. The role remains ill-defined. The purpose of this study was to explore perceptions of Department Chairs (DCs) and Other Education Stakeholders (OESs) regarding the VCE role. METHODS DCs and OESs at institutions with a VCE were surveyed. Descriptive statistics and cross-tabulations were calculated (SAS V9.4). RESULTS The overall response rate was 25% (166/666). There were significant differences in whether DCs and OESs agree that the VCE supports others in fulfilling educational roles (95.2% vs 49.5%, p = 0.0002), is critical in achieving education missions (90.5% vs 56.6%, p = 0.0032), enhances the quality of education (95.3% vs 65.7%, p = 0.0174), and is important to education teams (95.0% vs 68.7%, p = 0.0464). CONCLUSIONS DCs value the VCE role more so than OESs, whom VCEs support. In order for VCEs to be effective educational leaders in Departments of Surgery, the needs of key stakeholders deserve further clarification.
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Affiliation(s)
- Sarah Hayek
- Geisinger Medical Center, Department of Surgery, USA.
| | - Brandi Woo
- Geisinger Commonwealth School of Medicine, USA
| | | | | | | | | | - Mohsen M Shabahang
- Geisinger Medical Center, Department of Surgery, Chair of the Geisinger Surgical Institute, USA
| | - Brigitte K Smith
- University of Utah, Department of Surger, Division of Vascular Surgery, USA.
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Sarfati MR, Griffin CL, Kraiss LW, Smith BK, Brooke BS. Vascular surgery triage during the coronavirus disease 2019 pandemic. J Vasc Surg 2020; 73:1858-1868. [PMID: 33253873 PMCID: PMC7694555 DOI: 10.1016/j.jvs.2020.11.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/09/2020] [Indexed: 12/02/2022]
Abstract
Objective The coronavirus disease 2019 (COVID-19) pandemic has resulted in a marked increase in hospital usage, medical resource scarcity, and rationing of surgical procedures. This has created the need for strategies to triage surgical patients. We have described our experience using the American College of Surgeons (ACS) COVID-19 guidelines for triage of vascular surgery patients in an academic surgery practice. Methods We used the ACS guidelines as a framework to direct the triage of vascular surgery patients during the COVID-19 pandemic. We retrospectively analyzed the results of this triage during the first month of surgical restriction at our hospital. Patients undergoing surgery were identified by reviewing the operating room schedule. We reviewed the electronic medical records (EMRs) and assigned an ACS category, condition, and tier class to each completed surgery. Surgeries that were postponed during the same period were identified from a prospectively maintained list. We reviewed the EMRs for all postponed surgeries and assigned an ACS category, condition, and tier class to each surgery. We reviewed the EMRs for all postponed procedures to identify any adverse events related to the treatment delay. Results We performed 69 surgeries in 52 patients during the study period. All surgeries were performed to treat emergent, urgent, or time-sensitive elective diagnoses. Of the 69 surgeries, 47 (68%) were from tier 3 and 22 (32%) from tier 2b. We did not perform any surgeries from tier 1 or 2a. We postponed surgery for 66 patients during the same period, of which 36 (55%) were from tier 1, 22 (33%) from tier 2a, 5 (8%) from tier 2b, and 3 (5%) could not be assigned a tier class. No tier 3 surgeries were postponed. Of the 66 patients, 3 (4.5%) experienced an adverse event that could be attributed to the treatment delay. Conclusions The ACS triage guidelines provided an effective method to decrease vascular surgical volumes during the COVID-19 pandemic without an increase in patient morbidity. We believe the clinical utility of the guidelines would be strengthened by incorporating the SURGCON/VASCCON (surgical activity condition/vascular activity condition) threat level alert system.
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Affiliation(s)
- Mark R Sarfati
- Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah.
| | - Claire L Griffin
- Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Larry W Kraiss
- Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Brigitte K Smith
- Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Benjamin S Brooke
- Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
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Huffman EM, Anderson TN, Choi JN, Smith BK. Why the Lab? What is Really Motivating General Surgery Residents to Take Time for Dedicated Research. J Surg Educ 2020; 77:e39-e46. [PMID: 32768383 DOI: 10.1016/j.jsurg.2020.07.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/01/2020] [Accepted: 07/19/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Over one third of general surgery residents interrupt their clinical training to pursue dedicated research time (DRT), which has financial implications for programs and residents. Studies have examined the impact of DRT on academic outcomes, but little is known about why residents pursue DRT. Therefore, this study aimed to examine resident motivations regarding DRT in order to gain an understanding of resident goals and challenges surrounding this phase of training. DESIGN Surgical residents currently participating in DRT and residents considering completing DRT were recruited to participate. Members of the research team at each institution conducted interviews and focus groups, which were recorded and transcribed. Data was analyzed using the qualitative method of open and focused coding. Identified themes guided the development of a conceptual framework. SETTING Interviews and focus groups were held at three geographically diverse US academic health centers. PARTICIPANTS Twenty-one surgery residents participated. RESULTS Reasons for pursuing DRT fell into 1 of 3 themes: strategic career planning, professional development, and personal rejuvenation. Residents described the perceived need for publications or networking to enhance future competitiveness for desired fellowships or academic appointments. Residents also expressed the desire to have time for career exploration and to cultivate mentorship for their professional career. The need to take time off for more personal reasons, including burnout, was pervasive. Additionally, many in DRT felt under-supported in developing their research skills and expressed a desire for more formal instruction and guidance from mentors. CONCLUSIONS General surgery residents' motivations to pursue DRT are multifactorial. Professional development is a pervasive motivation and includes learning skills that can be applied to future research. Current DRT programs may be inadequate in supporting residents to achieve this goal. These results can be used to inform programmatic efforts to optimize DRT for residents and mentors alike.
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Affiliation(s)
| | - Tiffany N Anderson
- Stanford University, Department of Surgery, Goodman Surgical Education Center, Stanford, California
| | - Jennifer N Choi
- Indiana University, Department of Surgery, Indianapolis, Indiana
| | - Brigitte K Smith
- University of Utah, Department of Surgery, Division of Vascular Surgery, Salt Lake City, Utah
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Abstract
Pompe disease (glycogen storage disease type II) is caused by mutations in acid α-glucosidase (GAA) resulting in lysosomal pathology and impairment of the muscular and cardio-pulmonary systems. Enzyme replacement therapy (ERT), the only approved therapy for Pompe disease, improves muscle function by reducing glycogen accumulation but this approach entails several limitations including a short drug half-life and an antibody response that results in reduced efficacy. To address these limitations, new treatments such as gene therapy are under development to increase the intrinsic ability of the affected cells to produce GAA. Key components to gene therapy strategies include the choice of vector, promoter, and the route of administration. The efficacy of gene therapy depends on the ability of the vector to drive gene expression in the target tissue and also on the recipient's immune tolerance to the transgene protein. In this review, we discuss the preclinical and clinical studies that are paving the way for the development of a gene therapy strategy for patients with early and late onset Pompe disease as well as some of the challenges for advancing gene therapy.
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Affiliation(s)
- S M Salabarria
- Department of Pediatrics and Powell Gene Therapy Center, University of Florida, Gainesville, Floria, USA
| | - J Nair
- Department of Pediatrics and Powell Gene Therapy Center, University of Florida, Gainesville, Floria, USA
| | - N Clement
- Department of Pediatrics and Powell Gene Therapy Center, University of Florida, Gainesville, Floria, USA
| | - B K Smith
- Department of Physical Therapy and Center for Respiratory Research and Rehabilitation, University of Florida, Gainesville, Florida, USA
| | - N Raben
- Laboratory of Protein Trafficking and Organelle Biology, Cell and Developmental Biology Center, National Heart, Lung and Blood Institute, NIH, Bethesda, Maryland, USA
| | - D D Fuller
- Department of Physical Therapy and Center for Respiratory Research and Rehabilitation, University of Florida, Gainesville, Florida, USA
| | - B J Byrne
- Department of Pediatrics and Powell Gene Therapy Center, University of Florida, Gainesville, Floria, USA
| | - M Corti
- Department of Pediatrics and Powell Gene Therapy Center, University of Florida, Gainesville, Floria, USA
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Pender T, Boi L, Urbik VM, Glasgow R, Smith BK. Implementation and Evaluation of a Novel High-Value Care Curriculum in a Single Academic Surgery Department. J Am Coll Surg 2020; 232:81-90. [PMID: 33022401 DOI: 10.1016/j.jamcollsurg.2020.08.770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/21/2020] [Accepted: 08/31/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND High value care (HVC), maximizing quality while minimizing cost, has become a major focus of surgical practice. Effective education in healthcare value concepts is critical during residency to ensure graduates are able to deliver high value surgical care and participate in interprofessional teams to improve the system. STUDY DESIGN An HVC curriculum was implemented at a single academic medical center. Sixty-six residents from general surgery, plastic surgery, otolaryngology, and urology completed the curriculum over 3 academic years (2016 to 2019). The 1-year curriculum taught residents the concepts of HVC before participating in a value improvement project the following year. Residents' knowledge of value was assessed pre- and post-participation using a validated assessment tool, the Quality Improvement Knowledge Application Tool Revised (QIKAT-R), and a curriculum-specific assessment tool. The overall success of the program was evaluated by assessing residents' skills in completing value improvement projects using a novel scoring rubric. RESULTS After completing the program, residents expressed improved confidence in their ability to complete a value improvement project. Residents also demonstrated improved knowledge on the curriculum-specific assessment (4.7/13 to 10.9/13) and the scenario assessment using the QIKAT-R tool (8.5/27 to 16.4/27). As the program underwent iterative improvements each year, the quality of the residents' projects also improved, as assessed by the novel scoring rubric. CONCLUSIONS Multimodal assessment demonstrated improvement in residents' objective knowledge of HVC principles, residents' ability to design and lead clinical value improvement projects, and residents' confidence they could use HVC principles in their current and future practice.
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Affiliation(s)
- Tyler Pender
- Department of Surgery, Division of General Surgery, University of Utah, Salt Lake City, UT
| | - Luca Boi
- University of Utah Hospital and Clinics, University of Utah, Salt Lake City, UT
| | - Veronica M Urbik
- University of Utah School of Medicine, University of Utah, Salt Lake City, UT
| | - Robert Glasgow
- Department of Surgery, Division of General Surgery, University of Utah, Salt Lake City, UT
| | - Brigitte K Smith
- Division of Vascular Surgery, University of Utah, Salt Lake City, UT.
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Malhotra NR, Smith JD, Jacobs AC, Johnson CE, Khan US, Ellison HB, Brintz BJ, Millar MM, Cloud WG, Nahmias J, Hendershot KM, Smith BK. High value care education in general surgery residency programs: A multi-institutional needs assessment. Am J Surg 2020; 221:291-297. [PMID: 33039148 DOI: 10.1016/j.amjsurg.2020.09.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/22/2020] [Accepted: 09/08/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The ACGME mandates that residency programs provide training related to high value care (HVC). The purpose of this study was to explore HVC education in general surgery residency programs. METHODS An electronic survey was distributed to general surgery residents in geographically diverse programs. RESULTS The response rate was 29% (181/619). Residents reported various HVC components in their curricula. Less than half felt HVC is very important for their future practice (44%) and only 15% felt confident they could lead a QI initiative in practice. Only 20% of residents reported participating in a root cause analysis and less than one-third of residents (30%) were frequently exposed to cost considerations. CONCLUSION Few residents feel prepared to lead quality improvement initiatives, have participated in patient safety processes, or are aware of patients' costs of care. This underscores the need for improved scope and quality of HVC education and establishment of formal curricula.
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Affiliation(s)
- Neha R Malhotra
- University of Utah, Department of Surgery, Division of Urology, United States.
| | | | | | - Cali E Johnson
- University of Southern California, Department of Surgery, Division of Vascular Surgery, United States.
| | - Uzer S Khan
- West Virginia University, Department of Surgery, United States.
| | - Halle B Ellison
- Geisinger Health, Department of Surgery, Department of Palliative Care, United States.
| | - Benjamin J Brintz
- University of Utah, Department of Internal Medicine, Division of Epidemiology, United States.
| | - Morgan M Millar
- University of Utah, Department of Internal Medicine, Division of Epidemiology, United States.
| | - William G Cloud
- Baptist Memorial Memphis, Department of Surgery, Chief Quality & Safety Officer, United States.
| | - Jeffry Nahmias
- University of California - Irvine, Department of Surgery, United States.
| | | | - Brigitte K Smith
- University of Utah, Department of Surgery, Division of Vascular Surgery, Vice-Chair of Education, United States.
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Peacock J, Holeman TA, Griffin CL, Smith BK, Sarfati MR, Kraiss LW, Beckstrom J, Brooke BS. Functional Decline Among Frail Patients After Vascular Surgery. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.04.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gilbertson EA, Bailey TR, Kraiss LW, Griffin CL, Smith BK, Sarfati M, Beckstrom J, Brooke BS. Long-Term Impact of Vascular Surgery Stress on Frail Older Patients. Ann Vasc Surg 2020; 70:9-19. [PMID: 32603848 DOI: 10.1016/j.avsg.2020.06.048] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/11/2020] [Accepted: 06/24/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Frailty is a syndrome where the ability to cope with acute physiological stress is compromised, although it is unclear what impact this stress has on long-term outcomes. Vascular-Physiological and Operative Severity Score for enumeration of Mortality and Morbidity is a validated method for calculating levels of stress associated with vascular procedures. We designed this study to evaluate the long-term impact of different levels of surgical stress among frail older patients undergoing vascular surgery procedures. METHODS We identified all independently living patients who underwent prospective frailty assessment followed by an elective vascular surgery procedure captured in the Vascular Quality Initiative registry (endovascular abdominal aortic aneurysm [AAA] repair, thoracic endovascular aortic repair, suprainguinal and infrainguinal bypass, peripheral vascular intervention, carotid endarterectomy, and open AAA) at an academic institution between January 2016 and July 2018. Patient- and procedure-level data were obtained from our institutional data warehouse and Vascular Quality Initiative database, and used to calculate Vascular-Physiological and Operative Severity Score for enumeration of Mortality and Morbidity scores. The association between frailty and composite outcome of any major complications (surgical site infection; graft thrombectomy; major amputation; adverse cardiac, pulmonary, or neurologic event; acute renal insufficiency; and/or reoperation related to the index procedure), nonhome living status, or death within 1 year after low-, medium-, and high-stress vascular procedures was evaluated using bivariate and logistic regression models. RESULTS A total of 163 patients were identified (70% male, mean age 67.8 years) who underwent open AAA repair (6%), endovascular AAA repair (21%), thoracic endovascular aortic repair (7%), suprainguinal bypass (5%), infrainguinal bypass (18%), carotid endarterectomy (18%), or peripheral vascular interventions (25%), which included 44 (27%) patients diagnosed with frailty before surgery. Overall, frail patients had significantly higher rates of the 1-year composite outcome (48% frail versus 27% nonfrail; P = 0.012) when compared with nonfrail patients, with a significant dose-dependent effect as the level of stress increased. In comparison, increasing levels of surgical stress had a negligible effect on long-term outcomes among nonfrail patients. The interaction between frailty and high surgical stress was found in adjusted regression models to be a significant predictor of adverse outcomes within 1 year after vascular surgery (odds ratio, 3.3; 95% confidence interval, 1.3-8.6; P < 0.01). CONCLUSIONS Frail patients who undergo high-stress vascular procedures have a significantly higher rate of complications leading to loss of functional independence and mortality within the year after their surgery. These data suggest that estimates of surgical stress should be incorporated into clinical decision making for frail older patients before and after surgery.
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Affiliation(s)
- Ellen A Gilbertson
- Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Travis R Bailey
- Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Larry W Kraiss
- Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Claire L Griffin
- Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Brigitte K Smith
- Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Mark Sarfati
- Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Julie Beckstrom
- Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Benjamin S Brooke
- Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT.
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Griffin CL, Sharma V, Sarfati MR, Smith BK, Kraiss LW, McKellar SH, Koliopoulou A, Brooke BS, Selzman CH, Glotzbach JP. Aortic disease in the time of COVID-19 and repercussions on patient care at an academic aortic center. J Vasc Surg 2020; 72:408-413. [PMID: 32360374 PMCID: PMC7192110 DOI: 10.1016/j.jvs.2020.04.487] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/22/2020] [Indexed: 01/02/2023]
Affiliation(s)
- Claire L Griffin
- Division of Vascular Surgery, Department of Surgery, University of Utah Health, Salt Lake City, Utah.
| | - Vikas Sharma
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health, Salt Lake City, Utah
| | - Mark R Sarfati
- Division of Vascular Surgery, Department of Surgery, University of Utah Health, Salt Lake City, Utah
| | - Brigitte K Smith
- Division of Vascular Surgery, Department of Surgery, University of Utah Health, Salt Lake City, Utah
| | - Larry W Kraiss
- Division of Vascular Surgery, Department of Surgery, University of Utah Health, Salt Lake City, Utah
| | - Stephen H McKellar
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health, Salt Lake City, Utah
| | - Antigone Koliopoulou
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health, Salt Lake City, Utah
| | - Benjamin S Brooke
- Division of Vascular Surgery, Department of Surgery, University of Utah Health, Salt Lake City, Utah
| | - Craig H Selzman
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health, Salt Lake City, Utah
| | - Jason P Glotzbach
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health, Salt Lake City, Utah
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Gilbertson EA, Bailey TR, Kraiss LW, Griffin CL, Smith BK, Sarfati M, Beckstrom J, Brooke BS. Long-term Impact of Vascular Surgery Stress On Frail Older Patients. Ann Vasc Surg 2020. [DOI: 10.1016/j.avsg.2020.01.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Purnell SM, Wolf L, Millar MM, Smith BK. A National Survey of Integrated Vascular Surgery Residents' Experiences With and Attitudes About Quality Improvement During Residency. J Surg Educ 2020; 77:158-165. [PMID: 31810901 DOI: 10.1016/j.jsurg.2019.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/17/2019] [Accepted: 09/02/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Integrated vascular surgery residency, or "0+5," programs provide education in the Accreditation Council for Graduate Medical Education (ACGME) competencies of Systems-Based Practice (SBP) and Practice-Based Learning and Improvement (PBLI), which include milestones related to quality improvement (QI). It is unclear what QI curricula are in place in 0+5 programs nationally or how 0+5 residents perceive the importance of QI. OBJECTIVE The purpose of this study is to assess current 0+5 residents' knowledge, experiences with, and attitudes about QI. DESIGN A survey was developed using the ACGME Common Program Requirements and Milestones pertaining to QI. All 0+5 residents from 2017 to 2018 academic year were emailed an electronic link to the survey. Descriptive statistics and cross-tabulations were calculated using Stata/MP version 13.1. SETTING All 0+5 vascular surgery residency programs in the United State (n = 52). PARTICIPANTS The survey was completed by 35% (n = 90/257) of 0+5 residents, representing 75% of 0+5 programs in the United States (n = 39/52). RESULTS Forty-one percent of respondents felt that applying QI methods is very important and 33% felt that QI education is very important for their future work, however, just 13% felt very prepared to lead a QI initiative. Residents' perceptions of preparedness to lead QI projects and the importance they attached to QI education were significantly influenced by their participation in a QI project (p = 0.003 and p = 0.038 respectively). Finally, just 8% (n = 6) of residents responded correctly to all 13 knowledge-based questions and these residents felt better prepared to lead a QI initiative compared to those who answered incorrectly (p = 0.002). CONCLUSIONS Most 0+5 residents report participation in a QI project during residency, however, few feel prepared to lead a QI initiative in practice. Furthermore, only half of PGY5 0+5 residents report achieving specific ACGME targets for graduation pertaining to QI. Current QI curricula in 0+5 programs may be inadequate in teaching fundamental QI concepts and achieving ACGME competency targets for graduation.
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Affiliation(s)
- Shawn M Purnell
- Houston Methodist Hospital, Department of Surgery, Houston, Texas.
| | - Laura Wolf
- University of Utah, School of Medicine, Salt Lake City, Utah
| | - Morgan M Millar
- University of Utah, Division of Epidemiology, Department of Internal Medicine, Salt Lake City, Utah
| | - Brigitte K Smith
- University of Utah, Department of Surgery, Division of Vascular Surgery, Salt Lake City, Utah
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Ghaffarian AA, Foss WT, Donald G, Kraiss LW, Sarfati M, Griffin CL, Smith BK, Brooke BS. Prognostic implications of diagnosing frailty and sarcopenia in vascular surgery practice. J Vasc Surg 2019; 70:892-900. [DOI: 10.1016/j.jvs.2018.11.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 11/05/2018] [Indexed: 12/30/2022]
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Smith BK, Davies MG, Harris IB. The Current State of the 0+5 Integrated Vascular Surgery Residency Training Paradigm: A Scoping Review of the Literature. J Surg Educ 2019; 76:990-1004. [PMID: 30713138 DOI: 10.1016/j.jsurg.2019.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 01/08/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND The 0+5 integrated vascular surgery residency program (IVSR) was introduced as a training model toward board certification in vascular surgery over 10 years ago. The pros and cons of this training model have been debated. OBJECTIVE The purpose of this review is to investigate, using qualitative methods, what is known about the development, implementation, and outcomes of the IVSR paradigm. DESIGN A systematic search of the literature pertaining to the IVSR training model was conducted to include literature from 2005 to 2016. A search strategy involving use of 4 literature databases, 4 search terms, and 4 inclusion criteria was used. Three independent reviewers screened titles and abstracts for inclusion. Data abstraction was performed by 1 reviewer. Qualitative content analysis was completed using the method of constant comparative analysis associated with a grounded theory design by all 3 reviewers. RESULTS Of 890 articles initially identified, 33 articles were found to meet inclusion criteria for full review. Nineteen (57%) were research articles with an average Medical Education Research Study Quality Instrument score of 6.3 out of 18. The remaining articles were categorized as editorials, presidential addresses, invited commentaries, and historical summaries. Three major themes related to the IVSR program were identified: context of program development, processes of the program once implemented, and outcomes. CONCLUSIONS The literature on the IVSR paradigm reflects contextual, process, and outcome issues. Research articles are of generally low quality and there is a paucity of analyses of outcome issues. Further research is recommended to identify and understand the outcomes of the model.
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Affiliation(s)
- Brigitte K Smith
- Department of Surgery, University of Utah, Division of Vascular Surgery, Salt Lake City, Utah.
| | - Mark G Davies
- University of Texas Health Sciences Center - San Antonio, Division of Vascular/Endovascular Surgery, San Antonio, Texas
| | - Ilene B Harris
- University of Illinois - Chicago, Department of Medical Education and Department of Pathology, Chicago, Illinois
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Ghaffarian AA, Foss WT, Kraiss LW, Smith BK, Griffin CL, Sarfati MR, Brooke BS. Prognostic Implications of Diagnosing Frailty and Sarcopenia in Vascular Surgery Practice: Form Versus Function. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.06.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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