Educational Value of Surgical Residents Operating as Teaching Assistant

OBJECTIVE

To assess the educational of value of teaching assistant (TA) cases from the perspectives of attending, chief resident, and junior resident. We hypothesized the greatest educational value of TA cases would be for chief residents more so than other team members.

DESIGN

A prospective survey was designed and collected for TA cases separately from attendings, chief residents, and junior residents to assess operative details and educational value. The study period ran from August 2021 through December 2022. Qualitative and quantitative analysis was undertaken to compare answers and discover themes in the free-text responses of attendings and residents.

SETTING

Single center, tertiary care institution, Maine Medical Center, Department of Surgery, Portland, ME PARTICIPANTS: Sixty-nine teaching assistant cases were captured from a total of 117 completed surveys that were completed by 44 chief residents, 49 junior residents, 22 attendings (n = 22) and 2 APPs.

RESULTS

A wide variety of TA cases were included in the study with the most common reason for performing a TA case being resident request 68%. Operative complexity was most commonly rated easiest third (50%) and middle third (41%) of overall cases. Both junior and chief residents felt that compared to working with an attending alone, TA cases contributed more or much more to their procedural independence >80% of the time. Attendings reported learning something about the resident's skills that they were not expecting in 59% of the cases. Thematic analysis: attendings focused on the steps of the procedure, including the technical aspects, particularly regarding opening while residents largely focused on communication and preparation.

CONCLUSIONS

Teaching assistant cases seem to have more educational value for chief and junior residents than attendings. Both junior and chief residents felt that compared to working with an attending alone, TA cases contributed more or much more to their procedural independence >80% of the time.

SMART CUREs: a Professional Development Program for Advancing Teaching Assistant Preparedness To Facilitate Course-Based Undergraduate Research Experiences

Course-based undergraduate research experiences (CUREs) have emerged as a viable platform to engage large numbers of students in real-world scientific practices. Historically, CUREs have been offered throughout science, technology, engineering, and mathematics curricula at both the introductory and advanced levels and have been facilitated by a variety of individuals, including faculty members, postdoctoral fellows, and graduate teaching assistants (GTAs). This latter population, in particular, has increasingly been tasked with facilitating CUREs, yet they often receive little meaningful professional development to improve pedagogical skills vital to this type of instruction. To address this disparity, we designed and evaluated a semester-long intervention to support GTAs (N = 7) responsible for leading CUREs at our institution during the Fall 2020 semester. Intervention activities included synchronous interactive discussions, reflective journaling, and asynchronous practical exercises. Analysis of retrospective postintervention survey responses and focus group interview data revealed that participants exhibited gains in their understanding of the dimensions of CUREs, strategies for mentoring undergraduates, and use of various pedagogical techniques as well as confidence in addressing and adopting those dimensions and strategies in their courses. Furthermore, participants reported finding value in the sense of community created through the intervention, which served as a means to share ideas and struggles throughout the term.

Illustrated Protocols to Improve Undergraduate Student Research Independence

One big challenge for undergraduate research students is gaining independence in the laboratory. In this curricular project, undergraduate students transformed research protocols developed for experienced scientists into protocols understandable to someone new to a laboratory. This process enabled themselves and other students to more quickly learn and master new techniques and advance to independent projects. Typically, students started with an original research protocol that assumed basic knowledge, such as instructions that came with a kit (i.e. plasmid purification kit instructions). Students created notes that explained the purpose of each step and reagent and provided example calculations. Then students illustrated the protocols with photos of materials needed, equipment used, action shots of difficult steps and screenshots of software programs. This approach has been used by students in laboratory courses and by new independent research students learning laboratory techniques. In the laboratory courses where students contributed to this project as part of a writing assignment, additional professional experience was gained by presenting a talk about their completed Illustrated Protocols to their classmates and by creating group posters that were presented at an undergraduate research symposium. After completion of this activity, undergraduate students gained confidence by applying their new knowledge to create user-friendly protocols. Students reported increased understanding of what is happening in each step, while instructors reported increased student independence and confidence that the protocol was being applied correctly and consistently. Thus, designing Illustrated Protocols enhanced learning and independence for the students creating the protocol and provided valuable help for future students.

Roles matter: Graduate student perceptions of active learning in the STEM courses they take and those they teach

Despite many calls to reform undergraduate science, technology, engineering, and math (STEM) education to incorporate active learning into classes, there has been little attention paid to graduate level classrooms or courses taught by graduate students. Here, we set out to understand if and how STEM graduate students' perceptions of active learning change in the classes they take versus those they teach. We found that graduate students had taken relatively few graduate level classes using active learning and they felt that more time should be devoted to active learning in the courses they were taking. Teaching assistants felt that they were devoting the right amount of class time to active learning in the classes they taught. Graduate students also felt that they were using teaching methods in the classes they taught that were different from those they thought should be used when teaching undergraduates and were different from how they preferred to learn when taking classes.

Designing, implementing, and evaluating the process of training advisor and teaching assistant at Isfahan medical school

INTRODUCTION

The study aimed to design, implement, and evaluate the process of advisor and teaching assistant (TA) to increase the quality of cascade training in principal educational groups, presenting the obstacles and problems of this educational intervention and introducing them to educational planners.

METHODOLOGY

This applied developmental research was conducted in Isfahan University of Medical Sciences in 2017-2018 in principal educational groups (internal medicine, surgery, pediatrics, gynecology, and cardiology). For this purpose, a working party called TAs was composed of managers, faculty members, and active and interested assistants, including 24 people. The action plan, bylaws, job description, and logbooks were completed by the method of the focus group. Getting the report, monitoring the activity, exchanging the ideas, and drawing up the various plans were continuously done through bi-monthly in-person meetings, and the virtual group was organized for monitoring, starting a training logbook, and doing semi-organized interviews to evaluate.

RESULTS

In a total of 1131 h, various educational activities were conducted such as cooperating with the advisor, teaching some part of a class, holding a workshop, contributing to question design, preparing the educational resources, and organizing an educational round.

CONCLUSION

Improving the knowledge, attitude, and practice of assistants in cascade training, regulating their activities, learning the teaching skills, and exercising them with the teacher were some of the most significant opportunities of this study.

The Effect of Resident Participation on Appendectomy Operative Times

OBJECTIVE

To assess the association between level of resident autonomy and operative times for appendectomies.

DESIGN

A single center retrospective analysis of electronic medical record data of patients who underwent an appendectomy from 1/1/2017 to 12/31/2018. Medical record numbers s were matched with cases entered in the ACGME Resident Case Log system. Cases were stratified by resident role ("First Assistant," "Surgeon Junior," "Surgeon Chief," or "Teaching Assistant") and operative times were compared to cases without resident participation using student's t test.

SETTING

Maine Medical Center, Department of Surgery, Portland, Maine.

PARTICIPANTS

Inclusion criteria: ≥5 years old, underwent appendectomy at a tertiary medical center during the study duration, and either had corresponding Case-log data or had no resident involvement. Patients who underwent appendectomy as part of a larger procedure were excluded.

RESULTS

Six hundred eighty-eight patients met inclusion criteria, with residents participating in 574 (83.5%) cases. Overall mean operating time was 51 ± 21.5 minutes. Attending physicians without resident participation had the shortest OR times (43 ± 19.1 minutes). There was no difference in operating time between chief resident involvement and attending physicians without resident participation (45 ± 21; p = 0.43). Cases with residents involved as "First Assistant" (53 ± 18.6 minutes; p = 0.04) "Surgeon Junior" (52 ± 24.0 minutes; p < 0.001), or "Teaching Assistant" (57 ± 21.6 minutes; p < 0.001) were found to have longer operating times as compared to attending physicians operating without a resident.

CONCLUSIONS

Operative times for appendectomies are impacted by resident role. Chief residents' operative times approach that of attendings when operating as Surgeon Chief, however they are significantly longer when operating as Teaching Assistant. Involvement of junior residents in any role lengthen operating times. This suggests that surgical education influences operating room efficiency.

See None, Do Some, Teach None: An Analysis of the Contemporary Operative Experience as Nonprimary Surgeon

OBJECTIVE

The operative experience of today's general surgery resident has changed, but little is known about the modern experience as nonprimary surgeon. We set out to explore changes in the operative experience of general surgery residents as first assistant (FA) and teaching assistant (TA).

DESIGN, SETTING, AND PARTICIPANTS

This is a review of ACGME national operative log reports from 1990 to 2018. TA and FA cases were analyzed. Statistical analysis was performed using polynomial regression analysis and Kruskal-Wallis test. Statistical significance was set at p < 0.05.

RESULTS

30,260 individuals completed general surgery residency during the study period with medians of 951 (interquartile range: 929-974) total major, 63 (31-184) FA, and 32 (25-48) TA cases. As a proportion of total cases completed, FA cases decreased from 21.8% of the total operative experience in 1990 to 2.5% in 2018, and TA cases declined from 7.4% of the total operative experience in 1990 to 3.5% in 2018. Regression modeling demonstrated that both operative roles decreased over time, but at a progressively decreasing rate, with FA cases reaching a "floor" around 2010 and TA cases reaching a "breakpoint" in 2008 at which time operative volume rebounded and began to increase. Among the core general surgery domains of abdomen and alimentary tract, compositional analysis revealed a decrease across each of the 11 operative subcategories (all p < 0.05) for FA, and for TA, a decrease in 6 of the 11 operative subcategories (stomach, small intestine, large intestine, anorectal, hernia, and biliary, all p < 0.05).

CONCLUSIONS

Over the past 3 decades, the resident operative experience as nonprimary surgeon has decreased dramatically, with today's residents graduating with fewer FA and TA cases. As surgical training has traditionally relied heavily on an apprenticeship model for learning technical skills, it is essential that surgical educators recognize and rectify these trends.

A Long-Term Follow-Up Study of Former Dental School Teaching Assistants: Are They Teaching After Graduation?

There has been growth in teaching opportunities for dental students over the past two decades, but little research on whether these experiences have led to actual positions in academia. The aims of this study were to determine whether former teaching assistants at New York University College of Dentistry continued in dental academia after graduation or intended to teach during their careers and to assess their reasons for or for not teaching. Of the 294 former teaching assistants who taught their peers from 2003 to 2014, 106 responded to a survey, for a response rate of 36%. Of the respondents, 28% reported having teaching appointments, with 7% (n=8) having full-time teaching appointments and 21% (n=22) having part-time teaching appointments in a dental school or hospital-based program at some point after graduation. The most common reasons given for teaching were "intellectual stimulation" and "enjoyment" followed by "interactions with students." The most reported reason for not teaching was "student loan debt," followed by "too busy building private practice," "limited teaching opportunities in area," and "family commitments." Significantly, 95% of these former teaching assistants either taught or intended to teach during their careers, and they were six times less likely to rule out future teaching than dental school seniors in national surveys. These findings suggest that participating in teaching opportunities in dental school plants the seed for future teaching. More follow-up studies should be undertaken to see which types of teaching assistant programs are more successful in creating long-term teaching commitments.

Improved medical student perception of ultrasound using a paired anatomy teaching assistant and clinician teaching model

This study describes a new teaching model for ultrasound (US) training, and evaluates its effect on medical student attitudes toward US. First year medical students participated in hands-on US during human gross anatomy (2014 N = 183; 2015 N = 182). The sessions were facilitated by clinicians alone in 2014, and by anatomy teaching assistant (TA)-clinician pairs in 2015. Both cohorts completed course evaluations which included five US-related items on a four-point scale; cohort responses were compared using Mann-Whitney U tests with significance threshold set at 0.05. The 2015 survey also evaluated the TAs (three items, five-point scale). With the adoption of the TA-clinician teaching model, student ratings increased significantly for four out of five US-items: "US advanced my ability to learn anatomy" increased from 2.91 ± 0.77 to 3.35 ± 0.68 (P < 0.0001), "Incorporating US increased my interest in anatomy" from 3.05 ± 0.84 to 3.50 ± 0.71 (P < 0.0001), "US is relevant to my current educational needs" from 3.36 ± 0.63 to 3.54 ± 0.53 (P = 0.015), and "US training should start in Phase I" from 3.36 ± 0.71 to 3.56 ± 0.59 (P = 0.010). Moreover, more than 84% of students reported that TAs enhanced their understanding of anatomy (mean 4.18 ± 0.86), were a valuable part of US training (mean 4.23 ± 0.89), and deemed the TAs proficient in US (mean 4.24 ± 0.86). By using an anatomy TA-clinician teaching team, this study demonstrated significant improvements in student perceptions of the impact of US on anatomy education and the relevancy of US training to the early stages of medical education. Anat Sci Educ 11: 175-184. © 2017 American Association of Anatomists.