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D'Angelo JD, Rivera M, Rasmussen TE, Nelson MH, Behm KT, Kelley SR, D'Angelo ALD. Assessing the stops framework for coping with intraoperative errors: Evidence of efficacy, hints of hubris, and a bridge to abridging burnout. Surgery 2024:S0039-6060(24)00237-X. [PMID: 38763791 DOI: 10.1016/j.surg.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/21/2024] [Accepted: 04/06/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Answering calls in the literature, we developed and introduced an evidence-based tool for surgeons facing errors in the operating room: the STOPS framework (stop, talk to you team, obtain help, plan, succeed). The purpose of this research was to assess the impact of presenting this psychological tool on resident coping in the operating room and the related outcome of burnout while examining sex differences. METHODS In a natural experiment, general surgery residents were invited to attend 2 separate educational conferences regarding coping with errors in the operating room. Three months later, all residents were asked to fill out a survey assessing their coping in the operating room, level of burnout, and demographics. We assessed the impact of the educational intervention by comparing those who attended the coping conferences with those who did not attend. RESULTS Thirty-five residents responded to the survey (65% response rate, 54% female respondents, 49% junior residents). Our hypothesized moderated mediation model was supported. Sex was found to moderate the impact of the STOPS framework-female residents who attended the coping educational conference reported higher coping self-efficacy, whereas attendance had no statistically significant impact on male levels of coping self-efficacy. In turn, higher coping self-efficacy was associated with lower levels of burnout. CONCLUSION Our results suggest that there is evidence of efficacy in this instruction-female residents presented this material report higher levels of coping in the operating room compared to those who did not receive the framework. Further, increase in coping ability was associated with reduced levels of burnout for both genders.
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Affiliation(s)
| | - Mariela Rivera
- Divsion of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, MN
| | | | | | - Kevin T Behm
- Mayo Clinic, Division of Colon and Rectal Surgery, Rochester, MN
| | - Scott R Kelley
- Mayo Clinic, Division of Colon and Rectal Surgery, Rochester, MN
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Nofi CP, Roberts BK, Hansen L, Coppa GF, Patel V. Surgical Rehabilitation for Research Residents: A Pilot Program to Offset Surgical Skill Decay. JOURNAL OF SURGICAL EDUCATION 2023; 80:1385-1394. [PMID: 37567801 DOI: 10.1016/j.jsurg.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 06/13/2023] [Accepted: 07/16/2023] [Indexed: 08/13/2023]
Abstract
OBJECTIVE Select general surgery residents in the surgeon-scientist pipeline dedicate time away from clinical residency to conduct research. However, these research residents (RR) are vulnerable to operative skill decay. The aim of this study is to assess the feasibility of implementation and impact of an organized intervention designed to combat skill decay experienced by RR. DESIGN RR were enrolled in a pilot Surgical Rehabilitation Program (SRP). The SRP is comprised of 12 cadaver-based simulation sessions and supplemented with Fundamentals of Laparoscopic Surgery-based simulation workouts. The RR were integrated with the clinical residents (CR) during the cadaver sessions and were subsequently performance tested, surveyed, and interviewed. SETTING One academic general surgery residency program graduating 8 chief residents yearly in New York. PARTICIPANTS General surgery CR and residents on dedicated research years. RESULTS Data were collected for all local RR (n = 8) and 77% (n = 37) of CR. Local RR conducted research within the same health system that sponsors the residency. RR experienced gaps in training ranging from 2 to 4 years. All RR were permitted to moonlight on surgical services, however performed 0 operations and only 0.88 procedures on average per shift. Although RR performed similarly to level-matched CR on basic laparoscopic tasks, they required significantly more time on laparoscopic suturing-based skills than CR (p < 0.001). RR had significantly lower confidence levels precadaver sessions but gained confidence postcadaver sessions (p < 0.05), whereas CR confidence was unchanged. Regarding the SRP, qualitative interviews revealed major themes emphasizing the integration of RR, exposure to CR and faculty, technical skill development, maintenance of surgical know-how, and improved confidence for RR. CONCLUSIONS The implementation of such structured interventions, like our SRP, aimed at supporting RR over gap years is essential to help residents maintain skills and confidence needed to achieve their goals of becoming surgeon scientists.
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Affiliation(s)
- Colleen P Nofi
- Northwell North Shore University Hospital/Long Island Jewish Medical Center Department of Surgery, Manhasset, New York.
| | - Bailey K Roberts
- Northwell North Shore University Hospital/Long Island Jewish Medical Center Department of Surgery, Manhasset, New York
| | - Laura Hansen
- Northwell North Shore University Hospital/Long Island Jewish Medical Center Department of Surgery, Manhasset, New York; Zucker School of Medicine at Hofstra/Northwell Department of Surgery, Hempstead, New York
| | - Gene F Coppa
- Northwell North Shore University Hospital/Long Island Jewish Medical Center Department of Surgery, Manhasset, New York; Zucker School of Medicine at Hofstra/Northwell Department of Surgery, Hempstead, New York
| | - Vihas Patel
- Northwell North Shore University Hospital/Long Island Jewish Medical Center Department of Surgery, Manhasset, New York; Zucker School of Medicine at Hofstra/Northwell Department of Surgery, Hempstead, New York
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3
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Egan CE, Lee YJ, Stratigis JD, Ku J, Greenberg JA, Beninato T, Zarnegar R, Fahey TJ, Agrusa CJ, Finnerty BM. An Original Study: Is There an Optimal Time to Complete Dedicated Research During Surgical Residency? Twelve Years of Research Experience After PGY2 or PGY3. JOURNAL OF SURGICAL EDUCATION 2023; 80:1207-1214. [PMID: 37442697 DOI: 10.1016/j.jsurg.2023.06.014] [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: 03/05/2023] [Revised: 06/01/2023] [Accepted: 06/11/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE We aimed to determine if there is an optimal time to complete dedicated research during surgical residency. BACKGROUND Research is an integral part of academic general surgical residency, and dedicated research usually occurs after the 2nd or 3rd post-graduate year (PGY). The timing of dedicated research and its association with resident productivity, self-assessed competency (including technical skills), and fellowship match is not known. METHODS PubMed was queried for publications resulting after dedicated research time for graduating surgical residents at a single institution from 2010 to 2021. Graduates were surveyed about their research experience and placed into 2 groups: research after PGY2 or PGY3. RESULTS Sixty-six of 91 (73%) graduating residents completed dedicated research (after PGY2, n=28; after PGY3, n=38). Median number of total and first author publications was similar between groups; however, research after PGY2 was associated with an increased number of basic science publications by fellowship application deadlines (PGY2: 1.0[0-13] vs PGY3: 0.0[0-6], p=0.02). With a 79% survey response rate, there were no differences in self-assessed competencies upon return from research between cohorts. Most surveyed residents matched at their top fellowship choice (PGY2:70% vs PGY3:62%, p=0.77). CONCLUSIONS Research after PGY2 or PGY3 had no association with residents' total number of publications, self-assessed competency, or rates of matching at first choice fellowship. As research after PGY2 had an increased number of basic science publications by time of fellowship application, surgical residents applying to fellowships that highly value basic science research may benefit from completing dedicated research after PGY2.
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Affiliation(s)
- Caitlin E Egan
- Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York.
| | - Yeon Joo Lee
- Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York
| | - John D Stratigis
- Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York
| | - Joyce Ku
- Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York
| | - Jacques A Greenberg
- Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York
| | - Toni Beninato
- Department of Surgery, Rutgers-Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Rasa Zarnegar
- Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York
| | - Thomas J Fahey
- Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York
| | - Christopher J Agrusa
- Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York
| | - Brendan M Finnerty
- Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York
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Juarez-Casso FM, Castro-Varela A, Nguyen A, Stulak JM, Greason KL, Crestanello JA, Schaff HV. Having a successful dedicated research time in cardiothoracic surgery. JTCVS OPEN 2023; 15:355-358. [PMID: 37808052 PMCID: PMC10556928 DOI: 10.1016/j.xjon.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/30/2023] [Accepted: 07/05/2023] [Indexed: 10/10/2023]
Affiliation(s)
| | | | - Anita Nguyen
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - John M. Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Kevin L. Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
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Nofi CP, Roberts BK, Demyan L, Balakrishnan N, DePeralta DK, Coppa GF, Patel V. Recovery of Skill Decay After COVID-19 Redeployments and Implications for Competency Attainment. J Surg Res 2023; 285:150-157. [PMID: 36680875 PMCID: PMC9805903 DOI: 10.1016/j.jss.2022.12.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 12/02/2022] [Accepted: 12/25/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION The COVID-19 pandemic immediately interrupted procedural training. The lasting impact of reduced caseloads and service redeployments on procedural-resident training has been underexplored. This longitudinal study investigated the long-term perspectives of skill decay after short breaks in training and implications for ensuring resident competency attainment. METHODS Web-based cross-sectional surveys distributed immediately after (June 2020) compared to 1 y after (July 2021) COVID-19 redeployments at two tertiary academic medical centers of an integrated health system in New York. Participants included general surgery, surgical subspecialty, and anesthesiology residents and faculty. RESULTS Fifty-five residents and 33 faculty completed the survey. Ninety-point nine percent of residents and 36.4% of faculty were redeployed to COVID-ICUs. Sixty-three-point seven percent of residents and 75.0% of faculty reported a reduction in resident technical skills in the short-term, with significantly less (45.5% of residents and 21.2% of faculty) reporting persistent reduction in technical skill after 1 y (P = 0.001, P < 0.001). Seventy-five percent of residents and 100% of faculty were confident residents would be able to practice independently at the conclusion of their training. Sixty-five-point five percent of residents and 63.6% of faculty felt that residents experienced a durable improvement in critical care skills. Residents also reported a positive long-term impact on professional core competencies at 1 y. CONCLUSIONS Longitudinal surveillance of residents after COVID-19 redeployments suggests washout of temporary skill decay and return of resident confidence upon resumption of traditional training. This may provide insight into the impact of other short-term training interruptions on resident skill and promote greater resident support upon training resumption to ensure competency attainment.
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Affiliation(s)
- Colleen P Nofi
- Northwell North Shore/Long Island Jewish General Surgery, Manhasset, New York.
| | - Bailey K Roberts
- Northwell North Shore/Long Island Jewish General Surgery, Manhasset, New York
| | - Lyudmyla Demyan
- Northwell North Shore/Long Island Jewish General Surgery, Manhasset, New York
| | - Nalini Balakrishnan
- Northwell North Shore/Long Island Jewish General Surgery, Manhasset, New York
| | - Danielle K DePeralta
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York; Northwell North Shore/Long Island Jewish Surgical Oncology, New Hyde Park, New York
| | - Gene F Coppa
- Northwell North Shore/Long Island Jewish General Surgery, Manhasset, New York; Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Vihas Patel
- Northwell North Shore/Long Island Jewish General Surgery, Manhasset, New York; Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
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Lee EKS, Verhoeff K, Purich K, Sydora D, Turner SR, Strickland M. Factors Associated With Resident Research Success: An Analysis of Canadian General Surgery Trainees. JOURNAL OF SURGICAL EDUCATION 2023; 80:520-527. [PMID: 36581542 DOI: 10.1016/j.jsurg.2022.12.005] [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: 10/15/2022] [Revised: 12/03/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Better understanding the research productivity of Canadian general surgery residents and factors associated with success would provide a valuable reference and help inform actions to enable success. We aimed to characterize the research productivity of Canadian general surgery residents and to evaluate factors associated with residents' research quantity and impact. DESIGN A cross-sectional, observational study was performed using publicly available data evaluating Canadian General Surgery resident research productivity. Research productivity was characterized using measures including publications per postgraduate year (PGY) and CiteScore among others. Residency programs were then comparatively assessed using a multivariable logistic regression to evaluate program and resident factors associated with achieving >50th percentile research productivity. SETTING AND PARTICIPANTS All General Surgery residents from English speaking Canadian training programs were included in this study, which was completed at the University of Alberta, a tertiary level academic center in Edmonton, Canada. RESULTS A wide range of resident research productivity was observed across Canada with the median publications per PGY of 0.29, and the median sum of a resident's publication CiteScores of 2.05. The median h-index was 0.90. Graduate degree completion and publication experience prior to residency were significantly associated with higher publications per PGY (OR 2.94 and OR 2.10, respectively), as well as higher mean CiteScore (OR 3.42 and 2.24). The program factors that were assessed, including program size, research blocks, mandatory projects, or higher staff research productivity, did not show significant association with increased research output. CONCLUSIONS There is a wide range in research output by general surgery residents across the country. Successful completion of graduate degrees and the experience of publication prior to residency are associated with higher research productivity and impact.
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Affiliation(s)
- Esther K S Lee
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Kevin Verhoeff
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
| | - Kieran Purich
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Dasan Sydora
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Simon R Turner
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Matt Strickland
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
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Nofi C, Roberts B, Demyan L, Sodhi N, DePeralta D, Zimmern A, Aronsohn J, Molmenti E, Patel V. A Survey of the Impact of the COVID-19 Crisis on Skill Decay Among Surgery and Anesthesia Residents. JOURNAL OF SURGICAL EDUCATION 2022; 79:330-341. [PMID: 34625397 PMCID: PMC8445777 DOI: 10.1016/j.jsurg.2021.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 08/12/2021] [Accepted: 09/12/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The SARS-CoV-2 (COVID-19) pandemic has profoundly impacted healthcare delivery and strained medical training. This study explores resident and faculty perceptions regarding the impact of the COVID-19 crisis on technical skill decay of surgical and anesthesia residents. We hypothesized that many residents perceived that their technical abilities diminished due to a short period of interruption in their training. DESIGN An IRB-exempt, web-based cross-sectional survey distributed to residents and faculty SETTING: Two large academic tertiary medical centers, North Shore University Hospital and Long Island Jewish Medical Center, of the Northwell Health System in New York. PARTICIPANTS General surgery, anesthesiology, plastic surgery, cardiothoracic surgery, orthopedic surgery, oral maxillofacial surgery, urology, podiatry residents and faculty. RESULTS All residents reported a significant impact on their training. Residents (82%) and faculty (94%) reported a significant reduction in case volumes due to the COVID-19 pandemic (p < 0.05). 64% of residents reported a reduction in technical skills, and 75% of faculty perceived a decrease in resident technical skills. Residents were concerned about fulfilling ACGME case requirements, however faculty were more optimistic that residents would achieve level-appropriate proficiency by the conclusion of their training. Both residents and faculty felt that resident critical care skills improved as a result of redeployment to COVID-19 intensive care units (66% and 94%). Additionally, residents reported increased confidence in their ability to care for critically ill patients and positive impact on professional competencies. CONCLUSIONS Effects of the COVID-19 pandemic on residency training are multi-dimensional. The majority of surgical and anesthesia residents perceived that their technical ability diminished as a result of skill decay, whereas other skillsets improved. Longitudinal surveillance of trainees is warranted to evaluate the effect of reduced operative volume and redeployment on professional competency.
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Affiliation(s)
- Colleen Nofi
- Northwell North Shore/Long Island Jewish General Surgery, Manhasset, New York.
| | - Bailey Roberts
- Northwell North Shore/Long Island Jewish General Surgery, Manhasset, New York
| | - Lyudmyla Demyan
- Northwell North Shore/Long Island Jewish General Surgery, Manhasset, New York
| | - Nipun Sodhi
- Northwell North Shore/Long Island Jewish Orthopaedic Surgery, Manhasset, New York
| | - Danielle DePeralta
- Northwell North Shore/Long Island Jewish General Surgery, Manhasset, New York; Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Andrea Zimmern
- Northwell North Shore/Long Island Jewish General Surgery, Manhasset, New York; Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Judith Aronsohn
- Northwell North Shore/Long Island Jewish General Surgery, Manhasset, New York; Northwell North Shore/Long Island Jewish Anesthesiology, Manhasset, New York
| | - Ernesto Molmenti
- Northwell North Shore/Long Island Jewish General Surgery, Manhasset, New York; Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Vihas Patel
- Northwell North Shore/Long Island Jewish General Surgery, Manhasset, New York; Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
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Mikhail A, Connor AA, Ahmed N. Impact of Research Training on Performance in General Surgery Residency. JOURNAL OF SURGICAL EDUCATION 2022; 79:342-348. [PMID: 34824045 DOI: 10.1016/j.jsurg.2021.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 09/07/2021] [Accepted: 10/14/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION It is common for North American surgical trainees to interrupt clinical training to complete 2 or more years of research training. The impact of this practice on surgical aptitudes is unknown. The University of Toronto has large general surgery and surgeon scientist training programs. We compared the examination scores of general surgery residents in continuous clinical training with those of residents whose training was interrupted by research. METHODS We collected anonymized scores obtained at written and oral annual in-training examinations by general surgery residents at the University of Toronto from 2011 to 2016, inclusive. The written exam assessed knowledge, while the oral exam assessed judgment. Residents were dichotomized into continuous versus non-continuous clinical training streams. We compared performance prior to, during, and following divergence for research training both within and between the 2 groups. RESULTS At the junior resident level, future enrollment in research training was associated with higher examination performance (Pwritten = .003). Annual scores plateaued during research training, while scores of residents who continued in continuous clinical training improved year over year (Pwritten = .009). Non-continuous stream resident exam scores remained stagnant after 1 year then improved in the second year after return to clinical training (Pwritten = .00007). Scores obtained in the final year of residency training did not significantly differ between residents who underwent continuous versus non-continuous clinical training. Results from written and oral exams trended concordantly. CONCLUSIONS We demonstrate that interruption of clinical training for 2 or more years of research is associated with a stagnation of performance on annual in-training examinations assessing both knowledge and judgment. This phenomenon is followed by an eventual catching-up after at least 2 years return to full-time clinical training. This may inform residency program curriculum design.
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Affiliation(s)
| | - Ashton A Connor
- Department of Surgery, Houston Methodist Hospital, Houston, USA
| | - Najma Ahmed
- University of Toronto, Toronto, Ontario, Canada; St. Michael's Hospital, Toronto, Ontario, Canada.
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Schumm MA, Huang IA, Blair KJ, Nameth C, Tseng CH, Quach C, Wagner JP, Lewis CE, Donahue TR, Tillou A. Association of research timing with surgery resident perceptions of operative autonomy and satisfaction: A multi-institutional study. Surgery 2022; 172:102-109. [DOI: 10.1016/j.surg.2022.01.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 01/15/2022] [Accepted: 01/31/2022] [Indexed: 10/18/2022]
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Ten Cate O, Taylor DR. The recommended description of an entrustable professional activity: AMEE Guide No. 140. MEDICAL TEACHER 2021; 43:1106-1114. [PMID: 33167763 DOI: 10.1080/0142159x.2020.1838465] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Entrustable professional activities (EPAs) have received much attention in the literature since they were first proposed in 2005. Useful guidelines, workshops, courses, and conferences have supported faculty in developing programs and designing assessment procedures using EPAs and entrustment decision-making. Yet, the need for clarification remains, particularly as more programs make the step from design to implementation.Well-written EPAs provide a natural construct to establish the outcome of training. To be useful, EPAs require more than a suitable title. This AMEE Guide elaborates eight sections of a full EPA description, and provides explanations and justifications for each. These sections are: title; specification and limitations; risks in case of failure; most relevant competency domains; knowledge, skills, attitudes and experiences; information sources to assess progress and support summative entrustment; entrustment/supervision level expected at which stage of training; and time period to expiration if not practiced.Constructing fully elaborated EPAs creates a shared mental model amongst learners and programs, informs competency-based curriculum design, directs ad-hoc and formal entrustment decision-making, and provides standards for certifying bodies and boundaries for scope of practice. The framework intends to support curricular leaders looking to adopt new EPAs, or revise and define established EPAs for competency-based education.
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Affiliation(s)
- Olle Ten Cate
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
| | - David R Taylor
- Department of Medicine, Queen's University, Kingston, Canada
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D'Angelo JD, Lund S, Busch RA, Tevis S, Mathis KL, Kelley SR, Dozois EJ, D'Angelo ALD. Coping with errors in the operating room: Intraoperative strategies, postoperative strategies, and sex differences. Surgery 2021; 170:440-445. [PMID: 33810853 DOI: 10.1016/j.surg.2021.02.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/08/2021] [Accepted: 02/13/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Prior work has identified intraoperative and postoperative coping strategies among surgeons and has demonstrated surgical errors to have a significant impact on patient outcomes and physicians. Little research has considered which coping strategies are most common among surgeons and if there exist coping strategy differences among sex or training level. METHODS An electronic survey was distributed to surgical faculty and trainees at 3 institutions. Variables included coping techniques after making an error in the operating room. Participants were asked to report the effectiveness of their overall coping strategy. RESULTS A total of 168 participants (56% male, 45% faculty) experienced an operative error and answered questions regarding coping strategies. The only coping strategy significantly associated with positive ratings of coping effectiveness was, upon error, taking a step back and taking time to think and act (r = 0.17; P = .024). There were differences between men and women in both intra and postoperative coping strategies. Men (mean = 3.69/5, standard error = .09) viewed their overall coping strategy as more effective than women (mean = 3.38/5, standard error = .09), t(158.86) = 2.47; P = .015. CONCLUSION Although both male and female surgeons reported making errors in the operating room, differences exist in the strategies surgeons use to cope with these mistakes, and strategies differ in their ratings of effectiveness.
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Affiliation(s)
| | - Sarah Lund
- General Surgery, Mayo Clinic, Rochester, MN
| | - Rebecca A Busch
- Division Of Acute Care and Regional General Surgery, University of Wisconsin, Madison, WI
| | - Sarah Tevis
- Division of Surgical Oncology, University of Colorado, Aurora, CO
| | - Kellie L Mathis
- Division Colon and Rectal Surgery, Mayo Clinic, Rochester, MN
| | - Scott R Kelley
- Division Colon and Rectal Surgery, Mayo Clinic, Rochester, MN
| | - Eric J Dozois
- Division Colon and Rectal Surgery, Mayo Clinic, Rochester, MN
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Zuo KJ, Meng Y, Gordon L, Saun TJ, Mazine A, Ahuja CS, Lipsman N, Rutka JT, Fehlings MG. Navigating the Postgraduate Research Fellowship: A Roadmap for Surgical Residents. J Surg Res 2020; 256:282-289. [PMID: 32712442 DOI: 10.1016/j.jss.2020.06.054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 05/03/2020] [Accepted: 06/16/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND To preserve the future of surgical innovation, opportunities for surgical residents to receive structured research training are paramount. The objective of this article is to help surgical residents navigate a research fellowship by overviewing key topics such as choosing an area of focus and supervisor, applying for external funding, transitioning away from clinical duties, managing intellectual property, integrating family planning, and incorporating research experience into independent career development. MATERIALS AND METHODS Using the framework of the University of Toronto's graduate degree-awarding Surgeon-Scientist Training Program, the authors outline key considerations, decisions, and pearls for surgical residents considering or currently enrolled in a full-time research fellowship training program. RESULTS Full-time research fellowships offer a unique opportunity for residents interested in an academic career. Such full-time research fellowships away from clinical duties allow surgical trainees to focus on developing key research competencies, including how to generate hypotheses, apply research methodology, gain experience presenting and publishing manuscripts, and ultimately apply these skills as independent investigators to improve patient and population health. Research fellowships may also be an opportunity to develop intellectual property or facilitate family planning. Practical tips are provided for the transition back into clinical training and how to effectively market one's research skills for career advancement. CONCLUSIONS The authors outline key considerations, decisions, and pearls for surgical residents considering or currently enrolled in a full-time research fellowship training program. By adhering to the principles highlighted in this article, residents will be able to successfully navigate a full-time research fellowship to optimize their intellectual development, maximize their academic productivity, and facilitate their transition into an independent investigator.
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Affiliation(s)
- Kevin J Zuo
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ying Meng
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Lauren Gordon
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; International Centre for Surgical Safety, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Tomas J Saun
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Amine Mazine
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Christopher S Ahuja
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Nir Lipsman
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - James T Rutka
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Cell Biology, SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael G Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Division of Genetics and Development, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Spinal Program, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
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Mohamadipanah H, Perrone K, Peterson K, Garren M, Parthiban C, Sunkara A, Zinn M, Pugh C. Can Virtual Reality Be Used to Track Skills Decay During the Research Years? J Surg Res 2019; 247:150-155. [PMID: 31776024 DOI: 10.1016/j.jss.2019.10.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 09/21/2019] [Accepted: 10/01/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Time away from surgical practice can lead to skills decay. Research residents are thought to be prone to skills decay, given their limited experience and reduced exposure to clinical activities during their research training years. This study takes a cross-sectional approach to assess differences in residents' skills at the beginning and end of their research years using virtual reality. We hypothesized that research residents will have measurable decay in psychomotor skills when evaluated using virtual reality. METHODS Surgical residents (n = 28) were divided into two groups; the first group was just beginning their research time (clinical residents: n = 19) and the second group (research residents: n = 9) had just finished at least 2 y of research. All participants were asked to perform a target-tracking task using a haptic device, and their performance was compared using Welch's t-test. RESULTS Research residents showed a higher level of "tracking error" (1.69 ± 0.44 cm versus 1.40 ± 0.19 cm; P = 0.04) and a similar level of "path length" (62.5 ± 10.5 cm versus 62.1 ± 5.2 cm; P = 0.92) when compared with clinical residents. CONCLUSIONS The increased "tracking error" among residents at the end of their research time suggests fine psychomotor skills decay in residents who spend time away from clinical duties during laboratory time. This decay demonstrates the need for research residents to regularly participate in clinical activities, simulation, or assessments to minimize and monitor skills decay while away from clinical practice. Additional longitudinal studies may help better map learning and decay curves for residents who spend time away from clinical practice.
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Affiliation(s)
| | - Kenneth Perrone
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Katherine Peterson
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Margaret Garren
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Chembian Parthiban
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Adhira Sunkara
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Michael Zinn
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Carla Pugh
- Department of Surgery, Stanford University School of Medicine, Stanford, California.
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Gawad N, Allen M, Fowler A. Decay of Competence with Extended Research Absences During Residency Training: A Scoping Review. Cureus 2019; 11:e5971. [PMID: 31803553 PMCID: PMC6874279 DOI: 10.7759/cureus.5971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A significant number of residents in postgraduate training programs pursue dedicated research training. Currently, no formal curricula exist to transition residents back into clinical roles following dedicated research leave. This scoping review aims to determine what literature exists on the challenges faced by trainees who interrupt their clinical training for extended periods of time for research leave. The Pubmed and Medline databases were searched for all study designs related to postgraduate trainees taking academic or research leave. A three-step selection process including title, abstract and full-article review was employed to identify articles that mentioned decay of knowledge, skill or competence. A narrative review of the literature was generated to present key themes identified within the studies. The search yielded 174 articles of which five investigated resident skill decay during research leave. The five studies included for analysis were cohort studies that used general surgery residents’ self-perception and faculty members’ perception of residents’ skill decay as a measure. Residents and faculty perceived decay of residents’ technical skills, leadership skills and knowledge following dedicated research leave. The greatest decay perceived was in technical skills, specifically with more complex tasks and longer periods of non-use. This review identified that residents and faculty perceive a decay of resident skills following dedicated research training. To provide the necessary support to limit this potential decay, as well as to assist in the transition back into clinical training, the needs of and challenges faced by research residents and postgraduate programs must be better understood.
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Affiliation(s)
- Nada Gawad
- Surgery, University of Ottawa, Ottawa, CAN
| | - Molly Allen
- Emergency Medicine, University of Toronto, Toronto, CAN
| | - Amanda Fowler
- Surgery, Memorial University of Newfoundland, St. John's, CAN
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