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Quach WT, Hennessy C, Lindsell CJ, Langerman A. Public Perceptions and Informational Needs Regarding Surgical Residents. JOURNAL OF SURGICAL EDUCATION 2024; 81:37-47. [PMID: 37852873 PMCID: PMC10842999 DOI: 10.1016/j.jsurg.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/15/2023] [Accepted: 09/10/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE Identify what topics are of most interest to patients regarding surgical residents. DESIGN Survey of general public describing a hypothetical surgery and then assessing comfort level with resident involvement in surgery, reactions to disclosure statements regarding resident involvement, and desires for additional information. This data was used to produce an amended statement about surgical residents and their involvement in a hypothetical surgery to determine the impact of increased information on participant comfort. SETTING Online survey via Mechanical Turk. PARTICIPANTS Our sample was broadly representative of the United States based on race and age, but with higher education level than United States census data. RESULTS Using a combination of hierarchical clustering, weighted averages, and VAS scoring, questions that were most highly valued by participants were related to what the resident will be doing in the operation and the impact of resident involvement. Participants who had a past negative experience with residents assigned higher importance to all questions, even those that may be seen as not clinically relevant. Increasing the amount of proactively provided information did not have a significant effect on comfort (p = 0.219) when compared to our baseline statement, except with those who reported past negative experience with residents (p = 0.039). CONCLUSIONS These results demonstrate that the majority of potential patients want to know specific details about the residents' skills, what they will be doing in their surgery, and the impact of their participation. Surgeons should be attuned to patients with past negative experiences, who may desire more information. Additional information alone may not be sufficient to comfort some patients, and future research should consider information delivery styles and interpersonal effects on patient comfort level.
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Affiliation(s)
- William T Quach
- Vanderbilt University School of Medicine, Nashville, Tennessee; Surgical Ethics Program, VUMC Center for Biomedical Ethics and Society, Nashville, Tennessee
| | - Cassandra Hennessy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Alexander Langerman
- Surgical Ethics Program, VUMC Center for Biomedical Ethics and Society, Nashville, Tennessee; Vanderbilt University Medical Center, Department of Otolaryngology - Head and Neck Surgery, Nashville, Tennessee.
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Marder RS, Shah NV, Naziri Q, Maheshwari AV. The impact of surgical trainee involvement in total knee arthroplasty: a systematic review of surgical efficacy, patient safety, and outcomes. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:255-298. [PMID: 35022881 DOI: 10.1007/s00590-021-03179-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/27/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Trainee involvement in patient care has raised concerns about the potential risk of adverse outcomes and harming patients. We sought to analyze the impact and potential consequence of surgical trainee involvement in total knee arthroplasty (TKA) procedures in terms of surgical efficacy, patient safety, and functional outcomes. METHODS We systematically reviewed Medline/PubMed, EMBASE, the Cochrane library, and Scopus databases in April 2021. Eligible studies reported on the impact of trainee participation in TKA procedures performed with and without such involvement. RESULTS Twenty-three publications met our eligibility criteria and were included in our study. These studies reported on 132,624 surgeries completed on 132,416 patients. Specifically, 23,988 and 108,636 TKAs were performed with and without trainee involvement, respectively. The mean operative times for procedures with (n = 19,573) and without (n = 94,581) trainee involvement were 99.77 and 85.05 min, respectively. Both studies that reported data on cost of TKAs indicated a significant increase (p < 0.001) associated with procedures completed by teaching hospitals compared to private practices. Mean overall complication rates were 7.20% and 7.36% for TKAs performed with (n = 9,386) and without (n = 31,406) trainees. Lastly, the mean Knee Society Scale (KSS) knee scores for TKAs with (n = 478) and without (n = 806) trainee involvement were similar; 82.81 and 82.71, respectively. CONCLUSION Our systematic review concurred with previous studies that reported trainee involvement during TKAs increases the mean operative time. However, the overall complication rates and functional outcomes were similar. Larger studies with a better methodology and higher level of evidence are still needed for a resolute conclusion.
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Affiliation(s)
- Ryan S Marder
- Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Neil V Shah
- Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Qais Naziri
- Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Aditya V Maheshwari
- Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA.
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Anyomih TT, Jennings T, Mehta A, O'Neill JR, Panagiotopoulou I, Gourgiotis S, Tweedle E, Bennett J, Davies RJ, Simillis C. Systematic review and meta-analysis comparing perioperative outcomes of emergency appendectomy performed by trainee vs trained surgeon. Am J Surg 2023; 225:168-179. [PMID: 35927089 DOI: 10.1016/j.amjsurg.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/23/2022] [Accepted: 07/14/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Appendectomy is a benchmark operation for trainee progression, but this should be weighed against patient safety and perioperative outcomes. METHODS Systematic literature review and meta-analysis comparing outcomes of appendectomy performed by trainees versus trained surgeons. RESULTS Of 2086 articles screened, 29 studies reporting on 135,358 participants were analyzed. There was no difference in mortality (Odds ratio [OR] 1.08, P = 0.830), overall complications (OR 0.93, P = 0.51), or major complications (OR 0.56, P = 0.16). There was no difference in conversion from laparoscopic to open surgery (OR 0.81, P = 0.12) and in intraoperative blood loss (Mean Difference [MD] 5.58 mL, P = 0.25). Trainees had longer operating time (MD 7.61 min, P < 0.0001). Appendectomy by trainees resulted in shorter duration of hospital stay (MD 0.16 days, P = 0.005) and decreased reoperation rate (OR 0.78, P = 0.05). CONCLUSIONS Appendectomy performed by trainees does not compromise patient safety. Due to statistical heterogeneity, further randomized controlled trials, with standardized reported outcomes, are required.
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Affiliation(s)
- Theophilus Tk Anyomih
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Thomas Jennings
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Alok Mehta
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - J Robert O'Neill
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ioanna Panagiotopoulou
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Stavros Gourgiotis
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Elizabeth Tweedle
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - John Bennett
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - R Justin Davies
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Constantinos Simillis
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
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Bosley ME, Werenski HE, Powell MS, Meredith JW, Randle RW. Inguinal Hernia Repairs on the Chief's Service: A Safe Educational Model in Resident Entrustment. JOURNAL OF SURGICAL EDUCATION 2022; 79:1246-1252. [PMID: 35649957 DOI: 10.1016/j.jsurg.2022.05.010] [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: 01/19/2022] [Revised: 04/08/2022] [Accepted: 05/11/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE We hypothesized that a Chief Resident Service educational model provides safe care for patients compared to that received on standard academic services where rotating residents adopt the practices and preferences of their attending. DESIGN We retrospectively identified patients undergoing inguinal hernia repairs from July 2016 through June 2019 and matched Chief's service patients to standard academic service patients 1:1 on CPT, sex and age. We compared patient characteristics, recurrence rates, outcomes and complications. SETTING Tertiary care center, single institution. PARTICIPANTS Overall, 77 patients undergoing inguinal hernia repairs (66% open and 34% laparoscopic) on the Chief's service matched successfully to 77 standard academic service patients during the study period. RESULTS Age, BMI and ASA were similar between the services, but Chief's service patients were less likely to be current smokers (1.3% vs. 24.7%) and more likely to be former smokers (59.7% vs. 26.0%) than standard academic service patients (p < 0.01). Patients presenting with incarcerated hernias (5.2% vs. 9.1%), recurrent (10.4% vs. 5.2%) and bilateral hernias (19.5% vs. 10.4%) were similar between the Chief's service and standard academic services, respectively (all p > 0.05). Operative times were longer for the Chief's service for open (123 min vs. 67, p < 0.01) and laparoscopic (112 min vs. 79, p = 0.02) repairs. Recurrence rates (6.5% vs. 3.9%, p = 0.47) and complications including infection, seroma or hematoma requiring evacuation and need for reoperation were similarly low (p > 0.05) between the Chief's and standard academic services, respectively. Despite low complication rates, Chief's service patients were more likely to present to the ED post-op (14.3% vs. 1.3%; p = 0.001), but readmission rates were similarly low (2.6% vs. 0%, p = 0.09). CONCLUSIONS Providing general surgery chief residents with a supervised opportunity to direct, plan and provide surgical care in clinic and the operating room, as a transition to independent practice following graduation, is safe for patients presenting with inguinal hernias. Concerns about patient safety should not be a barrier to maximizing entrustment for the evaluation and operative management of select core general surgery diagnoses and operations.
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Affiliation(s)
- Maggie E Bosley
- Department of Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina.
| | - Hope E Werenski
- Department of Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Myron S Powell
- Department of Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - J Wayne Meredith
- Department of Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Reese W Randle
- Department of Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina.
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Burkhard MD, Farshad M, Suter D, Cornaz F, Leoty L, Fürnstahl P, Spirig JM. Spinal decompression with patient-specific guides. Spine J 2022; 22:1160-1168. [PMID: 35017055 DOI: 10.1016/j.spinee.2022.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/20/2021] [Accepted: 01/03/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Patient-specific instruments (PSI) have been well established in spine surgery for pedicle screw placement. However, its utility in spinal decompression surgery is yet to be investigated. PURPOSE The purpose of this study was to investigate the feasibility and utility of PSI in spinal decompression surgery compared with conventional freehand (FH) technique for both expert and novice surgeons. STUDY DESIGN Human cadaver study. METHODS Thirty-two midline decompressions were performed on 4 fresh-frozen human cadavers. An expert spine surgeon and an orthopedic resident (novice) each performed 8 FH and 8 PSI-guided decompressions. Surgical time for each decompression method was measured. Postoperative decompression area, cranial decompression extent in relation to the intervertebral disc, and lateral recess bony overhang were measured on postoperative CT-scans. In the PSI-group, the decompression area and osteotomy accuracy were evaluated. RESULTS The surgical time was similar in both techniques, with 07:25 min (PSI) versus 06:53 min (FH) for the expert surgeon and 12:36 min (PSI) vs. 11:54 (FH) for the novice surgeon. The postoperative cranial decompression extent and the lateral recess bony overhang did not differ between both techniques and surgeons. Further, the postoperative decompression area was significantly larger with the PSI than with the FH for the novice surgeon (477 vs. 305 mm2; p=.01), but no significant difference was found between both techniques for the expert surgeon. The execution of the decompression differed from the preoperative plan in the decompression area by 5%, and the osteotomy planes had an accuracy of 1-3 mm. CONCLUSION PSI-guided decompression is feasible and accurate with similar procedure time to the standard FH technique in a cadaver model, which warrants further investigation in vivo. In comparison to the FH technique, a more extensive decompression was achieved with PSI in the novice surgeon's hands in this study. CLINICAL SIGNIFICANCE The PSI-guided spinal decompression technique may be a useful alternative to FH decompression in certain situations. A special potential of the PSI technique could lie in the technical aid for novice surgeons and in situations with unconventional anatomy or pathologies such as deformity or tumor. This study serves as a starting point toward PSI-guided spinal decompression, but further in vivo investigations are necessary.
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Affiliation(s)
- Marco D Burkhard
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Switzerland.
| | - Mazda Farshad
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Switzerland; University Spine Center Zurich, Balgrist University Hospital, University of Zurich, Switzerland
| | - Daniel Suter
- Research in Orthopedic Computer Science (ROCS), University Hospital Balgrist, University of Zurich, Switzerland
| | - Frédéric Cornaz
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Switzerland
| | - Laura Leoty
- Research in Orthopedic Computer Science (ROCS), University Hospital Balgrist, University of Zurich, Switzerland
| | - Philipp Fürnstahl
- Research in Orthopedic Computer Science (ROCS), University Hospital Balgrist, University of Zurich, Switzerland
| | - José Miguel Spirig
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Switzerland; University Spine Center Zurich, Balgrist University Hospital, University of Zurich, Switzerland
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Pande R, Halle-Smith JM, Thorne T, Hiddema L, Hodson J, Roberts KJ, Arshad A, Connor S, Conlon KCP, Dickson EJ, Giovinazzo F, Harrison E, de Liguori Carino N, Hore T, Knight SR, Loveday B, Magill L, Mirza D, Pandanaboyana S, Perry RJ, Pinkney T, Siriwardena AK, Satoi S, Skipworth J, Stättner S, Sutcliffe RP, Tingstedt B. Can trainees safely perform pancreatoenteric anastomosis? A systematic review, meta-analysis, and risk-adjusted analysis of postoperative pancreatic fistula. Surgery 2022; 172:319-328. [PMID: 35221107 DOI: 10.1016/j.surg.2021.12.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/22/2021] [Accepted: 12/27/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The complexity of pancreaticoduodenectomy and fear of morbidity, particularly postoperative pancreatic fistula, can be a barrier to surgical trainees gaining operative experience. This meta-analysis sought to compare the postoperative pancreatic fistula rate after pancreatoenteric anastomosis by trainees or established surgeons. METHODS A systematic review of the literature was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, with differences in postoperative pancreatic fistula rates after pancreatoenteric anastomosis between trainee-led versus consultant/attending surgeons pooled using meta-analysis. Variation in rates of postoperative pancreatic fistula was further explored using risk-adjusted outcomes using published risk scores and cumulative sum control chart analysis in a retrospective cohort. RESULTS Across 14 cohorts included in the meta-analysis, trainees tended toward a lower but nonsignificant rate of all postoperative pancreatic fistula (odds ratio: 0.77, P = .45) and clinically relevant postoperative pancreatic fistula (odds ratio: 0.69, P = .37). However, there was evidence of case selection, with trainees being less likely to operate on patients with a pancreatic duct width <3 mm (odds ratio: 0.45, P = .05). Similarly, analysis of a retrospective cohort (N = 756 cases) found patients operated by trainees to have significantly lower predicted all postoperative pancreatic fistula (median: 20 vs 26%, P < .001) and clinically relevant postoperative pancreatic fistula (7 vs 9%, P = .020) rates than consultant/attending surgeons, based on preoperative risk scores. After adjusting for this on multivariable analysis, the risks of all postoperative pancreatic fistula (odds ratio: 1.18, P = .604) and clinically relevant postoperative pancreatic fistula (odds ratio: 0.85, P = .693) remained similar after pancreatoenteric anastomosis by trainees or consultant/attending surgeons. CONCLUSION Pancreatoenteric anastomosis, when performed by trainees, is associated with acceptable outcomes. There is evidence of case selection among patients undergoing surgery by trainees; hence, risk adjustment provides a critical tool for the objective evaluation of performance.
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Affiliation(s)
| | | | - Rupaly Pande
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital, Birmingham, UK.
| | - James M Halle-Smith
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Thomas Thorne
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Lydia Hiddema
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - James Hodson
- Institute of Translational Medicine, Queen Elizabeth Hospital, Birmingham, UK
| | - Keith J Roberts
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital, Birmingham, UK; Institute of Immunology and Immunotherapy, University of Birmingham, UK
| | | | - Ali Arshad
- Hepatobiliary and Pancreatic Surgery Unit, University Hospital of Southampton, New Zealand
| | - Saxon Connor
- Department of General Surgery, Christchurch Hospital, New Zealand
| | - Kevin C P Conlon
- Hepatobiliary and Pancreatic Surgery Unit, University of Dublin, Trinity College, Ireland
| | - Euan J Dickson
- Hepatobiliary and Pancreatic Surgery Unit, Glasgow Royal Infirmary, Scotland, UK
| | - Francesco Giovinazzo
- General Surgery and Liver Transplantation Unit, Policlinico Universitario Agostino Gemelli, Rome, Italy. https://www.twitter.com/FranGiovinazzo
| | - Ewen Harrison
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, UK. https://www.twitter.com/ewenharrison
| | - Nicola de Liguori Carino
- Hepatobiliary and Pancreatic Surgery Unit, Manchester University NHS FT, UK. https://www.twitter.com/deLiguoriCarino
| | - Todd Hore
- Department of General Surgery, Christchurch Hospital, New Zealand
| | - Stephen R Knight
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, UK
| | - Benjamin Loveday
- Hepatobiliary and Pancreatic Surgery Unit, Royal Melbourne Hospital, Parkville, VIC, Australia. https://www.twitter.com/BenPTLoveday
| | - Laura Magill
- Birmingham Surgical Trials Consortium, University of Birmingham, UK
| | - Darius Mirza
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital, Birmingham, UK. https://www.twitter.com/DrDariusMirza
| | - Sanjay Pandanaboyana
- HPB and Transplant Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK. https://www.twitter.com/Sanjay_HPB
| | - Rita J Perry
- Birmingham Surgical Trials Consortium, University of Birmingham, UK
| | - Thomas Pinkney
- Birmingham Surgical Trials Consortium, University of Birmingham, UK. https://www.twitter.com/pinkney_t
| | | | - Sohei Satoi
- Division of Pancreatobiliary Surgery, Kansai Medical University, Osaka, Japan; Division of Surgical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - James Skipworth
- Hepatobiliary and Pancreatic Surgery Unit, University Hospitals Bristol NHS Foundation Trust, UK
| | - Stefan Stättner
- Hepatobiliary and Pancreatic Surgery Unit, Salzkammergut Klinikum OÖG, Sweden. https://www.twitter.com/SStattner
| | - Robert P Sutcliffe
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital, Birmingham, UK. https://www.twitter.com/liveRPancSurg
| | - Bobby Tingstedt
- Hepatobiliary and Pancreatic Surgery Unit, Lund University, Sweden. https://www.twitter.com/conlonhpb
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The impact of surgical trainee involvement in total hip arthroplasty: a systematic review of surgical efficacy, patient safety, and outcomes. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:1365-1409. [PMID: 35662374 DOI: 10.1007/s00590-022-03290-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Concerns persist that trainee participation in surgical procedures may compromise patient care and potentiate adverse events and costs. We aimed to analyse the potential impact and consequences of surgical trainee involvement in total hip arthroplasty (THA) procedures in terms of surgical efficacy, patient safety, and functional outcomes. METHODS We systematically reviewed Medline/PubMed, EMBASE, the Cochrane library, and Scopus databases in October 2021. Eligible studies reported a direct comparison between THA cases performed with and without trainee involvement. RESULTS Eighteen publications met our eligibility criteria and were included in our study. The included studies reported on 142,450 THAs completed on 142,417 patients. Specifically, 48,155 and 94,295 surgeries were completed with and without trainee involvement, respectively. The mean operative times for procedures with (n = 5,662) and without (n = 14,763) trainee involvement were 106.20 and 91.41 min, respectively. Mean overall complication rates were 6.43% and 5.93% for THAs performed with (n = 4842) and without (n = 12,731) trainees. Lastly, the mean Harris Hip Scores (HHS) for THAs performed with (n = 442) and without (n = 750) trainee participation were 89.61 and 86.97, respectively. CONCLUSION Our systematic review confirmed previous studies' reports of increased operative time for THA cases with trainee involvement. However, based on the overall similar complication rates and functional hip scores obtained, patients should be reassured concerning the relative safety of trainee involvement in THA. Future prospective studies with higher levels of evidence are still needed to reinforce the existing evidence.
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Meyer MA, Tarabochia MA, Goh BC, Hietbrink F, Houwert RM, Dyer GSM. The Impact of Resident Involvement on Outcomes and Costs in Elective Hand and Upper Extremity Surgery. J Hand Surg Am 2022:S0363-5023(22)00121-6. [PMID: 35461739 DOI: 10.1016/j.jhsa.2022.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 12/15/2021] [Accepted: 02/02/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to assess the impact of resident involvement on periprocedural outcomes and costs after common procedures performed at an academic hand surgical practice. METHODS A retrospective review was performed in all patients undergoing 7 common elective upper extremity procedures between January 2008 and December 2018: carpal tunnel release, distal radius open reduction and internal fixation (ORIF), trigger finger release, thumb carpometacarpal arthroplasty, phalanx closed reduction and percutaneous pinning, cubital tunnel release, and olecranon ORIF. The medical record was reviewed to determine the impact of surgical assistants (resident, fellow, or physician assistant) on periprocedural outcomes, periprocedural costs, and 1-year postoperative outcomes. The involvement of surgical trainees operating under direct supervision was compared with the entire operation performed by the attending surgeon with a physician assistant present. RESULTS A total of 396 procedures met the inclusion criteria. Analysis of the whole study sample revealed low rates of intraoperative complications, wound complications, medical complications, readmissions, and mortality. Subgroup analysis of carpal tunnel releases revealed significantly greater tourniquet times for residents compared with physician assistants (7 ± 2 min, 6 ± 1 min), as well as longer overall operating room times for residents compared to fellows or physician assistants (17 ± 5 min, 13 ± 3 min, 12 ± 3 min). Operating room times for distal radius ORIF were significantly greater among residents compared to fellows or physician assistants (68 ± 19 min, 57 ± 17 min, 56 ± 14 min). There were no differences in any other perioperative metrics or periprocedural costs for the trigger finger release or cubital tunnel release cohorts. CONCLUSIONS Resident involvement in select upper extremity procedures can lengthen operative times but does not have an impact on blood loss or operating room costs. CLINICAL RELEVANCE Surgeons should be aware that having a resident assistant slightly increases operative times in elective hand surgery.
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Affiliation(s)
- Maximilian A Meyer
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
| | | | - Brian C Goh
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Falco Hietbrink
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - R Marijn Houwert
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - George S M Dyer
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA
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9
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Storm AC, Fishman DS, Buxbaum JL, Coelho-Prabhu N, Al-Haddad MA, Amateau SK, Calderwood AH, DiMaio CJ, Elhanafi SE, Forbes N, Fujii-Lau LL, Jue TL, Kohli DR, Kwon RS, Law JK, Pawa S, Thosani NC, Wani S, Qumseya BJ. American Society for Gastrointestinal Endoscopy guideline on informed consent for GI endoscopic procedures. Gastrointest Endosc 2022; 95:207-215.e2. [PMID: 34998575 DOI: 10.1016/j.gie.2021.10.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 10/24/2021] [Indexed: 12/11/2022]
Abstract
Informed consent is the cornerstone of the ethical practice of procedures and treatments in medicine. The purpose of this document from the American Society for Gastrointestinal Endoscopy (ASGE) Standards of Practice Committee is to provide an update on best practice of the informed consent process and other issues around informed consent and shared decision-making for endoscopic procedures. The principles of informed consent are based on longstanding legal doctrine. Several new concepts and clinical trials addressing the best practice of informed consent will help guide practitioners of the burgeoning field of GI endoscopic procedures. After a literature review and an iterative discussion and voting process by the ASGE Standards of Practice Committee, this document was produced to update our guidance on informed consent for the practicing endoscopist. Because this document was designed by considering the laws and broad practice of endoscopy in the United States, legal requirements may differ by state and region, and it is the responsibility of the endoscopist, practice managers, and other healthcare organizations to be aware of local laws. Our recommendations are designed to improve the informed consent experience for both physicians and patients as they work together to diagnose and treat GI diseases with endoscopy.
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Affiliation(s)
- Andrew C Storm
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Douglas S Fishman
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - James L Buxbaum
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | | | - Mohammad A Al-Haddad
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Stuart K Amateau
- Division of Gastroenterology Hepatology and Nutrition, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Audrey H Calderwood
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Christopher J DiMaio
- Department of Gastroenterology, Mount Sinai School of Medicine, New York, New York, USA
| | - Sherif E Elhanafi
- Department of Gastroenterology, Texas Tech University, El Paso, Texas, USA
| | - Nauzer Forbes
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Larissa L Fujii-Lau
- Department of Gastroenterology, The Queen's Medical Center, Honolulu, Hawaii, USA
| | - Terry L Jue
- Department of Gastroenterology, The Permanente Medical Group, San Francisco, California, USA
| | - Divyanshoo R Kohli
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Richard S Kwon
- Division of Gastroenterology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Joanna K Law
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Swati Pawa
- Department of Gastroenterology, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Nirav C Thosani
- Center for Interventional Gastroenterology at UTHealth, McGovern Medical School, Houston, Texas, USA
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Bashar J Qumseya
- Department of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, USA
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Chambers JG. Patients' Perceptions of Residents Involved in Their Care in a Community General Surgery Practice. Am Surg 2021; 88:352-355. [PMID: 34734538 DOI: 10.1177/00031348211050817] [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: 11/17/2022]
Abstract
BACKGROUND Resident involvement in patient care in the general surgery setting is most often encountered in an academic setting. Many community hospitals have residents involved in patient care as well. There are no studies that gauge patients' perceptions in the involvement of residents in their general surgery care in the community setting. METHODS Patients were given a Northeast Georgia Health System Graduate Medical Education Department Institutional review Board approved 26-question questionnaire during their office visit gauging their wiliness to allow a resident be involved in their care, and their understanding of what a resident is. RESULTS A total of 196 patients completed the survey with answers that could be analyzed. Overall, 67.3% would allow residents be involved in their care. The main reasons for this were to educate future surgeons, they enjoy a teaching environment, and that they have had residents involved in their care and it was a good experience. Of the 27 % that did not want a resident involved in their care, the main reason was they only wanted their doctor involved in their care. Of the respondents, 58 % were comfortable having a resident involved in their surgery or procedure. Only 14% noted that they would prefer not to have a resident involved in their procedure or surgery. CONCLUSIONS Patents appear receptive to general surgery residents' involvement in their care in the community setting. This is reassuring as community practices may be more receptive to including residents in their practices, based upon these findings.
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Affiliation(s)
- James G Chambers
- 471918Northeast Georgia Health system Braselton, Braselton, GE, USA
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Resident Involvement in Hip Arthroscopy Procedures Does Not Affect Short-Term Surgical Outcomes. Arthrosc Sports Med Rehabil 2021; 3:e1367-e1376. [PMID: 34712975 PMCID: PMC8527250 DOI: 10.1016/j.asmr.2021.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/23/2021] [Indexed: 12/21/2022] Open
Abstract
Purpose To evaluate whether the presence of residents in hip arthroscopy (HA) procedures affects short-term surgical outcomes. Methods The American College of Surgeons National Surgical Quality Improvement Program Database was used to identify patients who underwent HA from 2006 to 2012. Demographic and 30-day outcome variables were compared between cohorts of patients with and without residents. Multivariate logistic regression was used to identify whether resident involvement was an independent risk factor for adverse outcomes. Propensity score matching was performed to control for all demographic and intraoperative variables. Results A total of 869 patients (59.7% female) were included in this study, 626 of which reported data on resident involvement. Patients were mostly White (73.4% of cases without a resident, 51.8% with a resident, P < .05). Those with residents were younger (P = .016), had lower modified 5-item frailty index (mFI-5) scores (P = .028), and had fewer cardiac comorbidities (P = .008). There was no difference in diabetic status, dyspnea symptoms, history of chronic obstructive pulmonary disease, renal comorbidity, neurologic comorbidity, cumulative comorbidities, history of bleeding disorders, inpatient vs. outpatient treatment, preoperative functional status, smoking history, and steroid use for chronic conditions. There was no difference in all complications, operative time, length of stay, reoperation, readmission, wound complication, venous thromboembolism, blood transfusions, or sepsis. Propensity score match for demographic and intraoperative differences found no association between resident involvement and increased complications. Resident involvement was not an independent risk factor for all complications studied. Conclusion Resident involvement in HA procedures was not a risk factor for 30-day complications between 2006 and 2012. Resident involvement did not increase the risk of adverse outcomes, readmission, reoperation, or length of stay, nor did it significantly increase operative times.
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Fellow Versus Resident: Graduate Medical Education and Patient Outcomes After Anterior Cervical Diskectomy and Fusion Surgery. J Am Acad Orthop Surg 2020; 28:e401-e407. [PMID: 31365356 DOI: 10.5435/jaaos-d-18-00645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The effect of spine fellow versus orthopaedic surgery resident assistance on outcomes in anterior cervical diskectomy and fusion (ACDF) has not been well studied. The objective of this study was to determine differences in patient health-related outcomes based on the level of surgical trainees. METHODS Consecutive cases of ACDF (n = 407) were reviewed at a single high-volume institution between 2015 and 2017 and were separated into two groups based on whether they were fellow-assisted or resident-assisted. Demographic and clinical variables were recorded, and health-related quality of life was evaluated using the Short Form-12 (SF-12) survey. The SF-12, visual analog scale pain score, and neck disability index were compared between the two groups. Surgery level, surgical time, preoperative Charlson Comorbidity Index, estimated blood loss, equivalent morphine use, perioperative complications, and 30-day readmission were also recorded. Patient outcomes were compared using an unpaired t-test as well as multivariate linear regression, controlling for age, sex, body mass index, Charlson Comorbidity Index, presurgical visual analog scale, SF-12, and neck disability index. Results were reported with the 95% confidence interval. RESULTS Spine surgery fellows and orthopaedic surgery residents participated in 228 and 179 ACDF cases, respectively. No notable demographic differences between the two groups were found. A higher proportion of three or more level ACDF surgeries assisted by fellows versus residents was found. Estimated blood loss was greater in fellow-assisted ACDF cases. Both surgery time and total time in the room were also longer in the fellow-assisted ACDF group. No 30-day readmissions were found in either groups, and only one case of acute hemorrhagic anemia was found in the fellow-assisted group. Overall, postoperative complications were higher in the resident group; however, no difference with regard to intraoperative complications between groups was found. DISCUSSION This study shows that patient health-related outcomes are similar in ACDF cases that were fellow-assisted versus resident-assisted. However, fellow-assisted ACDF cases were associated with more blood loss and longer surgery time.
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Akar B, Aslancan R, Doğan O, Başbuğ A, Sivaslιoğlu A, Çalιşkan E. The Effect of Hands-On Cadaver and Live Surgery Practice on Surgeons' Performance in Urogynecologic Operations: One-Year Follow-Up. J Gynecol Surg 2020. [DOI: 10.1089/gyn.2019.0041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Bertan Akar
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Istinye University, Istanbul, Turkey
| | - Reyhan Aslancan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Bahcesehir University, Kadıköy, Turkey
| | - Ozan Doğan
- Department of Obstetrics and Gynecology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Alper Başbuğ
- Department of Obstetrics and Gynecology, Faculty of Medicine, Düzce University, Düzce, Turkey
| | - Akιn Sivaslιoğlu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Eray Çalιşkan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Okan University, Istanbul, Turkey
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Surgical training in spine surgery: safety and patient-rated outcome. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:807-816. [DOI: 10.1007/s00586-019-05883-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 01/11/2019] [Indexed: 10/27/2022]
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Miller ZA, Amin A, Tu J, Echenique A, Winokur RS. Simulation-based Training for Interventional Radiology and Opportunities for Improving the Educational Paradigm. Tech Vasc Interv Radiol 2018; 22:35-40. [PMID: 30765075 DOI: 10.1053/j.tvir.2018.10.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The current model for medical education is based on the Master-Apprentice model which was adopted into practice over a century ago. Since then, there have been many changes in healthcare and the environment in which trainees learn, practice and become proficient in procedural and critical thinking skills. The current model for medical education has however, not changed considerably in this time frame, resulting in significant limitations to trainee education. Simulator-based training is a technique which can minimize the limitations of the apprenticeship model by mitigating the effect of time constraints, increased emphasis on patient safety and satisfaction and nonstandardization of Interventional Radiology (IR) curricula. Currently, simulators are utilized in some IR programs, however robust research into simulators must be performed to prove the educational validity of simulators and support formalization and widespread integration of simulation based training into a new, improved and standardized IR curriculum.
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Affiliation(s)
- Zoe A Miller
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, FL.
| | - Ayush Amin
- University of Miami Miller School of Medicine, Miami, FL
| | - Joanthan Tu
- University of Miami Miller School of Medicine, Miami, FL
| | - Ana Echenique
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, FL
| | - Ronald S Winokur
- Department of Radiology, Division of Interventional Radiology, Weill Cornell Medicine, New York, NY
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Kempenich JW, Willis RE, Fayyadh MA, Campi HD, Cardenas T, Hopper WA, Giovannetti CA, Reed CC, Dent DL. Video-Based Patient Education Improves Patient Attitudes Toward Resident Participation in Outpatient Surgical Care. JOURNAL OF SURGICAL EDUCATION 2018; 75:e61-e67. [PMID: 30217778 DOI: 10.1016/j.jsurg.2018.07.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/28/2018] [Accepted: 07/30/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Decipher if patient attitudes toward resident participation in surgical care can be improved with patient education using a video-based modality. DESIGN A survey using a 5-pt Likert scale was created, piloted, and distributed in general and colorectal surgery outpatient clinics that had residents involved with patient care at 2 facilities, both with control and intervention groups. The intervention group viewed a short video (∼4 min) explaining the role, education, and responsibilities of medical students, residents, and attending surgeons prior to answering the survey. SETTING General and colorectal surgery outpatient clinics at the University of Texas Health San Antonio, Texas. PARTICIPANTS A total of 383 responses were collected, all clinic patients were eligible. RESULTS The majority of patients (82%) welcomed resident participation in their health care. Eighteen percent of patients did not expect residents to be involved in their care. Patients had favorable views of residents participating during their surgical procedures with 77% responding "agree" or "strongly agree" to a senior resident assisting with a complicated procedure. Patients who viewed the video versus control were less concerned with how much of the procedure the resident would perform (76% vs 86%, p = 0.010). Patients who viewed the video felt less inconvenienced (p = 0.004). CONCLUSIONS The majority of patients are welcoming to resident participation in their surgical care but only 54% were expecting resident involvement at their clinic visit. Early explanation with an educational video of resident roles, education, and responsibilities may help bridge the gap and improve patient experience.
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Affiliation(s)
- Jason W Kempenich
- University of Texas Health Science Center at San Antonio, San Antonio, Texas.
| | - Ross E Willis
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Mohammed Al Fayyadh
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Haisar Dao Campi
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Tatiana Cardenas
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - William A Hopper
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | | | - Charles C Reed
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Daniel L Dent
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Impact of resident participation on outcomes following lumbar fusion: An analysis of 5655 patients from the ACS-NSQIP database. J Clin Neurosci 2018; 56:131-136. [DOI: 10.1016/j.jocn.2018.06.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 05/01/2018] [Accepted: 06/19/2018] [Indexed: 01/21/2023]
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Bannister SL, Dolson MS, Lingard L, Keegan DA. Not just trust: factors influencing learners' attempts to perform technical skills on real patients. MEDICAL EDUCATION 2018; 52:605-619. [PMID: 29446155 DOI: 10.1111/medu.13522] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/14/2017] [Accepted: 12/06/2017] [Indexed: 06/08/2023]
Abstract
CONTEXT As part of their training, physicians are required to learn how to perform technical skills on patients. The previous literature reveals that this learning is complex and that many opportunities to perform these skills are not converted into attempts to do so by learners. This study sought to explore and understand this phenomenon better. METHODS A multi-phased qualitative study including ethnographic observations, interviews and focus groups was conducted to explore the factors that influence technical skill learning. In a tertiary paediatric emergency department, staff physician preceptors, residents, nurses and respiratory therapists were observed in the delivery and teaching of technical skills over a 3-month period. A constant comparison methodology was used to analyse the data and to develop a constructivist grounded theory. RESULTS We conducted 419 hours of observation, 18 interviews and four focus groups. We observed 287 instances of technical skills, of which 27.5% were attempted by residents. Thematic analysis identified 14 factors, grouped into three categories, which influenced whether residents attempted technical skills on real patients. Learner factors included resident initiative, perceived need for skill acquisition and competing priorities. Teacher factors consisted of competing priorities, interest in teaching, perceived need for residents to acquire skills, attributions about learners, assessments of competency, and trust. Environmental factors were competition from other learners, judgement that the patient was appropriate, buy-in from team members, consent from patient or caregivers, and physical environment constraints. CONCLUSIONS Our findings suggest that neither the presence of a learner in a clinical environment nor the trust of the supervisor is sufficient to ensure the learner will attempt a technical skill. We characterise this phenomenon as representing a pool of opportunities to conduct technical skills on live patients that shrinks to a much smaller pool of technical skill attempts. Learners, teachers and educators can use this knowledge to maximise the number of attempts learners make to perform technical skills on real patients.
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Affiliation(s)
- Susan L Bannister
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mark S Dolson
- Department of Anthropology, Faculty of Arts, University of Waterloo, Waterloo, Ontario, Canada
| | - Lorelei Lingard
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - David A Keegan
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Elyashiv O, Zussman NM, Ben-Zvi M, Bar J, Sagiv R, Condrea A, Ginath S. Is There a Difference in the Outcome of Mid-Urethral Sling Operations Performed by Urogynecologists Compared with Supervised Residents? J Minim Invasive Gynecol 2018; 25:878-883. [PMID: 29339299 DOI: 10.1016/j.jmig.2018.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 01/05/2018] [Accepted: 01/08/2018] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE To compare the operative results of midurethral sling (MUS) surgeries for stress urinary incontinence (SUI) performed by residents under the guidance of an attending specialist in urogynecology and those performed by attendings. DESIGN Retrospective chart review (Canadian Task Force classification II-2). SETTING University hospital. PATIENTS A retrospective analysis of all MUS surgeries performed at a single public tertiary medical center between January 2009 and December 2013 was carried out. A total of 257 patients underwent transobturator tape (TOT) placement during the study period, including 136 (52.9%) placed by an attending specialist in urogynecology (group A) and 121 (47.1%) placed by a resident, under the guidance of an attending (group B). MEASUREMENTS The efficacy of treatment was evaluated in terms of early postoperative course, reoperation, and symptom improvement, as based on the Pelvic Floor Distress Inventory short form (PFDI-20) questionnaire. The primary outcome was patient-reported symptoms of SUI, as assessed with the PFDI-20 questionnaire, as well as absence of surgical retreatment for SUI. RESULTS Immediate postoperative complications were comparable in the 2 groups, as were subjective failure and self-reported SUI. The primary outcome-moderate and severe symptoms of SUI-were reported by 23.7% of the patients in group A and 23.6% of those in group B (p = .91). At a mean follow-up of 40 months in both groups, symptoms, as assessed using the urinary scale and prolapse scale of the PFDI-20, were also similar in the 2 groups. The rate of reoperation with repeated sling for SUI was 5% in both groups. CONCLUSION The operative results of TOT surgery for SUI performed by residents under the guidance of an attending specialist in urogynecology did not differ significantly from those performed by the attendings themselves.
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Affiliation(s)
- Osnat Elyashiv
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv, Israel.
| | - Noa Mevorach Zussman
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Masha Ben-Zvi
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Jacob Bar
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Ron Sagiv
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Alexander Condrea
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Shimon Ginath
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv, Israel
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The Effect of Resident Involvement on Postoperative Short-Term Surgical Outcomes in Immediate Breast Reconstruction. Plast Reconstr Surg 2017; 139:1325-1334. [DOI: 10.1097/prs.0000000000003346] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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22
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Carr RA, Chung CW, Schmidt CM, Jester A, Kilbane ME, House MG, Zyromski NJ, Nakeeb A, Schmidt CM, Ceppa EP. Impact of Fellow Versus Resident Assistance on Outcomes Following Pancreatoduodenectomy. J Gastrointest Surg 2017; 21:1025-1030. [PMID: 28194616 DOI: 10.1007/s11605-017-3383-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 01/31/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Participation by surgical trainees in complex procedures is key to their development as future practicing surgeons. The impact of surgical fellows versus general surgery resident assistance on outcomes in pancreatoduodenectomy (PD) has not been well studied. The purpose of this study was to determine differences in patient outcomes based on level of surgical trainee. METHODS Consecutive cases of PD (n = 254) were reviewed at a single high-volume institution over a 2-year period (July 2013-June 2015). Thirty-day outcomes were monitored through the American College of Surgeon's National Surgical Quality Improvement Program (NSQIP) and Quality In-Training Initiative. Patient outcomes were compared between PD assisted by general surgery residents versus hepatopancreatobiliary fellows. RESULTS The hepatopancreatobiliary surgery fellows and general surgery residents participated in 109 and 145 PDs, respectively. The incidence of each individual postoperative complication (renal, infectious, pancreatectomy-specific, and cardiopulmonary), total morbidity, mortality, and failure to rescue were the same between groups. CONCLUSIONS Patient operative outcomes were the same between fellow- and resident-assisted PD. These results suggest that hepatopancreatobiliary surgery fellows and general surgery residents should be offered the same opportunities to participate in complex general surgery procedures.
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Affiliation(s)
- Rosalie A Carr
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 541, Indianapolis, IN, 46202, USA
| | - Catherine W Chung
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 541, Indianapolis, IN, 46202, USA
| | - Christian M Schmidt
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 541, Indianapolis, IN, 46202, USA
| | - Andrea Jester
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 541, Indianapolis, IN, 46202, USA
| | - Molly E Kilbane
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 541, Indianapolis, IN, 46202, USA
| | - Michael G House
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 541, Indianapolis, IN, 46202, USA
| | - Nicholas J Zyromski
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 541, Indianapolis, IN, 46202, USA
| | - Attila Nakeeb
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 541, Indianapolis, IN, 46202, USA
| | - C Max Schmidt
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 541, Indianapolis, IN, 46202, USA
| | - Eugene P Ceppa
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 541, Indianapolis, IN, 46202, USA.
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Morgan R, Kauffman DF, Doherty G, Sachs T. Resident and attending assessments of operative involvement: Do we agree? Am J Surg 2017; 213:1178-1185.e1. [DOI: 10.1016/j.amjsurg.2016.07.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 07/15/2016] [Accepted: 07/19/2016] [Indexed: 10/21/2022]
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Computer Simulation and Digital Resources for Plastic Surgery Psychomotor Education. Plast Reconstr Surg 2017; 138:730e-738e. [PMID: 27673543 DOI: 10.1097/prs.0000000000002558] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Contemporary plastic surgery residents are increasingly challenged to learn a greater number of complex surgical techniques within a limited period. Surgical simulation and digital education resources have the potential to address some limitations of the traditional training model, and have been shown to accelerate knowledge and skills acquisition. Although animal, cadaver, and bench models are widely used for skills and procedure-specific training, digital simulation has not been fully embraced within plastic surgery. Digital educational resources may play a future role in a multistage strategy for skills and procedures training. The authors present two virtual surgical simulators addressing procedural cognition for cleft repair and craniofacial surgery. Furthermore, the authors describe how partnerships among surgical educators, industry, and philanthropy can be a successful strategy for the development and maintenance of digital simulators and educational resources relevant to plastic surgery training. It is our responsibility as surgical educators not only to create these resources, but to demonstrate their utility for enhanced trainee knowledge and technical skills development. Currently available digital resources should be evaluated in partnership with plastic surgery educational societies to guide trainees and practitioners toward effective digital content.
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Morgan R, Kauffman DF, Doherty G, Sachs T. Resident and Attending Perceptions of Resident Involvement: An Analysis of ACGME Reporting Guidelines. JOURNAL OF SURGICAL EDUCATION 2017; 74:415-422. [PMID: 27816432 DOI: 10.1016/j.jsurg.2016.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 10/03/2016] [Accepted: 10/13/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE For general surgery residents (Residents) to log an operation, the ACGME requires "significant involvement" in diagnosis (DX), operation selection (SEL), operation (OPR), preoperative (PRE), and postoperative (POC) care. We compared how residents and attending surgeons (Attendings) perceived residents' role in each of these core requirements. DESIGN Residents and attendings completed surveys postoperatively regarding responsibility for each core requirement on a 5-point Likert scale from "Completely Attending" to "Completely Resident." Significance was determined using Chi-square analysis (p < 0.05) and degree of agreement was calculated using Spearman's rank correlation (rs). SETTING Boston Medical Center, Boston, MA (tertiary institution). RESULTS A total of 302 paired surveys were analyzed. Residents more often performed a significant portion of the later stages of care (DX = 27%, PRE = 29%, SEL = 27%, OPR = 87%, and POC = 84%). Residents completed the majority of each requirement more frequently in operations performed in the acute setting compared to elective operations: DX (70% vs 8%, p < 0.01), PRE (74% vs 10%, p < 0.01), SEL (65% vs 11%, p < 0.01), OPR (100% vs 89%, p = 0.02), POC (100% vs 77%, p < 0.01). Resident participation was inversely related to operational complexity for DX (p < 0.01), PRE (p < 0.01), SEL (p < 0.01), and OPR (p = 0.01). Resident involvement in OPR increased at the end of the academic year (p = 0.05) and when working with junior attendings (<5 years in practice) (p = 0.01). Interpair agreement was greatest for DX (rs = 0.70) and lowest for POC (rs = 0.35). When residents and attendings did not agree in their answers, residents generally overstated their contribution to the DX (68%), PRE (58%), and SEL (64%) but understated their contribution in OPR (63%) and POC (62%). CONCLUSIONS Residents and attendings demonstrated reliable agreement for most core requirements, but residents were often unable to be involved in all 5 core requirements. Resident involvement was weighted toward later stages of patient care, yet residents often underestimated their contributions. Operational acuity, complexity, and attending experience correlated with resident operative involvement.
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Affiliation(s)
- Ryan Morgan
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Douglas F Kauffman
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Gerard Doherty
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Teviah Sachs
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts.
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Folsom C, Serbousek K, Lydiatt W, Rieke K, Sayles H, Smith R, Panwar A. Impact of resident training on operative time and safety in hemithyroidectomy. Head Neck 2017; 39:1212-1217. [DOI: 10.1002/hed.24742] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 12/08/2016] [Accepted: 01/03/2017] [Indexed: 01/28/2023] Open
Affiliation(s)
- Craig Folsom
- Department of Otolaryngology - Head and Neck Surgery; Naval Medical Center Portsmouth; Portsmouth Virginia
| | - Kimberly Serbousek
- Division of Head and Neck Surgery, Department of Otolaryngology - Head and Neck Surgery; University of Nebraska Medical Center; Omaha Nebraska
| | - William Lydiatt
- Head and Neck Surgical Oncology; Nebraska Methodist Hospital; Omaha Nebraska
| | - Katherine Rieke
- College of Public Health; University of Nebraska Medical Center; Omaha Nebraska
| | - Harlan Sayles
- College of Public Health; University of Nebraska Medical Center; Omaha Nebraska
| | - Russell Smith
- Head and Neck Surgical Oncology; Nebraska Methodist Hospital; Omaha Nebraska
| | - Aru Panwar
- Division of Head and Neck Surgery, Department of Otolaryngology - Head and Neck Surgery; University of Nebraska Medical Center; Omaha Nebraska
- Head and Neck Surgical Oncology; Nebraska Methodist Hospital; Omaha Nebraska
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Kantor O, Schneider AB, Rojnica M, Benjamin AJ, Schindler N, Posner MC, Matthews JB, Roggin KK. Implementing a resident acute care surgery service: Improving resident education and patient care. Surgery 2016; 161:876-883. [PMID: 27932029 DOI: 10.1016/j.surg.2016.09.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/10/2016] [Accepted: 09/24/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND To simulate the duties and responsibilities of an attending surgeon and allow senior residents more intraoperative and perioperative autonomy, our program created a new resident acute care surgery consult service. METHODS We structured resident acute care surgery as a new admitting and inpatient consult service managed by chief and senior residents with attending supervision. When appropriate, the chief resident served as a teaching assistant in the operation. Outcomes were recorded prospectively and reviewed at weekly quality improvement conferences. The following information was collected: (1) teaching assistant case logs for senior residents preimplentation (n = 10) and postimplementation (n = 5) of the resident acute care surgery service; (2) data on the proportion of each case performed independently by residents; (3) resident evaluations of the resident acute care surgery versus other general operative services; (4) consult time for the first 12 months of the service (June 2014 to June 2015). RESULTS During the first year after implementation, the number of total teaching assistant cases logged among graduating chief residents increased from a mean of 13.4 ± 13.0 (range 4-44) for preresident acute care surgery residents to 30.8 ± 8.8 (range 27-36) for postresident acute care surgery residents (P < .01). Of 323 operative cases, the residents performed an average of 82% of the case independently. There was a significant increase in the satisfaction with the variety of cases (mean 5.08 vs 4.52, P < .01 on a 6-point Likert scale) and complexity of cases (mean 5.35 vs 4.94, P < .01) on service evaluations of resident acute care surgery (n = 27) in comparison with other general operative services (n = 127). In addition, creation of a 1-team consult service resulted in a more streamlined consult process with average consult time of 22 minutes for operative consults and 25 minutes for nonoperative consults (range 5-90 minutes). CONCLUSION The implementation of a resident acute care surgery service has increased resident autonomy, teaching assistant cases, and satisfaction with operative case variety, as well as the efficiency of operative consultation at our institution.
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Affiliation(s)
- Olga Kantor
- Department of Surgery, University of Chicago Medicine, Chicago, IL
| | | | - Marko Rojnica
- Department of Surgery, University of Chicago Medicine, Chicago, IL
| | | | - Nancy Schindler
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL
| | | | | | - Kevin K Roggin
- Department of Surgery, University of Chicago Medicine, Chicago, IL.
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Guan J, Brock AA, Karsy M, Couldwell WT, Schmidt MH, Kestle JRW, Jensen RL, Dailey AT, Schmidt RH. Managing overlapping surgery: an analysis of 1018 neurosurgical and spine cases. J Neurosurg 2016; 127:1096-1104. [PMID: 27911238 DOI: 10.3171/2016.8.jns161226] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Overlapping surgery-the performance of parts of 2 or more surgical procedures at the same time by a single lead surgeon-has recently come under intense scrutiny, although data on the effects of overlapping procedures on patient outcomes are lacking. The authors examined the impact of overlapping surgery on complication rates in neurosurgical patients. METHODS The authors conducted a retrospective review of consecutive nonemergent neurosurgical procedures performed during the period from May 12, 2014, to May 12, 2015, by any of 5 senior neurosurgeons at a single institution who were authorized to schedule overlapping cases. Overlapping surgery was defined as any case in which 2 patients under the care of a single lead surgeon were under anesthesia at the same time for any duration. Information on patient demographics, premorbid conditions, surgical variables, and postoperative course were collected and analyzed. Primary outcome was the occurrence of any complication from the beginning of surgery to 30 days after discharge. A secondary outcome was the occurrence of a serious complication-defined as a life-threatening or life-ending event-during this same period. RESULTS One thousand eighteen patients met the inclusion criteria for the study. Of these patients, 475 (46.7%) underwent overlapping surgery. Two hundred seventy-one patients (26.6%) experienced 1 or more complications, with 134 (13.2%) suffering a serious complication. Fourteen patients in the cohort died, a rate of 1.4%. The overall complication rate was not significantly higher for overlapping cases than for nonoverlapping cases (26.3% vs 26.9%, p = 0.837), nor was the rate of serious complications (14.7% vs 11.8%, p = 0.168). After adjustments for surgery type, surgery duration, body mass index, American Society of Anesthesiologists (ASA) physical classification grade, and intraoperative blood loss, overlapping surgery remained unassociated with overall complications (OR 0.810, 95% CI 0.592-1.109, p = 0.189). Similarly, after adjustments for surgery type, surgery duration, body mass index, ASA grade, and neurological comorbidity, there was no association between overlapping surgery and serious complications (OR 0.979, 95% CI 0.661-1.449, p = 0.915). CONCLUSIONS In this cohort, patients undergoing overlapping surgery did not have an increased risk for overall complications or serious complications. Although this finding suggests that overlapping surgery can be performed safely within the appropriate framework, further investigation is needed in other specialties and at other institutions.
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Affiliation(s)
- Jian Guan
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Andrea A Brock
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Michael Karsy
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - William T Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Meic H Schmidt
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - John R W Kestle
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Randy L Jensen
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Andrew T Dailey
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Richard H Schmidt
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
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Kempenich JW, Willis RE, Blue RJ, Al Fayyadh MJ, Cromer RM, Schenarts PJ, Van Sickle KR, Dent DL. The Effect of Patient Education on the Perceptions of Resident Participation in Surgical Care. JOURNAL OF SURGICAL EDUCATION 2016; 73:e111-e117. [PMID: 27663084 DOI: 10.1016/j.jsurg.2016.05.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/05/2016] [Accepted: 05/09/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To decipher if patient attitudes toward resident participation in their surgical care can be improved with patient education regarding resident roles, education, and responsibilities. DESIGN An anonymous questionnaire was created and distributed in outpatient surgery clinics that had residents involved with patient care. In total, 3 groups of patients were surveyed, a control group and 2 intervention groups. Each intervention group was given an informational pamphlet explaining the role, education, and responsibilities of residents. The first pamphlet used an analogy-based explanation. The second pamphlet used literature citations and statistics. SETTING Keesler Medical Center, Keesler AFB, MS. University of Texas Health Science Center at San Antonio, San Antonio, TX. PARTICIPANTS A total of 454 responses were collected and analyzed-211 in the control group, 118 in the analogy pamphlet group, and 125 in the statistics pamphlet group. RESULTS Patients had favorable views of residents assisting with their surgical procedures, and the majority felt that outcomes were the same or better regardless of whether they read an informational pamphlet. Of all the patients surveyed, 80% agreed or strongly agreed that they expect to be asked permission for residents to be involved in their care. Further, 52% of patients in the control group agreed or strongly agreed to a fifth-year surgery resident operating on them independently for routine procedures compared to 62% and 65% of the patients who read the analogy pamphlet and statistics pamphlet, respectively (p = 0.05). When we combined the 2 intervention groups compared to the control group, this significant difference persisted (p = 0.02). CONCLUSION Most patients welcome resident participation in their surgical care, but they expect to be asked permission for resident involvement. Patient education using an information pamphlet describing resident roles, education, and responsibilities improved patient willingness to allow a chief resident to operate independently.
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Affiliation(s)
- Jason W Kempenich
- Department of General Surgery, Keesler Medical Center, Keesler AFB, Biloxi, Mississippi.
| | - Ross E Willis
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Robert J Blue
- Department of General Surgery, Keesler Medical Center, Keesler AFB, Biloxi, Mississippi
| | - Mohammed J Al Fayyadh
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Robert M Cromer
- Department of General Surgery, Keesler Medical Center, Keesler AFB, Biloxi, Mississippi
| | - Paul J Schenarts
- Division of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Kent R Van Sickle
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Daniel L Dent
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Kshirsagar RS, Chandy Z, Mahboubi H, Verma SP. Does resident involvement in thyroid surgery lead to increased postoperative complications? Laryngoscope 2016; 127:1242-1246. [PMID: 27753090 DOI: 10.1002/lary.26176] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 04/23/2016] [Accepted: 06/09/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the impact of resident involvement during thyroid surgery on 30-day postoperative complications. STUDY DESIGN Retrospective cohort study. METHODS All patients who underwent thyroid surgery in 2011 were identified from the American College of Surgeons National Surgical Quality Improvement Program database. Patient demographics, perioperative details, resident involvement in surgery, and 30-day postoperative complications were extracted. Propensity score analysis was used to match resident and nonresident cases. Univariate and multivariate analysis were performed to determine the relationship between resident involvement in thyroid surgery and postoperative outcomes. RESULTS One thousand seven hundred forty-seven patients with and 1,747 patients without resident involvement were case-matched for patient demographics, perioperative variables, and surgical case type. There was no significant difference (P = .19) in 30-day postoperative complication rates of surgeries with and without resident involvement, which were 1.4% and 2%, respectively. Operative time was longer in surgeries with residents than those without residents (119 ± 67 minutes vs. 102 ± 55 minutes, P < .001). Cases with resident involvement had an unplanned reoperation rate of 0.9%, which was significantly lower than the 2.3% rate of surgeries without residents (P = .001). Multivariate analysis revealed no significant association between resident involvement and overall complications (odds ratio = 0.70; P = .18). CONCLUSIONS Resident participation in thyroid surgery was not associated with an increased 30-day postoperative complication rate. These findings demonstrate that patient safety is not adversely affected by resident participation in thyroid surgery. LEVEL OF EVIDENCE 2C Laryngoscope, 127:1242-1246, 2017.
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Affiliation(s)
- Rijul S Kshirsagar
- Department of Head and Neck Surgery, Kaiser Permanente Oakland Medical Center, Oakland, California
| | - Zachariah Chandy
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Hossein Mahboubi
- University Voice and Swallowing Center, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, U.S.A
| | - Sunil P Verma
- University Voice and Swallowing Center, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, U.S.A
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Massenburg BB, Sanati-Mehrizy P, Jablonka EM, Taub PJ. The Impact of Resident Participation in Outpatient Plastic Surgical Procedures. Aesthetic Plast Surg 2016; 40:584-91. [PMID: 27234526 DOI: 10.1007/s00266-016-0651-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 05/05/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Ensuring patient safety along with a complete surgical experience for residents is of utmost importance in plastic surgical training. The effect of resident participation on the outcomes of outpatient plastic surgery procedures remains largely unknown. We assess the impact of resident participation on surgical outcomes using a prospective, validated, national database. METHODS We identified all outpatient procedures performed by plastic surgeons between 2007 and 2012 in the American College of Surgeons National Surgical Quality Improvement Program database. Multivariate regression models assessed the impact of resident participation when compared to attendings alone on 30-day wound complications, overall complications, and return to the operating room (OR). RESULTS A total of 18,641 patients were identified: 12,414 patients with an attending alone and 6227 with residents participating. The incidence of overall complications, wound complications, and return to OR was increased with resident participation. When confounding variables were controlled for in multivariate analysis, resident participation was no longer associated with increased risk of wound complications. When stratified by year, incidence of overall complications, wound complications, and return to OR in the resident participation group are trending down and fail to be significantly different in 2011 and 2012. Multivariate analysis shows a similar trend. CONCLUSIONS Resident participation is no longer independently associated with increased complications in outpatient plastic surgery in recent years, suggesting that plastic surgical training is successfully continuing to improve in both outcomes and safety. Additional prospective studies that characterize patient outcomes with resident seniority and the degree of resident participation are warranted. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Barber EL, Harris B, Gehrig PA. Trainee participation and perioperative complications in benign hysterectomy: the effect of route of surgery. Am J Obstet Gynecol 2016; 215:215.e1-7. [PMID: 26884272 DOI: 10.1016/j.ajog.2016.02.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 01/29/2016] [Accepted: 02/09/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Intraoperative trainee involvement in hysterectomy is common. However, the effect of intraoperative trainee involvement on perioperative complications depending on surgical approach is unknown. OBJECTIVE To estimate the effect of intraoperative trainee involvement on perioperative complication after vaginal, laparoscopic, and abdominal hysterectomy for benign disease. METHODS Patients undergoing laparoscopic, vaginal, or abdominal hysterectomy for benign disease from 2010 to 2012 were identified from the American College of Surgeons National Surgical Quality Improvement Program database. Patients with and without trainee involvement were compared with regard to perioperative complications. Complications that occurred from the start of surgery to 30-days postoperatively were included. Perioperative complications were defined via the use of the validated Clavien-Dindo scale with ≥grade 3 complications defined as major and ≤grade 2 complications defined as minor. Major complications included myocardial infarction, pneumonia, venous thromboembolism, deep or organ space surgical-site infection, stroke, fascial dehiscence, unplanned return to the operating room, renal failure, cardiopulmonary arrest, sepsis, intubation greater than 48 hours, and death. Minor complications included urinary tract infection, blood transfusion, and superficial wound infection. To estimate the effect of trainee involvement depending on route of surgery, a stratified analysis was performed. Bivariable analysis and adjusted multivariable logistic regression were used. RESULTS We identified 22,499 patients, of whom 42.1% had trainee participation. Surgical approaches were vaginal (22.7%), abdominal (47.1%), and laparoscopic (30.2%). The rate of major complication was 3.2%, and minor complication was 7.2%. In bivariable analysis, trainee involvement was associated with major complications in vaginal hysterectomy (3.3% vs 2.3%, P = .03), but not laparoscopic (3.0% vs 2.9%, P = .78) or abdominal hysterectomy (4.4% vs 3.6%, P = .07). Trainee involvement was also associated with minor complication in vaginal (7.3% vs 5.4%, P = .007), laparoscopic (5.9% vs 4.3%, P < .001), and abdominal hysterectomy (14.1% vs 9.2%, P < .001). In a multivariable analysis in which we adjusted for age, body mass index, medical comorbidity, American Society of Anesthesiologists score, and surgical complexity, the association between trainee involvement in vaginal hysterectomy and major complication persisted (adjusted odds ratio 1.45, 95% confidence interval 1.03-2.04); however, when operative time was added to the model, there was no longer an association between trainee involvement and major complication (adjusted odds ratio 1.26, 95% confidence interval 0.89-1.80). CONCLUSION Surgical approach influences the relationship between trainee involvement and perioperative complication. Operative time is a key mediator of the relationship between trainee involvement and complication, and may be a modifiable risk factor.
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Affiliation(s)
- Emma L Barber
- University of North Carolina, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chapel Hill, North Carolina.
| | - Benjamin Harris
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
| | - Paola A Gehrig
- University of North Carolina, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chapel Hill, North Carolina; Lineberger Clinical Cancer Center, University of North Carolina, Chapel Hill, North Carolina
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The Effect of Resident Involvement on Surgical Outcomes for Common Urologic Procedures: A Case Study of Uni- and Bilateral Hydrocele Repair. Urology 2016; 94:70-6. [DOI: 10.1016/j.urology.2016.03.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 02/19/2016] [Accepted: 03/03/2016] [Indexed: 11/18/2022]
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The Association between Resident Involvement and Postoperative Short-term Surgical Morbidity in Immediate Breast Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016. [PMCID: PMC4956897 DOI: 10.1097/gox.0000000000000771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abt NB, Reh DD, Eisele DW, Francis HW, Gourin CG. Does resident participation influence otolaryngology-head and neck surgery morbidity and mortality? Laryngoscope 2016; 126:2263-9. [DOI: 10.1002/lary.25973] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 02/12/2016] [Accepted: 02/19/2016] [Indexed: 12/21/2022]
Affiliation(s)
- Nicholas B. Abt
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland U.S.A
| | - Douglas D. Reh
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland U.S.A
| | - David W. Eisele
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland U.S.A
| | - Howard W. Francis
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland U.S.A
| | - Christine G. Gourin
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland U.S.A
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Impact of Resident Participation on Outcomes After Single-Level Anterior Cervical Diskectomy and Fusion: An Analysis of 3265 Patients from the American College of Surgeons National Surgical Quality Improvement Program Database. Spine (Phila Pa 1976) 2016; 41:E289-96. [PMID: 26555830 DOI: 10.1097/brs.0000000000001230] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Multicenter retrospective cohort study. OBJECTIVE To investigate the relationship between resident involvement in the operating room and 30-day complication rates in patients undergoing single-level anterior cervical diskectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA Although an integral part of academic medicine, surgical resident participation in the operating room and its impact on patient outcomes have been a topic of debate. No large-scale study has been performed to examine this relationship in ACDF. METHODS The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was retrospectively reviewed to identify all patients who underwent single-level ACDF procedures during 2006-2013. A propensity score-matching algorithm was employed to minimize baseline differences. Multivariate logistic regression analysis of unadjusted and propensity-matched cohorts was performed to examine the effect of resident participation on 30-day postoperative complication rates and length of hospital stay. RESULTS A total of 3265 patients met inclusion criteria. The propensity score-matching procedure yielded 1003 pairs of well-matched nonresident and resident pairs. The multivariate analysis of propensity score-matched population demonstrated that resident involvement was not associated with an increased risk for any of the complications analyzed, including overall complications, medical complications, surgical complications, mortality, cardiac arrest, deep venous thrombosis, or length of total hospital stay. CONCLUSION This large-scale, population-based study found that surgical resident participation in the operating room did not increase the risk of 30-day complications nor prolonged the length of hospital stay. Resident participation, however, was associated with an increased operative duration. Strategies to improve residents' technical proficiency outside of the operating room may enhance patient safety. LEVEL OF EVIDENCE 3.
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Saliba AN, Taher AT, Tamim H, Harb AR, Mailhac A, Radwan A, Jamali FR. Impact of Resident Involvement in Surgery (IRIS-NSQIP): Looking at the Bigger Picture Based on the American College of Surgeons-NSQIP Database. J Am Coll Surg 2016; 222:30-40. [DOI: 10.1016/j.jamcollsurg.2015.10.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 10/08/2015] [Indexed: 12/21/2022]
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Sachs TE, Pawlik TM. See one, do one, and teach none: resident experience as a teaching assistant. J Surg Res 2015; 195:44-51. [DOI: 10.1016/j.jss.2014.08.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 07/18/2014] [Accepted: 08/01/2014] [Indexed: 11/16/2022]
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Bydon M, Abt NB, De la Garza-Ramos R, Macki M, Witham TF, Gokaslan ZL, Bydon A, Huang J. Impact of resident participation on morbidity and mortality in neurosurgical procedures: an analysis of 16,098 patients. J Neurosurg 2015; 122:955-61. [DOI: 10.3171/2014.11.jns14890] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECT
The authors sought to determine the impact of resident participation on overall 30-day morbidity and mortality following neurosurgical procedures.
METHODS
The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who had undergone neurosurgical procedures between 2006 and 2012. The operating surgeon(s), whether an attending only or attending plus resident, was assessed for his or her influence on morbidity and mortality. Multivariate logistic regression, was used to estimate odds ratios for 30-day postoperative morbidity and mortality outcomes for the attending-only compared with the attending plus resident cohorts (attending group and attending+resident group, respectively).
RESULTS
The study population consisted of 16,098 patients who had undergone elective or emergent neurosurgical procedures. The mean patient age was 56.8 ± 15.0 years, and 49.8% of patients were women. Overall, 15.8% of all patients had at least one postoperative complication. The attending+resident group demonstrated a complication rate of 20.12%, while patients with an attending-only surgeon had a statistically significantly lower complication rate at 11.70% (p < 0.001). In the total population, 263 patients (1.63%) died within 30 days of surgery. Stratified by operating surgeon status, 162 patients (2.07%) in the attending+resident group died versus 101 (1.22%) in the attending group, which was statistically significant (p < 0.001). Regression analyses compared patients who had resident participation to those with only attending surgeons, the referent group. Following adjustment for preoperative patient characteristics and comorbidities, multivariate regression analysis demonstrated that patients with resident participation in their surgery had the same odds of 30-day morbidity (OR = 1.05, 95% CI 0.94–1.17) and mortality (OR = 0.92, 95% CI 0.66–1.28) as their attendingonly counterparts.
CONCLUSIONS
Cases with resident participation had higher rates of mortality and morbidity; however, these cases also involved patients with more comorbidities initially. On multivariate analysis, resident participation was not an independent risk factor for postoperative 30-day morbidity or mortality following elective or emergent neurosurgical procedures.
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Can robot-assisted radical prostatectomy be taught to chief residents and fellows without affecting operative outcomes? Prostate Int 2015; 3:47-50. [PMID: 26157767 PMCID: PMC4494638 DOI: 10.1016/j.prnil.2015.03.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 01/29/2015] [Indexed: 01/26/2023] Open
Abstract
Purpose To determine whether robot-assisted radical prostatectomy (RARP) may be taught to chief residents and fellows without influencing operative outcomes. Methods Between August 2011 and June 2012, 388 patients underwent RARP by a single primary surgeon (DIL) at our institution. Our teaching algorithm divides RARP into five stages, and each trainee progresses through the stages in a sequential manner. Statistical analysis was conducted after grouping the cohort according to the surgeons operating the robotic console: attending only (n = 91), attending and fellow (n = 152), and attending and chief resident (n = 145). Approximately normal variables were compared utilizing one-way analysis of variance, and categorical variables were compared utilizing two-tailed χ2 test; P < 0.05 was considered statistically significant. Results There was no difference in mean age (P = 0.590), body mass index (P = 0.339), preoperative SHIM (Sexual Health Inventory for Men) score (P = 0.084), preoperative AUASS (American Urologic Association Symptom Score) (P = 0.086), preoperative prostate-specific antigen (P = 0.258), clinical and pathological stage (P = 0.766 and P = 0.699, respectively), and preoperative and postoperative Gleason score (P = 0.775 and P = 0.870, respectively). Operative outcomes such as mean estimated blood loss (P = 0.807) and length of stay (P = 0.494) were similar. There was a difference in mean operative time (P < 0.001; attending only = 89.3 min, attending and fellow 125.4 min, and attending and chief resident 126.9 min). Functional outcomes at 3 months and 1 year postoperatively such as urinary continence rate (P = 0.977 and P = 0.720, respectively), and SHIM score (P = 0.661 and P = 0.890, respectively) were similar. The rate of positive surgical margins (P = 0.058) was similar. Conclusions Training chief residents and fellows to perform RARP may be associated with increased operative times, but does not compromise short-term functional and oncological outcomes.
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Matulewicz RS, Pilecki M, Rambachan A, Kim JY, Kundu SD. Impact of Resident Involvement on Urological Surgery Outcomes: An Analysis of 40,000 Patients from the ACS NSQIP Database. J Urol 2014; 192:885-90. [DOI: 10.1016/j.juro.2014.03.096] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Richard S. Matulewicz
- Departments of Urology and Surgery (MP, AR, JYSK), Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew Pilecki
- Departments of Urology and Surgery (MP, AR, JYSK), Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Aksharananda Rambachan
- Departments of Urology and Surgery (MP, AR, JYSK), Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - John Y.S. Kim
- Departments of Urology and Surgery (MP, AR, JYSK), Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Shilajit D. Kundu
- Departments of Urology and Surgery (MP, AR, JYSK), Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Edelstein AI, Lovecchio FC, Saha S, Hsu WK, Kim JYS. Impact of Resident Involvement on Orthopaedic Surgery Outcomes: An Analysis of 30,628 Patients from the American College of Surgeons National Surgical Quality Improvement Program Database. J Bone Joint Surg Am 2014; 96:e131. [PMID: 25100784 DOI: 10.2106/jbjs.m.00660] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Operative procedural training is a key component of orthopaedic surgery residency. The influence of intraoperative resident participation on the outcomes of surgery has not been studied extensively using large, population-based databases. METHODS We identified 30,628 patients who underwent orthopaedic procedures from the 2011 American College of Surgeons National Surgical Quality Improvement Program. Outcomes as measured by perioperative complications, readmission rates, and mortality within thirty days were compared for cases with and without intraoperative resident involvement. RESULTS Logistic regression with propensity score analysis revealed that intraoperative resident participation was associated with decreased rates of overall complications (odds ratio, 0.717 [95% confidence interval, 0.657 to 0.782]), medical complications (odds ratio, 0.723 [95% confidence interval, 0.661 to 0.790]), and mortality (odds ratio, 0.638 [95% confidence interval, 0.427 to 0.951]). Resident presence in the operating room was not predictive of wound complications (odds ratio, 0.831 [95% confidence interval, 0.656 to 1.053]), readmission (odds ratio, 0.962 [95% confidence interval, 0.830 to 1.116]), or reoperation (odds ratio, 0.938 [95% confidence interval, 0.758 to 1.161]). A second analysis by propensity score stratification into quintiles grouped by similar probability of intraoperative resident presence showed resident involvement to correlate with decreased rates of overall and medical complications in three quintiles, but increased rates of overall and medical complications in one quintile. All other outcomes were equivalent across quintiles. CONCLUSIONS Orthopaedic resident involvement during surgical procedures is associated with lower risk of perioperative complications and mortality in the National Surgical Quality Improvement Program database. The results support resident participation in the operative care of orthopaedic patients. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Adam I Edelstein
- Departments of Orthopaedic Surgery (A.I.E. and W.K.H.) and Surgery (F.C.L., S.S., and J.Y.S.K.), Northwestern University, Feinberg School of Medicine, 675 North Saint Clair Street, Galter Suite 19-250, Chicago, IL 60611. E-mail address for J.Y.S. Kim:
| | - Francis C Lovecchio
- Departments of Orthopaedic Surgery (A.I.E. and W.K.H.) and Surgery (F.C.L., S.S., and J.Y.S.K.), Northwestern University, Feinberg School of Medicine, 675 North Saint Clair Street, Galter Suite 19-250, Chicago, IL 60611. E-mail address for J.Y.S. Kim:
| | - Sujata Saha
- Departments of Orthopaedic Surgery (A.I.E. and W.K.H.) and Surgery (F.C.L., S.S., and J.Y.S.K.), Northwestern University, Feinberg School of Medicine, 675 North Saint Clair Street, Galter Suite 19-250, Chicago, IL 60611. E-mail address for J.Y.S. Kim:
| | - Wellington K Hsu
- Departments of Orthopaedic Surgery (A.I.E. and W.K.H.) and Surgery (F.C.L., S.S., and J.Y.S.K.), Northwestern University, Feinberg School of Medicine, 675 North Saint Clair Street, Galter Suite 19-250, Chicago, IL 60611. E-mail address for J.Y.S. Kim:
| | - John Y S Kim
- Departments of Orthopaedic Surgery (A.I.E. and W.K.H.) and Surgery (F.C.L., S.S., and J.Y.S.K.), Northwestern University, Feinberg School of Medicine, 675 North Saint Clair Street, Galter Suite 19-250, Chicago, IL 60611. E-mail address for J.Y.S. Kim:
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Seib CD, Greenblatt DY, Campbell MJ, Shen WT, Gosnell JE, Clark OH, Duh QY. Adrenalectomy outcomes are superior with the participation of residents and fellows. J Am Coll Surg 2014; 219:53-60. [PMID: 24702888 DOI: 10.1016/j.jamcollsurg.2014.02.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 02/10/2014] [Accepted: 02/19/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Adrenalectomy is a complex procedure performed in many settings, with and without residents and fellows. Patients often ask, "Will trainees be participating in my operation?" and seek reassurance that their care will not be adversely affected. The purpose of this study was to determine the association between trainee participation and adrenalectomy perioperative outcomes. STUDY DESIGN We performed a cohort study of patients who underwent adrenalectomy from the 2005 to 2011 American College of Surgeons NSQIP database. Trainee participation was classified as none, resident, or fellow, based on postgraduate year of the assisting surgeon. Associations between trainee participation and outcomes were determined via multivariate linear and logistic regression. RESULTS Of 3,694 adrenalectomies, 732 (19.8%) were performed by an attending surgeon with no trainee, 2,315 (62.7%) involved a resident, and 647 (17.5%) involved a fellow. The participation of fellows was associated with fewer serious complications (7.9% with no trainee, 6.0% with residents, and 2.8% with fellows; p < 0.001). In a multivariate model, the odds of serious 30-day morbidity were lower when attending surgeons operated with residents (odds ratio = 0.63; 95% CI, 0.45-0.89). Fellow participation was associated with significantly lower odds of overall (odds ratio = 0.51; 95% CI, 0.32-0.82) and serious (odds ratio = 0.31; 95% CI, 0.17-0.57) morbidity. There was no significant association between trainee participation and 30-day mortality. CONCLUSIONS In this analysis of multi-institutional data, the participation of residents and fellows was associated with decreased odds of perioperative adrenalectomy complications. Attending surgeons performing adrenalectomies with trainee assistance should reassure patients of the equivalent or superior care they are receiving.
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Affiliation(s)
- Carolyn D Seib
- Department of Surgery, University of California, San Francisco, San Francisco, CA.
| | | | | | - Wen T Shen
- Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Jessica E Gosnell
- Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Orlo H Clark
- Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Quan-Yang Duh
- Department of Surgery, University of California, San Francisco, San Francisco, CA
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Sachs TE, Ejaz A, Weiss M, Spolverato G, Ahuja N, Makary MA, Wolfgang CL, Hirose K, Pawlik TM. Assessing the experience in complex hepatopancreatobiliary surgery among graduating chief residents: is the operative experience enough? Surgery 2014; 156:385-93. [PMID: 24953270 DOI: 10.1016/j.surg.2014.03.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 03/08/2014] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Resident operative autonomy and case volume is associated with posttraining confidence and practice plans. Accreditation Council for Graduate Medical Education requirements for graduating general surgery residents are four liver and three pancreas cases. We sought to evaluate trends in resident experience and autonomy for complex hepatopancreatobiliary (HPB) surgery over time. METHODS We queried the Accreditation Council for Graduate Medical Education General Surgery Case Log (2003-2012) for all cases performed by graduating chief residents (GCR) relating to liver, pancreas, and the biliary tract (HPB); simple cholecystectomy was excluded. Mean (±SD), median [10th-90th percentiles] and maximum case volumes were compared from 2003 to 2012 using R(2) for all trends. RESULTS A total of 252,977 complex HPB cases (36% liver, 43% pancreas, 21% biliary) were performed by 10,288 GCR during the 10-year period examined (Mean = 24.6 per GCR). Of these, 57% were performed during the chief year, whereas 43% were performed as postgraduate year 1-4. Only 52% of liver cases were anatomic resections, whereas 71% of pancreas cases were major resections. Total number of cases increased from 22,516 (mean = 23.0) in 2003 to 27,191 (mean = 24.9) in 2012. During this same time period, the percentage of HPB cases that were performed during the chief year decreased by 7% (liver: 13%, pancreas 8%, biliary 4%). There was an increasing trend in the mean number of operations (mean ± SD) logged by GCR on the pancreas (9.1 ± 5.9 to 11.3 ± 4.3; R(2) = .85) and liver (8.0 ± 5.9 to 9.4 ± 3.4; R(2) = .91), whereas those for the biliary tract decreased (5.9 ± 2.5 to 3.8 ± 2.1; R(2) = .96). Although the median number of cases [10th:90th percentile] increased slightly for both pancreas (7.0 [4.0:15] to 8.0 [4:20]) and liver (7.0 [4:13] to 8.0 [5:14]), the maximum number of cases preformed by any given GCR remained stable for pancreas (51 to 53; R(2) = .18), but increased for liver (38 to 45; R(2) = .32). The median number of HPB cases that GCR performed as teaching assistants (TAs) remained at zero during this time period. The 90th percentile of cases performed as TA was less than two for both pancreas and liver. CONCLUSION Roughly one-half of GCR have performed fewer than 10 cases in each of the liver, pancreas, or biliary categories at time of completion of residency. Although the mean number of complex liver and pancreatic operations performed by GCR increased slightly, the median number remained low, and the number of TA cases was virtually zero. Most GCR are unlikely to be prepared to perform complex HPB operations.
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Affiliation(s)
- Teviah E Sachs
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Aslam Ejaz
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Matthew Weiss
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gaya Spolverato
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nita Ahuja
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Martin A Makary
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Kenzo Hirose
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Timothy M Pawlik
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
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Schoenfeld AJ, Serrano JA, Waterman BR, Bader JO, Belmont PJ. The impact of resident involvement on post-operative morbidity and mortality following orthopaedic procedures: a study of 43,343 cases. Arch Orthop Trauma Surg 2013; 133:1483-91. [PMID: 23995548 DOI: 10.1007/s00402-013-1841-3] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Indexed: 02/09/2023]
Abstract
BACKGROUND Few studies have addressed the role of residents' participation in morbidity and mortality after orthopaedic surgery. The present study utilized the 2005-2010 National Surgical Quality Improvement Program (NSQIP) dataset to assess the risk of 30-day post-operative complications and mortality associated with resident participation in orthopaedic procedures. METHODS The NSQIP dataset was queried using codes for 12 common orthopaedic procedures. Patients identified as having received one of the procedures had their records abstracted to obtain demographic data, medical history, operative time, and resident involvement in their surgical care. Thirty-day post-operative outcomes, including complications and mortality, were assessed for all patients. A step-wise multivariate logistic regression model was constructed to evaluate the impact of resident participation on mortality- and complication-risk while controlling for other factors in the model. Primary analyses were performed comparing cases where the attending surgeon operated alone to all other case designations, while a subsequent sensitivity analysis limited inclusion to cases where resident participation was reported by post-graduate year. RESULTS In the NSQIP dataset, 43,343 patients had received one of the 12 orthopaedic procedures queried. Thirty-five percent of cases were performed with resident participation. The mortality rate, overall, was 2.5 and 10 % sustained one or more complications. Multivariate analysis demonstrated a significant association between resident participation and the risk of one or more complications [OR 1.3 (95 % CI 1.1, 1.4); p < 0.001] as well as major systemic complications [OR 1.6 (95 % CI 1.3, 2.0); p < 0.001] for primary joint arthroplasty procedures only. These findings persisted even after sensitivity testing. CONCLUSIONS A mild to moderate risk for complications was noted following resident involvement in joint arthroplasty procedures. No significant risk of post-operative morbidity or mortality was appreciated for the other orthopaedic procedures studied. LEVEL OF EVIDENCE II (Prognostic).
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Affiliation(s)
- Andrew J Schoenfeld
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, 5005 N. Piedras Street, El Paso, TX, 79920, USA,
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Bunker DLJ. Ethical tensions in surgery: who is doing my operation? ANZ J Surg 2013; 83:503-4. [PMID: 24049792 DOI: 10.1111/ans.12274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Resident Participation in Index Laparoscopic General Surgical Cases: Impact of the Learning Environment on Surgical Outcomes. J Am Coll Surg 2013; 216:96-104. [DOI: 10.1016/j.jamcollsurg.2012.08.014] [Citation(s) in RCA: 149] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 08/10/2012] [Accepted: 08/14/2012] [Indexed: 12/21/2022]
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Naiditch JA, Lautz TB, Raval MV, Madonna MB, Barsness KA. Effect of Resident Postgraduate Year on Outcomes After Laparoscopic Appendectomy for Appendicitis in Children. J Laparoendosc Adv Surg Tech A 2012; 22:715-9. [PMID: 22845738 DOI: 10.1089/lap.2012.0032] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Jessica A. Naiditch
- Department of Surgery, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Timothy B. Lautz
- Department of Surgery, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mehul V. Raval
- Department of Surgery, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mary Beth Madonna
- Department of Surgery, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Katherine A. Barsness
- Department of Surgery, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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The delivery of general paediatric surgery in Ireland: a survey of higher surgical trainees. Ir J Med Sci 2012; 181:459-62. [PMID: 22893387 DOI: 10.1007/s11845-011-0784-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Accepted: 11/05/2011] [Indexed: 10/28/2022]
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