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Thelen AE, Marcotte KM, Diaz S, Gates R, Chen X, George BC, Krumm AE. Variation in Competence of Graduating General Surgery Trainees. JOURNAL OF SURGICAL EDUCATION 2024; 81:17-24. [PMID: 38036389 DOI: 10.1016/j.jsurg.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 07/22/2023] [Accepted: 11/03/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE To examine the readiness of general surgery residents in their final year of training to perform 5 common surgical procedures based on their documented performance during training. DESIGN Intraoperative performance ratings were analyzed using a Bayesian mixed effects approach, adjusting for rater, trainee, procedure, case complexity, and postgraduate year (PGY) as random effects as well as month in academic year and cumulative, procedure-specific performance per trainee as fixed effects. This model was then used to estimate each PGY 5 trainee's final probability of being able to independently perform each procedure. The actual, documented competency rates for individual trainees were then identified across each of the 5 most common general surgery procedures: appendectomy, cholecystectomy, ventral hernia repair, groin hernia repair, and partial colectomy. SETTING This study was conducted using data from members of the SIMPL collaborative. PARTICIPANTS A total of 17,248 evaluations of 927 PGY5 general surgery residents were analyzed from 2015 to 2021. RESULTS The percentage of residents who requested a SIMPL rating during their PGY5 year and achieved a ≥90% probability of being rated as independent, or "Practice-Ready," was 97.4% for appendectomy, 82.4% for cholecystectomy, 43.5% for ventral hernia repair, 24% for groin hernia repair, and 5.3% for partial colectomy. CONCLUSIONS There is substantial variation in the demonstrated competency of general surgery residents to perform several common surgical procedures at the end of their training. This variation in readiness calls for careful study of how surgical residents can become more adequately prepared to enter independent practice.
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Affiliation(s)
- Angela E Thelen
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan; MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
| | - Kayla M Marcotte
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan; University of Michigan Medical School, Ann Arbor, Michigan; Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan
| | - Sarah Diaz
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan; University of Michigan Medical School, Ann Arbor, Michigan
| | - Rebecca Gates
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Xilin Chen
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Brian C George
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Andrew E Krumm
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan
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Shaban L, Mkandawire P, O'Flynn E, Mangaoang D, Mulwafu W, Stanistreet D. Quality Metrics and Indicators for Surgical Training: A Scoping Review. JOURNAL OF SURGICAL EDUCATION 2023; 80:1302-1310. [PMID: 37481412 DOI: 10.1016/j.jsurg.2023.06.023] [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: 05/02/2023] [Accepted: 06/17/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Surgical training quality is critical to ensure that trainees receive adequate preparation to perform surgical procedures independently and that patients receive safe, effective, and high-quality care. Numerous surgical training quality indicators have been proposed, investigated and implemented. However, the existing evidence base for these indicators is limited, with most studies originating from English-speaking, high-income countries. OBJECTIVES This scoping review aimed to identify the range of quality indicators that have been proposed and evaluated in the literature, and to critically evaluate the existing evidence base for these indicators. METHODS A systematic literature search was conducted using MEDLINE and Embase databases to identify studies reporting on surgical training quality indicators. A total of 68 articles were included in the review. RESULTS Operative volume is the most commonly cited indicator and has been investigated for its effects on trainee exam performance and career progression. Other indicators include operative diversity, workplace-based assessments, regular evaluation and feedback, academic achievements, formal teaching, and learning agreements, and direct observation of procedural skills. However, these indicators are largely based on qualitative analyses and expert opinions and have not been validated quantitatively using clear outcome measures for trainees and patients. CONCLUSIONS Future research is necessary to establish evidence-based indicators of high-quality surgical training, including in low-resource settings. Quantitative and qualitative studies are required to validate existing indicators and to identify new indicators that are relevant to diverse surgical training environments. Lastly, any approach to surgical training quality must prioritize the benefit to both trainees and patients, ensuring training success, career progression, and patient safety.
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Affiliation(s)
- Lawa Shaban
- Institute of Global Surgery, School of Population Health, RCSI, Dublin, Ireland.
| | - Payao Mkandawire
- Department of Surgery, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Eric O'Flynn
- Institute of Global Surgery, School of Population Health, RCSI, Dublin, Ireland
| | - Deirdre Mangaoang
- Institute of Global Surgery, School of Population Health, RCSI, Dublin, Ireland
| | - Wakisa Mulwafu
- Department of Surgery, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Debbi Stanistreet
- Department of Public Health and Epidemiology, School of Population Health, RCSI, Dublin, Ireland
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Potts JR, Fallat ME, Gaskins J, Azarow KS, Caniano DA. Contemporary General Surgery Resident Learning Experience in Pediatric Surgery. J Am Coll Surg 2021; 233:564-574. [PMID: 34265425 DOI: 10.1016/j.jamcollsurg.2021.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 10/20/2022]
Affiliation(s)
- John R Potts
- Superior Value in Program Accreditation GME Consultants, Chicago, IL.
| | - Mary E Fallat
- Division of Pediatric Surgery, Hiram C Polk, Jr Department of Surgery, University of Louisville School of Medicine, Louisville, KY
| | - Jeremy Gaskins
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY
| | - Kenneth S Azarow
- Department of Surgery, Oregon Health Sciences University, Portland, OR
| | - Donna A Caniano
- Department of Accreditation, Recognition and Field Activities, ACGME, Chicago, IL
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Sugiyama T, Clapp T, Nelson J, Eitel C, Motegi H, Nakayama N, Sasaki T, Tokairin K, Ito M, Kazumata K, Houkin K. Immersive 3-Dimensional Virtual Reality Modeling for Case-Specific Presurgical Discussions in Cerebrovascular Neurosurgery. Oper Neurosurg (Hagerstown) 2021; 20:289-299. [PMID: 33294936 DOI: 10.1093/ons/opaa335] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/12/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Adequate surgical planning includes a precise understanding of patient-specific anatomy and is a necessity for neurosurgeons. Although the use of virtual reality (VR) technology is emerging in surgical planning and education, few studies have examined the effectiveness of immersive VR during surgical planning using a modern head-mounted display. OBJECTIVE To investigate if and how immersive VR aids presurgical discussions of cerebrovascular surgery. METHODS A multiuser immersive VR system, BananaVisionTM, was developed and used during presurgical discussions in a prospective patient cohort undergoing cerebrovascular surgery. A questionnaire/interview was administered to multiple surgeons after the surgeries to evaluate the effectiveness of the VR system compared to conventional imaging modalities. An objective assessment of the surgeon's knowledge of patient-specific anatomy was also conducted by rating surgeons' hand-drawn presurgical illustrations. RESULTS The VR session effectively enhanced surgeons' understanding of patient-specific anatomy in the majority of cases (83.3%). An objective assessment of surgeons' presurgical illustrations was consistent with this result. The VR session also effectively improved the decision-making process regarding minor surgical techniques in 61.1% of cases and even aided surgeons in making critical surgical decisions about cases involving complex and challenging anatomy. The utility of the VR system was rated significantly higher by trainees than by experts. CONCLUSION Although rated as more useful by trainees than by experts, immersive 3D VR modeling increased surgeons' understanding of patient-specific anatomy and improved surgical strategy in certain cases involving challenging anatomy.
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Affiliation(s)
- Taku Sugiyama
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Tod Clapp
- Department of Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Jordan Nelson
- Department of Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Chad Eitel
- Department of Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Hiroaki Motegi
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Naoki Nakayama
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Tsukasa Sasaki
- Department of Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Kikutaro Tokairin
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Masaki Ito
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Ken Kazumata
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kiyohiro Houkin
- Department of Emergent Neurocognition, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
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Catapano JS, Fredrickson VL. Commentary: Immersive 3-Dimensional Virtual Reality Modeling for Case-Specific Presurgical Discussions in Cerebrovascular Neurosurgery. Oper Neurosurg (Hagerstown) 2021; 20:E210-E211. [PMID: 33372944 DOI: 10.1093/ons/opaa444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 11/11/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Vance L Fredrickson
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah School of Medicine, Salt Lake City, Utah
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Oser FJ, Grimsley BM, Swinford AJ, Brown SM, Mulcahey MK. Variety and Complexity of Surgical Exposure, Operative Autonomy, and Program Reputation Are Important Factors for Orthopaedic Sports Medicine Fellowship Applicants. Arthrosc Sports Med Rehabil 2021; 3:e855-e859. [PMID: 34195654 PMCID: PMC8220604 DOI: 10.1016/j.asmr.2021.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 02/10/2021] [Indexed: 01/24/2023] Open
Abstract
Purpose To identify the factors considered most important by sports medicine fellowship applicants when deciding where to apply and ultimately interview. Methods An anonymous, electronic survey was distributed in 2018 via e-mail to orthopaedic surgery residents who applied to a specific orthopaedic sports medicine fellowship program in 2015 and 2016. The survey included questions regarding the number of fellowships applications per respondent and the number of interviews they were offered and accepted. Questions regarding the application process were included. Participants also were asked to rank 9 criteria from most to least important (1 being most important; 9 being least important) when deciding where to apply or accept interviews. Each criterion’s score reflects its average ranking among respondents. Results Among the 99 orthopaedic surgery residents applying to this fellowship program, 42 (42.4%) completed the survey. The factors considered most influential included variety and complexity of surgical exposure (2.16), autonomy (3.72), and reputation of faculty members (4.05). The factors considered least important were program size (7.21), job placement of past fellows (7.07), and geographic location (5.68). Conclusions Variety and complexity of surgical exposure, operative autonomy, and program reputation were valued as the most important factors for orthopaedic surgery residents applying to sports medicine fellowship programs. Clinical Relevance The information obtained in this study may provide sports medicine fellowship programs and orthopaedic residents with a better understanding of factors that are considered to be important by sports medicine fellowship applicants. This will improve training for future sports medicine specialists, thus improving the care that they provide to their patients.
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Affiliation(s)
- Francis J Oser
- Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | | | | | - Symone M Brown
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Mary K Mulcahey
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
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Rowcroft A, Joh D, Pandanaboyana S, Loveday B. Hepato-pancreato-biliary and transplant surgery experience among New Zealand general surgery trainees. ANZ J Surg 2021; 91:1125-1130. [PMID: 33682311 DOI: 10.1111/ans.16714] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 02/16/2021] [Accepted: 02/16/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Subspecialty surgery experience during general surgery training in Australasia is influenced by many factors, including duration of training, training location and the introduction of post-fellowship training programmes. Experience in hepato-pancreato-biliary (HPB) and transplant surgery is part of the general surgery curriculum, although trainee experience in these subspecialties has not been quantified in this region, which is relevant to post-fellowship training programmes. Therefore, the aim of this study was to quantify the HPB and transplant operative experience of New Zealand (NZ) general surgery trainees. METHODS Operative logbook data were analysed for all NZ trainees from 2013 to 2017, including procedures categorized as pancreatic, biliary, hepatic and transplant surgery only. The number of cases within each category was used to model the cumulative operative experience over a 5-year training programme. RESULTS During the study period, 118 trainees (303 trainee years) recorded 15 662 HPB and transplant procedures. Of these, 13 838 (88.4%) were cholecystectomies (mean cumulative experience 219.3 cases). Excluding cholecystectomy, trainees had a mean cumulative experience of 5.7 biliary, 7.5 pancreatic, 8.1 liver and 4.2 transplant procedures during their training. Transplant experience was predominantly access for peritoneal dialysis (228/260, 86.7%), with cumulative transplant experience otherwise reaching 0.47 procedures over 5 years. CONCLUSION Exposure to HPB and transplant surgery during general surgery training in NZ is limited beyond cholecystectomy. Additional exposure during post-fellowship training is likely required for general surgeons to practice in these subspecialties.
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Affiliation(s)
- Alistair Rowcroft
- Department of Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Daniel Joh
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Sanjay Pandanaboyana
- Department of Surgery, University of Auckland, Auckland, New Zealand.,HPB and Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Benjamin Loveday
- Department of Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, University of Auckland, Auckland, New Zealand.,Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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8
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Biggs A, Tyler J, Arnander M, Pearse Y, Tennent D. Procedure-Specific Arthroscopic Simulation Using 3-Dimensional Printing. Arthrosc Tech 2021; 10:e127-e129. [PMID: 33532218 PMCID: PMC7823098 DOI: 10.1016/j.eats.2020.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 09/20/2020] [Indexed: 02/03/2023] Open
Abstract
Surgical simulation offers a solution to the problems of reduced training time and surgical exposure by allowing trainees to develop surgical skills outside of the operating room in a safe, cost-effective environment. We developed a highly detailed, procedure-specific shoulder arthroscopy simulator using 3-dimesional printing with the aim of providing greater access to cost-effective simulation support to trainees.
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Affiliation(s)
| | | | | | | | - Duncan Tennent
- Address correspondence to Duncan Tennent, F.R.C.S.(Orth), Trauma and Orthopaedic Department, St George’s Hospital, Blackshaw Rd., London SW17 0QT, UK.
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9
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Melkonian V, Huy T, Varma CR, Nazzal M, Randall HB, Nguyen MTJ. The Creation of a Novel Low-Cost Bench-Top Kidney Transplant Surgery Simulator and a Survey on Its Fidelity and Educational Utility. Cureus 2020; 12:e11427. [PMID: 33312823 PMCID: PMC7727770 DOI: 10.7759/cureus.11427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Resident inexperience during time-sensitive vascular anastomoses of a kidney transplant can negatively impact outcomes. In light of this, we created a low-cost bench-top kidney transplant surgery simulator to help residents practice vascular anastomoses. Methods We searched for inexpensive materials to design an iliac fossa and kidney allograft. Eighteen residents with real-life kidney transplant experience trialed the simulator and scored its fidelity and educational utility on a 0-100 visual analog scale (VAS) survey. Results A 35.9 x 19.4 x 12.4 cm plastic box mimicked the iliac fossa. Hooks attached to the box's sidewall held under tension 1.27 and 0.64 cm diameter Penrose drains to replicate the external iliac vein and artery. A modified kidney-shaped stress ball with 1.27 x 4, 0.64 x 4, and 0.64 x 15 cm Penrose drains replicated a kidney allograft with its vein, artery, and ureter, respectively. Residents performed and assisted in vascular anastomoses on the simulator. The iliac fossa and allograft cost $20.20 and each practice run cost $7.20. Residents thought that the simulator was less difficult than real-life procedure, had acceptable fidelity levels, and they highly rated its educational utility. Conclusion Our novel low-cost bench-top kidney transplant surgery simulator focusing on vascular anastomoses received positive educational feedback from residents.
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Affiliation(s)
- Vatche Melkonian
- Surgery, Abdominal Transplant Center, Saint Louis University Hospital, St. Louis, USA
| | - Tess Huy
- Surgery, University of California Los Angeles, Los Angeles, USA
| | - Chintalapati R Varma
- Surgery, Abdominal Transplant Center, Saint Louis University Hospital, St. Louis, USA
| | - Mustafa Nazzal
- Surgery, Abdominal Transplant Center, Saint Louis University Hospital, St. Louis, USA
| | - Henry B Randall
- Surgery, Abdominal Transplant Center, Saint Louis University Hospital, St. Louis, USA
| | - Minh-Tri J Nguyen
- Transplant Surgery, Transplant Institute, Loma Linda University Medical Center, Loma Linda, USA
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White MD, Agarwal N, Alan N. Longitudinal Survey of Trainee Case Log Entry for Carotid Endarterectomy: Trends in Neurologic, General, and Vascular Surgery. World Neurosurg 2020; 146:e658-e663. [PMID: 33144210 DOI: 10.1016/j.wneu.2020.10.145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Multiple surgical specialties perform carotid endarterectomy (CEA). As indications for CEA narrows, neurosurgery residents are less exposed to this procedure. This study aims to determine trends in CEA training among graduating trainees in neurosurgery and compare these to general and vascular surgery. METHODS ACGME case log reports were retrospectively reviewed from 2013 to 2019 for neurologic, general, and vascular surgery residencies and vascular surgery fellowship. These annual reports contain the mean number of logged cases for graduating trainees and their level of participation. We analyzed trends in logged cases over the study period and compared mean number of logged cases between specialties and their respective required minimum numbers. RESULTS Neurosurgery residents (13.5 ± 0.76) performed significantly more CEAs than their counterparts in general surgery (9.4 ± 0.34, P < 0.01) but less in integrated vascular surgery (57.7 ± 0.88) and vascular surgery fellowship (47.9 ± 0.79, both P < 0.001). The only statistically significant change over the study period was a decline in mean number of cases logged by general surgery residents at -0.4 cases/year (P < 0.001). Trainees in all specialties reported around twice as many cases as the respective Accreditation Council for Graduate Medical Education required minimum numbers. Neurosurgery residents demonstrated increasing participation as lead surgeons by 0.7 cases/year (P = 0.04) and a concurrent decline as senior surgeons by 1.4 cases/year (P < 0.01). CONCLUSIONS Neurosurgery residents exceeded their minimum requirements for CEA, with increasing trend in higher level of participation. But neurosurgery residents' exposure to this procedure was far less significant than their colleagues in vascular surgery, a gap that may widen over time and should be addressed proactively.
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Affiliation(s)
- Michael D White
- Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nima Alan
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
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Meholick AL, Jesneck JL, Thanawala RM, Seymour NE. Use of a Secure Web-Based Data Management Platform to Track Resident Operative Performance and Program Educational Quality Over Time. JOURNAL OF SURGICAL EDUCATION 2020; 77:e187-e195. [PMID: 32600891 DOI: 10.1016/j.jsurg.2020.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/25/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE In surgery residency programs, Accreditation Council for Graduate Medical Education mandated performance assessment can include assessment in the operating room to demonstrate that necessary quality and autonomy goals are achieved by the conclusion of training. For the past 3 years, our institution has used The Ottawa Surgical Competency Operating Room Evaluation (O-SCORE) instrument to assess and track operative skills. Evaluation is accomplished in near real-time using a secure web-based platform for data management and analytics (Firefly). Simultaneous to access of the platform's case logging function, the O-SCORE instrument is delivered to faculty members for rapid completion, facilitating quality, and timeliness of feedback. We sought to demonstrate the platform's utility in detecting operative performance changes over time in response to focused educational interventions based on stored case log and O-SCORE data. DESIGN Stored resident performance assessments for the most frequently performed laparoscopic procedures (cholecystectomy, appendectomy, inguinal hernia repair, ventral hernia repair) were examined for 3 successive academic years (2016-2019). During this time, 4 of 36 residents had received program-assigned supplemental simulation training to improve laparoscopic skills. O-SCORE data for these residents were extracted from peer data, which were used for comparisons. Assigned training consisted of a range of videoscopic and virtual reality skills drills with performance objectives. O-SCORE responses were converted to integers and autonomy scores for items pertaining to technical skill were compared before and after educational interventions (Student's t-tests). These scores were also compared to aggregate scores in the nonintervention group. Bayesian-modeled learning curves were used to characterize patterns of improvement over time. SETTING University of Massachusetts Medical School-Baystate Surgery Residency and Baystate Medical Center PARTICIPANTS: General surgery residents (n = 36) RESULTS: During the period of review, 3325 resident cases were identified meeting the case type criteria. As expected, overall autonomy increased with the number of cases performed. The 4 residents who had been assigned supplemental training (6-18 months) had preintervention score averages that were lower than that of the nonintervention group (2.25 ± 0.43 vs 3.57 ± 1.02; p < 0.0001). During the respective intervention periods, all 4 residents improved autonomy scores (increase to 3.40 ± 0.61; p < 0.0001). Similar improvements were observed for tissue handling, instrument handling, bimanual dexterity, visuospatial skill, and operative efficiency component skills. Postintervention scores were not significantly different compared to scores for the non-intervention group. Bayesian-modeled learning curves showed a similar pattern of postintervention performance improvement. CONCLUSIONS The data management platform proved to be an effective tool to track responses to supplemental training that was deemed necessary to close defined skills gaps in laparoscopic surgery. This could be seen both in individual and in aggregated data. We were gratified that at the conclusion of the supplemental training, O-SCORE results for the intervention group were not different than those seen in the non-intervention group.
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Affiliation(s)
- Adriana L Meholick
- University of Massachusetts Medical School-Baystate, Department of Surgery, Springfield, Massachusetts
| | | | - Ruchi M Thanawala
- Division of Cardiothoracic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Neal E Seymour
- University of Massachusetts Medical School-Baystate, Department of Surgery, Springfield, Massachusetts.
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Collins C, Dudas L, Johnson M, Davenport D, Bernard A, Beck S, Muchow R, Pittman T, Talley C. ACGME Operative Case Log Accuracy Varies Among Surgical Programs. JOURNAL OF SURGICAL EDUCATION 2020; 77:e78-e85. [PMID: 32950429 DOI: 10.1016/j.jsurg.2020.08.045] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/29/2020] [Accepted: 08/29/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE This study evaluates the accuracy of reported the Accreditation Council for Graduate Medical Education (ACGME) operative case logs from graduated residents compared to institutional operating room electronic records (ORER). We hope this will help guide review committees and institutions develop complete, accurate resident case logs. DESIGN This is a retrospective, cross-sectional study of general surgery (GS), neurosurgery (NS), and orthopedic surgery (OS) resident physicians. ACGME and ORER cases from 2009 to 2010 were analyzed and each case and current procedural terminology (CPT) code directly compared (ORER vs. ACGME). SETTING Single academic tertiary-care medical center (University of Kentucky, Lexington, KY). PARTICIPANTS Eleven thousand nine hundred and twenty-three cases for 46 residents among the 3 residency programs were analyzed. RESULTS There was an overall logging accuracy of 72% for ORER cases reflected in the ACGME case logs. OS residents had a higher rate of logging accuracy (OS 91%, GS 69%, NS 58%, chi-square p = 0.014) and mean annual number of cases compared to the other 2 programs (OS 452, GS 183, NS 237, ANOVA p = 0.001). NS residents had higher accuracy of CPT codes than post-graduate years 2 to 5 in other programs (p < 0.017). There was a strong positive correlation between the number of cases completed per resident and case logging accuracy, (rho = 0.769, p < 0.001) consistent for NS and GS, but not OS. CONCLUSIONS This study shows only 72% of a residents' operative experience is captured in the ACGME case log across 3 surgical programs. There is significant variability among surgical programs and among post-graduate year cohorts regarding case log and CPT code accuracy. There is a strong correlation with the total number of cases performed and increasing case log accuracy. Low case log accuracy may reflect individual resident behavior instead of program operative exposure. Further studies are needed to determine if ORER may serve as a more complete assessment of the operative experience of a resident and program.
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Affiliation(s)
- Courtney Collins
- University of Kentucky, Department of Surgery, Lexington, Kentucky
| | - Lauren Dudas
- West Virginia University, Department of Surgery, Morgantown, West Virginia
| | - Mason Johnson
- University of Kentucky, Department of Surgery, Lexington, Kentucky
| | - Daniel Davenport
- University of Kentucky, Department of Surgery, Lexington, Kentucky
| | - Andrew Bernard
- University of Kentucky, Department of Surgery, Lexington, Kentucky
| | - Sandra Beck
- University of Kentucky, Department of Surgery, Lexington, Kentucky
| | - Ryan Muchow
- University of Kentucky, Department of Orthopaedic Surgery & Sports Medicine, Lexington, Kentucky
| | - Thomas Pittman
- University of Kentucky, Department of Neurosurgery, Lexington, Kentucky
| | - Cynthia Talley
- Medical University of South Carolina, Charleston, South Carolina.
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Morris MC, Baker JE, Edwards MJ. Surgeons, Scholars, and Leaders Symposium: A 5-Year Experience. Am Surg 2020. [DOI: 10.1177/000313481908501224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Department of Surgery at the University of Cincinnati developed the Surgeons, Scholars, and Leaders Symposium to address the underappreciated aspects of surgical education that are critical in the development of the academic surgeon. Surgical education has undergone many gaps since the beginning of a traditional surgical residency, first pioneered by Dr. Halsted in 1904; still, many gaps in surgical education remain. Topics such as research, financial planning, leadership, career development, and many others are not adequately addressed in formalized training. The Surgeons, Scholars, and Leaders Symposium was first held in January 2015 in Jackson Hole, WY, and has subsequently become an annual event. Recurrent themes addressed at the Symposium include global health, resident autonomy, research program development, leadership, mentorship, career development, and managing transitions. The annual Surgeons, Scholars, and Leaders Symposium has been instrumental in addressing these underappreciated aspects of surgeon development and will continue to be an important venue for the next generation of surgical leaders.
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Affiliation(s)
- Mackenzie C. Morris
- Department of Surgery, Section of General Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Jennifer E. Baker
- Department of Surgery, Section of General Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Michael J. Edwards
- Department of Surgery, Section of General Surgery, University of Cincinnati, Cincinnati, Ohio
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Abstract
OBJECTIVE The aim of the study was to address the controversy surrounding the effects of duty hour reform on new surgeon performance, we analyzed patients treated by new surgeons following the transition to independent practice. SUMMARY BACKGROUND DATA In 2003, duty hour reform affected all US surgical training programs. Its impact on the performance of new surgeons remains unstudied. METHODS We studied 30-day mortality among 1,483,074 Medicare beneficiaries undergoing general and orthopedic operations between 1999 and 2003 ("traditional" era) and 2009 and 2013 ("modern" era). The operations were performed by 2762 new surgeons trained before the reform, 2119 new surgeons trained following reform and 15,041 experienced surgeons. We used a difference-in-differences analysis comparing outcomes in matched patients treated by new versus experienced surgeons within each era, controlling for the hospital, operation, and patient risk factors. RESULTS Traditional era odds of 30-day mortality among matched patients treated by new versus experienced surgeons were significantly elevated [odds ratio (OR) 1.13; 95% confidence interval (CI) (1.05, 1.22), P < 0.001). The modern era elevated odds of mortality were not significant [OR 1.06; 95% CI (0.97-1.16), P = 0.239]. Relative performance of new and experienced surgeons with respect to 30-day mortality did not appear to change from the traditional era to the modern era [OR 0.93; 95% CI (0.83-1.05), P = 0.233]. There were statistically significant adverse changes over time in relative performance to experienced surgeons in prolonged length of stay [OR 1.08; 95% CI (1.02-1.15), P = 0.015], anesthesia time [9 min; 95% CI (8-10), P < 0.001], and costs [255USD; 95% CI (2-508), P = 0.049]. CONCLUSIONS Duty hour reform showed no significant effect on 30-day mortality achieved by new surgeons compared to their more experienced colleagues. Patients of new surgeons, however, trained after duty hour reform displayed some increases in the resources needed for their care.
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Cortez AR, Winer LK, Katsaros GD, Kassam AF, Shah SA, Diwan TS, Cutler Quillin R. Resident Operative Experience in Hepatopancreatobiliary Surgery: Exposing the Divide. J Gastrointest Surg 2020; 24:796-803. [PMID: 31012042 DOI: 10.1007/s11605-019-04226-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 03/29/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Accreditation Council for Graduate Medical Education (ACGME) requires an experience in hepatopancreatobiliary (HPB) surgery as part of general surgery residency training. The composition of this experience, however, is unclear. We set out to evaluate current trends in the HPB experience of US general surgery residents. METHODS National ACGME operative case logs from 1990 to 2016 were examined with a focus on the HPB operative domains. Time-trend analysis was performed using ANOVA and linear regression analysis. RESULTS Median biliary, liver, and pancreatic operative volumes increased by 30%, 33%, and 27% over the 27-year study period (all p < 0.05). Both core and advanced HPB cases increased, but the rate of increase for core was four times greater than that of advanced. However, when cholecystectomy was excluded, this trend reversed such that HPB core operations decreased by 11 cases over the study period. Further analysis demonstrated that laparoscopic cholecystectomy comprised 90% of all biliary cases and 77% of all HPB cases for graduates in 2016. Finally, operative volume variability-the difference in case numbers between high and low volume residents-increased by 16%, 21%, and 73% for the biliary, liver, and pancreatic domains, respectively (all p < 0.05). CONCLUSIONS Despite increases in overall HPB operative volume, the HPB experience is changing for today's surgical trainees. Moreover, the HPB experience is comprised largely of a single operation-the cholecystectomy. Awareness of these trends is important for surgical educators to facilitate adequate exposure to HPB surgery among general surgery residents.
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Affiliation(s)
- Alexander R Cortez
- Cincinnati Research on Education in Surgical Training (CREST), Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, ML 0558, Cincinnati, OH, 45267-0558, USA.
| | - Leah K Winer
- Cincinnati Research on Education in Surgical Training (CREST), Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, ML 0558, Cincinnati, OH, 45267-0558, USA
| | - Gianna D Katsaros
- Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Al-Faraaz Kassam
- Cincinnati Research on Education in Surgical Training (CREST), Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, ML 0558, Cincinnati, OH, 45267-0558, USA
| | - Shimul A Shah
- Division of Transplantation, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Tayyab S Diwan
- Division of Transplantation, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - R Cutler Quillin
- Cincinnati Research on Education in Surgical Training (CREST), Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, ML 0558, Cincinnati, OH, 45267-0558, USA
- Division of Transplantation, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
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Rogers CM, Saway B, Busch CM, Simonds GR. The Effects of 24-Hour Neurosurgical Call on Fine Motor Dexterity, Cognition, and Mood. Cureus 2019; 11:e5687. [PMID: 31720156 PMCID: PMC6822998 DOI: 10.7759/cureus.5687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Concerns regarding the effects of fatigue on physician performance and quality of life lead to the implementation of duty hour restrictions for residents by the Accreditation Council for Graduate Medical Education (ACGME). These restrictions have been met by strong criticism from the neurosurgical community. This is partly due to a lack of objective evidence that fatigue results in decrements in professional function in neurological surgeons. There is also concern that the restrictions have diminished clinical and operative experience as well as the development of professional responsibility in residency. Objective: To evaluate whether 24-hour neurosurgical call has an objective impact on fine motor dexterity, cognitive thinking skills, and mental well-being. Methods: Subjects were tested before and after taking 24 hours of neurosurgical call. We evaluated fine motor dexterity using the Vienna Test System Motor Performance Series, cognitive thinking abilities using a battery of paper-pencil neuropsychological tests, and mental well-being using the Profile of Mood States. Results: A total of 27 subjects were included in this study, 12 seasoned to neurosurgical call and 15 naive to neurosurgical call. The seasoned subjects demonstrated no statistically significant change in performance after call on any of the tests for fine motor dexterity or cognitive thinking abilities. The nonseasoned subjects demonstrated multiple decrements in fine motor dexterity and cognitive thinking abilities after taking call. In the Motor Performance Series, they had a statistically significant decrease in the speed of untargeted movements in the nondominant hand during the tapping test (p = 0.002), and a decline in the precision of fine motor movements and information processing as evidenced by an increase in the number of errors of the dominant hand in the line tracking test (p = 0.014). There was a statistically significant decline in their immediate memory during Hopkins Verbal Learning Test (p = 0.025), and complex attention, mental flexibility, and visual-motor speed in the Trail Making Test (p = 0.03). The Profile of Mood States found no difference in feelings of anger (p = 0.54), tension (p = 0.358), or depression (p = 0.65). There were increased feelings of confusion (p < 0.001) and decreased feelings of vigor (p < 0.001) and friendliness (p = 0.001). Nonseasoned subjects had an increase in total mood disturbance (p = 0.012) but seasoned subjects did not (p = 0.083). Conclusion: Our results suggest that fatigue-induced decrements in professional function can be ameliorated by experience with prolonged duty hours. In contrast to nonseasoned subjects, those who were conditioned to 24-hour neurosurgical call demonstrated resilience in fine motor dexterity and cognitive thinking skills, and exhibited no change in total mood disturbance. An argument can be made that we are turning the neurosurgical training paradigm upside down with the current ACGME duty hour restrictions.
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Affiliation(s)
- Cara M Rogers
- Department of Surgery, Division of Neurological Surgery, Virginia Tech Carilion School of Medicine and Fralin Biomedical Research Institute, Roanoke, USA
| | - Brian Saway
- Department of Surgery, Division of Neurological Surgery, Virginia Tech Carilion School of Medicine and Fralin Biomedical Research Institute, Roanoke, USA
| | - Christopher M Busch
- Department of Surgery, Division of Neurological Surgery, Virginia Tech Carilion School of Medicine and Fralin Biomedical Research Institute, Roanoke, USA
| | - Gary R Simonds
- Department of Surgery, Division of Neurological Surgery, Virginia Tech Carilion School of Medicine and Fralin Biomedical Research Institute, Roanoke, USA
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Homma Y, Mogami A, Baba T, Naito K, Watari T, Obayashi O, Kaneko K. Is actual surgical experience reflected in virtual reality simulation surgery for a femoral neck fracture? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:1429-1434. [PMID: 31187262 DOI: 10.1007/s00590-019-02465-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 06/06/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION A virtual reality simulator developed for orthopaedic and trauma surgical training has been introduced. However, it is unclear whether the experiences of actual surgery are reflected in virtual reality simulation surgery (VRSS) using a simulator. The aim of this study is to investigate whether the results in VRSS differ between a trauma expert and a trauma novice. METHODS In Group A (expert), there are ten orthopaedic trauma surgeons and in Group B (novice) ten residents within 2 years after medical school graduation. VRSS for a femoral neck fracture using Hansson hook-pins (Test 1) and Hansson twin hook plate (Test 2) was performed. The parameters evaluated were total procedure time (s), fluoroscopy time (s), number of times X-ray was used (defined by the number of times the foot pedal was used), number of retries in guide placement, and final implant position. RESULTS In Test 1, the averages of four parameters (distance to posterior cortex (p = 0.009), distal pin distance above lesser trochanter (p = 0.015), distal pin hook angular error (p = 0.004), and distal pin tip distance to centre (lateral) (p = 0.015)) were significantly different between Groups A and B. In Test 2, no parameters in a mean were significantly different between groups, but seven parameters in a variance (guide wire distance to joint surface (p = 0.0191), twin hook length outside barrel (p = 0.011), twin hook tip distance to centre (lateral) (p = 0.042), twin hook distance to centre of lateral cortex (lateral) (p = 0.016), plate end alignment error (lateral) (p = 0.027), guide wire angle with lateral cortex (front) (p = 0.024), and 3.2-mm drill outside cortex (p = 0.000)) were significantly different between groups. In Test 1, Group B showed significantly longer fluoroscopy time than Group A (p = 0.044). In Test 2, Group B showed significantly fewer instances of X-ray use than Group A (p = 0.046). CONCLUSIONS Our study showed that the experiences of actual surgery are reflected in the result of VRSS using the simulator.
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Affiliation(s)
- Yasuhiro Homma
- Department of Orthopaedic Surgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Atsuhiko Mogami
- Department of Orthopaedic Surgery, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, 410-2295, Shizuoka, Japan
| | - Tomonori Baba
- Department of Orthopaedic Surgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kiyohito Naito
- Department of Orthopaedic Surgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Taiji Watari
- Department of Orthopaedic Surgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Osamu Obayashi
- Department of Orthopaedic Surgery, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, 410-2295, Shizuoka, Japan
| | - Kazuo Kaneko
- Department of Orthopaedic Surgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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Bingmer K, Ofshteyn A, Stein SL, Marks JM, Steinhagen E. Decline of open surgical experience for general surgery residents. Surg Endosc 2019; 34:967-972. [DOI: 10.1007/s00464-019-06881-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 05/29/2019] [Indexed: 11/24/2022]
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Silvestre J, Hernandez JM, Lee DI. Disparities in Pediatric Operative Experience during Urology Residency Training. Urology 2019; 127:24-29. [DOI: 10.1016/j.urology.2019.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/01/2019] [Accepted: 02/04/2019] [Indexed: 12/28/2022]
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Cairo SB, Craig W, Gutheil C, Han PKJ, Hyrkas K, Macken L, Whiting JF. Quantitative Analysis of Surgical Residency Reform: Using Case-Logs to Evaluate Resident Experience. JOURNAL OF SURGICAL EDUCATION 2019; 76:25-35. [PMID: 30195662 DOI: 10.1016/j.jsurg.2018.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 04/17/2018] [Accepted: 05/27/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Curricular changes at a mid-sized surgical training program were developed to rebalance clinical rotations, optimize education over service, decrease the size of service teams, and integrate apprenticeship-type experiences. This study quantifies the operative experience before and after implementation as part of a mixed-methods program evaluation. STUDY DESIGN Retrospective review of case-log data and data from the Accreditation Council for Graduate Medical Education (ACGME) and the American College of Surgeons National Surgical Quality Improvement Program: quality in-training initiative to evaluate case volume pre- and postintervention. RESULTS 11,365 cases, excluding "first-assistant" and "endoscopic" cases, were logged for an average of 291 and 263 cases/resident pre- and postintervention, respectively. Average case volume increased significantly for postgraduate year (PGY) 3 residents and decreased significantly for PGY 4 residents between the two time periods. Variability was observed among residents at the same PGY level both pre- and postintervention, with coefficients of variation of 6.0% to 34.1% in 2014 to 2015 and 11.2% to 66.8% in 2015 to 2016. Inter-resident variability persisted when comparing a specific procedure between ACGME case-log and quality in-training initiative data sets. CONCLUSION The data suggest that inter-resident variability in case load is not an artifact of case logging behavior alone, but may reflect personal preferences and choices in case selection that are not impacted by curriculum change. Logging behavior and accuracy of case-logs may contribute to variability. The shift in case load from PGY 4 to PGY 3 after curriculum implementation requires validation by ongoing analysis of ACGME case-log data.
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Affiliation(s)
- Sarah B Cairo
- Maine Medical Center Department of Surgery, Portland, Maine; Women and Children's Hospital of Buffalo, Buffalo, New York.
| | - Wendy Craig
- Center for Outcomes Research and Evaluation (CORE) and Maine Medical Center Research Institute, Portland, Maine
| | - Caitlin Gutheil
- Center for Outcomes Research and Evaluation (CORE) and Maine Medical Center Research Institute, Portland, Maine
| | - Paul K J Han
- Center for Outcomes Research and Evaluation (CORE) and Maine Medical Center Research Institute, Portland, Maine; Palliative Medicine, Hospice of Southern Maine, Scarborough, Maine
| | - Kristiina Hyrkas
- Center for Nursing Research and Quality Outcomes, Maine Medical Center, Portland, Maine
| | - Lynda Macken
- Center for Nursing Research and Quality Outcomes, Maine Medical Center, Portland, Maine
| | - James F Whiting
- Maine Medical Center Department of Surgery, Portland, Maine; Clinical Associate Professor of Surgery, Tufts University School of Medicine at Maine Medical Center, Portland, Maine
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Putnam MD, Adams JE, Lender P, Van Heest AE, Shanedling JR, Nuckley DJ, Bechtold JE. Examination of Skill Acquisition and Grader Bias in a Distal Radius Fracture Fixation Model. JOURNAL OF SURGICAL EDUCATION 2018; 75:1299-1308. [PMID: 29502990 DOI: 10.1016/j.jsurg.2018.01.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/07/2017] [Accepted: 01/24/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Primary: Assess the ability of faculty graders to predict the objectively measured strength of distal radius fracture fixation. Secondary: Compare resident skill variation and retention related to other knowable training data. DESIGN Residents were allowed 60 minutes to stabilize a standardized distal radius fracture using an assigned fixed-angle volar plate. Faculty observed and subjectively graded the residents without providing real-time feedback. Objective biomechanical evaluation (construct strength and stiffness) was compared to subjective grades. Resident-specific characteristics (sex, PGY, and ACGME case log) were also used to compare the objective data. SETTING A simulated operating room in our laboratory. PARTICIPANTS Post-graduate year 2, 3, 4, and 5 orthopedic residents. RESULTS Primary: Faculty were not successful at predicting objectively measured fixation, and their subjective scoring suggests confirmation bias as PGY increased. Secondary: Resident year-in-training alone did not predict objective measures (p = 0.53), but was predictive of subjective scores (p < 0.001). Skills learned were not always retained, as 29% of residents objectively failed subsequent to passing. Notably, resident-reported case-specific experience alone was inversely correlated with objective fixation strength. CONCLUSIONS This testing model enabled the collection of objective and subjective resident skill scores. Faculty graders did not routinely predict objective measures, and their subjective assessment appears biased related to PGY. Also, in vivo case volume alone does not predict objective results. Familiar faculty teaching consistency, and resident grading by external faculty unfamiliar with tested residents, might alter these results.
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Affiliation(s)
- Matthew D Putnam
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota.
| | | | - Paul Lender
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Ann E Van Heest
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Janet R Shanedling
- Clinical and Translational Science, University of Minnesota, Minneapolis, Minnesota
| | | | - Joan E Bechtold
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota; Minneapolis Medical Research Foundation and Excelen Center for Bone and Joint Education and Research, Minneapolis, Minnesota.
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Cortez AR, Katsaros GD, Dhar VK, Drake FT, Pritts TA, Sussman JJ, Edwards MJ, Quillin RC. Narrowing of the surgical resident operative experience: A 27-year analysis of national ACGME case logs. Surgery 2018; 164:577-582. [PMID: 29929755 DOI: 10.1016/j.surg.2018.04.037] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/17/2018] [Accepted: 04/13/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although overall operative volume has remained stable since the implementation of duty hours, more detailed analyses suggest shifts in the resident operative experience. Understanding these differences allows educators to better appreciate the impact of the current training environment on resident preparation for practice. METHODS National Accreditation Council for Graduate Medical Education case logs from 1990 to 2016 were reviewed. Statistical analysis was performed using analysis of variance and linear regression analysis. RESULTS Over the study period there was no change in total major cases. Subcategory analysis revealed an increase in skin and soft tissue, alimentary tract, abdomen, and endocrine with a concurrent decrease in breast, pediatrics, and trauma. During this time, residents completed fewer cases during their chief year, operated more during non-chief years, taught fewer operations, and assisted in minimal cases. Finally, a decrease in the variability of overall operative volume for total major cases was found as a result of 90th and 10th percentiles converging toward the median. CONCLUSION Although total major cases logged by residents have remained stable, the operative experience of general surgery residents has narrowed significantly. Residents are operating earlier and performing fewer teaching and first assistant cases. Surgical educators must look beyond total case numbers and be aware of these changes to ensure all residents achieve technical competency on graduation.
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Affiliation(s)
| | | | - Vikrom K Dhar
- Department of Surgery, University of Cincinnati, Cincinnati, OH
| | - F Thurston Drake
- Department of Surgery, Boston University School of Medicine, Boston, MA
| | | | | | | | - R Cutler Quillin
- Center for Liver Disease and Transplantation, Columbia University Medical Center, New York, NY
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Cortez AR, Dhar VK, Sussman JJ, Pritts TA, Edwards MJ, Quillin RC. Not all operative experiences are created equal: a 19-year analysis of a single center's case logs. J Surg Res 2018; 229:127-133. [PMID: 29936979 DOI: 10.1016/j.jss.2018.03.070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/19/2018] [Accepted: 03/29/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although national operative volumes have remained stable, surgical educators should appreciate the changing experience of today's surgical residents. We set out to evaluate operative volume trends at our institution and study the impact of resident learning styles on operative experience. MATERIALS AND METHODS The Accreditation Council for Graduate Medical Education operative log data from 1999 to 2017 for a single general surgery residency program were examined. All residents completed the Kolb Learning Style Inventory. Statistical analyses were performed using linear regression analysis, Student's t-test, and Fischer's exact test. RESULTS Over the study period, 106 general surgery residents graduated from our program. There were 87% action learners and 13% observation learners. Although there was no change in total major, total chief, or total non-chief cases, a decrease in teaching assistant cases was observed. Subcategory analysis revealed that there was an increase in operative volume on graduation in the following categories: skin, soft tissue, and breast; alimentary tract; abdomen; pancreas; operative trauma; pediatric; basic laparoscopy; complex laparoscopy; and endoscopy with a concurrent decrease in liver, vascular, and endocrine. Learning style analysis found that action learners completed significantly more cases than observation learners in most domains in which operative volume increased. CONCLUSIONS While the operative volume at our center remained stable over the study period, the experience of general surgery residents has become narrowed toward a less subspecialized, general surgery experience. These shifts may disproportionally impact trainees as observation learners operate less than action learners. Residency programs should therefore incorporate methods such as learning style assessment to identify residents at risk of a suboptimal experience.
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Affiliation(s)
| | - Vikrom K Dhar
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | | | - Timothy A Pritts
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | | | - R Cutler Quillin
- Center for Liver Disease and Transplantation, Columbia University Medical Center, New York, New York
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Abstract
BACKGROUND Recent attention has sought to standardize hand surgery training in the United States. This study analyzes the variability in operative hand experience for orthopedic and general surgery residents. METHODS Case logs for orthopedic and general surgery residency graduates were obtained from the American Council of Graduate Medical Education (2006-2007 to 2014-2015). Plastic surgery case logs were not available for comparison. Hand surgery case volumes were compared between specialties with parametric tests. Intraspecialty variation in orthopedic surgery was assessed between the bottom and top 10th percentiles in procedure categories. RESULTS Case logs for 9605 general surgery residents and 5911 orthopedic surgery residents were analyzed. Orthopedic surgery residents performed a greater number of hand surgery cases than general surgery residents ( P < .001). Mean total hand experience ranged from 2.5 ± 4 to 2.8 ± 5 procedures for general surgery residents with no reported cases of soft tissue repairs, vascular repairs, and replants. Significant intraspecialty variation existed in orthopedic surgery for all hand procedure categories (range, 3.3-15.0). CONCLUSIONS As the model for hand surgery training evolves, general surgeons may represent an underutilized talent pool to meet the critical demand for hand surgeon specialists. Future research is needed to determine acceptable levels of training variability in hand surgery.
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Affiliation(s)
| | - Ines C. Lin
- University of Pennsylvania, Philadelphia, USA
| | | | - Benjamin Chang
- University of Pennsylvania, Philadelphia, USA,Hospital of the University of Pennsylvania, Philadelphia, USA,Benjamin Chang, Associate Professor of Clinical Surgery, Division of Plastic Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 10 Penn Tower, Philadelphia, PA 19104, USA.
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Naik ND, Abbott EF, Aho JM, Pandian TK, Thiels CA, Heller SF, Farley DR. The ACGME Case Log System May Not Accurately Represent Operative Experience Among General Surgery Interns. JOURNAL OF SURGICAL EDUCATION 2017; 74:e106-e110. [PMID: 29055744 DOI: 10.1016/j.jsurg.2017.09.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 09/28/2017] [Accepted: 09/30/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To assess if the Accreditation Council for Graduate Medical Education (ACGME) case log system accurately captures operative experience of our postgraduate year 1 (PGY-1) residents. DESIGN ACGME case log information was retrospectively obtained for 5 cohorts of PGY-1 residents (2011-2015) and compared to the number of operative cases captured by an institutional automated operative case report system, Surgical Access Utility System (SAUS). SAUS automatically captures all surgical team members who are listed in the operative dictation for a given case, including interns. A paired t-test analysis was used to compare number of cases coded between the 2 systems. SETTING Academic, tertiary care referral center with a large general surgery training program. PARTICIPANTS PGY-1 general surgery trainees (interns) from the years 2011-2015. RESULTS Forty-nine PGY-1 general surgery residents were identified over a 5-year period. Mean operative case volume per intern, per year, captured by the automated SAUS was 176.5 ± 28.1 (SD) compared to 126.3 ± 58.0 ACGME cases logged (mean difference = 50.2 cases, p < 0.001). CONCLUSIONS ACGME case log data may not accurately reflect the actual operative experience of our PGY-1 residents. If such data holds true for other general surgery training programs, the true impact of duty hour regulations on operative volume may be unclear when using the ACGME case log data. This current standard approach for using ACGME case logs as a representation of operative experience requires further scrutiny and potential revision to more accurately determine operative experience for accreditation purposes.
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Affiliation(s)
- Nimesh D Naik
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Eduardo F Abbott
- Multidisciplinary Simulation Center, Mayo Clinic, Rochester, Minnesota; Department of Internal Medicine, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Johnathon M Aho
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - T K Pandian
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Cornelius A Thiels
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Stephanie F Heller
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - David R Farley
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota; Multidisciplinary Simulation Center, Mayo Clinic, Rochester, Minnesota.
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Wolf KR, Taylor ZA, Placek SB, Tsai MW, Franklin BR, Ritter EM. Do Resident Case Logs Meet ACGME Requirements? A Comparison Between Acute Care and Elective Cases. JOURNAL OF SURGICAL EDUCATION 2017; 74:e45-e50. [PMID: 29222022 DOI: 10.1016/j.jsurg.2017.11.004] [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: 04/04/2017] [Revised: 10/11/2017] [Accepted: 11/16/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE Operative experience is at the core of general surgery residency, and recently operative volume requirements for graduating residents were increased. The ACGME has outlined 4 areas of required resident participation and documentation in order for a surgical case to be logged: determination or confirmation of the diagnosis, provision of preoperative care, selection and accomplishment of the operative procedure, and direction of the postoperative care. The purpose of this study was to examine whether general surgery residents are currently meeting the required care participation documentation standard and to examine the effect of acute care vs. elective cases on documentation. METHODS The operative case logs of 7 PGY-3 and 7 PGY-5 general surgery residents from March 2016 were retrospectively reviewed and compared to the electronic medical record (EMR) to verify documentation of resident participation in each of the 4 required areas. Chart review was also utilized to classify cases as either acute care or elective. RESULTS A total of 339 cases were reviewed (159 PGY-3 and 180 PGY-5). Of these, 251 cases were classified as elective and 88 were classified as acute care. Overall, documentation of comprehensive care (participation in all four required areas) was found for 44% of cases, with residents reporting participation in a higher percentage of comprehensive care (all 4 domains completed) than was actually documented in the EMR (71.9% vs. 44.4%, t[13] = 2.57, p = 0.023, d = 1.13). Comprehensive care was documented more frequently in elective cases than acute care cases (49.7% vs. 38.3%), and there was less discrepancy between perceived and documented comprehensive care within elective cases (67% vs. 49.7%, t[13] = 1.17, p = 0.27) than acute care cases (80.9% vs. 38.3%, t[13] = 4.40, p = 0.001). CONCLUSIONS Despite ACGME requirements, the majority of cases logged by general surgery residents do not have documentation by the operating resident in the EMR verifying provision of comprehensive care. Elective cases were more likely to meet documentation requirements than acute care cases, and we purport that this is possibly secondary to restricted work hours. We expect that other programs would find similar compliance in the documentation of comprehensive care. These results question whether the requirement for documenting comprehensive care to log a surgical case is practical in surgical residency training, particularly with an increasing demand for operative volume in the setting of limited work hours.
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Affiliation(s)
- Kathryn R Wolf
- Division of General Surgery, Department of Surgery at the Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda Maryland.
| | - Zachary A Taylor
- Division of General Surgery, Department of Surgery at the Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda Maryland
| | - Sarah B Placek
- Division of General Surgery, Department of Surgery at the Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda Maryland
| | - Michael W Tsai
- Division of General Surgery, Department of Surgery at the Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda Maryland
| | - Brenton R Franklin
- Division of General Surgery, Department of Surgery at the Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda Maryland
| | - E Matthew Ritter
- Division of General Surgery, Department of Surgery at the Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda Maryland
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Silvestre J, Lin IC, Levin LS, Chang B. Variable Operative Experience in Hand Surgery for Plastic Surgery Residents. JOURNAL OF SURGICAL EDUCATION 2017; 74:650-655. [PMID: 28363676 DOI: 10.1016/j.jsurg.2016.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 10/21/2016] [Accepted: 12/02/2016] [Indexed: 06/07/2023]
Abstract
BACKGROUND Efforts to standardize hand surgery training during plastic surgery residency remain challenging. We analyze the variability of operative hand experience at U.S. plastic surgery residency programs. METHODS Operative case logs of chief residents in accredited U.S. plastic surgery residency programs were analyzed (2011-2015). Trends in fold differences of hand surgery case volume between the 10th and 90th percentiles of residents were assessed graphically. Percentile data were used to calculate the number of residents achieving case minimums in hand surgery for 2015. RESULTS Case logs from 818 plastic surgery residents were analyzed of which a minority were from integrated (35.7%) versus independent/combined (64.3%) residents. Trend analysis of fold differences in case volume demonstrated decreasing variability among procedure categories over time. By 2015, fold differences for hand reconstruction, tendon cases, nerve cases, arthroplasty/arthrodesis, amputation, arterial repair, Dupuytren release, and neoplasm cases were below 10-fold. Congenital deformity cases among independent/combined residents was the sole category that exceeded 10-fold by 2015. Percentile data suggested that approximately 10% of independent/combined residents did not meet case minimums for arterial repair and congenital deformity in 2015. CONCLUSIONS Variable operative experience during plastic surgery residency may limit adequate exposure to hand surgery for certain residents. Future studies should establish empiric case minimums for plastic surgery residents to ensure hand surgery competency upon graduation.
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Affiliation(s)
- Jason Silvestre
- Division of Plastic Surgery, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ines C Lin
- Division of Plastic Surgery, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lawrence Scott Levin
- Division of Plastic Surgery, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Benjamin Chang
- Division of Plastic Surgery, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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