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Koljonen JL, Ruffolo AM, Neumeister MW, Sommer NZ. Strategies to Improve Resident Wellness in Plastic Surgery Training. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5858. [PMID: 38841530 PMCID: PMC11150031 DOI: 10.1097/gox.0000000000005858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/12/2024] [Indexed: 06/07/2024]
Abstract
Residency is known to be a challenging time in a surgeon's career. Surgical residents must learn the breadth of their field and develop technical skills while maintaining relationships and well-being outside their training. High burnout rates are well documented among all medical specialties, particularly during residency. Proven strategies in medical education that help decrease burnout and improve resident well-being, while maintaining quality patient care, have been reported in the medical education literature. However, little has been published specific to plastic surgery training programs. We discuss strategies that can be implemented into the curricula and workflow at plastic surgery residency programs to maximize resident well-being. We advocate for a multifaceted approach that includes a night float system, day call, integrating advanced practice providers to offload noneducational resident tasks, and establishing a wellness program. It is our hope that these strategies may serve as a guide for plastic surgery residency programs to promote general wellness and prevent burnout among trainees.
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Affiliation(s)
- Jessie L. Koljonen
- From the Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, Ill
| | - Alexis M. Ruffolo
- From the Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, Ill
| | - Michael W. Neumeister
- From the Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, Ill
| | - Nicole Z. Sommer
- From the Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, Ill
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Forman K, Bruno CJ, Izatt S, Fuloria M, Adams A, Kim M, Zuber J, Cano N, LaTuga MS. Building Relationships: Advanced Practice Providers and Fellows in Neonatal-Perinatal Medicine. Am J Perinatol 2024; 41:e2514-e2520. [PMID: 37541311 DOI: 10.1055/s-0043-1771503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
OBJECTIVE Advanced practice providers (APPs) are a critical component of health care teams, especially in the neonatal intensive care unit. At times, APPs and neonatal-perinatal medicine (NPM) fellows may experience tension in their professional relationship. They may perceive the other's performance and abilities differently. We hypothesized that satisfaction with the APP-NPM fellow interprofessional relationship would be associated with higher perception of APP competence by NPM fellows. STUDY DESIGN We surveyed 274 medical providers: NPM fellows (24.8%), NPM program directors (24.5%), and APPs (50.7%). APPs were defined as neonatal nurse practitioners, pediatric nurse practitioners, physician assistants, or neonatal hospitalists. We obtained demographic data, information about sources of conflict in the APP-NPM fellow relationship, level of satisfaction with the relationship, and targeted interventions for improvement. NPM fellow perception of APP competence as well as APP self-assessed competence were elicited. Statistical analyses were performed with chi-square tests and Fisher's exact tests. RESULTS Overall, APPs and NPM fellows were generally satisfied with their relationship. All groups reported APP competence as equivalent to a third-year NPM fellow. NPM fellow perception of APP competence increased with year of fellow training. Higher perceived APP competence by NPM fellows correlated with higher relationship satisfaction scores. Difficulties with teamwork, communication and respect were associated with lower satisfaction within the APP-NPM fellow relationship. CONCLUSION The professional working dynamic between these two groups is viewed positively by all. Satisfaction with the APP-NPM fellow relationship correlated with higher perception of APP competence by NPM fellows. Targeted interventions that increase NPM fellow perception of APP competence and ameliorate the difficulties encountered in the APP-NPM fellow relationship may improve this interprofessional relationship. KEY POINTS · Advanced practice providers and NPM fellows may have similar responsibilities leading to challenges.. · NPM fellows with higher perceived competence of APPs had higher satisfaction with their relationship.. · Training APPs to teach, creating interprofessional education, and routine debrief sessions may help..
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Affiliation(s)
- Katie Forman
- Division of Neonatology, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Christie J Bruno
- Division of Neonatology, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Susan Izatt
- Division of Neonatology, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Mamta Fuloria
- Division of Neonatology, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Aaron Adams
- Division of Neonatology, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Mimi Kim
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Jennifer Zuber
- Division of Neonatology, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Nefertiti Cano
- Division of Neonatology, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Mariam S LaTuga
- Division of Neonatology, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
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Zhou AE, Gronbeck C, Jain N, Aiudi D, Grant-Kels JM. Role of physician extenders in resident education and dermatology practice. Clin Dermatol 2024:S0738-081X(24)00059-2. [PMID: 38677564 DOI: 10.1016/j.clindermatol.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Affiliation(s)
- Albert E Zhou
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Christian Gronbeck
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Neelesh Jain
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Donna Aiudi
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut, USA; Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA.
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Braun-Inglis CM, Dressler EV, Myers JS, Benson AB, Flannery M, Good M, Denicoff A, Berenberg JL, DeTroye AT, O'Brien B, Kottschade L, Omatsu DA, Kittel CA, Nightingale CL, Foust M, Lesser GJ. Defining the Role of the Advanced Practice Provider Within the National Cancer Institute Community Oncology Research Program. JCO Oncol Pract 2024; 20:239-246. [PMID: 38175992 PMCID: PMC10911544 DOI: 10.1200/op.23.00501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/23/2023] [Accepted: 11/08/2023] [Indexed: 01/06/2024] Open
Abstract
PURPOSE Oncology advanced practice providers (APPs), including nurse practitioners, clinical nurse specialists, physician assistants, and clinical pharmacists, contribute significantly to quality cancer care. Understanding the research-related roles of APPs in the National Cancer Institute's (NCI) Community Oncology Research Program (NCORP) could lead to enhanced protocol development, trial conduct, and accrual. METHODS The 2022 NCORP Landscape Assessment Survey asked two questions about the utilization and roles of APPs in the NCORP. RESULTS A total of 271 practice groups completed the 2022 survey, with a response rate of 90%. Of the 259 nonpediatric exclusive practice groups analyzed in this study, 92% used APPs for clinical care activities and 73% used APPs for research activities. APPs most often provided clinical care for patients enrolled in trials (97%), followed by assistance with coordination (65%), presenting/explaining clinical trials (59%), screening patients (49%), ordering investigational drugs (37%), and consenting participants (24%). Some groups reported APPs as an enrolling investigator (18%) and/or participating in institutional oversight/selection of trials (15%). Only 5% of NCORP sites reported APPs as a site primary investigator for trials, and very few (3%) reported APPs participating in protocol development. CONCLUSION Practice groups report involving APPs in clinical research within the NCORP network; however, opportunities for growth exists. As team-based care has enhanced clinical practice in oncology, this same approach can be used to enhance successful research. Suggested strategies include supporting APP research-related time, recognition, and education. The findings of this survey and subsequent recommendations may be applied to all adult oncology practices that participate in clinical research.
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Affiliation(s)
| | | | - Jamie S. Myers
- University of Kansas, School of Nursing, Kansas City, KS
| | | | | | | | | | | | | | | | | | | | - Carol A. Kittel
- Wake Forest University School of Medicine, Winston-Salem, NC
| | | | - Melyssa Foust
- Gibbs Cancer Center and Research Institute at Pelham, Greer, SC
| | - Glenn J. Lesser
- Wake Forest University School of Medicine, Winston-Salem, NC
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Yu AT, Jepsen N, Prasad S, Klein JP, Doughty C. Adding Nocturnal Advanced Practice Providers to an Academic Inpatient Neurology Service Improves Residents' Educational Experience. Neurohospitalist 2023; 13:130-136. [PMID: 37064933 PMCID: PMC10091433 DOI: 10.1177/19418744221143207] [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: 04/18/2023] Open
Abstract
Background and Objectives: In the inpatient academic medical center, increased demand for clinical services often equates to an increased workload for trainees, which could have a positive or negative impact on their educational experience. In 2020, our academic medical center hired Advanced Practice Providers (APPs) to provide continuous additional overnight coverage for our neurology ward teaching service. We hypothesized that adding APPs and reducing overnight clinical workload for residents would have a positive impact on resident education. Methods: We performed a mixed-methods, prospective study that included needs-assessments by residents, semi-structured interviews with both residents and APPs, and surveys to residents and nursing staff. In addition, we collected quantitative data such as hours of sleep, number of admissions, and number of pages to capture the impact of APPs on resident overnight shifts. Results: The addition of APPs overnight increased the median hours of sleep overnight from 1 hour to 3 hours (P < .001) and decreased the median number of pages overnight from 31.5 to 17 (P < .001). The median number of patients the resident was responsible for cross-covering overnight decreased from 24 patients to 14 patients (P < .001). The majority of resident responses (94%) agreed that the addition of APPs benefited their education by reducing workload and increasing time allotted to reading and formulating plans for overnight admissions. 88% of residents agreed that the addition of APPs improved quality of life and reduced risk of burnout. Conclusion: Advanced Practice Providers significantly reduced resident workload, leading residents to report improvements in the educational experience overnight and reduced perceived risk of burnout.
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Affiliation(s)
- Andrew T. Yu
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Nicole Jepsen
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Sashank Prasad
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Joshua P. Klein
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
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Rosenblatt A, Ballard HA, Amortegui D, Yuce T, Bilimoria KY, Johnson JK, Hu YY. Invisible Work: Advanced Practice Providers' Role in the Education of Surgeons. JOURNAL OF SURGICAL EDUCATION 2022; 79:1353-1362. [PMID: 35863959 DOI: 10.1016/j.jsurg.2022.06.015] [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: 05/13/2022] [Revised: 06/21/2022] [Accepted: 06/28/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE As the composition and work of surgical teams evolve, the role of advanced practice providers (APPs) has expanded. We explored how APPs influence the training experience of surgeons from the perspectives of faculty, residents, and APPs. DESIGN Qualitative data were obtained from semi-structured open-ended interviews. A codebook was developed blending deductive and inductive logics. Dyads independently coded the transcripts using a constant comparative approach; differences were reconciled by consensus. RESULTS During 2-day site visits to 15 general surgery programs, 393 individual and small focus group interviews were conducted with residents, faculty, staff, and program leadership. Forty transcripts representing 51 interviewees (15 APPs, 23 residents, 13 faculty) were collected. We identified 4 major themes:1 APP as Educator: APPs play a significant role in resident education to ensure seamless patient care while allowing trainees room for clinical growth.2 Canary in the Coal Mine: APPs often are the first to notice a surgical trainee's mood and provide support to improve wellness.3 Division of Labor: Distribution of clinical workload has a direct impact on surgical trainees' educational experience and APP job satisfaction.4 Second-Class Citizen: APPs described experiences in which their expertise was disrespected, and their contributions were unrecognized. CONCLUSIONS APPs have an active and essential role in the well-being and education of surgeons during training. Surgical residency programs and hospitals have an opportunity to decrease the "invisibility" of the work of APPs through increased recognition of these roles and elevation of APP expertise through formal career development pathways.
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Affiliation(s)
- Audrey Rosenblatt
- Department of Pediatric Anesthesiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois.
| | - Heather A Ballard
- Department of Pediatric Anesthesiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois
| | - Daniela Amortegui
- Surgical Outcomes & Quality Improvement Center, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Tarik Yuce
- Surgical Outcomes & Quality Improvement Center, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Karl Y Bilimoria
- Surgical Outcomes & Quality Improvement Center, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Julie K Johnson
- Surgical Outcomes & Quality Improvement Center, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Yue-Yung Hu
- Surgical Outcomes & Quality Improvement Center, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois
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Braun-Inglis C, Williams EL, Macchiaroli A, Denicoff A, Gerber DE. Better Late Than Never: Fully Incorporating Oncology Advanced Practice Providers Into Cancer Clinical Trials. JCO Oncol Pract 2022; 18:729-732. [PMID: 35960907 PMCID: PMC9653202 DOI: 10.1200/op.22.00224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/01/2022] [Accepted: 07/12/2022] [Indexed: 01/05/2023] Open
Affiliation(s)
- Christa Braun-Inglis
- University of Hawaii School of Nursing and Dental Hygiene and University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Erin L. Williams
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Alyssa Macchiaroli
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Andrea Denicoff
- Clinical Investigations Branch, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD
| | - David E. Gerber
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
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Hidden Costs in Resident Training: Financial Cohort Analysis of First Assistants in Reduction Mammaplasty. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3333. [PMID: 33564574 PMCID: PMC7859249 DOI: 10.1097/gox.0000000000003333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/28/2020] [Indexed: 11/06/2022]
Abstract
Graduate medical education (GME) programs are vital to developing future plastic surgeons. However, their cost-efficiency has yet to be contextualized. This cohort quality improvement (QI) project aimed to measure the indirect costs an institution assumes in training surgical residents, by comparing the differences in operative time and procedural charges between a resident and a physician assistant (PA) first-assisting during adolescent reduction mammaplasty.
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Lack A, Saddik M, Engels P, Lethbridge S, Nenshi R. The emergence of the physician assistant role in a Canadian acute care surgery setting. Can J Surg 2020. [PMID: 33026310 DOI: 10.1503/cjs.002119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The role of physician assistants (PAs) in surgical care in Canada is expanding. Similarly, the acute care surgery (ACS) model continues to evolve, and PAs are increasingly being considered as members of ACS teams. However, their exact impact and contribution has not been well studied. Our study describes the contribution of a PA who worked full time on weekdays on an ACS team in a Canadian academic tertiary hospital. METHODS To quantify the PA's contributions, an ACS database was created in September 2016. Data on the number of ACS patient encounters, the number of ACS surgical consults, the number of ACS admissions, the PA's involvement in the operating room, the number of PA patient encounters and the number of multidisciplinary meetings were prospectively collected. We report data for 365 consecutive days from Dec. 30, 2016, to Dec. 29, 2017. RESULTS The ACS team had 11 651 patient encounters during the year, with a mean of 31.92 per day. The mean number of surgical consults per day was 5.89, and a mean of 2.08 surgical procedures were performed per day. The PA was involved in 53.5% of all patient encounters, despite working only during daytime hours on weekdays. Multidisciplinary meetings were conducted by the PA 94.9% of the time. Alternate level of care patients were seen by the PA 96.2% of the time. The PA was directly involved in 2.0% of the operating room procedures during the study period. CONCLUSION Integrating a PA on an ACS team adds value to patient care by providing consistency and efficient management of ward issues and patient care plans, including multidisciplinary discharge planning, timely emergency department consultations and effective organization of the ACS team members.
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Affiliation(s)
- Andrea Lack
- From Halton Healthcare, Oakville, Ont. (Lack); the Department of Surgery, McMaster University, Hamilton, Ont. (Saddik, Engels, Lethbridge, Nenshi); the Department of Surgery, Hamilton General Hospital, Hamilton, Ont. (Engels); and the Department of Surgery, St. Joseph's Healthcare Hamilton, Hamilton, Ont. (Nenshi)
| | - Maisa Saddik
- From Halton Healthcare, Oakville, Ont. (Lack); the Department of Surgery, McMaster University, Hamilton, Ont. (Saddik, Engels, Lethbridge, Nenshi); the Department of Surgery, Hamilton General Hospital, Hamilton, Ont. (Engels); and the Department of Surgery, St. Joseph's Healthcare Hamilton, Hamilton, Ont. (Nenshi)
| | - Paul Engels
- From Halton Healthcare, Oakville, Ont. (Lack); the Department of Surgery, McMaster University, Hamilton, Ont. (Saddik, Engels, Lethbridge, Nenshi); the Department of Surgery, Hamilton General Hospital, Hamilton, Ont. (Engels); and the Department of Surgery, St. Joseph's Healthcare Hamilton, Hamilton, Ont. (Nenshi)
| | - Sara Lethbridge
- From Halton Healthcare, Oakville, Ont. (Lack); the Department of Surgery, McMaster University, Hamilton, Ont. (Saddik, Engels, Lethbridge, Nenshi); the Department of Surgery, Hamilton General Hospital, Hamilton, Ont. (Engels); and the Department of Surgery, St. Joseph's Healthcare Hamilton, Hamilton, Ont. (Nenshi)
| | - Rahima Nenshi
- From Halton Healthcare, Oakville, Ont. (Lack); the Department of Surgery, McMaster University, Hamilton, Ont. (Saddik, Engels, Lethbridge, Nenshi); the Department of Surgery, Hamilton General Hospital, Hamilton, Ont. (Engels); and the Department of Surgery, St. Joseph's Healthcare Hamilton, Hamilton, Ont. (Nenshi)
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Beaulieu-Jones BR, Croitoru DP, Baertschiger RM. Advanced providers in pediatric surgery: Evaluation of role and perceived impact. J Pediatr Surg 2020; 55:583-589. [PMID: 31351706 DOI: 10.1016/j.jpedsurg.2019.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/29/2019] [Accepted: 07/07/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The shortage of medical doctors in certain geographies and certain disciplines, resident work hour limitations and the demonstrated positive impact of advanced providers (nurse practitioners, physician assistants and clinical nurse specialists) on the quality and efficiency of care in numerous specialties have led to broader integration of advanced providers in healthcare organizations. With regard to pediatric surgery, some tertiary centers have successfully implemented 24/7 nurse practitioner coverage for their inpatient services. However, pediatric surgery practices vary throughout North America and the broader presence and function of advanced providers among all practice types and settings has not been characterized previously. The purpose of this survey is to conduct a descriptive evaluation of current pediatric surgical practices in North America with regard to advanced provider coverage and their perceived impact on care delivery and patient satisfaction. METHODS A 14-item online survey, approved by the American Pediatric Surgical Association (APSA) Outcomes and Evidence-Based Practice Committee, was distributed to all full APSA members (N = 1189, opening rate of 56%), representing the vast majority of pediatric surgeons in North America. The survey investigated the practice characteristics of the responding surgeon, the presence and role of advanced providers in their practice and their perceived impact on patient care. Descriptive statistics were performed to characterize the function of advanced providers in pediatric surgery practices. Further analysis was performed to assess for geographic differences in staffing practices using United States Census Divisions. RESULTS A total of 266 pediatric surgeons completed the survey (response rate 22% and 40% considering "email send out" and "email opening" rates respectively), with 47.6% employed at free standing children's hospitals and 41.1% employed at a children's hospital within an adult hospital. Nearly all respondents (N = 244, 91.7%) reported the presence of advanced providers in their practice with nurse practitioners (N = 216) and physician assistants (N = 101) most commonly represented. The majority of advanced providers (N = 189, 77.8%) covered both general surgery and trauma patients. Advanced providers worked nearly equally in the outpatient (N = 219, 89.8%) and inpatient setting (N = 232, 95.1%), though less often in the neonatal (N = 131) or pediatric (N = 126) intensive care unit. Fifteen percent of surgeons (N = 40) reported that advanced providers provided 24/7 coverage within their surgical practice. Surgeons reported that advanced providers had a very positive (75%) or positive (21%) impact on their clinical practice, with none reporting a negative impact. Surgeons also reported that advanced providers had a very positive (74%) or positive (21%) impact on perceived patient satisfaction. The main area in which surgeons reported the most significant impact of associate providers was continuity of care (N = 77), efficiency of service (N = 66) and education of parents and patients (N = 53). CONCLUSION Pediatric surgical practices of all types are broadly utilizing advanced providers. Surgeons report that the integration of advanced providers across inpatient and outpatient settings has positively impacted care, advancing both continuity of care and efficiency of service. Advanced providers likely represent part of the solution to delivering quality care in current delivery systems. STUDY TYPE Prospective Study/ Survey LEVEL OF EVIDENCE: IV.
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Affiliation(s)
| | - Daniel P Croitoru
- Dartmouth Hitchcock Medical Center, Pediatric Surgery, Department of Surgery, Lebanon, NH
| | - Reto M Baertschiger
- Dartmouth Hitchcock Medical Center, Pediatric Surgery, Department of Surgery, Lebanon, NH.
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Trends in resident operative trauma: How to train future trauma surgeons? Am J Surg 2019; 218:1156-1161. [DOI: 10.1016/j.amjsurg.2019.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/07/2019] [Accepted: 09/10/2019] [Indexed: 11/23/2022]
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Cortez AR, Winer LK, Kassam AF, Hanseman DJ, Kuethe JW, Quillin RC, Potts JR. See None, Do Some, Teach None: An Analysis of the Contemporary Operative Experience as Nonprimary Surgeon. JOURNAL OF SURGICAL EDUCATION 2019; 76:e92-e101. [PMID: 31130507 DOI: 10.1016/j.jsurg.2019.05.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/08/2019] [Accepted: 05/13/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The operative experience of today's general surgery resident has changed, but little is known about the modern experience as nonprimary surgeon. We set out to explore changes in the operative experience of general surgery residents as first assistant (FA) and teaching assistant (TA). DESIGN, SETTING, AND PARTICIPANTS This is a review of ACGME national operative log reports from 1990 to 2018. TA and FA cases were analyzed. Statistical analysis was performed using polynomial regression analysis and Kruskal-Wallis test. Statistical significance was set at p < 0.05. RESULTS 30,260 individuals completed general surgery residency during the study period with medians of 951 (interquartile range: 929-974) total major, 63 (31-184) FA, and 32 (25-48) TA cases. As a proportion of total cases completed, FA cases decreased from 21.8% of the total operative experience in 1990 to 2.5% in 2018, and TA cases declined from 7.4% of the total operative experience in 1990 to 3.5% in 2018. Regression modeling demonstrated that both operative roles decreased over time, but at a progressively decreasing rate, with FA cases reaching a "floor" around 2010 and TA cases reaching a "breakpoint" in 2008 at which time operative volume rebounded and began to increase. Among the core general surgery domains of abdomen and alimentary tract, compositional analysis revealed a decrease across each of the 11 operative subcategories (all p < 0.05) for FA, and for TA, a decrease in 6 of the 11 operative subcategories (stomach, small intestine, large intestine, anorectal, hernia, and biliary, all p < 0.05). CONCLUSIONS Over the past 3 decades, the resident operative experience as nonprimary surgeon has decreased dramatically, with today's residents graduating with fewer FA and TA cases. As surgical training has traditionally relied heavily on an apprenticeship model for learning technical skills, it is essential that surgical educators recognize and rectify these trends.
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Affiliation(s)
- Alexander R Cortez
- Cincinnati Research on Education in Surgical Training (CREST), Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
| | - Leah K Winer
- Cincinnati Research on Education in Surgical Training (CREST), Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Al-Faraaz Kassam
- Cincinnati Research on Education in Surgical Training (CREST), Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Dennis J Hanseman
- Cincinnati Research on Education in Surgical Training (CREST), Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Joshua W Kuethe
- Cincinnati Research on Education in Surgical Training (CREST), Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Ralph Cutler Quillin
- Cincinnati Research on Education in Surgical Training (CREST), Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - John R Potts
- Accreditation Council for Graduate Medical Education, Chicago, Illinois
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Blitzer D, Stephens EH, Tchantchaleishvili V, Lou X, Chen P, Pattakos G, Vardas PN. Risks and Rewards of Advanced Practice Providers in Cardiothoracic Surgery Training: National Survey. Ann Thorac Surg 2018; 107:597-602. [PMID: 30312614 DOI: 10.1016/j.athoracsur.2018.08.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 07/12/2018] [Accepted: 08/20/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Changes in healthcare have led to increasing use of advanced practice providers (APPs), but their role in cardiothoracic surgery (CTS) education remains undefined. This study aimed to analyze the extent of APP use on the CTS team, their role within the hierarchy of clinical care, and the impact of physician extenders on CTS training from the resident perspective. METHODS CTS residents' responses to the 2017 Thoracic Surgery Residents Association/Thoracic Surgery Directors Association In-Service Training Examination survey regarding the role of APPs in specific clinical scenarios and perception of APP contribution to residents' educational environment were analyzed. Statistical analysis of categorical variables was performed in SPSS (version 22.0; IBM, Chicago, IL) using a Fisher's exact test and Pearson χ2 test with statistical significance set at p < 0.05. RESULTS Response rate was 82.1% (280/341). The median number of employed APPs was 16 to 20, and 50.4% (n = 141) reported 11 to 25 physician extenders at their institution. The median numbers of APPs in the operating room, floor, and intensive care unit were three, three, and two, respectively. Overall impression of APPs was positive in 87.5% (n = 245) of respondents, with 47.7% (n = 133) "very positive" and 40.1% "positive" (n = 112). In general, residents reported greater resident involvement in postoperative issues and operative consults and greater APP involvement in floor issues; 72.5% of residents had not missed a surgical opportunity due to APPs, whereas 9.6% missed an opportunity due to APPs despite being at an appropriate level of training. Of those that reported missed opportunities 44% were integrated thoracic surgery residents. There were no significant differences in APPs' operative role based on resident seniority. CONCLUSIONS The overall impression of APPs among CTS residents was favorable, and they are more commonly involved in assisting on the floor or the operating room. Occasionally residents reported missing a surgical opportunity due to APPs. There is further opportunity to optimize and standardize their role within programs to improve clinical outcomes and enhance the CTS educational experience for residents.
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Affiliation(s)
- David Blitzer
- Division of Thoracic and Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Elizabeth H Stephens
- Division of Cardiac, Thoracic & Vascular Surgery, Columbia University, New York, New York
| | | | - Xiaoying Lou
- Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia
| | - Peter Chen
- Department of Cardiothoracic Surgery, Baylor College of Medicine, Texas Heart Institute, Houston, Texas
| | - Greg Pattakos
- Department of Cardiothoracic Surgery, Baylor College of Medicine, Texas Heart Institute, Houston, Texas
| | - Panos N Vardas
- Division of Thoracic and Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
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