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Pradarelli AA, Park YS, Healy MG, Phitayakorn R, Petrusa E. National Profile of the ACGME Milestones 1.0 and 2.0 within General Surgery: A Seven-Year National Study from 2014 to 2021. J Surg Educ 2024; 81:626-638. [PMID: 38555246 DOI: 10.1016/j.jsurg.2024.01.016] [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: 06/16/2023] [Revised: 09/15/2023] [Accepted: 01/29/2024] [Indexed: 04/02/2024]
Abstract
PURPOSE The Accreditation Council for Graduate Medical Education (ACGME) introduced General Surgery Milestones 1.0 in 2014 and Milestones 2.0 in 2020 as steps toward competency-based training. Analysis will inform residency programs on curriculum development, assessment, feedback, and faculty development. This study describes the distributions and trends for Milestones 1.0 and 2.0 ratings and proportion of residents not achieving the level 4.0 graduation target. METHODS A deidentified dataset of milestone ratings for all ACGME-accredited General Surgery residency programs in the United States was used. Medians and interquartile ranges (IQR) were reported for milestone ratings at each PGY level. Percentages of PGY-5s receiving final year ratings of less than 4.0 were calculated. Wilcoxon rank sum tests were used to compare 1.0 and 2.0 median ratings. Kruskal-Wallis and Bonferroni post-hoc tests were used to compare median ratings across time periods and PGY levels. Chi-squared tests were used to compare the proportion of level 4.0 nonachievement under both systems. RESULTS Milestones 1.0 data consisted of 13,866 residents and Milestones 2.0 data consisted of 7,633 residents. For 1.0 and 2.0, all competency domain median ratings were higher for subsequent years of training. Milestones 2.0 had significantly higher median ratings at all PGY levels for all competency domains except Medical Knowledge. Percentages of PGY-5 residents not achieving the graduation target in Milestones 1.0 ranged from 27% to 42% and in 2.0 from 5% to 13%. For Milestones 1.0, all subcompetencies showed an increased number of residents achieving the graduation target from 2014 to 2019. CONCLUSIONS This study of General Surgery Milestones 1.0 and 2.0 data uncovered significant increases in average ratings and significantly fewer residents not achieving the graduation target under the 2.0 system. We hypothesize that these findings may be related more to rating bias given the change in rating scales, rather than a true increase in resident ability.
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Affiliation(s)
- Alyssa A Pradarelli
- Medical Education Design Lab, Department of Surgery, University of Michigan, Ann Arbor, Michigan; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
| | - Yoon Soo Park
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael G Healy
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Roy Phitayakorn
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
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Palenzuela DL, Gee D, Petrusa E, Maltby A, Andrus S, Paranjape C. Hiatal hernia reporting: time to remove subjectivity? Surg Endosc 2024; 38:437-442. [PMID: 37985491 DOI: 10.1007/s00464-023-10562-4] [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: 06/06/2023] [Accepted: 10/23/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION The size of a hiatal hernia (HH) is a key determinant of the approach for surgical repair. However, endoscopists will often utilize subjective terms, such as "small," "medium," and "large," without any standardized objective correlations. The aim of this study was to identify HHs described using objective axial length measurements versus subjective size allocations and compare them to their corresponding manometry and barium swallow studies. METHODS AND PROCEDURES Retrospective chart reviews were conducted on 93 patients diagnosed endoscopically with HHs between 2017 and 2021 at Newton-Wellesley Hospital. Information was collected regarding their HH subjective size assessment, axial length measurement (cm), manometry results, and barium swallow readings. Linear regression models were used to analyze the correlation between the objective endoscopic axial length measurements and manometry measurements. Ordered logistic regression models were used to correlate the ordinal endoscopic and barium swallow subjective size allocations with the continuous axial length measurements and manometry measurements. RESULTS Of the 93 endoscopy reports, 42 included a subjective size estimate, 38 had axial length measurement, and 12 gave both. Of the 34 barium swallow reads, only one gave an objective HH size measurement. Axial length measurements were significantly correlated with the manometry measurements (R2 = 0.0957, p = 0.049). The endoscopic subjective size estimates were also closely related to the manometry measurements (R2 = 0.0543, p = 0.0164). Conversely, the subjective size estimates from barium swallow reads were not significantly correlated with the endoscopic axial length measurements (R2 = 0.0143, p = 0.366), endoscopic subjective size estimates (R2 = 0.0481, p = 0.0986), or the manometry measurements (R2 = 0.0418, p = 0.0738). Mesh placement was significantly correlated to pre-operative endoscopic axial length measurement (p = 0.0001), endoscopic subjective size estimate (p = 0.0301), and barium swallow read (p = 0.0211). However, mesh placement was not significantly correlated with pre-operative manometry measurements (0.2227). CONCLUSIONS Endoscopic subjective size allocations and objective axial length measurements are associated with pre-operative objective measurements and intra-operative decisions, suggesting both can be used to guide clinical decision making. However, including axial length measurements in endoscopy reports can improve outcomes reporting.
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Affiliation(s)
| | - Denise Gee
- Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | - Charudutt Paranjape
- Massachusetts General Hospital, Boston, MA, USA
- Newton-Wellesley Hospital, Newton, MA, USA
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Whaley Z, Palenzuela D, Dzara K, Berkowitz LR, Moses J, Petrusa E, Phitayakorn R. Characterizing the Role of Surgical Vice Chair of Education: Stakeholder Needs and Current Practices. J Surg Res 2024; 293:497-502. [PMID: 37827027 DOI: 10.1016/j.jss.2023.09.038] [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: 03/08/2023] [Revised: 08/29/2023] [Accepted: 09/07/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION The role of a Department of Surgery (DoS) Vice Chair of Education (VCE) is a relatively new position intended to address the many changes and initiatives in medical education. The primary responsibilities and functions of a surgical VCE are not well described in the literature. This study examines the perceptions of stakeholders and current VCEs to develop a newly established position of VCE within an academic DoS. METHODS We conducted semistructured interviews of 13 faculties in our DoS. Each of these faculties hold the role of fellowship or residency program director. We also interviewed 13 VCEs from other departments within the same hospital system. Transcripts of these interviews were analyzed using reflexive thematic analysis, comparing the data gathered from the two populations. RESULTS There was a consensus of positivity about the new VCE position by the stakeholders with some residual uncertainty about how it would affect their work. Four themes resulted from analysis of stakeholder interviews including advocacy for education, balance of clinical, research, and educational duties, departmental integration, and faculty development as educators. Three themes were generated from analysis of interviews of VCEs including leverage of experience, framework establishment, and leadership in education. CONCLUSIONS Although exact VCE roles and responsibilities will be department dependent, this study may help other institutions craft their VCE positions and create a framework for understanding important stakeholder views.
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Affiliation(s)
- Zachary Whaley
- Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts; Department of Surgery, Weill Cornell College of Medicine, New York, New York.
| | - Deanna Palenzuela
- Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | - Kristina Dzara
- Department of Family and Community Medicine and Center for Scholarly Teaching and Learning, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Lori R Berkowitz
- Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | - Joy Moses
- Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | - Emil Petrusa
- Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | - Roy Phitayakorn
- Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
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Eurboonyanun C, Aphinives P, Wittayapairoch J, Eurboonyanun K, Srisuk T, Punchai S, Ruangwannasak S, Jenwitheesuk K, Petrusa E, Gee D, Phitayakorn R. Trend of minimally invasive and open surgery experience of general surgery residents: Accreditation Council for Graduate Medical Education general surgery case log in Thailand. J Minim Invasive Surg 2023; 26:121-127. [PMID: 37712311 PMCID: PMC10505362 DOI: 10.7602/jmis.2023.26.3.121] [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] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/17/2023] [Accepted: 09/06/2023] [Indexed: 09/16/2023]
Abstract
Purpose Minimally invasive surgery (MIS) offers patients several benefits, such as smaller incisions, and fast recovery times. General surgery residents should be trained in both open and MIS. We aimed to examine the trends of minimally invasive and open procedures performed by general surgery residents in Thailand. Methods A retrospective review of the Royal College of Surgeons of Thailand and Accreditation Council for Graduate Medical Education general surgery case logs from 2007 to 2018 was performed for common open and laparoscopic general surgery operations. The data were grouped by three time periods, which were 2007-2010, 2011-2014, and 2015-2018, and analyzed to explore changes in the operative trends. Results For Thai residents, the mean number of laparoscopic operations per person per year increased from 5.97 to 9.36 (56.78% increase) and open increased from 20.02 to 27.16 (35.67% increase). There was a significant increase in the average number of minimally invasive procedures performed among cholecystectomy (5.83, 6.57, 8.10; p < 0.001) and inguinal hernia repair (0.33, 0.35, 0.66; p < 0.001). Compared to general surgery residents in the United States, Thai residents had more experience with open appendectomy, but significantly less experience with all other operations/procedures. Conclusion The number of open and minimally invasive procedures performed or assisted by Thai general surgery residents has slowly increased, but generally lags behind residents in the United States. The Thai education program must be updated to improve residents' technical skills in open and laparoscopic surgery to remain competitive with their global partners.
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Affiliation(s)
- Chalerm Eurboonyanun
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Department of Surgery, The Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Potchavit Aphinives
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Kulyada Eurboonyanun
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Tharatip Srisuk
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Suriya Punchai
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Somchai Ruangwannasak
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Emil Petrusa
- Department of Surgery, The Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Denise Gee
- Department of Surgery, The Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Roy Phitayakorn
- Department of Surgery, The Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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McKinley SK, Wojcik BM, Witt EE, Hamdi I, Mansur A, Petrusa E, Mullen JT, Phitayakorn R. Inpatient Satisfaction With Surgical Resident Care After Elective General and Oncologic Surgery. Ann Surg 2023; 277:e1380-e1386. [PMID: 35856490 DOI: 10.1097/sla.0000000000005598] [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: 11/26/2022]
Abstract
OBJECTIVE To investigate inpatient satisfaction with surgical resident care. BACKGROUND Surgical trainees are often the primary providers of care to surgical inpatients, yet patient satisfaction with surgical resident care is not well characterized or routinely assessed. METHODS English-speaking, general surgery inpatients recovering from elective gastrointestinal and oncologic surgery were invited to complete a survey addressing their satisfaction with surgical resident care. Patients positively identified photos of surgical senior residents and interns before completing a modified version of the Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey (S-CAHPS). Adapted S-CAHPS items were scored using the "top-box" method. RESULTS Ninety percent of recruited patients agreed to participate (324/359, mean age=62.2, 50.3% male). Patients were able to correctly identify their seniors and interns 85% and 83% of the time, respectively ( P =0.14). On a 10-point scale, seniors had a mean rating of 9.23±1.27 and interns had a mean rating of 9.01±1.49 ( P =0.14). Ninety-nine percent of patients agreed it was important to help in the education of future surgeons. CONCLUSIONS Surgical inpatients were able to recognize their resident physicians with high frequency and rated resident care highly overall, suggesting that they may serve as a willing source of feedback regarding residents' development of core competencies such as interpersonal skills, communication, professionalism, and patient care. Future work should investigate how to best incorporate patient evaluation of surgical resident care routinely into trainee assessment to support resident development.
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Affiliation(s)
| | | | | | - Isra Hamdi
- Massachusetts General Hospital, Boston, MA
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Coe TM, McKinley SK, Hamdi I, Sinyard RD, Jogerst KM, Pradarelli AA, Petrusa E, Moses J, Saillant N, Phitayakorn R. The Big Sibling program: Impact of a medical student-resident mentorship program during the surgery clerkship. Am J Surg 2023; 225:650-655. [PMID: 35871028 DOI: 10.1016/j.amjsurg.2022.07.009] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/19/2022] [Accepted: 07/14/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND We created a Big Sibling mentorship program for medical students and studied the program effects. METHODS Between July 2019 to December 2020, students completing their surgery clerkship were paired with a Big Sibling surgical research resident. Participation in and perceptions of the program were assessed by survey. RESULTS 81 medical students and 25 residents participated with a 79% and 95% survey response rate, respectively. The most valuable topics discussed included ward skills, personal development and career advising. Students who interacted >2 times with their Big Sibling were more likely to perceive the operating room as a positive learning environment, view attendings as role models, and receive mentoring and feedback from residents and attendings (p = 0.03, 0.02, 0.01 respectively). 78% of residents thought the program was a positive experience and no residents found it burdensome. CONCLUSION The Big Siblings program enhances the surgery clerkship learning environment. Students who engaged with their Big Sibling had a more positive view of the clerkship and the mentorship provided by residents and attendings.
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Affiliation(s)
- Taylor M Coe
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | | | - Isra Hamdi
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Robert D Sinyard
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Kristen M Jogerst
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | | | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Joy Moses
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Noelle Saillant
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Roy Phitayakorn
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
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Coe TM, Jogerst KM, Petrusa E, Phitayakorn R, Lipman J. Effective Senior Surgical Residents as Defined by Their Peers: A Qualitative Content Analysis of Nontechnical Skills Development. Ann Surg 2023; 277:e707-e713. [PMID: 34334653 PMCID: PMC8799772 DOI: 10.1097/sla.0000000000005106] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This study aims to define an effective senior resident and understand the process of leadership and nontechnical skill development in the transition from junior to senior surgery resident. SUMMARY BACKGROUND General surgery residents are responsible for patient care, technically demanding operations, and diverse care team management. However, leadership skill development for the transition from junior to senior resident roles is often overlooked. METHODS We conducted 15 semi-structured focus groups with surgery residents from an urban, academic institution. Focus group transcripts were inductively coded. Using content analysis and constant comparative methodology, primary codes were refined into categories and organized into higher-level themes. RESULTS Thirty-three general surgery residents completed fifteen focus groups. Six themes were identified. Three themes describe the process of becoming an effective senior resident: how to define a senior resident's scope of practice, the transition process, and the importance of personal investment. Three themes were identified regarding effective seniors: ideal traits, teachable skills, and the team and patient impact. CONCLUSIONS Surgery residents define an effective senior resident as the team member with the highest level of experience who manages the big picture of patient care. The transition is improved by personal engagement and acknowledgement of the transition. Ideal traits of effective seniors, including emotional intelligence and inherent personality traits, allow a resident to more naturally assume this role; however, teachable skills, such as communication, expectation setting and competence, can be taught to improve one's effectiveness. The actions of a senior resident impact the team and patient care, underscoring the importance of understanding this role.
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Affiliation(s)
- Taylor M Coe
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Kristen M Jogerst
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Roy Phitayakorn
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Jeremy Lipman
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
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Jogerst KM, Coe TM, Petrusa E, Neil J, Davila V, Pearson D, Phitayakorn R, Gee D. Multidisciplinary perceptions on robotic surgical training: the robot is a stimulus for surgical education change. Surg Endosc 2022; 37:2688-2697. [PMID: 36414871 DOI: 10.1007/s00464-022-09708-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 10/11/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND It is unclear how to best establish successful robotic training programs or if subspecialty robotic program principles can be adapted for general surgery practice. The objective of this study is to understand the perspectives of high-volume robotic surgical educators on best practices in robotic surgery training and to provide recommendations transferable across surgical disciplines. METHODS This multi-institutional qualitative analysis involved semi-structured interviews with high-volume robotic educators from academic general surgery (AGS), community general surgery (CGS), urology (URO), and gynecology (GYN). Purposeful sampling and snowballing ensured high-volume status and geographically balanced representation across four strata. Interviews were transcribed, deidentified, and independently, inductively coded. A codebook was developed and refined using constant comparative method until interrater reliability kappa reached 0.95. A qualitative thematic, framework analysis was completed. RESULTS Thirty-four interviews were completed: AGS (n = 9), CGS (n = 8), URO (n = 9), and GYN (n = 8) resulting in 40 codes and four themes. Theme 1: intangibles of culture, resident engagement, and faculty and administrative buy-in are as important as tangibles of robot and simulator access, online modules, and case volumes. Theme 2: robotic OR integration stresses the trainee-autonomy versus patient-safety balance. Theme 3: trainees acquire robotic skills along individual learning curves; benchmark assessments track progress. Theme 4: AGS can learn from URO and GYN through multidisciplinary collaboration but must balance pre-existing training program use with context-specific curricular needs. CONCLUSIONS Robotic surgical experts emphasize the importance of universal training paradigms, such as a strong educational culture that balances autonomy and patient safety, collaboration between disciplines, and routine assessments for continuous growth. Often, introduction and acceptance of the robot serves as a stimulus to discuss broader surgical education change.
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Jogerst KM, Cassidy DJ, Coe TM, Monette D, Sell N, Eurboonyanum C, Hamdi I, Petrusa E, Stearns D, Gee DW, Chyn A, Saillant N, Takayesu JK. Interprofessional Trauma Team Training: Leveraging Each Specialties' Expertise to Teach Procedural-Based Skills. J Surg Educ 2022; 79:e273-e284. [PMID: 36283921 DOI: 10.1016/j.jsurg.2022.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 07/16/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The goal of this study was to utilize interprofessional trauma team training to teach procedural-based skills, teamwork, and assess the impact on the procedural comfort and interprofessional collaboration. DESIGN Interdisciplinary skills sessions were created to focus on chest tube placement and advanced ultrasound techniques. Chest tube sessions were taught by senior general surgery (GS) residents and faculty. Ultrasound sessions were taught by emergency medicine (EM) fellows and faculty. Mock trauma simulations for EM and GS residents and EM nurses, were developed to also focus on improving interprofessional trauma-bay collaboration. Sessions were held throughout the year for 2 consecutive academic years. After completing skills sessions and trauma scenarios, participants were surveyed on skill comfort, session utility, and willingness to collaborate with the other specialty. Likert scale responses were analyzed by specialty cohort and in aggregate. Free-text feedback responses were analyzed for common themes. SETTING Large, tertiary, urban academic medical center PARTICIPANTS: Forty seven EM residents and 32 GS residents completed instructional chest tube and ultrasound simulations, respectively. Twenty two EM residents, 24 GS residents, and 29 EM nurses participated in interprofessional trauma simulations. RESULTS For chest tube placement: 71% of EM residents reported feeling uncomfortable with the procedure prior to the session, with 100% reporting improved confidence afterwards. Seventy percent stated the model was realistic. One hundred percent thought it improved their procedural skills. All participants thought it was worthwhile, should be offered again in future years, and planned to incorporate what they learned in their future practice. For the ultrasound sessions: 61% of GS residents felt uncomfortable with the Focused Assessment with Sonography in Trauma prior to the simulation. Ninety four percent reported the improved skill and confidence, and felt the model was realistic. All participants felt sessions were worthwhile, should be offered again, and planned to incorporate what they learned in their future practice. For trauma simulations: 97% of participants felt scenarios were realistic and clinically relevant and planned to incorporate lessons learned in their future clinical practice. All participants thought participation was worthwhile. Ninety seven percent thought it improved their confidence with trauma clinical management and 56% reported it improved their skills. Many participants reported they appreciated learning from the other specialty's perspective, with greater than 95% of all participants reporting improved comfort and willingness to collaborate across disciplines when caring for future trauma patients. All participants requested the simulation sessions continue in future academic years. CONCLUSION Interprofessional trauma simulation sessions can harness the unique skill sets of different disciplines to teach procedural-based skills and improve interprofessional collaboration within the trauma bay.
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Affiliation(s)
- Kristen M Jogerst
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts; Department of Surgery, Mayo Clinic Hospital, Phoenix, Arizona.
| | - Douglas J Cassidy
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Taylor M Coe
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Derek Monette
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Naomi Sell
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Isra Hamdi
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Dana Stearns
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Denise W Gee
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Angela Chyn
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Noelle Saillant
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - James K Takayesu
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Jogerst KM, Park YS, Anteby R, Sinyard R, Coe TM, Cassidy D, McKinley SK, Petrusa E, Phitayakorn R, Mohapatra A, Gee DW. Impact of Rater Training on Residents Technical Skill Assessments: A Randomized Trial. J Surg Educ 2022; 79:e225-e234. [PMID: 36333174 DOI: 10.1016/j.jsurg.2022.09.013] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/28/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The ACS/APDS Resident Skills Curriculum's Objective Structured Assessment of Technical Skills (OSATS) consists of task-specific checklists and a global rating scale (GRS) completed by raters. Prior work demonstrated a need for rater training. This study evaluates the impact of a rater-training curriculum on scoring discrimination, consistency, and validity for handsewn bowel anastomosis (HBA) and vascular anastomosis (VA). DESIGN/ METHODS A rater training video model was developed, which included a GRS orientation and anchoring performances representing the range of potential scores. Faculty raters were randomized to rater training or no rater training and were asked to score videos of resident HBA/VA. Consensus scores were assigned to each video using a modified Delphi process (Gold Score). Trained and untrained scores were analyzed for discrimination and score spread and compared to the Gold Score for relative agreement. RESULTS Eight general and eight vascular surgery faculty were randomized to score 24 HBA/VA videos. Rater training increased rater discrimination and decreased rating scale shrinkage for both VA (mean trained score: 2.83, variance 1.88; mean untrained score: 3.1, variance 1.14, p = 0.007) and HBA (mean trained score: 3.52, variance 1.44; mean untrained score: 3.42, variance 0.96, p = 0.033). On validity analyses, a comparison between each rater group vs Gold Score revealed a moderate training impact for VA, trained κ=0.65 vs untrained κ=0.57 and no impact for HBA, R1 κ = 0.71 vs R2 κ = 0.73. CONCLUSION A rater-training curriculum improved raters' ability to differentiate performance levels and use a wider range of the scoring scale. However, despite rater training, there was persistent disagreement between faculty GRS scores with no groups reaching the agreement threshold for formative assessment. If technical skill exams are incorporated into high stakes assessments, consensus ratings via a standard setting process are likely a more valid option than individual faculty ratings.
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Affiliation(s)
- Kristen M Jogerst
- Department of General Surgery, Mayo Clinic Arizona, Phoenix, Arizona; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Yoon Soo Park
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Roi Anteby
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Robert Sinyard
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Taylor M Coe
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Douglas Cassidy
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Sophia K McKinley
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Roy Phitayakorn
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Abhisekh Mohapatra
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Denise W Gee
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
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Sinyard RD, Veeramani A, Rouanet E, Anteby R, Petrusa E, Phitayakorn R, Gee D, Terhune K. Gaps in Practice Management Skills After Training: A Qualitative Needs Assessment of Early Career Surgeons. J Surg Educ 2022; 79:e151-e160. [PMID: 35842404 DOI: 10.1016/j.jsurg.2022.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/25/2022] [Revised: 05/23/2022] [Accepted: 06/18/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Shifts in American healthcare delivery mechanisms pose significant hurdles to new physicians. Surgeons are particularly susceptible to these changes, but surgical residency educational efforts primarily focus on technical and clinical training to the exclusion of business and management practices. This study conducted a needs assessment of perceived gaps in practice management skills among early career surgeons to guide future training curricula. METHODS This study was an exploratory qualitative study following the Consolidated Criteria for Reporting Qualitative Research. Purposive sampling was used to identify early career (<5 years following fellowship completion) surgeons across the United States. A semi-structured interview guide was created from interviews with surgical administrators and physician administrative curricula. Transcripts were de-identified and analyzed using a constructivist grounded theory approach. RESULTS Ten surgeons from 6 specialties and 6 institutions were interviewed along with 3 surgeon administrators. Three major domains of need were identified: (1) fundamentals of procedural coding, clinical billing, & compliance, (2) finding/building a practice, and (3) navigating organizational challenges. First, surgeons thought trainees would benefit from a better understanding of reimbursement schema and the basics of health policy. They also thought that more exposure to malpractice litigation, especially for handling case review or expert witness requests, would be helpful for discerning how to handle such issues early in their career. In addition, early career surgeons expressed a desire to have dedicated mentorship time, a primer on evaluating job offers with simulated contract negotiation, and guidance regarding administrative roles. Finally, surgeons requested training in change management techniques, care pathway construction, and the basics of staffing decisions. CONCLUSIONS There are significant practice management gaps in surgical training which may be amenable to targeted educational efforts during a residency or fellowship program. Future research will test the generalizability of these findings as well as build curricula that adequately meet these needs.
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Affiliation(s)
- Robert D Sinyard
- Massachusetts General Hospital, Department of Surgery; Boston, Massachusetts.
| | | | - Eva Rouanet
- Brigham & Women's Hospital, Department of Surgery; Boston, Massachusetts
| | - Roi Anteby
- Massachusetts General Hospital, Department of Surgery; Boston, Massachusetts
| | - Emil Petrusa
- Massachusetts General Hospital, Department of Surgery; Boston, Massachusetts
| | - Roy Phitayakorn
- Massachusetts General Hospital, Department of Surgery; Boston, Massachusetts
| | - Denise Gee
- Massachusetts General Hospital, Department of Surgery; Boston, Massachusetts
| | - Kyla Terhune
- Department of Surgery, Vanderbilt University Medical Center; Nashville, Tennessee
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12
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Cassidy DJ, Jogerst K, Coe T, Monette D, Sell N, Eurboonyanum C, Hamdi I, Sampson M, Petrusa E, Stearns D, Gee DW, Chyn A, Saillant N, Takayesu JK. Simulation versus reality: what can interprofessional simulation teach us about team dynamics in the trauma bay? Global Surg Educ 2022; 1:56. [PMID: 38013715 PMCID: PMC9614190 DOI: 10.1007/s44186-022-00063-8] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 11/08/2022]
Abstract
Purpose Surgical consultation and the joint management of trauma patients is a common scenario in the emergency department. The goal of this study was to utilize interprofessional trauma team training to understand the role of simulation and its impact on the overall culture of trauma-related care. Methods Interdisciplinary trauma simulation scenarios were completed by 12 groups of emergency medicine residents, general surgery residents, and emergency medicine nurses across two academic years. Following each simulation, a debriefing session was held to reflect on the scenario, focusing on team interactions. Debriefing sessions were audio-recorded, transcribed, deidentified, and independently, inductively coded by two members of the research team. Using the constant comparative method, a codebook was developed and refined until interrater reliability was confirmed with a kappa of > 0.9. Codes were organized into higher level themes. Results There were 72 participants, including 23 general surgery residents, 19 emergency medicine residents, and 30 emergency medicine nurses. 214 primary codes were collapsed into 29 coding categories, with 6 emerging themes. Pre-trauma bay impact describes how interactions prior to the trauma scenario can impact how team members communicate, trust one another, and ultimately care for the patient. Role and team identity explores the importance of one knowing their individual role in the trauma bay and how it impacts overall team identity. Resource allocation describes the balance of having appropriate resources to efficiently care for patients while not negatively impacting crowd control or role identity. Impact of the simulation experience highlights the impact of the lower stakes simulation scenario on learning and reflection as well as concerns with simulation fidelity. Trauma leader traits and actions outlines inherent traits and learned actions of trauma leaders that impact how the trauma scenario unfolds. Interprofessional team performance describes the overall performance of the trauma team, including but not limited to the type of communication used, teamwork behaviors, and transition of care of the patient. Conclusions Interdisciplinary trauma simulations and structured debriefing sessions provide insights into team dynamics and interprofessional relationships. Simulations and debriefing sessions can promote understanding, respect, and familiarity of team members' roles; recognition of key characteristics of high functioning leaders and teams; and discovery of conflict mitigating strategies for future interdisciplinary team improvement. Simulation sessions allow implementation of quality improvement measures and communication and leadership strategy practice in a safe, collaborative learning environment. The lessons learned from these sessions can encourage participants to reexamine how they interact and function as a team within the real-life trauma bay.
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Affiliation(s)
| | - Kristen Jogerst
- Department of Surgery, Mayo Clinic Hospital, Phoenix, AZ USA
| | - Taylor Coe
- Department of Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Derek Monette
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA USA
| | - Naomi Sell
- Department of Surgery, Massachusetts General Hospital, Boston, MA USA
| | | | - Isra Hamdi
- Department of Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Michael Sampson
- Department of Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Dana Stearns
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA USA
| | - Denise W. Gee
- Department of Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Angela Chyn
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA USA
| | - Noelle Saillant
- Department of Surgery, Massachusetts General Hospital, Boston, MA USA
| | - James K. Takayesu
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA USA
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13
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Cassidy DJ, Coe TM, Jogerst KM, McKinley SK, Sell NM, Sampson M, Park YS, Petrusa E, Goldstone RN, Hashimoto DA, Gee DW. Transfer of virtual reality endoscopy training to live animal colonoscopy: a randomized control trial of proficiency vs. repetition-based training. Surg Endosc 2022; 36:6767-6776. [PMID: 35146554 PMCID: PMC8831003 DOI: 10.1007/s00464-021-08958-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 12/09/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Low first-time pass rates of the Fundamentals of Endoscopic Surgery (FES) exam stimulated development of virtual reality (VR) simulation curricula for test preparation. This study evaluates the transfer of VR endoscopy training to live porcine endoscopy performance and compares the relative effectiveness of a proficiency-based vs repetition-based VR training curriculum. METHODS Novice endoscopists completed pretesting including the FES manual skills examination and Global Assessment of GI Endoscopic Skills (GAGES) assessment of porcine upper and lower endoscopy. Participants were randomly assigned one of two curricula: proficiency-based or repetition-based. Following curriculum completion, participants post-tested via repeat FES examination and GAGES porcine endoscopy assessments. The two cohorts pre-to-post-test differences were compared using ANCOVA. RESULTS Twenty-two residents completed the curricula. There were no differences in demographics or clinical endoscopy experience between the groups. The repetition group spent significantly more time on the simulator (repetition: 242.2 min, SD 48.6) compared to the proficiency group (proficiency: 170.0 min, SD 66.3; p = 0.013). There was a significant improvement in porcine endoscopy (pre: 10.6, SD 2.8, post: 16.6, SD 3.4; p < 0.001) and colonoscopy (pre: 10.4, SD 2.7, post: 16.4, SD 4.2; p < 0.001) GAGES scores as well as FES manual skills performance (pre: 270.9, SD 105.5, post: 477.4, SD 68.9; p < 0.001) for the total cohort. There was no difference in post-test GAGES performance or FES manual skills exam performance between the two groups. Both the proficiency and repetition group had a 100% pass rate on the FES skills exam following VR curriculum completion. CONCLUSION A VR endoscopy curriculum translates to improved performance in upper and lower endoscopy in a live animal model. VR curricula type did not affect FES manual skills examination or live colonoscopy outcomes; however, a proficiency curriculum is less time-consuming and can provide a structured approach to prepare for both the FES exam and clinical endoscopy.
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Affiliation(s)
- Douglas J Cassidy
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St. GRB-425, Boston, MA, 02114, USA.
| | - Taylor M Coe
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St. GRB-425, Boston, MA, 02114, USA
| | - Kristen M Jogerst
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St. GRB-425, Boston, MA, 02114, USA
- Department of Surgery, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Sophia K McKinley
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St. GRB-425, Boston, MA, 02114, USA
| | - Naomi M Sell
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St. GRB-425, Boston, MA, 02114, USA
| | - Michael Sampson
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St. GRB-425, Boston, MA, 02114, USA
| | - Yoon Soo Park
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St. GRB-425, Boston, MA, 02114, USA
| | - Robert N Goldstone
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St. GRB-425, Boston, MA, 02114, USA
| | - Daniel A Hashimoto
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St. GRB-425, Boston, MA, 02114, USA
| | - Denise W Gee
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St. GRB-425, Boston, MA, 02114, USA.
- Department of Surgery, Massachusetts General Hospital, 15 Parkman St. WAC-460, Boston, MA, 02114, USA.
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Jogerst K, Chou E, Tanious A, Latz C, Boitano L, Mohapatra A, Petrusa E, Dua A. Virtual Simulation of Intra-operative Decision-Making for Open Abdominal Aortic Aneurysm Repair: A Mixed Methods Analysis. J Surg Educ 2022; 79:1043-1054. [PMID: 35379583 DOI: 10.1016/j.jsurg.2022.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/22/2021] [Revised: 02/02/2022] [Accepted: 03/04/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To create and pilot test a novel open abdominal aortic aneurysm (AAA) repair virtual simulation focused on intraoperative decision-making. To identify if the simulation replicated real-time intra-operative decision-making and discover how learners' respond to this type of simulation. DESIGN An explanatory sequential mixed methods study. We developed a step-by-step outline of major intra-operative decision points within a standard open AAA repair. Perioperative and intraoperative decision-making trees were developed and coded into an online virtual simulation. The simulation was piloted. Quantitative data was collected from the simulation platform. We then performed a qualitative thematic analysis on feedback from interviewed participants. SETTING Four academic general and vascular surgical training programs across the US. PARTICIPANTS Seventeen vascular and general surgery trainees and 6 vascular surgery faculty. RESULTS Participants spent on average 27 minutes (range: 8-45 minutes) interacting with the interface. 93% of participants reported feeling they were making real intraoperative decisions. 85% said it added to their knowledge base. 96% requested additional simulations. 22 interviews were completed: 241 primary codes were collapsed into 21 parent codes, and 6 emerging themes identified. Themes included the benefit of how (1) "Virtual Learning Could Standardize the Training Experience"; how (2) "Dealing with the Unexpected" as a trainee is an important part of surgical education growth, and that this (3) "Choose Your Own Adventure" virtual format simulates this intraoperative growth experience. Participants requested a (4) "Looping Feature Feedback Diagram" for future simulation iterations and highlighted that (5) "Fancier is Not Necessarily More Educational." Finally, many trainees wondered about (6) "The Attending Impact" from the simulation: if faculty would notice a difference between trainees who did vs did not utilize the simulation for case preparation. CONCLUSIONS Operative simulation training should focus on both technical skills and intra-operative decision-making, particularly "dealing with the unexpected." The learners' responses indicate that a low-fidelity, scalable, virtual platform can effectively deliver knowledge and allow for intra-operative decision-making practice in a remote learning environment.
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Affiliation(s)
- Kristen Jogerst
- Department of Surgery, Mayo Clinic, Phoenix, Arizona; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
| | - Elizabeth Chou
- Department of Vascular Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Adam Tanious
- Department of Vascular Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Christopher Latz
- Department of Vascular Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Laura Boitano
- Department of Vascular Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Abhisekh Mohapatra
- Department of Vascular Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Anahita Dua
- Department of Vascular Surgery, Massachusetts General Hospital, Boston, Massachusetts
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15
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McKinley SK, Witt EE, Acker RC, Cassidy DJ, Hamdi I, Mansur A, Ghosh A, Evenson A, Askari R, Petrusa E, Saillant N, Phitayakorn R. A multisite study of medical student perspectives on the core surgical clerkship. Surgery 2022; 171:1215-1223. [PMID: 35078627 DOI: 10.1016/j.surg.2021.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/28/2021] [Accepted: 09/13/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND The surgical clerkship is the primary surgical learning experience for medical students. This study aims to understand student perspectives on the surgery clerkship both before and after the core surgical rotation. METHODS Medical students at 4 academic hospitals completed pre and postclerkship surveys that included open-ended questions regarding (1) student learning goals and concerns and (2) how surgical clerkship learning could be enhanced. Thematic analysis was performed, and interrater reliability was calculated. RESULTS Ninety-one percent of students completed both a pre and postclerkship survey (n =162 of 179), generating 320 preclerkship and 270 postclerkship responses. Mean kappa coefficients were 0.83 and 0.82 for pre and postclerkship primary themes, respectively. Thematic analysis identified 5 broad themes: (1) core learning expectations, (2) understanding surgical careers, culture, and work, (3) inhabiting the role of a surgeon, (4) inclusion in the surgical team, and (5) the unique role of the medical student on clinical clerkships. Based on these themes, we propose a learner-centered model of a successful surgical clerkship that satisfies discrete student learning and goals and career objectives while ameliorating the challenges of high-stakes clinical surgical environments such as the operating room. CONCLUSION Understanding student perspectives on the surgery clerkship, including preclerkship motivations and concerns and postclerkship reflections on surgical learning, revealed potential targets of intervention to improve the surgery clerkship. Future investigation may elucidate whether the proposed model of the elements of a successful surgery clerkship learning facilitates improvement of the surgical learning environment and enhanced surgical learning.
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Affiliation(s)
- Sophia K McKinley
- Massachusetts General Hospital, Boston, MA. https://twitter.com/SophiaKMcKinley
| | - Emily E Witt
- Harvard Medical School, Boston, MA. https://twitter.com/wittee333
| | - Rachael C Acker
- University of Pennsylvania, Philadelphia, PA. https://twitter.com/AckerRachael
| | - Douglas J Cassidy
- Massachusetts General Hospital, Boston, MA. https://twitter.com/DJCSurgEd
| | - Isra Hamdi
- Massachusetts General Hospital, Boston, MA
| | | | | | - Amy Evenson
- Beth Israel Deaconess Medical Center, Boston, MA
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16
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Cadieux M, Healy M, Petrusa E, Cooke L, Traeger L, Kesselheim JC, Riva-Cambrin J, Phitayakorn R. Implementation of competence by design in Canadian neurosurgery residency programs. Med Teach 2022; 44:380-387. [PMID: 34726559 DOI: 10.1080/0142159x.2021.1994937] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The Royal College of Physicians and Surgeons of Canada (RCPSC) recently redesigned the Canadian neurosurgery residency training curriculum by implementing a competency-based model of training known as Competence by Design (CBD) centered around the assessment of Entrustable Professional Activities (EPAs). This sequential explanatory mixed-methods study evaluated potential benefits and pitfalls of CBD in Canadian neurosurgery residency education. METHODS Two four-month interval surveys were distributed to all Canadian neurosurgery residents participating in CBD. The surveys assessed important educational components: CBD knowledge of key stakeholders, potential system barriers, and educational/psychological impacts on residents. Paired t-tests were done to assess changes over time. Based on longitudinal survey responses, semi-structured interviews were conducted to investigate in-depth residents' experience with CBD in neurosurgery. The qualitative analysis followed an explanatory approach, and a thematic analysis was performed. RESULTS Surveys had 82% average response rate (n = 25). Over time, most residents self-reported that they retrospectively understood concepts around CBD intentions (p = 0.02). Perceived benefits included faculty evaluations with more feedback that was clearer and more objective (53% and 51%). Pitfalls included the amount of time needed to navigate through EPAs (90%) and residents forgetting to initiate EPA forms (71%). There was no significant change over time. During interviews, five key themes were found. Potential solutions identified by residents to enhance their experience included learning analytics data availability, mobile app refinement, and dedicated time to integrate EPAs in the workflow. CONCLUSION This study was the first to assess resident-perceived benefits and pitfalls of the neurosurgery CBD training program in an educational framework context. In general, residents believed that theoretical principles behind CBD were valuable, but that technological ability and having enough time to request EPA assessments were significant barriers to success. Long-term studies are required to determine the definitive outcomes of CBD on residents' performance and ultimately, on patient care.
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Affiliation(s)
- Magalie Cadieux
- Harvard Medical School, Boston, MA, USA
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Michael Healy
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Lara Cooke
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Lara Traeger
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jennifer C Kesselheim
- Harvard Medical School, Boston, MA, USA
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - Jay Riva-Cambrin
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Roy Phitayakorn
- Harvard Medical School, Boston, MA, USA
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
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17
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Hayden EM, Petrusa E, Sherman A, Feinstein DM, Khoury K, Krupat E, Pawlowski J, Oriol NE, Smithedajkul PY, Venkatan SK, Gordon JA. Association of Simulation Participation With Diagnostic Reasoning Scores in Preclinical Students. Simul Healthc 2022; 17:35-41. [PMID: 34120136 DOI: 10.1097/sih.0000000000000589] [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: 11/25/2022]
Abstract
PURPOSE The aim of the study was to evaluate for an association between the number of voluntary mannequin simulation sessions completed during the school year with scores on a year-end diagnostic reasoning assessment among second-year medical students. METHOD This is retrospective analysis of participation in 0 to 8 extracurricular mannequin simulation sessions on diagnostic reasoning assessed among 129 second-year medical students in an end-of-year evaluation. For the final skills assessment, 2 physicians measured students' ability to reason through a standardized case encounter using the Diagnostic Justification (DXJ) instrument (4 categories each scored 0-3 by raters reviewing students' postencounter written summaries). Rater scores were averaged for a total DXJ score (0-12). To provide additional baseline comparison, zero participation students were divided into 2 groups based on intent to participate: those who signed up for extracurricular sessions but never attended versus those who never expressed interest. Scores across the attendance groups were compared with an analysis of variance and trend analysis. RESULTS The class DXJ mean equaled 7.56, with a standard deviation of 2.78 and range of 0 to 12. Post hoc analysis after a significant analysis of variance (F = 4.91, df = 8, 128, P < 0.001) showed those participating in 1 or more extracurricular sessions had significantly higher DXJ scores than those not participating. Students doing 7 extracurricular sessions had significantly higher DXJ scores than those doing 0 and 2 (P < 0.05). Zero attendance groups were not different. A significant linear trend (R = 0.48, F = 38.0, df = 1, 127, P < 0.001) was found with 9 groups. A significant quadratic effect, like a dose-response pattern, was found (F = 18.1, df = 2, 125, P < 0.001) in an analysis including both zero attendance groups, a low (1-4 extracurricular sessions) group and a high (5-8) group. CONCLUSIONS Higher year-end diagnostic reasoning scores were associated with increased voluntary participation in extracurricular mannequin-based simulation exercises in an approximate dose-response pattern.
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Affiliation(s)
- Emily M Hayden
- From the Gilbert Program in Medical Simulation, Harvard Medical School; MGH Learning Laboratory, Departments of Emergency Medicine and Surgery, Massachusetts General Hospital; Departments of Medicine and Anesthesia, Beth Israel Deaconess Medical Center; and Department of Medicine, Brigham and Women's Hospital, Boston, MA
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18
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Acker R, Healy MG, Vanderkruik R, Petrusa E, McKinley S, Phitayakorn R. Finding my people: Effects of student identity and vulnerability to Stereotype Threat on sense of belonging in surgery. Am J Surg 2022; 224:384-390. [PMID: 35115175 DOI: 10.1016/j.amjsurg.2022.01.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 05/15/2021] [Revised: 12/30/2021] [Accepted: 01/19/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Diversity in surgery lags behind the medical student population. We documented first-year medical students' vulnerability to stereotype threat (VST) and its impact on a sense of belonging in surgery. METHODS All first-year medical students at a single academic institution were surveyed. Demographics, VST, anticipated clerkship experience, and sense of belonging were assessed. RESULTS 44% of students were vulnerable to ST in upcoming clerkships, with the majority worried about surgical clerkships. More student from races/ethnicities underrepresented in medicine (URM; 74%) and sexual minorities (62%) were vulnerable than white (30%) and heterosexual (38%) students respectively (p = 0.001 and p = 0.017). Knowing a surgeon with a shared identity would enhance belonging for most students (84%). VST was higher for those who do not anticipate working with (p < 0.001) or do not know a surgeon (p = 0.0001) who shares their identity. CONCLUSION VST significantly influences a student's sense of belonging in surgery. More research is needed to promote inclusivity in surgery.
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Affiliation(s)
- Rachael Acker
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
| | - Michael G Healy
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA; Massachusetts General Hospital, Dept of Surgery, 15 Parkman St, Boston, MA, 02114, USA.
| | - Rachel Vanderkruik
- Massachusetts General Hospital, Dept of Surgery, 15 Parkman St, Boston, MA, 02114, USA.
| | - Emil Petrusa
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA; Massachusetts General Hospital, Dept of Surgery, 15 Parkman St, Boston, MA, 02114, USA.
| | - Sophia McKinley
- Massachusetts General Hospital, Dept of Surgery, 15 Parkman St, Boston, MA, 02114, USA.
| | - Roy Phitayakorn
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA; Massachusetts General Hospital, Dept of Surgery, 15 Parkman St, Boston, MA, 02114, USA.
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Anteby R, Sinyard RD, Jogerst KM, McKinley SK, Coe TM, Petrusa E, Phitayakorn R, Scott DJ, Brunt LM, Gee DW. Challenges of virtual interviewing for surgical fellowships: a qualitative analysis of applicant experiences. Surg Endosc 2022; 36:3763-3771. [PMID: 34448935 PMCID: PMC8393782 DOI: 10.1007/s00464-021-08691-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 08/24/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND The COVID-19 pandemic forced surgical fellowship programs to transition from in-person to remote applicant interviews; the virtual interviewing format presented new and unique challenges. We sought to understand applicants' perceived challenges to virtual interviewing for a surgical fellowship program. METHOD A grounded theory-based qualitative study was performed utilizing semi-structured interviews with fellowship applicants from the 2020 fellowship match. All Fellowship Council-registered applicants were eligible. We purposefully sampled participants to balance across gender, specialty-choice, and academic versus community-program affiliation. Interviews were inductively analyzed by two researchers for prominent themes. RESULTS Fifteen interviews were conducted. Participants were 60% male (n = 9), with 33% (n = 5) from non-academic institutions. They applied for the following fellowships: Advanced Gastrointestinal/Minimal Invasive (55%), Bariatric (30%), Hepatopancreatobiliary (10%) and Surgical Oncology (5%). Four main themes emerged to describe virtual interview process challenges: (1) perceived data deficiency, (2) superficial personal connections, (3) magnification of non-professionalism, and (4) logistical frustrations. Applicants recommend program directors provide more information about the fellowship prior to interview day and offer informal independent interactions with current and previous fellows. CONCLUSIONS According to fellowship applicants, virtual interviews resulted in a lack of information for rank-list decision making ultimately requiring them to rely on other information avenues to base their decisions. These applicants have offered advice to fellowship program directors and future applicants to better optimize this process.
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Affiliation(s)
- Roi Anteby
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.
- School of Public Health, Harvard University, Boston, MA, USA.
| | - Robert D Sinyard
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Kristen M Jogerst
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
- Department of General Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Sophia K McKinley
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Taylor M Coe
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Roy Phitayakorn
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Daniel J Scott
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - L Michael Brunt
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Denise W Gee
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
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Anteby R, Petrusa E, Ferrone CR, Mullen JT, Phitayakorn R. Which Patient Do I Attend to First? Night-float Simulation to Assess Surgical Intern's Clinical Prioritization Skills. J Surg Educ 2021; 78:e226-e231. [PMID: 34366286 DOI: 10.1016/j.jsurg.2021.07.014] [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: 03/26/2021] [Accepted: 07/18/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Night-float rotations require general surgery interns to prioritize multiple competing patients' needs efficiently and accurately. Research is lacking on whether these skills can be taught and to what degree the prioritizations taught match overall attending surgeon expectations. DESIGN A night-float situation was developed to simulate the experience of surgical interns responding to multiple patients' needs. Participants were instructed to rank order 10 patient paper-case scenarios with a variety of clinical urgencies. After completing their first ranking, the interns participated in a faculty-facilitated peer discussion (intervention) and were then instructed to re-rank their priorities. Their performance was compared pre- and post-intervention, and to the ranking of 16 surgery faculty attendings. SETTING Massachusetts General Hospital, Department of Surgery, Boston, MA. PARTICIPANTS Post-graduate year (PGY) 1 surgical residents. RESULTS Two classes of general surgery interns (n = 25) completed the prioritization training simulation in the middle of their internship year, one class in 2018 and one in 2020. Agreement between interns regarding patient prioritization ranking increased after the facilitated peer discussion (pre-intervention mean standard deviation = 1.8 versus 0.9 post-intervention; p = 0.03). In the post-intervention mean rank, four cases moved by one position (p < 0.05). The facilitated discussion resulted in increased absolute agreement between individual interns and attendings' ranks (mean agreement 38 ± 17% pre-intervention Vesus mean 50 ± 20% post-intervention, p = 0.02). The scenarios with highest agreement between interns and attendings concerned patients with the most urgent conditions. Scenarios with the lowest agreement were those ranked with medium-to-low urgency. CONCLUSION A faculty-led facilitated discussion appears to increase clinical prioritization consistency among surgical interns and better align their prioritizations with expectations of local attending surgeons.
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Affiliation(s)
- Roi Anteby
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts; School of Public Health, Harvard University, Boston, Massachusetts
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Cristina R Ferrone
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - John T Mullen
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Roy Phitayakorn
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
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Wojcik BM, McKinley SK, Fong ZV, Mansur A, Bloom JP, Amari N, Hamdi I, Chang DC, Petrusa E, Mullen JT, Phitayakorn R. The Resident-Run Minor Surgery Clinic: A Four-Year Analysis of Patient Outcomes, Satisfaction, and Resident Education. J Surg Educ 2021; 78:1838-1850. [PMID: 34092535 DOI: 10.1016/j.jsurg.2021.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 12/02/2020] [Revised: 03/04/2021] [Accepted: 04/01/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE A resident-run minor surgery clinic was developed to increase resident procedural autonomy. We evaluated whether 1) there was a significant difference between complications and patient satisfaction when procedures were independently performed by surgical residents vs. a surgical attending and 2) if participation was associated with an increase in resident procedural confidence. DESIGN Third year general surgery residents participated in a weekly procedure clinic from 2014-2018. Post-procedure complications and patient satisfaction were compared between patients operated on by residents vs. the staff surgeon. Residents were surveyed regarding their confidence in independently performing a variety of clinic-based patient care tasks. SETTING Massachusetts General Hospital General in Boston, MA; an academic tertiary care general surgery residency program. PARTICIPANTS Post-graduate year three general surgery residents that ran the clinic as part of a general surgery rotation. RESULTS 1230 patients underwent 1592 procedures (612 in resident clinic, 980 in attending clinic). There was no significant difference in the 30-day complication rate between patients operated on by the resident vs. attending (2.5% vs. 1.9%, p = 0.49). 459 patient satisfaction surveys were administered with a 79.1% response rate. There was no significant difference in the overall quality of care rating between residents and the attending surgeon (87.5% top-box rating vs. 93.1%, p = 0.15). Twenty-one residents completed both a pre- and post-rotation survey (77.8% response rate). The proportion of residents indicating that they could independently perform a variety of patient care tasks significantly increased across the rotation (all p < 0.05). CONCLUSION Mid-level general surgery residents can independently perform office-based procedures without detriment to safety or patient satisfaction. The resident-run procedure clinic serves as an environment for residents to grow in confidence in both technical and non-technical skills. Given the high rate at which patients provide resident feedback, future work may investigate how to best incorporate patient derived evaluations into resident assessment.
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Affiliation(s)
- Brandon M Wojcik
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Sophia K McKinley
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Zhi Ven Fong
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Arian Mansur
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Jordan P Bloom
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Noor Amari
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Isra Hamdi
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - David C Chang
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - John T Mullen
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Roy Phitayakorn
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
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Coe TM, Chirban AM, McBroom TJ, Cloonan DJ, Brownlee SA, Moses J, Yeh H, Petrusa E, Saillant N, Dageforde LA. Virtual student-transplant patient interactions empower patients and enhance student transplantation knowledge. Am J Surg 2021; 222:1120-1125. [PMID: 34635311 PMCID: PMC10072134 DOI: 10.1016/j.amjsurg.2021.09.025] [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: 07/09/2021] [Revised: 08/28/2021] [Accepted: 09/23/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION There is variation in exposure to transplantation in undergraduate medical education. We created a program pairing medical students with transplant patients for semi-structured, virtual encounters and studied the impact on both students and patients using qualitative content analysis. METHODS Fifty medical students were paired with transplant recipients and donors for non-medical virtual encounters. Separate focus groups were conducted, deidentified, and analyzed using a constant comparative method. RESULTS Three themes related to the student experience emerged: transplant-related relationships, a deeper understanding of the patient's journey to transplant, and alterations of their personal view of organ donation and transplantation. Three themes emerged from the patient's experiences: the benefits of conversations, the patient as a teacher, and spreading the message of organ donation and transplantation. CONCLUSIONS This novel program demonstrates that virtual student-patient interactions are a useful approach to engage patients and a unique way to teach medical students about transplantation and donation.
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Affiliation(s)
- Taylor M Coe
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Ariana M Chirban
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | | | - Daniel J Cloonan
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Sarah A Brownlee
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Joy Moses
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Heidi Yeh
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Noelle Saillant
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Leigh Anne Dageforde
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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Jogerst K, Tanious A, Chou EL, Boitano LT, Decarlo C, Mohapatra A, Petrusa E, Dua A. Virtual Simulation of Intra-operative Decision-making for Open Abdominal Aortic Aneurysm Repair: A Mixed Methods Analysis. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.06.063] [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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Eurboonyanun C, Wittayapairoch J, Aphinives P, Petrusa E, Gee DW, Phitayakorn R. Adaptation to Open-Book Online Examination During the COVID-19 Pandemic. J Surg Educ 2021; 78:737-739. [PMID: 33011103 PMCID: PMC7467022 DOI: 10.1016/j.jsurg.2020.08.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 05/16/2020] [Revised: 07/23/2020] [Accepted: 08/29/2020] [Indexed: 05/09/2023]
Abstract
INTRODUCTION COVID-19 altered medical education systems worldwide as many medical schools quickly changed to online assessment systems. However, the feasibility of online assessment and how it compares to traditional examinations is unclear. METHODS We compared 4th year medical students' online surgery clerkship assessment scores to the traditional written examinations. The percent of correct scores using online open-book examination was compared to the results of the traditional closed-book examination in the previous three rotations. Additional correlation between grade point average(GPA) and examination performance were reviewed. RESULTS Compared with the traditional groups, medical students who took the online, open-book examination had a significantly higher mean score in both MCQ(85.21 vs. 77.36, 72.43, 83.00, p<0.001) and essay examinations (187.36 vs. 158.77, 152.17, 152.29, p<0.001), but a significantly lower mean score in short answer examination (60.09 vs. 66.79, 67.73, 64.82, p<0.001). The online open-book examination group had a significantly lower correlation between the essay score and their GPA than the previous traditional groups (z=2.81 p=0.005, z=2.23 p=0.026, z=2.19 p=0.029). CONCLUSION Although an online, open-book examination was feasible during the COVID-19 pandemic, this study indicates that mean scores are significantly different which has important implications regarding grading and standard setting. More research is required to assess other effects of this new assessment on long-term knowledge retention and application.
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Affiliation(s)
- Chalerm Eurboonyanun
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Department of Surgery, The Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| | | | - Potchavit Aphinives
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Emil Petrusa
- Department of Surgery, The Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Denise W Gee
- Department of Surgery, The Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Roy Phitayakorn
- Department of Surgery, The Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Sell NM, Cassidy DJ, McKinley SK, Petrusa E, Gee DW, Antonoff MB, Phitayakorn R. A Needs Assessment of Video-based Education Resources Among General Surgery Residents. J Surg Res 2021; 263:116-123. [PMID: 33652173 DOI: 10.1016/j.jss.2021.01.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 07/31/2020] [Revised: 01/10/2021] [Accepted: 01/31/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Video-based education (VBE) is an effective tool for knowledge and skill acquisition for medical students, but its utility is less clear for resident physicians. We sought to determine how to incorporate VBE into a general surgery resident operative curriculum. METHODS We conducted a single-institution, survey-based needs assessment of general surgery residents to determine desired content and format of an operative VBE module. RESULTS The response rate was 84% (53/63), with 66% senior (postgraduate year ≥3) resident respondents. VBE was the most commonly cited resource that residents used to prepare for an operation (93%) compared with surgical textbooks (89%) and text-based website content (57%). Junior residents were more likely to utilize text-based website content than senior residents (P < 0.01). The three most important operative video components were accuracy, length, and cost. Senior residents significantly preferred videos that were peer-reviewed (P < 0.05) and featured attending surgeons whom they knew (P = 0.03). A majority of residents (59%) believed 5-10 min is the ideal length of an operative video. Across all postgraduate year levels, residents indicated that detailed instruction of each operative step was the most important content of a VBE module. Senior residents believed that the overall indications and details of each step of the operation were the most important contents of VBE for a junior resident. CONCLUSIONS At this institution, general surgery residents preferentially use VBE resources for operative preparation. A centralized, standardized operative resource would likely improve resident studying efficiency, but would require personalized learning options to work for both junior and senior surgery residents.
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Affiliation(s)
- Naomi M Sell
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Douglas J Cassidy
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Sophia K McKinley
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Denise W Gee
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, MD Anderson Cancer Center, Houston, Texas
| | - Roy Phitayakorn
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
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26
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Cassidy DJ, McKinley SK, Ogunmuyiwa J, Mullen JT, Phitayakorn R, Petrusa E, Kim MJ. Surgical autonomy: A resident perspective and the balance of teacher development with operative independence. Am J Surg 2021; 221:336-344. [DOI: 10.1016/j.amjsurg.2020.10.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/05/2020] [Accepted: 10/18/2020] [Indexed: 10/23/2022]
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Jogerst KM, Eurboonyanun C, Park YS, Cassidy D, McKinley SK, Hamdi I, Phitayakorn R, Petrusa E, Gee DW. Implementation of the ACS/ APDS Resident Skills Curriculum reveals a need for rater training: An analysis using generalizability theory. Am J Surg 2021; 222:541-548. [PMID: 33516415 DOI: 10.1016/j.amjsurg.2021.01.018] [Citation(s) in RCA: 3] [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: 10/05/2020] [Revised: 12/16/2020] [Accepted: 01/11/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The American College of Surgeons (ACS)/Association of Program Directors in Surgery (APDS) Resident Skills Curriculum includes validated task-specific checklists and global rating scales (GRS) for Objective Structured Assessment of Technical Skills (OSATS). However, it does not include instructions on use of these assessment tools. Since consistency of ratings is a key feature of assessment, we explored rater reliability for two skills. METHODS Surgical faculty assessed hand-sewn bowel and vascular anastomoses in real-time using the OSATS GRS. OSATS were video-taped and independently evaluated by a research resident and surgical attending. Rating consistency was estimated using intraclass correlation coefficients (ICC) and generalizability analysis. RESULTS Three-rater ICC coefficients across 24 videos ranged from 0.12 to 0.75. Generalizability reliability coefficients ranged from 0.55 to 0.8. Percent variance attributable to raters ranged from 2.7% to 32.1%. Pairwise agreement showed considerable inconsistency for both tasks. CONCLUSIONS Variability of ratings for these two skills indicate the need for rater training to increase scoring agreement and decrease rater variability for technical skill assessments.
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Affiliation(s)
- Kristen M Jogerst
- Department of General Surgery, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA; Department of Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.
| | - Chalerm Eurboonyanun
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA; Department of Surgery, Khon Kaen University, 123 Tambon Sila, Mueang Khon Kaen District, Khon Kaen 40002, Thailand.
| | - Yoon Soo Park
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.
| | - Douglas Cassidy
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.
| | - Sophia K McKinley
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.
| | - Isra Hamdi
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.
| | - Roy Phitayakorn
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.
| | - Denise W Gee
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.
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Cassidy DJ, Chakraborty S, Panda N, McKinley SK, Mansur A, Hamdi I, Mullen J, Petrusa E, Phitayakorn R, Gee D. The Surgical Knowledge "Growth Curve": Predicting ABSITE Scores and Identifying "At-Risk" Residents. J Surg Educ 2021; 78:50-59. [PMID: 32694087 DOI: 10.1016/j.jsurg.2020.06.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 04/23/2020] [Revised: 06/09/2020] [Accepted: 06/28/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Resident performance on the American Board of Surgery In-Training Examination (ABSITE) is used for evaluation of surgical knowledge and guides resident selection for institutional remediation programs. Remediation thresholds have historically been based on ABSITE percentile scores; however, this does not account for predictors that can impact a resident's exam performance. We sought to identify predictors of yearly ABSITE performance to help identify residents "at-risk" for performing below their expected growth trajectory. DESIGN The knowledge of the residents, as measured by standardized ABSITE scores, was modeled as a function of the corresponding postgraduate year via a linear mixed effects regression model. Additional model covariates included written USMLE-1-3 examination scores, gender, number of practice questions completed, and percentage correct of practice questions. For each resident, the predicted ABSITE standard score along with a 95% bootstrap prediction interval was obtained. Both resident-specific and population-level predictions for ABSITE standard scores were also estimated. SETTING The study was conducted at a single, large academic medical center (Massachusetts General Hospital, Boston, MA). PARTICIPANTS Six years of general surgery resident score reports at a single institution between 2014 and 2019 were deidentified and analyzed. RESULTS A total of 376 score reports from 130 residents were analyzed. Covariates that had a significant effect on the model included USMLE-1 score (PGY1: p = 0.013; PGY2: p = 0.007; PGY3: p = 0.011), USMLE-2 score (PGY1: p < 0.001; PGY2: p < 0.001; PGY3: p < 0.001; PGY4: p < 0.001; PGY5: p = 0.032), male gender (PGY1: p = 0.003; PGY2: p < 0.001; PGY3: p < 0.001; PGY4: p = 0.008), and number of practice questions completed (p=0.003). Five residents were identified as having "fallen off" their predicted knowledge curve, including a single resident on 2 occasions. Population prediction curves were obtained at 7 different covariate percentile levels (5%, 10%, 25%, 50%, 75%, 90%, and 95%) that could be used to plot predicted resident knowledge progress. CONCLUSION Performance on USMLE-1 and -2 examinations, male gender, and number of practice questions completed were positive predictors of ABSITE performance. Creating residency-wide knowledge growth curves as well as individualized predictive ABSITE performance models allows for more efficient identification of residents potentially at risk for poor ABSITE performance and structured monitoring of surgical knowledge progression.
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Affiliation(s)
- Douglas J Cassidy
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
| | - Saptarshi Chakraborty
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, Manhattan, New York
| | - Nikhil Panda
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Sophia K McKinley
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Arian Mansur
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Isra Hamdi
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - John Mullen
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Roy Phitayakorn
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Denise Gee
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
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Coe TM, McBroom TJ, Brownlee SA, Regan K, Bartels S, Saillant N, Yeh H, Petrusa E, Dageforde LA. Medical Students and Patients Benefit from Virtual Non-Medical Interactions Due to COVID-19. J Med Educ Curric Dev 2021; 8:23821205211028343. [PMID: 34368454 PMCID: PMC8299878 DOI: 10.1177/23821205211028343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/09/2021] [Indexed: 05/26/2023]
Abstract
BACKGROUND Patient care restrictions created by the COVID-19 pandemic constrained medical students' ability to interact directly with patients. Additionally, organ transplant recipients faced increasing isolation due to the rise of telemedicine, the importance of social distancing and their immunosuppressed state. We created a pilot program to pair students with transplant patients for structured, virtual encounters and studied its impact on medical students and patients. METHODS In May 2020, medical students conducted virtual visits with patients via telephone or video conferencing. Patients and students were surveyed regarding their experiences and independent focus groups were conducted. The survey responses and focus group discussions were deidentified, transcribed, and analyzed for themes. RESULTS Ten participating students were in their first, second, or final year of medical school. The 14 patients were liver or kidney transplant recipients or kidney donors. All interactions lasted longer than 30 minutes, with 56% greater than 1 hour. Three themes emerged related to the student experience: improvement of their clinical communication skills, development of knowledge and attitudes related to organ transplantation and donation, and independent management of a patient encounter. Three themes related to the patient experience: appreciation of the opportunity to share their personal patient experience to help educate future physicians, a cathartic and personally illuminating experience and an opportunity to share the message of donation. CONCLUSIONS This pilot program provided a novel opportunity for virtual student-patient interactions that was feasible, well-received, and mutually beneficial. The use of virtual non-medical patient experiences allowed for experiential learning during which students learned about both clinical medicine and enhanced their communication skills directly from patients. Additionally, patients were able to engage with medical students in a new way, as teachers of clinical interactions, and reported a high level of satisfaction in addition to deriving personal benefit.
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Affiliation(s)
- Taylor M Coe
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Transplant Center, Massachusetts General Hospital, Boston, MA, USA
| | | | - Sarah A Brownlee
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Transplant Center, Massachusetts General Hospital, Boston, MA, USA
| | - Karen Regan
- Transplant Center, Massachusetts General Hospital, Boston, MA, USA
| | - Stephen Bartels
- Harvard Medical School, Boston, MA, USA
- The Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Noelle Saillant
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Heidi Yeh
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Transplant Center, Massachusetts General Hospital, Boston, MA, USA
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Leigh Anne Dageforde
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Transplant Center, Massachusetts General Hospital, Boston, MA, USA
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Cassidy DJ, Mullen JT, Gee DW, Joshi AR, Klingensmith ME, Petrusa E, Phitayakorn R. #SurgEdVidz: Using Social Media to Create a Supplemental Video-Based Surgery Didactic Curriculum. J Surg Res 2020; 256:680-686. [DOI: 10.1016/j.jss.2020.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 11/30/2022]
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Atkinson RB, Ortega G, Green AR, Chun MBJ, Harrington DT, Lipsett PA, Mullen JT, Petrusa E, Reidy E, Haider AH, Smink DS. Concordance of Resident and Patient Perceptions of Culturally Dexterous Patient Care Skills. J Surg Educ 2020; 77:e138-e145. [PMID: 32739444 PMCID: PMC7704898 DOI: 10.1016/j.jsurg.2020.07.007] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/02/2020] [Accepted: 07/10/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Disparities in surgical care persist. To mitigate these disparities, we are implementing and testing the Provider Awareness and Cultural dexterity Toolkit for Surgeons (PACTS), a curriculum to improve surgical residents' cultural dexterity during clinical encounters. We analyzed baseline data to look for concordance between residents' self-perceived cultural dexterity skills and patients' perceptions of their skills. We hypothesized that residents would rate their skills in cultural dexterity higher than patients would perceive those skills. METHODS Prior to the implementation of the curriculum, surgical residents at 5 academic medical centers completed a self-assessment of their skills in culturally dexterous patient care using a modified version of the Cross-Cultural Care Survey. Randomly selected surgical inpatients at these centers completed a similar survey about the quality of culturally dexterous care provided by a surgery resident on their service. Likert scale responses for both assessments were classified as high (agree/strongly agree) or low (neutral/disagree/strongly disagree) competency. Resident and patient ratings of cultural dexterity were compared. Assessments were considered dexterous if 75% of responses were in the high category. Univariate and multivariate analysis was conducted using STATA 16. RESULTS A total of 179 residents from 5 surgical residency programs completed self-assessments prior to receiving the PACTS curriculum, including 88 (49.2%) women and 97 (54.2%) junior residents (PGY 1-2s), of whom 54.7% were White, 19% were Asian, and 8.9% were Black/African American. A total of 494 patients with an average age of 55.1 years were surveyed, of whom 238 (48.2%) were female and 320 (64.8%) were White. Fifty percent of residents viewed themselves as culturally dexterous, while 57% of patients reported receiving culturally dexterous care; this difference was not statistically significant (p = 0.09). Residents who perceived themselves to be culturally dexterous were more likely to self-identify as non-White as compared to White (p < 0.05). On multivariate analysis, White patients were more likely to report highly dexterous care, whereas Black patients were more likely to report poorly dexterous care (p < 0.05). CONCLUSIONS At baseline, half of patients reported receiving culturally dexterous care from surgical residents at 5 academic medical centers in the United States. This was consistent with residents' self-assessment of their cultural dexterity skills. White patients were more likely to report receiving culturally dexterous care as compared to non-White patients. Non-White residents were more likely to feel confident in their cultural dexterity skills. A novel curriculum has been designed to improve these interactions between patients and surgical residents.
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Affiliation(s)
- Rachel B Atkinson
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Gezzer Ortega
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Maria B J Chun
- John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii
| | - David T Harrington
- Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Pamela A Lipsett
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - John T Mullen
- Massachusetts General Hospital, Boston, Massachusetts
| | - Emil Petrusa
- Massachusetts General Hospital, Boston, Massachusetts
| | - Emma Reidy
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Adil H Haider
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts; Aga Khan University Medical College, Karachi, Pakistan
| | - Douglas S Smink
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
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McKinley SK, Cassidy DJ, Sell NM, Mullen JT, Saillant N, Petrusa E, Phitayakorn R, Gee D. A qualitative study of the perceived value of participation in a new Department of Surgery Research Residents as teachers program. Am J Surg 2020; 220:1194-1200. [PMID: 32723491 DOI: 10.1016/j.amjsurg.2020.06.056] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/06/2020] [Accepted: 06/25/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aims to understand the perspectives of surgical residents who completed a Research Residents as Teachers Program (RRATP). METHODS Our RRATP included a 6 h workshop followed by formal teaching opportunities across one academic year. Resident teachers participated in semi-structured interviews, which were inductively analyzed for prominent themes. RESULTS Eight surgical research residents completed the RRATP workshop and taught 330 h (median = 26 h, range: 8-105). Interview participation rate was 100%; kappa was 0.81. Residents reported four themes: 1) increased knowledge of teaching principles with subsequent teaching changes, specific factors that contributed to their development as a teacher, numerous personal benefits to participation, and broad positive consequences for the surgical department including improved culture and patient care. CONCLUSION A RRATP can generate a significant number of formal teaching hours by surgical research residents, who perceive a high value of formal education training to themselves and their surgical residency program.
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Affiliation(s)
- Sophia K McKinley
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street GRB 425, Boston, MA, 02114, USA.
| | - Douglas J Cassidy
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street GRB 425, Boston, MA, 02114, USA.
| | - Naomi M Sell
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street GRB 425, Boston, MA, 02114, USA.
| | - John T Mullen
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street GRB 425, Boston, MA, 02114, USA.
| | - Noelle Saillant
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street GRB 425, Boston, MA, 02114, USA.
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street GRB 425, Boston, MA, 02114, USA.
| | - Roy Phitayakorn
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street GRB 425, Boston, MA, 02114, USA.
| | - Denise Gee
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street GRB 425, Boston, MA, 02114, USA.
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McKinley SK, Cassidy DJ, Mansur A, Saillant N, Ghosh A, Evenson A, Askari R, Haynes A, Cho N, James BC, Olasky J, Rangel E, Petrusa E, Phitayakorn R. Identification of Specific Educational Targets to Improve the Student Surgical Clerkship Experience. J Surg Res 2020; 254:49-57. [PMID: 32408030 DOI: 10.1016/j.jss.2020.03.066] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/12/2020] [Accepted: 03/31/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND This study describes the relationship between medical student perception of surgery, frequency of positive surgery clerkship activities, and overall surgical clerkship experience. METHODS Medical students at four academic hospitals completed pre- and post-clerkship surveys assessing 1) surgery clerkship activities/experiences and 2) perceptions of surgery during the 2017-2018 academic year. RESULTS Ninety-one percent of students completed both a pre- and post-clerkship survey (n = 162 of 179). Student perception of surgery significantly improved across the clerkship overall (P < 0.0001) and for 7 of 21 specific items. Eighty-six percent of students agreed that the clerkship was a meaningful experience. Sixty-six percent agreed that the operating room was a positive learning environment. Multivariable logistic regression identified one-on-one mentoring from a resident (OR [95% CI] = 2.12 [1.11-4.04], P = 0.02) and establishing a meaningful relationship with a surgical patient (OR = 2.21 [1.12-4.37], P = 0.02) as activities predictive of student agreement that the surgical clerkship was meaningful. Making an incision (OR = 2.92 [1.54-5.56], P = 0.001) and assisting in dissection (OR = 1.67 [1.03-2.69], P = 0.035) were predictive of student agreement that the operating room was a positive learning environment. Positive student perception of surgery before the clerkship was associated with increased frequency of positive clerkship activities including operative involvement (r = 0.26, P = 0.001) and relationships with surgical attendings (r = 0.20, P = 0.01), residents (r = 0.41, P < 0.0001), and patients (r = 0.24, P = 0.003). CONCLUSIONS Interventions to improve surgery clerkship quality should target enhancing student relationships with residents and surgical patients as well as providing opportunity for student operative involvement beyond just suturing. In addition, fostering positive perceptions of surgery in the preclinical period may increase meaningfulness and experience with the later surgery clerkship.
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Affiliation(s)
- Sophia K McKinley
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Douglas J Cassidy
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Arian Mansur
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Noelle Saillant
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Amy Evenson
- Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Reza Askari
- Harvard Medical School, Boston, Massachusetts
| | - Alex Haynes
- Department of Surgery, Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts
| | - Nancy Cho
- Harvard Medical School, Boston, Massachusetts
| | - Benjamin C James
- Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Jaisa Olasky
- Department of Surgery, Dell Medical School, University of Texas, Austin, Texas
| | | | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Roy Phitayakorn
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Qi D, Petrusa E, Kruger U, Milef N, Abu-Nuwar MR, Haque M, Lim R, Jones DB, Turkseven M, Demirel D, Halic T, De S, Saillant N. Surgeons With Five or More Actual Cricothyrotomies Perform Significantly Better on a Virtual Reality Simulator. J Surg Res 2020; 252:247-254. [PMID: 32304931 PMCID: PMC7295680 DOI: 10.1016/j.jss.2020.03.021] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/28/2020] [Accepted: 03/08/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Discriminating performance of learners with varying experience is essential to developing and validating a surgical simulator. For rare and emergent procedures such as cricothyrotomy (CCT), the criteria to establish such groups are unclear. This study is to investigate the impact of surgeons' actual CCT experience on their virtual reality simulator performance and to determine the minimum number of actual CCTs that significantly discriminates simulator scores. Our hypothesis is that surgeons who performed more actual CCT cases would perform better on a virtual reality CCT simulator. METHODS 47 clinicians were recruited to participate in this study at the 2018 annual conference of the Society of American Gastrointestinal and Endoscopic Surgeons. We established groups based on three different experience thresholds, that is, the minimal number of CCT cases performed (1, 5, and 10), and compared simulator performance between these groups. RESULTS Participants who had performed more clinical cases manifested higher mean scores in completing CCT simulation tasks, and those reporting at least 5 actual CCTs had significantly higher (P = 0.014) simulator scores than those who had performed fewer cases. Another interesting finding was that classifying participants based on experience level, that is, attendings, fellows, and residents, did not yield statistically significant differences in skills related to CCT. CONCLUSIONS The simulator was sensitive to prior experience at a threshold of 5 actual CCTs performed.
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Affiliation(s)
- Di Qi
- Center for Modeling, Simulation, and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, New York.
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, Harvard School of Medicine, Boston, Massachusetts
| | - Uwe Kruger
- Center for Modeling, Simulation, and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, New York; Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York
| | - Nicholas Milef
- Center for Modeling, Simulation, and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, New York
| | - Mohamad Rassoul Abu-Nuwar
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard School of Medicine, Boston, Massachusetts
| | - Mohamad Haque
- Anderson Simulation Center, Madigan Army Medical Center, Tacoma, Washigton
| | - Robert Lim
- Tripler Army Medical Center, Honolulu, Hawaii
| | - Daniel B Jones
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard School of Medicine, Boston, Massachusetts
| | - Melih Turkseven
- Center for Modeling, Simulation, and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, New York
| | - Doga Demirel
- Department of Computer Science, Florida Polytechnic University, Lakeland, Florida
| | - Tansel Halic
- Computer Science Department, University of Central Arkansas, Conway, Arkansas
| | - Suvranu De
- Center for Modeling, Simulation, and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, New York
| | - Noelle Saillant
- Department of Surgery, Massachusetts General Hospital, Harvard School of Medicine, Boston, Massachusetts
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McKinley SK, Sell NM, Saillant N, Coe TM, Lau T, Cooper CM, Haynes AB, Petrusa E, Phitayakorn R. Enhancing the Formal Preclinical Curriculum to Improve Medical Student Perception of Surgery. J Surg Educ 2020; 77:788-798. [PMID: 32192888 DOI: 10.1016/j.jsurg.2020.02.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 01/03/2020] [Accepted: 02/15/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND This study aims to determine the effect of formal, preclinical curricular interventions on medical students' perceptions of surgeons, surgical learning objectives, and concerns regarding the surgical clerkship. METHODS Thirty-eight medical students underwent a newly required, formal introduction to surgery during the preclinical curriculum. Two months later, these students were given surveys regarding their perception of surgery before and after a bootcamp-style transitions to the wards workshop that immediately preceded their core clinical rotations. Student responses were compared to historical peers. RESULTS Thirty-seven students participated in the study (97.4%). Relative to historical peers, students demonstrated improved overall perception of surgery (71.2 vs 66.6, p = 0.046). A smaller proportion of students indicated that they were worried about evaluation (18.9% in 2018 vs 55.3% in 2017, p = 0.001) and interactions with surgical educators (18.9% vs 50%, p = 0.005). Students' overall perception of surgery significantly improved after participation in the transition to the wards workshop (71.2 to 77.8, p ≤ 0.0001), as did student agreement with 9 of 21 specific items. Improvement in surgical perception across the bootcamp-style workshop was similar to that of a prior workshop (8.6 in 2018 vs 6.4 in 2017, p = 0.21). CONCLUSIONS A preclinical introduction to surgery can have a positive impact on medical student perception of surgery prior to entry to the wards and may mitigate student fears regarding their surgical rotation.
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Affiliation(s)
- Sophia K McKinley
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
| | - Naomi M Sell
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Noelle Saillant
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Taylor M Coe
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Trevin Lau
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Massachusetts
| | - Cynthia M Cooper
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Alex B Haynes
- Surgery and Perioperative Care, Dell Medical School at the University of Texas Austin, Austin, Texas
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Roy Phitayakorn
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
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Mai CL, Wongsirimeteekul P, Petrusa E, Minehart R, Hemingway M, Pian-Smith M, Eromo E, Phitayakorn R. Prevention and Management of Operating Room Fire: An Interprofessional Operating Room Team Simulation Case. MedEdPORTAL 2020; 16:10871. [PMID: 32051852 PMCID: PMC7012309 DOI: 10.15766/mep_2374-8265.10871] [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] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 09/07/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Operating room (OR) fire can be a devastating and costly event to patients and health care providers. Prevention and effective management of such fires may present difficulties even for experienced OR staff. METHODS This simulation involved a 52-year-old man presenting for excisional biopsy of a cervical lymph node to be performed under sedation. Participants were expected to identify and manage both contained and uncontained fires resulting from ignition by electrosurgical cautery. We conducted weekly multidisciplinary simulations in the mock OR at Massachusetts General Hospital. Participants included surgery and anesthesiology residents, certified registered nurse anesthetists, registered nurses, and surgical technicians. Participants were unaware of the scenario content. Each 90-minute session was divided into three parts: an orientation (10 minutes), the case with rapid cycle debriefing (65 minutes), and a final debriefing with course evaluations (15 minutes). Equipment consisted of a simulation OR with general surgery supplies, general anesthesia equipment, a high-fidelity Laerdal SimMan 3G simulator, a code cart, a defibrillator, dry ice for smoke effects, and a projector with a fire image. RESULTS From April to June 2015, 86 participants completed this simulation. Participants reported that the simulation scenario was realistic (80%), was relevant to their clinical practice (93%), changed their practice (82%), and promoted teamwork (80%). DISCUSSION Prevention and management of OR fire require collaboration and prompt coordination between anesthesiologists, surgeons, and nurses. This simulation case scenario was implemented to train multidisciplinary learners in the identification and crisis management of such an event.
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Affiliation(s)
- Christine L. Mai
- Pediatric Anesthesiologist, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital
| | | | - Emil Petrusa
- Surgical Education Researcher, Department of Surgery, Massachusetts General Hospital
| | - Rebecca Minehart
- Anesthesiologist, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital
| | | | - May Pian-Smith
- Anesthesiologist, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital
| | - Ersne Eromo
- Anesthesiologist, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital
| | - Roy Phitayakorn
- General and Endocrine Surgeon, Department of Surgery, Massachusetts General Hospital
- Director of Medical Student Education, Department of Surgery, Massachusetts General Hospital
- Director of Surgery Education Research, Department of Surgery, Massachusetts General Hospital
- Senior Education Research and Development Consultant, New England Journal of Medicine Group
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McKinley SK, Wang LJ, Gartland RM, Westfal ML, Costantino CL, Schwartz D, Merrill AL, Petrusa E, Lillemoe K, Phitayakorn R. "Yes, I'm the Doctor": One Department's Approach to Assessing and Addressing Gender-Based Discrimination in the Modern Medical Training Era. Acad Med 2019; 94:1691-1698. [PMID: 31274522 DOI: 10.1097/acm.0000000000002845] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
While gender-based bias and discrimination (GBD) is known to exist in medical training, there is limited guidance for training programs on how to understand and combat this issue locally. The Massachusetts General Hospital Department of Surgery established the Gender Equity Task Force (GETF) to address GBD in the local training environment. In 2017, members of the GETF surveyed residents in surgery, anesthesia, and internal medicine at 2 academic hospitals to better understand perceived sources, frequency, forms, and effects of GBD. Overall, 371 residents completed the survey (60% response rate, 197 women). Women trainees were more likely to endorse personal experience of GBD and sexual harassment than men (P < .0001), with no effect of specialty on rates of GBD or sexual harassment. Patients and nursing staff were the most frequently identified groups as sources of GBD. While an overwhelming majority of both men (86%) and women (96%) respondents either experienced or observed GBD in the training environment, less than 5% of respondents formally reported such experiences, most frequently citing a belief that nothing would happen. Survey results served as the basis for a variety of interventions addressing nursing staff and patients as sources of GBD, low confidence in formal reporting mechanisms, and the pervasiveness of GBD, including sexual harassment, across specialties. These results reproduce other studies' findings that GBD and sexual harassment disproportionately affect women trainees while demonstrating how individual training programs can incorporate local GBD data when planning interventions to address GBD.
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Affiliation(s)
- Sophia K McKinley
- S.K. McKinley is resident physician, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts. L.J. Wang is resident physician, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts. R.M. Gartland is resident physician, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts. M.L. Westfal is resident physician, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts. C.L. Costantino is resident physician, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts. D. Schwartz is resident physician, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts. A.L. Merrill is a fellow, Department of Surgery, Ohio State University, Columbus, Ohio. E. Petrusa is associate professor, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts. K. Lillemoe is professor and chair, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts. R. Phitayakorn is associate professor, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
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Cassidy DJ, Panda N, McKinley SK, Mansur A, Mullen JT, Petrusa E, Phitayakorn R, Gee DW. Does Clinical Exposure Matter? An Analysis of General Surgery Categorical Intern Schedules and the Impact of Rotation Timing on ABSITE Performance. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.1230] [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: 10/25/2022]
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Axelsson CGS, Curry WT, Healy MG, Petrusa E, Rooney DM, Wolbrink T, Phitayakorn R. This is Not Brain Surgery: Increasing Neurosurgical Knowledge and Retention in Medical Students Through Usage of a Video-Based Education Curriculum. Neurosurgery 2019. [DOI: 10.1093/neuros/nyz310_324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
INTRODUCTION
The fundamental elements of neurosurgical care are essential for all medical students regardless of their ultimate clinical specialty. However, the high-pressured neurosurgical environment leaves limited time for teaching medical students. One potential solution is the use of video-based education modules, but the effectiveness and usage of these modules in surgery is unclear.
METHODS
A 2-wk asynchronous, VBE (video based education) curriculum of four key neurosurgical topics as outlined in the Congress of Neurological Surgeons' curriculum for medical students (Intracranial Hemorrhage, Neuro-Imaging, Hydrocephalus, and Glasgow Coma Scale) was created and implemented for surgery clerkship students (n = 65). On day 1 of the study, each student was randomly assigned to 1 of 2 pairs, given a pretest for knowledge and self-efficacy on all 4 topics, and provided with the link for 2 of the 4 VBE modules. On day 14, a post-test for knowledge and self-efficacy on all four topics was completed. Usage analytics were employed to track views of assigned content.
RESULTS
Students who watched the modules (n = 53) increased their knowledge (+11.0%, P = .001) and self-efficacy (+1.37, P = .001) from pre- to post. Students who did not watch the modules (n = 12) showed no change in knowledge (58.8% vs 58.3%, P = NS), but a significant increase in their self-efficacy ratings (+1.42, P = .009). Learning analytics revealed that vast majority of learners (81%) engaged with the curriculum and watched their assigned videos once or on multiple occasions. 19% of learners did not engage with the curriculum, citing their heavy workload as a primary reason.
CONCLUSION
This study shows that a focused, asynchronous, VBE curriculum in neurosurgery has a significantly positive effect on knowledge and self-efficacy scores amongst medical students. Future studies will investigate how to improve learner compliance and better understand the gap in knowledge improvement vs self-efficacy.
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Wojcik BM, McKinley SK, Amari N, Chang DC, Wachtel H, Petrusa E, Mullen JT, Phitayakorn R. A comparison of patient satisfaction when office-based procedures are performed by general surgery residents versus an attending surgeon. Surgery 2019; 166:116-122. [DOI: 10.1016/j.surg.2019.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 02/04/2019] [Accepted: 02/07/2019] [Indexed: 11/29/2022]
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McKinley SK, Hashimoto DA, Mansur A, Cassidy D, Petrusa E, Mullen JT, Phitayakorn R, Gee DW. Feasibility and Perceived Usefulness of Using Head-Mounted Cameras for Resident Video Portfolios. J Surg Res 2019; 239:233-241. [PMID: 30856516 DOI: 10.1016/j.jss.2019.01.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 10/18/2018] [Revised: 12/21/2018] [Accepted: 01/11/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND There is limited guidance on how to longitudinally administer simulation materials or to incorporate video recordings into assessment portfolios of simulated surgical skills. MATERIALS AND METHODS We launched a longitudinal weekly simulation curriculum for PGY1-PGY3 surgical residents based on the ACS/APDS Curriculum. Residents underwent monthly objective structured assessment of technical skills (OSATS) while wearing head-mounted cameras. Videos of OSATS performance accrued into individual online video portfolios. Residents were surveyed about their attitudes toward video recording. RESULTS Twenty-seven general surgical residents participated, completing 161 OSATS encompassing 11 distinct skills and generating 258 videos of simulated skills performance. The overall survey response rate was 88%. Residents viewed the curriculum favorably overall, and 36.4% of residents accessed their videos. Of those who did not watch their videos, 78.6% cited not having enough time, whereas 28.6% did not think the videos would be useful. Over 95% of surveyed residents expressed interest in having a video library of attending-performed procedures, 59.1% were interested in having their own operations recorded, and 45.5% were interested in video-based coaching. CONCLUSIONS Residents viewed longitudinal administration of the ACS/APDS Curriculum positively. Although video recording in simulation is feasible, resident interest may be higher for intraoperative recordings than for simulated skills.
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Affiliation(s)
- Sophia K McKinley
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Daniel A Hashimoto
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Arian Mansur
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Douglas Cassidy
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - John T Mullen
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Roy Phitayakorn
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Denise W Gee
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
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McKinley SK, Kochis M, Cooper CM, Saillant N, Haynes AB, Petrusa E, Phitayakorn R. Medical students' perceptions and motivations prior to their surgery clerkship. Am J Surg 2019; 218:424-429. [PMID: 30732867 DOI: 10.1016/j.amjsurg.2019.01.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 06/22/2018] [Accepted: 01/10/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND This study aims to determine the effect of a pre-clerkship workshop on medical students' perceptions of surgery and surgeons and to describe their concerns and learning goals. METHODS Thirty-nine medical students completed surveys before and after a workshop preceding their surgery clerkship. Quantitative data and free responses that were inductively coded were used to assess effectiveness. RESULTS Perceptions from 38 students (response rate = 97.4%) significantly improved for 11 of 21 items. At pre-workshop, the most frequently cited learning goals were improving technical skills (58%), surgical knowledge (53%), and understanding surgical culture and work (53%). Students' top concerns were meeting clerkship demands (68%) and being evaluated (55%). After the workshop, student learning objectives and concerns remained largely unchanged. CONCLUSIONS A pre-clerkship workshop improved student perceptions of surgery and surgeons. Understanding students' intrinsic motivations may facilitate future clerkship curriculum improvement via better alignment of educator and student goals and objectives.
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Affiliation(s)
- Sophia K McKinley
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street GRB 425, Boston, MA, 02114, United States.
| | - Michael Kochis
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street GRB 425, Boston, MA, 02114, United States.
| | - Cynthia M Cooper
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street GRB 425, Boston, MA, 02114, United States.
| | - Noelle Saillant
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street GRB 425, Boston, MA, 02114, United States.
| | - Alex B Haynes
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street GRB 425, Boston, MA, 02114, United States.
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street GRB 425, Boston, MA, 02114, United States.
| | - Roy Phitayakorn
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street GRB 425, Boston, MA, 02114, United States.
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Hashimoto DA, Axelsson CG, Jones CB, Phitayakorn R, Petrusa E, McKinley SK, Gee D, Pugh C. Surgical procedural map scoring for decision-making in laparoscopic cholecystectomy. Am J Surg 2018; 217:356-361. [PMID: 30470551 DOI: 10.1016/j.amjsurg.2018.11.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/20/2018] [Accepted: 11/12/2018] [Indexed: 01/13/2023]
Abstract
INTRODUCTION The objective of this study was to determine whether decision-based procedural mapping demonstrates differences in attendings versus residents. METHODS Attendings and residents were interviewed about operative decision-making in laparoscopic cholecystectomy (LC) using a cognitive task analysis framework. Interviews were converted into procedural maps. Operative steps, patient factors, and surgeon factors noted by attendings and residents were compared. Two scoring methods were used to compare map structures of attendings versus residents. RESULTS Six attendings and six residents were interviewed. There were no significant differences in the number of patient or surgeon factors identified. Attendings had significantly more operative steps (29.67 ± 1.9 vs. 23.3 ± 1.9, p = 0.04) and crosslinks (3.2 ± 0.5 vs. 1 ± 0.4, p = 0.005) in their maps and a higher total score (90.2 ± 8.4 vs. 63.2 ± 3.8, p = 0.015) than residents. CONCLUSION LC procedural map scoring for attendings and residents demonstrated significant differences in structural complexity and may provide a useful framework for assessing decision making.
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Affiliation(s)
- Daniel A Hashimoto
- Department of Surgery, Massachusetts General Hospital, United States; Harvard Medical School, United States.
| | | | - Cara B Jones
- Department of Surgery, Massachusetts General Hospital, United States
| | - Roy Phitayakorn
- Department of Surgery, Massachusetts General Hospital, United States; Harvard Medical School, United States
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, United States; Harvard Medical School, United States
| | - Sophia K McKinley
- Department of Surgery, Massachusetts General Hospital, United States; Harvard Medical School, United States
| | - Denise Gee
- Department of Surgery, Massachusetts General Hospital, United States; Harvard Medical School, United States
| | - Carla Pugh
- Department of Surgery, Stanford University, United States
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McKinley SK, Wojcik BM, Kochis M, Mansur A, Jones CB, Petrusa E, Mullen J, Traeger L, Phitayakorn R. A Pilot Study of Inpatient Satisfaction Rating of Surgical Resident Care. J Surg Educ 2018; 75:e192-e203. [PMID: 30195665 DOI: 10.1016/j.jsurg.2018.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 04/02/2018] [Revised: 07/14/2018] [Accepted: 08/07/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To describe inpatient satisfaction with surgical resident care given the increasing importance of patient satisfaction as a quality metric. DESIGN Surgical inpatients were invited to complete a survey that addressed their satisfaction with and attitudes regarding surgical resident care. The survey was based on the Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey (S-CAHPS). Patients were required to positively identify photos of resident physicians prior to providing ratings. Adapted S-CAHPS items were scored using the "top-box" method. SETTING Massachusetts General Hospital, a tertiary academic center. PARTICIPANTS General surgery inpatients recovering from elective, major abdominal surgery were recruited on postoperative days 2 to 4. RESULTS Ninety-one percent of approached patients participated (102/112, mean age = 62.9, 51.6% male). Patients positively identified both seniors and interns 88% of the time. Thirteen seniors and 19 interns were rated, with 1 to 14 evaluations per trainee. Overall quality of care ratings for seniors and interns were 9.35 and 9.09, respectively (0-10 scale, 10 = "best possible care"). Sixty-three percent of senior resident evaluations and 60% of intern evaluations received a score of 10. The proportion of residents receiving top-box scores ranged from 59.5% to 97.7% depending on the item. Forty percent of senior resident and 38% of intern evaluations received top-box scores for all 8 items. Over 96% of patients reported strong or moderate agreement with the statements "I feel it is important to help in the education of future surgeons." CONCLUSIONS Surgical inpatients willingly completed ratings about their surgery residents, typically can recognize their resident physicians, and rate quality of care highly. Despite many high ratings, there is room for improvement in some S-CAHPS domains. These results indicate patients are a valuable source of feedback regarding a resident's progress in several core competencies such as interpersonal skills, communication, professionalism, and patient care.
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Affiliation(s)
| | | | | | - Arian Mansur
- Massachusetts General Hospital, Boston, Massachusetts.
| | | | - Emil Petrusa
- Massachusetts General Hospital, Boston, Massachusetts.
| | - John Mullen
- Massachusetts General Hospital, Boston, Massachusetts.
| | - Lara Traeger
- Massachusetts General Hospital, Boston, Massachusetts
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Bohnen JD, Demetri L, Fuentes E, Butler K, Askari R, Anand RJ, Petrusa E, Kaafarani HMA, Yeh DD, Saillant N, King D, Briggs S, Velmahos GC, Moya MD. High-Fidelity Emergency Department Thoracotomy Simulator With Beating-Heart Technology and OSATS Tool Improves Trainee Confidence and Distinguishes Level of Skill. J Surg Educ 2018; 75:1357-1366. [PMID: 29496361 DOI: 10.1016/j.jsurg.2018.02.001] [Citation(s) in RCA: 11] [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: 09/20/2017] [Revised: 12/23/2017] [Accepted: 02/01/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Resuscitative Thoracotomy or Emergency Department Thoracotomy (EDT) is a time-sensitive and potentially life-saving procedure. Yet, trainee experience with this procedure is often limited in both clinical and simulation settings. We sought to develop a high-fidelity EDT simulation module and assessment tool to facilitate trainee education. DESIGN Using the Kern model for curricular development, a group of expert trauma surgeons identified EDT as a high-stakes, low-frequency procedure. Task analysis identified 5 key steps of EDT: (1) opening chest/rib spreader utilization; (2) pericardiotomy/cardiac repair; (3) open cardiac massage; (4) clamping aorta; and (5) control of pulmonary hilum. A high-fidelity simulator with beating-heart technology was built. The previously validated Objective Structured Assessment of Technical Skills (OSATS) was adapted to create the "EDT-OSATS" which assessed performance along several domains: (1) Surgical technique (key steps); (2) general skills; and (3) global rating. A pilot test was performed to compare board-certified trauma surgeons (i.e., Experts) with categorical general surgery interns (i.e., Novices). Each subject received preparatory materials, completed a presimulation quiz, performed a videotaped procedure on the EDT simulator, and completed a postmodule survey. Two independent raters scored performances using the EDT-OSATS. Groups were compared in descriptive and unadjusted analyses. We hypothesized that our EDT simulation module would distinguish between expert vs novice performance and improve trainee confidence. SETTING Simulation laboratory at Massachusetts General Hospital in Boston, MA. PARTICIPANTS Trauma surgeons (Experts, n = 6) and categorical general surgery interns (Novices, n = 8). RESULTS Experts scored significantly higher than Novices on nearly all components of the EDT-OSATS, including: (1) surgical technique: pericardiotomy (4.2 vs 3.4, p = 0.040), cardiac massage (3.6 vs 2.4, p = 0.028), clamping aorta (4.1 vs 3.3, p = 0.035), control of pulmonary hilum (4.8 vs 3.4, p < 0.001); (2) general skills: time/motion (4.1 vs 2.9, p = 0.011), knowledge and handling of instruments (4.3 vs 3.1, p = 0.004), and (3) global rating (3.9 vs 2.9, p = 0.026). There was no statistical difference between groups on opening chest/rib spreader utilization (3.8 vs 3.3, p = 0.352) or procedure time (204sec vs 227sec, p = 0.401), though Experts scored numerically higher than Novices on every measure. Novices reported significantly increased confidence after the simulation (3.1 vs 1.4, p = 0.001). Ninety-three percent (13/14) of participants found the simulator realistic. CONCLUSIONS Our novel high-fidelity beating-heart EDT simulator is realistic and improves trainee confidence in this low-frequency, high-stakes emergency procedure. The EDT-OSATS tool differentiates between performances of experienced surgeons vs novice trainees on the beating-heart simulator. This training module and accompanying assessment instrument hold promise as a learning tool for clinicians who may perform emergency department thoracotomy.
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Affiliation(s)
- Jordan D Bohnen
- Department of Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Leah Demetri
- Department of Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Eva Fuentes
- Department of Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Kathryn Butler
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Reza Askari
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Rahul J Anand
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts; Learning Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - D Dante Yeh
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Noelle Saillant
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - David King
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Susan Briggs
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - George C Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Marc de Moya
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin-Froedtert Trauma Center, Milwaukee, Wisconsin.
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Berkowitz LR, James K, Petrusa E, York-Best C, Kaimal AJ. New Challenges for a Core Procedure: Development of a Faculty Workshop for Skills Maintenance for Abdominal Hysterectomy. J Surg Educ 2018; 75:942-946. [PMID: 29422404 DOI: 10.1016/j.jsurg.2017.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 10/20/2017] [Revised: 11/30/2017] [Accepted: 12/06/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To describe the development of a low-cost educational module for OB/GYN faculty skills maintenance for total abdominal hysterectomy (TAH), a low frequency core procedure in obstetrics and gynecology. DESIGN After review of existing educational tools and utilization of a modified Delphi method to establish consensus regarding key procedural components for skills maintenance, a 2-hour workshop was developed to review knowledge and participate in a simulation focused on the critical steps in performing TAH. An expert in TAH delivered a lecture highlighting important surgical considerations. Participants then rotated through simulation stations for critical steps in TAH: dissecting the bladder, identifying the ureter, and closing the cuff. Knowledge gains were assessed with a written pre- and posttest. Consecutive focus groups were conducted with participants on effectiveness of the workshop, and suggestions for improvement. Ideas identified in the first focus group were incorporated into the second workshop. SETTING Massachusetts General Hospital, an academic tertiary care facility with a single Obstetrics and Gynecology faculty group, located in Boston, Massachusetts. PARTICIPANTS Eligible participants were recruited via email from full time specialists in General Obstetrics and Gynecology at Massachusetts General Hospital. Of the 25 eligible gynecology faculty subjects, 22 participated (88%). RESULTS On pre or post-test comparison, 70% of participants scored higher on the posttest, demonstrating an increase in knowledge of critical TAH surgical steps. Focus group analyses identified the need for increased review and training demonstrations of TAH, and recommended continued offering of the workshop. CONCLUSIONS Based on focus group responses and pre or posttest comparisons, the workshop was deemed feasible and enhanced short-term learning. Future directions include utilizing more challenging anatomic models and simulation scenarios and optimizing integration of expert demonstration and individualized coaching, as well as identifying regionally tailored surgical workshop programming.
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Affiliation(s)
- Lori R Berkowitz
- Massachusetts General Hospital, Vincent Obstetrics and Gynecology, Boston, Massachusetts.
| | - Kaitlyn James
- Massachusetts General Hospital, Deborah Kelly Center for Outcomes Research, Vincent Obstetrics and Gynecology, Boston, Massachusetts
| | - Emil Petrusa
- Massachusetts General Hospital, Department of Surgery, Boston, Massachusetts
| | - Carey York-Best
- Massachusetts General Hospital, Vincent Obstetrics and Gynecology, Boston, Massachusetts
| | - Anjali J Kaimal
- Massachusetts General Hospital, Vincent Obstetrics and Gynecology, Boston, Massachusetts
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Lindeman B, Petrusa E, McKinley S, Hashimoto DA, Gee D, Smink DS, Mullen JT, Phitayakorn R. Corrigendum to "Association of burnout with emotional intelligence and personality in surgical residents: Can we predict who is most at risk?" [J Surg Educ (2017) e22-e30]. J Surg Educ 2018; 75:1135-1136. [PMID: 30008385 DOI: 10.1016/j.jsurg.2018.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Brenessa Lindeman
- Department of Surgery, Brigham and Women's Hospital, Boston, MA; Department of Surgery, University of Alabama at Birmingham, Birmingham, AL.
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Sophia McKinley
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | | | - Denise Gee
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Douglas S Smink
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - John T Mullen
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Roy Phitayakorn
- Department of Surgery, Massachusetts General Hospital, Boston, MA
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Wongsirimeteekul P, Mai CL, Petrusa E, Minehart R, Hemingway M, Pian-Smith M, Eromo E, Phitayakorn R. Identifying and Managing Intraoperative Arrhythmia: A Multidisciplinary Operating Room Team Simulation Case. MedEdPORTAL 2018; 14:10688. [PMID: 30800888 PMCID: PMC6342395 DOI: 10.15766/mep_2374-8265.10688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 09/30/2017] [Accepted: 01/28/2018] [Indexed: 05/29/2023]
Abstract
Introduction Resuscitation of a critically ill patient is challenging for both novice learners and experienced health care providers. During a critical event, not only is it important to identify the correct underlying diagnosis, it is equally crucial that the appropriate Advance Cardiac Life Support algorithm, medications, and defibrillator modality are implemented. This scenario features a 56-year-old female who presents for excisional biopsy of an inguinal lymph node to evaluate lymphadenopathy concerning for lymphoma. Intraoperatively, she goes into cardiopulmonary arrest. Participants must identify and manage three different scenarios: (1) ventricular fibrillation, (2) unstable ventricular tachycardia, and (3) bradycardia, including the use of the defibrillator. Method Weekly simulation sessions were conducted in the in situ simulation operating room at Massachusetts General Hospital. Surgical residents, anesthesiology residents, nurses, and surgical technicians participated in a multidisciplinary operating room team. Each approximately 60-minute session included an orientation, the case, and the debriefing. Equipment included a simulation operating room with general surgery supplies, general anesthesia equipment, a high-fidelity SimMan patient simulator, a code cart, and a defibrillator. Results Ninety-one multidisciplinary participants completed this scenario from September to December 2015. Participants reported that the scenario was applicable to their clinical practice (96%), promoted teamwork skills (88%), and encouraged interprofessional learning (94%). Discussion Intraoperative cardiac arrest is a devastating event that can result in poor patient outcomes if the care team is not thoroughly prepared for crisis management. This simulation case scenario was implemented to train multidisciplinary learners in the identification and management of such an event.
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Affiliation(s)
- Praelada Wongsirimeteekul
- Ophthalmology Resident, Chiang Mai University, Chiang Mai, Thailand
- Surgical Education Research Fellow, Department of Surgery, Massachusetts General Hospital
| | | | - Emil Petrusa
- Surgical Education Researcher, Department of Surgery, Massachusetts General Hospital
| | | | | | | | - Ersne Eromo
- Anesthesiologist, Massachusetts General Hospital
| | - Roy Phitayakorn
- General and Endocrine Surgeon, Massachusetts General Hospital
- Director of Medical Student Education and Surgery Education Research, Department of Surgery, Massachusetts General Hospital
- Senior Education Research and Development Consultant, NEJM Group
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Healy M, Petrusa E, Axelsson CG, Wongsirimeteekul P, Hamnvik OP, O’Rourke M, Feinstein R, Steeves R, Phitayakorn R. An Exploratory Study of a Novel Adaptive e-Learning Board Review Product Helping Candidates Prepare for Certification Examinations. MedEdPublish 2018. [DOI: 10.15694/mep.2018.0000162.1] [Citation(s) in RCA: 2] [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: 11/06/2022] Open
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50
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Wojcik BM, Fong ZV, Patel MS, Chang DC, Long DR, Kaafarani HM, Petrusa E, Mullen JT, Lillemoe KD, Phitayakorn R. Structured Operative Autonomy: An Institutional Approach to Enhancing Surgical Resident Education Without Impacting Patient Outcomes. J Am Coll Surg 2017; 225:713-724.e2. [DOI: 10.1016/j.jamcollsurg.2017.08.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 08/20/2017] [Accepted: 08/21/2017] [Indexed: 11/15/2022]
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