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Wile RK, Barnes KE, Charondo LB, Breyer K, Lager J, Campbell A, O'Sullivan PS. Student challenges during third-year perioperative clerkships through the lens of faculty and residents: A qualitative study. Clin Teach 2024. [PMID: 38323350 DOI: 10.1111/tct.13742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 01/12/2024] [Indexed: 02/08/2024]
Abstract
PURPOSE Studies of medical students suggest they often find the transition from the pre-clinical curriculum to clinical rotations particularly challenging during perioperative clerkships. Educators could add a new perspective into students' clerkship experiences and potential interventions to improve them. The purpose of this study was to examine the educator perspective on students' experiences in perioperative clerkships. The findings could inform potential curricular interventions to facilitate student transition from a didactic environment into perioperative clerkships. METHODS Semi-structured qualitative interviews were conducted with 16 faculty and residents in the departments of anaesthesia, obstetrics and gynaecology (OBGYN), and general surgery across multiple clinical teaching sites at one institution. Interview questions explored their perceptions of the challenges students face during their transition into perioperative clerkships and probed thoughts on curriculum interventions they believed would be the most beneficial. Interviews were recorded, transcribed and analysed thematically. FINDINGS Three themes were identified. Faculty and residents perceive that student experiences on perioperative clerkships are shaped by (1) students' ability to adapt to the specialty and operating room norms on these clerkships, (2) students' understanding of how they can meaningfully contribute to the clinical team, and (3) dedicated teaching time constraints. Interventions were suggested to address educator expectations and student gaps, such as implementing a pre-clerkship orientation across anaesthesia, general surgery and OBGYN. CONCLUSIONS To facilitate the medical student transition to perioperative clerkships, interventions should aid students in adapting to clerkship norms for these specialties and clarifying their role and expectations within the care team.
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Affiliation(s)
- Rachel K Wile
- School of Medicine, University of California, San Francisco, California, USA
| | - Katherine E Barnes
- School of Medicine, University of California, San Francisco, California, USA
| | - Leslie B Charondo
- School of Medicine, University of California, San Francisco, California, USA
| | - Kristine Breyer
- School of Medicine, University of California, San Francisco, California, USA
- Department of Anesthesia and Perioperative Medicine, University of California, San Francisco, California, USA
| | - Jeannette Lager
- School of Medicine, University of California, San Francisco, California, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California, USA
| | - Andre Campbell
- School of Medicine, University of California, San Francisco, California, USA
- Department of Surgery, University of California, San Francisco, California, USA
| | - Patricia S O'Sullivan
- School of Medicine, University of California, San Francisco, California, USA
- Department of Surgery, University of California, San Francisco, California, USA
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Banks KC, Barnes KE, Wile RK, Hung YY, Santos J, Hsu DS, Choe G, Elmadhun NY, Ashiku SK, Patel AR, Velotta JB. Outcomes of Anastomotic Evaluation Using Indocyanine Green Fluorescence during Minimally Invasive Esophagectomy. Am Surg 2023; 89:5124-5130. [PMID: 36327490 DOI: 10.1177/00031348221138084] [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] [Indexed: 11/06/2022]
Abstract
BACKGROUND Limited evidence exists assessing whether anastomotic evaluation using indocyanine green fluorescence (IGF) during minimally invasive esophagectomy (MIE) predicts or improves outcomes. We hypothesized that IGF helps surgeons predict anastomotic complications and reduces anastomotic leaks after MIE. METHODS In September 2019, our institution began routinely using IGF for intraoperative evaluation of anastomoses during MIE. Data were collected from patients undergoing MIE in the two years before and after this technology began being routinely used. Baseline characteristics and outcomes, including anastomotic leak, in patients who underwent indocyanine green fluorescence evaluation (ICG) and those who did not (nICG) were compared. Outcomes were also compared between ICG patients with normal versus abnormal fluorescence. RESULTS Overall, 181 patients were included. Baseline demographic and clinical characteristics did not differ between the ICG and nICG groups. ICG patients experienced higher rates of anastomotic leak (10.2% vs. 1.6%, P = .015) and 90-day mortality (8.5% vs. 1.6%, P = .04) compared to nICG patients. Due to lack of equipment availability, 19 nICG patients underwent MIE after the use of IGF became routine, and none developed leaks. ICG patients with abnormal fluorescence had higher rates of anastomotic leak (71.4% vs 1.9%, P < .001) and 30-day mortality (28.6% vs 0%, P = .012) compared to those with normal fluorescence. DISCUSSION Abnormal intraoperative IGF was associated with increased rate of anastomotic leak, suggesting predictive potential of IGF. However, its use was associated with an increased leak rate and higher mortality. Further studies are warranted to assess possible physiologic effects of indocyanine green on the esophageal anastomosis.
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Affiliation(s)
- Kian C Banks
- Department of Thoracic Surgery, Kaiser Permanente Northern California, Oakland, CA, USA
- Department of Surgery, UCSF East Bay, Oakland, CA, USA
| | | | - Rachel K Wile
- School of Medicine, University of California, San Francisco, CA, USA
| | - Yun-Yi Hung
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Jesse Santos
- Department of Thoracic Surgery, Kaiser Permanente Northern California, Oakland, CA, USA
- Department of Surgery, UCSF East Bay, Oakland, CA, USA
| | - Diana S Hsu
- Department of Thoracic Surgery, Kaiser Permanente Northern California, Oakland, CA, USA
- Department of Surgery, UCSF East Bay, Oakland, CA, USA
| | - Giye Choe
- Department of Thoracic Surgery, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Nassrene Y Elmadhun
- Department of Thoracic Surgery, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Simon K Ashiku
- Department of Thoracic Surgery, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Ashish R Patel
- Department of Thoracic Surgery, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Jeffrey B Velotta
- Department of Thoracic Surgery, Kaiser Permanente Northern California, Oakland, CA, USA
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Wile RK, Brian R, Rodriguez N, Chern H, Cruff J, O'Sullivan PS. Home practice for robotic surgery: a randomized controlled trial of a low-cost simulation model. J Robot Surg 2023; 17:2527-2536. [PMID: 37531043 PMCID: PMC10492874 DOI: 10.1007/s11701-023-01688-7] [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: 06/20/2023] [Accepted: 07/23/2023] [Indexed: 08/03/2023]
Abstract
Pre-operative simulated practice allows trainees to learn robotic surgery outside the operating room without risking patient safety. While simulation practice has shown efficacy, simulators are expensive and frequently inaccessible. Cruff (J Surg Educ 78(2): 379-381, 2021) described a low-cost simulation model to learn hand movements for robotic surgery. Our study evaluates whether practice with low-cost home simulation models can improve trainee performance on robotic surgery simulators. Home simulation kits were adapted from those described by Cruff (J Surg Educ 78(2): 379-381, 2021). Hand controllers were modified to mimic the master tool manipulators (MTMs) on the da Vinci Skills Simulator (dVSS). Medical students completed two da Vinci exercises: Sea Spikes 1 (SS1) and Big Dipper Needle Driving (BDND). They were subsequently assigned to either receive a home simulation kit or not. Students returned two weeks later and repeated SS1 and BDND. Overall score, economy of motion, time to completion, and penalty subtotal were collected, and analyses of covariance were performed. Semi-structured interviews assessed student perceptions of the robotic simulation experience. Thirty-three medical students entered the study. Twenty-nine completed both sessions. The difference in score improvement between the experimental and control groups was not significant. In interviews, students provided suggestions to increase fidelity and usefulness of low-cost robotic home simulation. Low-cost home simulation models did not improve student performance on dVSS after two weeks of at-home practice. Interview data highlighted areas to focus future simulation efforts. Ongoing work is necessary to develop low-cost solutions to facilitate practice for robotic surgery and foster more inclusive and accessible surgical education.
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Affiliation(s)
- Rachel K Wile
- School of Medicine, University of California, San Francisco, 533 Parnassus Ave, San Francisco, CA, 94143, USA.
| | - Riley Brian
- Department of Surgery, University of California, San Francisco, 513 Parnassus Avenue, S-321, San Francisco, CA, 94143, USA
| | - Natalie Rodriguez
- Department of Surgery, University of California, San Francisco, 513 Parnassus Avenue, S-321, San Francisco, CA, 94143, USA
| | - Hueylan Chern
- Department of Surgery, University of California, San Francisco, 513 Parnassus Avenue, S-321, San Francisco, CA, 94143, USA
| | - Jason Cruff
- Department of Obstetrics/Gynecology-Female Pelvic Medicine & Reconstructive Surgery, Marshfield Clinic Health System, Marshfield, WI, 54449, USA
| | - Patricia S O'Sullivan
- Department of Surgery, University of California, San Francisco, 513 Parnassus Avenue, S-321, San Francisco, CA, 94143, USA
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Banks KC, Sun A, Le ST, Wei J, Hsu DS, Ely S, Barnes KE, Wile RK, Maxim C, Ashiku SK, Patel AR, Velotta JB. Effect of reduced urinary catheter duration on time to ambulation after VATS lobectomy. Surgery in Practice and Science 2023. [DOI: 10.1016/j.sipas.2022.100150] [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: 12/23/2022] Open
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