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Koljonen JL, Ruffolo AM, Neumeister MW, Sommer NZ. Strategies to Improve Resident Wellness in Plastic Surgery Training. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5858. [PMID: 38841530 PMCID: PMC11150031 DOI: 10.1097/gox.0000000000005858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/12/2024] [Indexed: 06/07/2024]
Abstract
Residency is known to be a challenging time in a surgeon's career. Surgical residents must learn the breadth of their field and develop technical skills while maintaining relationships and well-being outside their training. High burnout rates are well documented among all medical specialties, particularly during residency. Proven strategies in medical education that help decrease burnout and improve resident well-being, while maintaining quality patient care, have been reported in the medical education literature. However, little has been published specific to plastic surgery training programs. We discuss strategies that can be implemented into the curricula and workflow at plastic surgery residency programs to maximize resident well-being. We advocate for a multifaceted approach that includes a night float system, day call, integrating advanced practice providers to offload noneducational resident tasks, and establishing a wellness program. It is our hope that these strategies may serve as a guide for plastic surgery residency programs to promote general wellness and prevent burnout among trainees.
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Affiliation(s)
- Jessie L. Koljonen
- From the Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, Ill
| | - Alexis M. Ruffolo
- From the Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, Ill
| | - Michael W. Neumeister
- From the Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, Ill
| | - Nicole Z. Sommer
- From the Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, Ill
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Fellow Efficiency During Anterior Cruciate Ligament Reconstruction Improves Over Time, Yet Is Less Than Experienced Physician Assistant But With No Significant Difference in Patient-Reported Outcomes. Arthrosc Sports Med Rehabil 2022; 5:e185-e192. [PMID: 36866287 PMCID: PMC9971861 DOI: 10.1016/j.asmr.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/27/2022] [Accepted: 11/08/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose To evaluate the intraoperative efficiency and patient outcomes of anterior cruciate ligament reconstruction (ACLR) assisted by a sports medicine fellow over the course of the academic year compared with an experienced physician assistant (PA). Methods A single-surgeon cohort of primary ACLRs with either bone-tendon-bone autograft or bone-tendon-bone allograft (without any other significant time-consuming procedures such as meniscectomy/repair) were evaluated using a patient registry system over 2 years assisted by an experienced PA compared with an orthopaedic surgery sports medicine fellow. There were 264 primary ACLRs included in this study. Outcomes included evaluation of surgical time, tourniquet time, and patient-reported outcome measures. Results The surgical efficiency of the fellow (as measured by surgical time and tourniquet time) improved over each academic quarter. Patient-reported outcomes between the 2 first-assist groups showed no significant difference over 2 years with both ACL graft groups combined. ACLRs assisted by the PA showed shorter tourniquet times by 22.1% and shorter total surgical times by 11.9% compared with the sports medicine fellows when both grafts were combined (P < .001). The surgical and tourniquet times (minutes) for the fellow (standard deviation of surgical time 19.5-25.0 and tourniquet time 19.5-25.0) did not average out to be more efficient in any of the 4 quarters of the year compared with the PA-assisted group (standard deviation of surgical time 14.4-14.8 and tourniquet time 14.8-22.4). Autografts showed more efficient tourniquet (18.7%) and skin-to-skin surgical times (11.1%) in the PA group compared with the fellow group (P < .001). Allografts showed more efficient tourniquet (37.7%) and skin-to-skin surgical times (12.8%) in the PA group compared with the fellow group (P < .001). Conclusions The surgical efficiency of the fellow during primary ACLRs improves over the academic year. Patient-reported outcomes are similar in cases assisted by the fellow compared with an experienced physician assistant. Cases assisted by the PA were performed more efficiently compared with the sports medicine fellow. Clinical Relevance The intraoperative efficiency of a sports medicine fellow objectively improves over the academic year for primary ACLRs but may not be as efficient as an experienced advanced practice provider; however, there appears to be no significant differences in patient-reported outcome measures between the 2 groups. This helps quantify the time commitment for attendings and academic medical institutions as the "cost of education" of trainees such as fellows.
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Kelley SR, D'Angelo JD, D'Angelo ALD, Behm KT, Colibaseanu DT, Merchea A, Mishra N, Dozois EJ, Mathis KL. The Effect of Advanced Practice Providers on ACGME Colon and Rectal Surgery Resident Diagnostic Index Case Volumes. JOURNAL OF SURGICAL EDUCATION 2022; 79:426-430. [PMID: 34702690 DOI: 10.1016/j.jsurg.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/04/2021] [Accepted: 10/02/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Prior to 2015 residents in our Accreditation Council for Graduation Medical Education (ACGME) colon and rectal surgery training program were in charge of managing, with faculty oversight, the outpatient anorectal clinic at our institution. Starting in 2015 advanced practice providers (APPs) working in the division assumed management of the clinic. The effect of APPs on ACGME resident index diagnostic case volumes has not been explored. Herein we examine ACGME case log graduate statistics to determine if the inclusion of APPs into our anorectal clinic practice has negatively affected resident index diagnostic anorectal case volumes. DESIGN ACGME year-end program reports were obtained for the years 2011 to 2019. Program anorectal diagnostic index volumes were recorded and compared to division volumes. Analysis of variance (ANOVA) and analysis of covariance (ANCOVA) tests were conducted to assess whether the number of cases per year (for each respective case type) prior to the introduction of APPs into the anorectal clinic (2011-2014) differed from the number of cases per year with the APP clinic in place (2015-2018). A p-value <0.05 was considered statistically significant. SETTING Mayo Clinic, Rochester, Minnesota (quaternary referral center). PARTICIPANTS Colon and rectal surgery resident year-end ACGME reports (2011-2019). RESULTS ANOVAs revealed a marginally significant (p = 0.007) downtrend for hemorrhoid diagnostic codes, and a significant uptrend (p = 0.000) for fistula cases. Controlling for overall division volume, ANCOVA only reveled significance for fistula cases (p = 0.004) with the involvement of APPs. CONCLUSIONS At our institution we found the inclusion of APPs into our anorectal clinic practice did not negatively affect colon and rectal surgery resident ACGME index diagnostic anorectal case volumes. Inclusion of APPs into a multidisciplinary practice can promote resident education by allowing trainees to pursue other educational opportunities without hindering ACGME index case volumes.
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Affiliation(s)
- Scott R Kelley
- Mayo Clinic, Division of Colon and Rectal Surgery, Rochester, Minnesota.
| | | | | | - Kevin T Behm
- Mayo Clinic, Division of Colon and Rectal Surgery, Rochester, Minnesota
| | | | - Amit Merchea
- Mayo Clinic, Division of Colon and Rectal Surgery, Jacksonville, Florida
| | - Nitin Mishra
- Mayo Clinic, Division of Colon and Rectal Surgery, Phoenix, Arizona
| | - Eric J Dozois
- Mayo Clinic, Division of Colon and Rectal Surgery, Rochester, Minnesota
| | - Kellie L Mathis
- Mayo Clinic, Division of Colon and Rectal Surgery, Rochester, Minnesota
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Azoulay D, Eshkenazy R, Pery R, Cordoba M, Haviv Y, Inbar Y, Zisman E, Lahat E, Salloum C, Lim C. The Impact of Establishing a Dedicated Liver Surgery Program at a University-affiliated Hospital on Workforce, Workload, Surgical Outcomes, and Trainee Surgical Autonomy and Academic Output. ANNALS OF SURGERY OPEN 2021; 2:e066. [PMID: 37636559 PMCID: PMC10455269 DOI: 10.1097/as9.0000000000000066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/31/2021] [Indexed: 02/07/2023] Open
Abstract
Objective To detail the implementation of a dedicated liver surgery program at a university-affiliated hospital and to analyze its impact on the community, workforce, workload, complexity of cases, the short-term outcomes, and residents and young faculties progression toward technical autonomy and academic production. Background Due to the increased burden of liver tumors worldwide, there is an increased need for liver centers to better serve the community and facilitate the education of trainees in this field. Methods The implementation of the program is described. The 3 domains of workload, research, and teaching were compared between 2-year periods before and after the implementation of the new program. The severity of disease, complexity of procedures, and subsequent morbidity and mortality were compared. Results Compared with the 2-year period before the implementation of the new program, the number of liver resections increased by 36% within 2 years. The number of highly complex resections, the number of liver resections performed by residents and young faculties, and the number of publications increased 5.5-, 40-, and 6-fold, respectively. This was achieved by operating on more severe patients and performing more complex procedures, at the cost of a significant increase in morbidity but not mortality. Nevertheless, operations during the second period did not emerge as an independent predictor of severe morbidity. Conclusions A new liver surgery program can fill the gap between the demand for and supply of liver surgeries, benefiting the community and the development of the next generation of liver surgeons.
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Affiliation(s)
- Daniel Azoulay
- From the Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, AP-HP, Université Paris-Saclay, Villejuif, France
- Department of General Surgery B, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Rony Eshkenazy
- Department of General Surgery B, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
- Intensive Care Unit, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Ron Pery
- Department of General Surgery B, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
- Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN
| | - Mordechai Cordoba
- Department of General Surgery B, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Yael Haviv
- Intensive Care Unit, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Yael Inbar
- Department of Radiology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Eliyahu Zisman
- Department of Anesthesiology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Eylon Lahat
- Department of General Surgery B, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Chady Salloum
- From the Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, AP-HP, Université Paris-Saclay, Villejuif, France
| | - Chetana Lim
- Department of HPB and Liver Transplantation, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
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Meschino MT, Giles AE, Engels PT, Rice TJ, Nenshi R, Marcaccio MJ. Impact of the acute care surgery model on resident operative experience in emergency general surgery. Can J Surg 2021; 64:E298-E306. [PMID: 34014063 PMCID: PMC8327998 DOI: 10.1503/cjs.019619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: The acute care surgery (ACS) model has been shown to improve patient, hospital and surgeon-specific outcomes. To date, however, little has been published on its impact on residency training. Our study compared the emergency general surgery (EGS) operative experiences of residents assigned to ACS versus elective surgical rotations. Methods: Resident-reported EGS case logs were prospectively collected over a 9-month period across 3 teaching hospitals. Descriptive statistics were tabulated and group comparisons were made using χ2 statistics for categorical data and t tests for continuous data. Results: Overall, 1061 cases were reported. Resident participation exceeded 90%). Appendiceal and biliary disease accounted for 49.7% of EGS cases. Residents on ACS rotations reported participating in twice as many EGS cases per block as residents on elective rotations (12.64 v. 6.30 cases, p < 0.01). Most cases occurred after hours while residents were on call rather than during daytime ACS hours (78.8% v. 21.1%, p < 0.01). Senior residents were more likely than junior residents to report having a primary operator role (71.3% v. 32.0%, p < 0.01). Although the timing of cases made no difference in the operative role of senior residents, junior residents assumed the primary operator role more often during the daytime than after hours (50.0% v. 33.1%, p = 0.01). Conclusion: Despite implementation of the ACS model, residents in our program obtained most of their EGS operative experience after hours while on call. Although further research is needed, our study suggests that improved daytime access to the operating room may represent an opportunity to improve the quantity and quality of the EGS operative experience at our academic network.
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Affiliation(s)
- Michael T Meschino
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Meschino, Giles, Engels, Rice, Nenshi, Maraccio)
| | - Andrew E Giles
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Meschino, Giles, Engels, Rice, Nenshi, Maraccio)
| | - Paul T Engels
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Meschino, Giles, Engels, Rice, Nenshi, Maraccio)
| | - Timothy J Rice
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Meschino, Giles, Engels, Rice, Nenshi, Maraccio)
| | - Rahima Nenshi
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Meschino, Giles, Engels, Rice, Nenshi, Maraccio)
| | - Michael J Marcaccio
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Meschino, Giles, Engels, Rice, Nenshi, Maraccio)
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Dickinson KJ, Bass BL, Pei KY. Public Perceptions of General Surgery Residency Training. JOURNAL OF SURGICAL EDUCATION 2021; 78:717-727. [PMID: 33160942 DOI: 10.1016/j.jsurg.2020.09.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/13/2020] [Accepted: 09/28/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Patients are integral to surgical training. Understanding our patients' perceptions of surgical training, resident involvement and autonomy is crucial to optimizing surgical education and thus patient care. In the modern, connected world many factors extrinsic to a patient's experience of healthcare may influence their opinion of our training systems (i.e., social media, television shows, and internet searches). The purpose of this article is to contextualize the literature investigating public perceptions of general surgery training to allow us to effect patient education initiatives to optimize both surgical training and patient safety. DESIGN This is a perspective including a literature review summarizing the current knowledge of public perceptions of general surgery training. CONCLUSIONS Little is published regarding patient and public perceptions of general surgery residency training and the role of residents within this. Current literature demonstrates that the majority of patients are willing to have residents participate in their care. Patients' attitude toward resident involvement in their operation is improved by utilizing educational materials and by ensuring a supervising attending is present within the operating room. These observations, coupled with future work to delve deeper into factors affecting public perceptions of surgical training and resident involvement within this, can guide strategies to improve surgical education.
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Affiliation(s)
| | - Barbara L Bass
- George Washington University School of Medicine and Health Services, Washington, District of Columbia
| | - Kevin Y Pei
- Department of Graduate Medical Education, Parkview Health, Fort Wayne, Indiana
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Eaton BC, Vesselinov R, Ahmeti M, Stansbury JJ, Regner J, Sadler C, Nevarez S, Lissauer M, Stout L, Harmon L, Glassett B, Hampton DA, Castro HJ, Cunningham K, Mulkey S, O'Meara L, Dia JJ, Bruns BR. Surgical Faculty Perception of Service-Based Advanced Practice Provider Impact: A Southwestern Surgical Congress Multicenter Survey. Am Surg 2020; 87:971-978. [PMID: 33295188 DOI: 10.1177/0003134820956929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A previous single-center survey of trauma and general surgery faculty demonstrated perceived positive impact of trauma and surgical subspecialty service-based advanced practice providers (SB APPs). The aim of this multicenter survey was to further validate these findings. METHODS Faculty surgeons on teams that employ SB APPs at 8 academic centers completed an electronic survey querying perception about advanced practice provider (APP) competency and impact. RESULTS Respondents agreed that SB APPs decrease workload (88%), length of stay (72%), contribute to continuity (92%), facilitate care coordination (87%), enhance patient satisfaction (88%), and contribute to best practice/safe patient care (83%). Fewer agreed that APPs contribute to resident education (50%) and quality improvement (QI)/research (36%). Although 93% acknowledged variability in the APP level of function, 91% reported trusting their clinical judgment. CONCLUSION This study supports the perception that SB APPs have a positive impact on patient care and quality indicators. Areas for potential improvement include APP contribution to resident education and research/QI initiatives.
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Affiliation(s)
- Barbara C Eaton
- 137889R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, MD, USA
| | - Roumen Vesselinov
- Department of Epidemiology and Public Health, Department of Anesthesiology, 12264University of Maryland, Baltimore, MD, USA
| | - Mentor Ahmeti
- 23506Sanford Medical Center Fargo, ND, USA.,School of Medicine and Health Sciences, 12281University of North Dakota, ND, USA
| | | | | | - Craig Sadler
- 6040Eastern Virginia Medical School, VA, USA.,Norfolk General Hospital, VA, USA
| | | | | | | | | | | | - David A Hampton
- Department of Surgery, Section of Trauma and Acute Care Surgery, University of Chicago Medicine and Biological Sciences, IL, USA
| | - Helen J Castro
- Department of Surgery, Section of Trauma and Acute Care Surgery, University of Chicago Medicine and Biological Sciences, IL, USA
| | | | | | - Lindsay O'Meara
- 137889R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, MD, USA
| | - Jose J Dia
- 137889R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, MD, USA
| | - Brandon R Bruns
- 137889R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, MD, USA
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Eaton B, O'Meara L, Herrera AV, Tesoriero R, Diaz J, Bruns B. Service-Based Advanced Practice Providers: The Surgeon's Perspective. Am Surg 2020. [DOI: 10.1177/000313481908500736] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The ACGME work hour restrictions facilitated increased utilization of service-based advanced practice providers (APPs) to offset reduced general surgery resident work hours. Information regarding attending surgeon perceptions of APP impact is limited. The aim of this survey was to gauge these perceptions with respect to workload, length of stay (LOS), safety, best practice, level of function, and clinical judgment. Attending surgeons on surgical teams that employ service-based APPs at an urban tertiary referral center responded to a survey at the completion of academic year 2016. Perceptions regarding APP impact on workload, LOS, safety, best practice, level of function, and clinical judgment were examined. Twenty-two attending surgeons (40%) responded. Respondents agreed that APPs always/usually decrease their workload (77%), decrease LOS (64%), improve safety (68%), contribute to best practice (82%), and decrease near misses (71%). They also agreed that APPs decrease resident workload (87%), but fewer agreed that APPs contribute to resident education (68%). The majority perceived APPs function at the PGY1/2 (43%) or PGY3 (39%) level and always/usually trust their clinical judgment (72%), and felt there was variability in level of function among APPs (56%). This single-center study illustrates that attending surgeons perceive a positive impact on patient care by service-based APPs.
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Affiliation(s)
- Barbara Eaton
- Division of Acute Care Surgery, University of Maryland, R Adams Cowley Shock Trauma Center, Baltimore, Maryland
| | - Lindsay O'Meara
- Division of Acute Care Surgery, University of Maryland, R Adams Cowley Shock Trauma Center, Baltimore, Maryland
| | - Anthony V. Herrera
- Center for Shock, Trauma and Anesthesiology Research, Baltimore, Maryland; and
| | - Ronald Tesoriero
- Division of Acute Care Surgery, University of Maryland, R Adams Cowley Shock Trauma Center, Baltimore, Maryland
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jose Diaz
- Division of Acute Care Surgery, University of Maryland, R Adams Cowley Shock Trauma Center, Baltimore, Maryland
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Brandon Bruns
- Division of Acute Care Surgery, University of Maryland, R Adams Cowley Shock Trauma Center, Baltimore, Maryland
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
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9
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Park SJ, Lee EJ, Kim SI, Kong SH, Jeong CW, Kim HS. Clinical Desire for an Artificial Intelligence-Based Surgical Assistant System: Electronic Survey-Based Study. JMIR Med Inform 2020; 8:e17647. [PMID: 32412421 PMCID: PMC7260656 DOI: 10.2196/17647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 01/04/2023] Open
Abstract
Background Techniques utilizing artificial intelligence (AI) are rapidly growing in medical research and development, especially in the operating room. However, the application of AI in the operating room has been limited to small tasks or software, such as clinical decision systems. It still largely depends on human resources and technology involving the surgeons’ hands. Therefore, we conceptualized AI-based solo surgery (AISS) defined as laparoscopic surgery conducted by only one surgeon with support from an AI-based surgical assistant system, and we performed an electronic survey on the clinical desire for such a system. Objective This study aimed to evaluate the experiences of surgeons who have performed laparoscopic surgery, the limitations of conventional laparoscopic surgical systems, and the desire for an AI-based surgical assistant system for AISS. Methods We performed an online survey for gynecologists, urologists, and general surgeons from June to August 2017. The questionnaire consisted of six items about experience, two about limitations, and five about the clinical desire for an AI-based surgical assistant system for AISS. Results A total of 508 surgeons who have performed laparoscopic surgery responded to the survey. Most of the surgeons needed two or more assistants during laparoscopic surgery, and the rate was higher among gynecologists (251/278, 90.3%) than among general surgeons (123/173, 71.1%) and urologists (35/57, 61.4%). The majority of responders answered that the skillfulness of surgical assistants was “very important” or “important.” The most uncomfortable aspect of laparoscopic surgery was unskilled movement of the camera (431/508, 84.8%) and instruments (303/508, 59.6%). About 40% (199/508, 39.1%) of responders answered that the AI-based surgical assistant system could substitute 41%-60% of the current workforce, and 83.3% (423/508) showed willingness to buy the system. Furthermore, the most reasonable price was US $30,000-50,000. Conclusions Surgeons who perform laparoscopic surgery may feel discomfort with the conventional laparoscopic surgical system in terms of assistant skillfulness, and they may think that the skillfulness of surgical assistants is essential. They desire to alleviate present inconveniences with the conventional laparoscopic surgical system and to perform a safe and comfortable operation by using an AI-based surgical assistant system for AISS.
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Affiliation(s)
- Soo Jin Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eun Ji Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Se Ik Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seong-Ho Kong
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hee Seung Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
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AANP Forum. J Nurse Pract 2019. [DOI: 10.1016/j.nurpra.2019.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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11
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Chaney AJ, Yataco ML. The Emerging Role of Nurse Practitioners and Physician Assistants in Liver Transplantation. Liver Transpl 2019; 25:1105-1109. [PMID: 31013382 DOI: 10.1002/lt.25474] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 04/17/2019] [Indexed: 02/07/2023]
Abstract
The evolving role of nurse practitioners (NPs) and physician assistants (PAs) in the United States continues to progress. NP and PA responsibilities have expanded from primary care practices to medical and surgical specialties. They provide acute care in hospitals and intensive care units, and they serve as educators, lobbyists, and researchers. Questions have arisen from NP/PA leaders, physician leaders, and administrators on how to best implement a successful NP/PA model within their practice. This article reviews some common themes in the literature by looking at the current state of NP/PA practice, outlines some practice models established therein, and provides recommendations for implementing a successful NP/PA model in a liver transplant practice.
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Affiliation(s)
- Amanda J Chaney
- Division of Transplant Medicine, Mayo Clinic, Jacksonville, FL
| | - Maria L Yataco
- Division of Transplant Medicine, Mayo Clinic, Jacksonville, FL
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Woelfel IA, Strosberg D, Abdel-Misih S, Harzman A. Growth in Monthly Case Volume in the First Year of Postgraduate Surgical Training. Am Surg 2019. [DOI: 10.1177/000313481908500119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | - Alan Harzman
- Department of Surgery Ohio State University Columbus, Ohio
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13
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Eaton B, Hessler L, O'Meara L, Herrera A, Tesoriero R, Diaz J, Bruns B. The impact of advanced practice providers on the surgical resident experience: Agree to disagree? Am J Surg 2018; 217:1107-1111. [PMID: 30343880 DOI: 10.1016/j.amjsurg.2018.10.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 10/09/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND We examined and compared APP versus surgical resident perceptions of the role of APPs in surgical subspecialty teams. METHODS Residents/first year surgical critical care fellows and inpatient service-specific APPs responded to a survey that examined perceptions about the APP-resident/fellow relationship. Statistical analysis compared responses using a Pearson chi-square test. RESULTS Thirty-two resident/fellows (48%) and 10 APPs (42%) responded. There was consensus that having an APP on service decreases workload, contributes to continuity of care and enhances resident-patient coordination education and agreement that there was clear communication and adequate collaboration. Both groups differed with respect to APPs contribution to resident/fellow clinical education, role definition and chain of command. The majority of trainees felt that APPs function at a PGY2 level (51.7%) compared to APPs, who felt that they functioned at a PGY4/5 (22%) or Fellow (44%) level. CONCLUSION APPs and resident/fellows agree that APPs impact resident workload, continuity of care and patient-coordination education.
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Affiliation(s)
- B Eaton
- University of Maryland, R Adams Cowley Shock Trauma Center, Division of Acute Care Surgery, 22 South Greene St, Baltimore MD 21201, USA.
| | - L Hessler
- Department of Surgery, University of Maryland School of Medicine, 22 South Greene St, Baltimore MD 21201, USA.
| | - L O'Meara
- University of Maryland, R Adams Cowley Shock Trauma Center, Division of Acute Care Surgery, 22 South Greene St, Baltimore MD 21201, USA.
| | - A Herrera
- Center for Shock, Trauma and Anesthesiology Research, 110 South Paca St, Room 03-002, Baltimore MD, 21201, USA.
| | - R Tesoriero
- University of Maryland, R Adams Cowley Shock Trauma Center, Division of Acute Care Surgery, 22 South Greene St, Baltimore MD 21201, USA; Department of Surgery, University of Maryland School of Medicine, 22 South Greene St, Baltimore MD 21201, USA.
| | - J Diaz
- University of Maryland, R Adams Cowley Shock Trauma Center, Division of Acute Care Surgery, 22 South Greene St, Baltimore MD 21201, USA; Department of Surgery, University of Maryland School of Medicine, 22 South Greene St, Baltimore MD 21201, USA.
| | - B Bruns
- University of Maryland, R Adams Cowley Shock Trauma Center, Division of Acute Care Surgery, 22 South Greene St, Baltimore MD 21201, USA; Department of Surgery, University of Maryland School of Medicine, 22 South Greene St, Baltimore MD 21201, USA.
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Blitzer D, Stephens EH, Tchantchaleishvili V, Lou X, Chen P, Pattakos G, Vardas PN. Risks and Rewards of Advanced Practice Providers in Cardiothoracic Surgery Training: National Survey. Ann Thorac Surg 2018; 107:597-602. [PMID: 30312614 DOI: 10.1016/j.athoracsur.2018.08.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 07/12/2018] [Accepted: 08/20/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Changes in healthcare have led to increasing use of advanced practice providers (APPs), but their role in cardiothoracic surgery (CTS) education remains undefined. This study aimed to analyze the extent of APP use on the CTS team, their role within the hierarchy of clinical care, and the impact of physician extenders on CTS training from the resident perspective. METHODS CTS residents' responses to the 2017 Thoracic Surgery Residents Association/Thoracic Surgery Directors Association In-Service Training Examination survey regarding the role of APPs in specific clinical scenarios and perception of APP contribution to residents' educational environment were analyzed. Statistical analysis of categorical variables was performed in SPSS (version 22.0; IBM, Chicago, IL) using a Fisher's exact test and Pearson χ2 test with statistical significance set at p < 0.05. RESULTS Response rate was 82.1% (280/341). The median number of employed APPs was 16 to 20, and 50.4% (n = 141) reported 11 to 25 physician extenders at their institution. The median numbers of APPs in the operating room, floor, and intensive care unit were three, three, and two, respectively. Overall impression of APPs was positive in 87.5% (n = 245) of respondents, with 47.7% (n = 133) "very positive" and 40.1% "positive" (n = 112). In general, residents reported greater resident involvement in postoperative issues and operative consults and greater APP involvement in floor issues; 72.5% of residents had not missed a surgical opportunity due to APPs, whereas 9.6% missed an opportunity due to APPs despite being at an appropriate level of training. Of those that reported missed opportunities 44% were integrated thoracic surgery residents. There were no significant differences in APPs' operative role based on resident seniority. CONCLUSIONS The overall impression of APPs among CTS residents was favorable, and they are more commonly involved in assisting on the floor or the operating room. Occasionally residents reported missing a surgical opportunity due to APPs. There is further opportunity to optimize and standardize their role within programs to improve clinical outcomes and enhance the CTS educational experience for residents.
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Affiliation(s)
- David Blitzer
- Division of Thoracic and Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Elizabeth H Stephens
- Division of Cardiac, Thoracic & Vascular Surgery, Columbia University, New York, New York
| | | | - Xiaoying Lou
- Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia
| | - Peter Chen
- Department of Cardiothoracic Surgery, Baylor College of Medicine, Texas Heart Institute, Houston, Texas
| | - Greg Pattakos
- Department of Cardiothoracic Surgery, Baylor College of Medicine, Texas Heart Institute, Houston, Texas
| | - Panos N Vardas
- Division of Thoracic and Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
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