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Halpern AI, Klein M, McSweeney B, Tran HV, Ganguli S, Haney V, Noureldine SI, Vaziri K, Jackson HT, Lee J. Trends in minimally invasive and open inguinal hernia repair: an analysis of ACGME general surgery case logs. Surg Endosc 2024:10.1007/s00464-024-10805-y. [PMID: 38632119 DOI: 10.1007/s00464-024-10805-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 03/21/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Groin hernia repair is one of the most commonly performed surgical procedures and is often performed by surgical interns and junior residents. While traditionally performed open, minimally invasive (MIS) groin hernia repair has become an increasingly popular approach. The purpose of this study was to determine the trends in MIS and open inguinal and femoral hernia repair in general surgery residency training over the past two decades. METHODS Accreditation Council for Graduate Medical Education (ACGME) national case log data of general surgery residents from 1999 through 2022 were reviewed. We collected means and standard deviations of open and MIS inguinal and femoral hernia repairs. Linear regression and ANOVA were used to identify trends in the average annual number of open and MIS hernia repairs logged by residents. Cases were distinguished between level of resident trainees: surgeon-chief (SC) and surgeon-junior (SJ). RESULTS From July 1999 to June 2022, the average annual MIS inguinal and femoral hernia repairs logged by general surgery residents significantly increased, from 7.6 to 47.9 cases (p < 0.001), and the average annual open inguinal and femoral hernia repairs logged by general surgery residents significantly decreased, from 51.9 to 39.7 cases (p < 0.001). SJ resident results were consistent with this overall trend. For SC residents, the volume of both MIS and open hernia repairs significantly increased (p < 0.001). CONCLUSIONS ACGME case log data indicates a trend of general surgery residents logging overall fewer numbers of open inguinal and femoral hernia repairs, and a larger proportion of open repairs by chief residents. This trend warrants attention and further study as it may represent a skill or knowledge gap with significant impact of surgical training.
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Affiliation(s)
- Alex I Halpern
- Department of Surgery, George Washington University School of Medicine & Health Sciences, 2150 Pennsylvania Ave NW, Suite 6B, Washington, DC, 20037, USA.
| | - Margaret Klein
- Department of Surgery, George Washington University School of Medicine & Health Sciences, 2150 Pennsylvania Ave NW, Suite 6B, Washington, DC, 20037, USA
| | - Benjamin McSweeney
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Hoang-Viet Tran
- Department of Surgery, George Washington University School of Medicine & Health Sciences, 2150 Pennsylvania Ave NW, Suite 6B, Washington, DC, 20037, USA
| | - Sangrag Ganguli
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Victoria Haney
- Department of Surgery, George Washington University School of Medicine & Health Sciences, 2150 Pennsylvania Ave NW, Suite 6B, Washington, DC, 20037, USA
| | - Salem I Noureldine
- Department of Surgery, George Washington University School of Medicine & Health Sciences, 2150 Pennsylvania Ave NW, Suite 6B, Washington, DC, 20037, USA
| | - Khashayar Vaziri
- Department of Surgery, George Washington University School of Medicine & Health Sciences, 2150 Pennsylvania Ave NW, Suite 6B, Washington, DC, 20037, USA
| | - Hope T Jackson
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Juliet Lee
- Department of Surgery, George Washington University School of Medicine & Health Sciences, 2150 Pennsylvania Ave NW, Suite 6B, Washington, DC, 20037, USA
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Campbell A, Alslaim H, Duson S, Rowe VL. Educating Trainees to Treat Peripheral Arterial Disease: Challenges and Opportunities. Ann Vasc Surg 2024:S0890-5096(24)00150-X. [PMID: 38582208 DOI: 10.1016/j.avsg.2023.12.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 04/08/2024]
Abstract
Educating trainees to treat Peripheral Artery Disease (PAD) carries specific contemporary challenges. The national increase of the prevalence of PAD combined with a significant shortage of vascular surgeons creates a need for concern for future management of this complex disease. Over the past 2 decades, traditional (5 + 2) and integrated (0 + 5) paradigms have fostered trainee annual growth and comparable case distribution and volumes in endovascular and open surgical treatment options have been maintained. Close evaluation into not only the absolute numbers of surgical cases, but the level of trainee involvement in each logged case is recommended. Future implementation of the Entrustable Professional Activity (EPA) modules will hopefully assist in ensuring linear development of surgical skill and judgment. Additionally, advances in individual and systems level techniques to enhance skill acquisition in the form of "off-the job training" and simulation-based training may provide an enhancement to traditional technical training methods. Finally, the possibility and role of artificial intelligence in vascular surgery skill training must not be ignored, but carefully explored and utilized to modernize cognitive and technical skill preparation for trainees in the and delivery of care for PAD patients. Overall, the training residents for the treatment of PAD patients will be associated with new challenges that vascular surgery must embrace and surmount to advance our specialty.
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Affiliation(s)
- Anthony Campbell
- Department of General Surgery, Medical College of Georgia, Augusta, GA
| | - Hossam Alslaim
- Department of Vascular Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Sira Duson
- University of Tennessee Health Science Center, Memphis, TN
| | - Vincent L Rowe
- Division of Vascular and Endovascular Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.
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O'Shea AW, Sweitzer KR, Bell DE. Comparing Graduating Plastic Surgery Residents' Case Logs With Accreditation Council for Graduate Medical Education Requirements, Content at National Meetings, and In-Service Examination Test Items. Ann Plast Surg 2024; 92:S267-S270. [PMID: 38556687 DOI: 10.1097/sap.0000000000003873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
BACKGROUND The importance of adaptable and up-to-date plastic surgery graduate medical education (GME) has taken on new meaning amidst accelerating surgical innovation and increasing calls for competency-based training standards. We aimed to examine the extent to which the procedures plastic surgery residents perform, as represented in case log data, align with 2 core standardized components of plastic surgery GME: ACGME (Accreditation Council for Graduate Medical Education) minimum procedure count requirements and the PSITE (Plastic Surgery In-Service Training Examination). We also examined their alignment with procedural representation at 2 major plastic surgery meetings. METHODS Nine categories of reconstructive and aesthetic procedures were identified. Three-year averages for the number of procedures completed in each category by residents graduating in 2019-2021 were calculated from ACGME national case log data reports. The ACGME procedure count minimum requirements were also ascertained. The titles and durations of medical programming sessions scheduled for Plastic Surgery The Meeting (PSTM) 2022 and the Plastic Surgery Research Council (PSRC) Annual Meeting 2022 were retrieved from online data. Finally, test items from the 2020 to 2022 administrations of the PSITE were retrieved. Conference sessions and test items were assigned to a single procedure category when possible. Percent differences were calculated for comparison. RESULTS The distribution of procedures on plastic surgery resident case logs differs from those of the major mechanisms of standardization in plastic surgery GME, in-service examination content more so than ACGME requirements. Meeting content at PSTM and PSRC had the largest percent differences with case log data, with PSTM being skewed toward aesthetics and PSRC toward reconstructive head and neck surgery. DISCUSSION The criteria and standards by which plastic surgery residents are evaluated and content at national meetings differ from the procedures they actually complete during their training. Although largely reflecting heterogeneity of the specialty, following these comparisons will likely prove useful in the continual evaluation of plastic surgery residency training, especially in the preparation of residents for the variety of training and practice settings they pursue.
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Affiliation(s)
| | - Keith R Sweitzer
- Division of Plastic Surgery, Department of Surgery, University of Rochester, Rochester, NY
| | - Derek E Bell
- Division of Plastic Surgery, Department of Surgery, University of Rochester, Rochester, NY
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Morrisey Z, Carroll T, Castle P, Botros M, Wilbur D. Trends in orthopaedic surgery resident case volume and the impact of COVID-19 on resident education. J Orthop 2024; 47:50-57. [PMID: 38022839 PMCID: PMC10679526 DOI: 10.1016/j.jor.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 11/10/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction COVID-19 had numerous objective and subjective effects on resident physician education. We intended to examine objective changes in orthopedic education that occurred during the COVID pandemic and other trends from 2018 to 2022 by analyzing surgical case logs from Accreditation Counsel for Graduate Medical Education (ACGME) approved American orthopedics programs. We hypothesized that surgical case load during the COVID pandemic would remain similar to pre-pandemic levels and case logs would show a general upward trend. Methods We analyzed 3146 resident case-logs from the ACGME national case-log report from academic years (AY) 2018-2022. Surgical cases were classified by their Current Procedural Terminology (CPT) codes and grouped by anatomical location (shoulder, hand, etc.). Results From AY 18-19 to "peak pandemic" AY 19-20, resident caseloads either had no change or increased in every orthopedic discipline with few exceptions. Residents performed fewer shoulder (p < 0.0001), wrist (p = 0.0023), knee (p < 0.0001) and leg/ankle (p = .0019) arthroscopies in AY 19-20 than AY 18-19. Hip arthroscopy was notably unchanged. Oncology, Spine, and Foot/Toes did not see any change from AY 18-19 to 21-22 while Microsurgeries decreased (p = .0061). There were substantial differences between high volume (90th percentile) residents, and low volume (10th percentile) residents. All other anatomic areas saw significant increases in caseload over those four academic years. Discussion/conclusion COVID had numerous effects on the orthopedic residency experience, however, any decreases in operative load were small, and largely isolated to the 19-20 AY. Microscopic and arthroscopic surgeries decreased during peak pandemic AY 19-20 when elective surgeries experienced cancellations. This illustrates that these areas of orthopedic education may be supplemented outside of the operating room if similar circumstances arise in the future. Otherwise, resident surgical caseloads continue to rise and show no signs of slowing.
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Affiliation(s)
- Zachary Morrisey
- University of Rochester School of Medicine, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Thomas Carroll
- University of Rochester Department of Orthopaedics and Physical Performance, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Patrick Castle
- University of Rochester Department of Orthopaedics and Physical Performance, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Mina Botros
- University of Rochester Department of Orthopaedics and Physical Performance, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Danielle Wilbur
- University of Rochester Department of Orthopaedics and Physical Performance, 601 Elmwood Ave, Rochester, NY, 14642, USA
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Silvestre J, Ahn J, Mehta S, Harris MB. Impact of the SARS-CoV-2 outbreak on ACGME-accredited orthopaedic trauma fellowship training. Injury 2023; 54:111137. [PMID: 37919113 DOI: 10.1016/j.injury.2023.111137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/07/2023] [Accepted: 10/14/2023] [Indexed: 11/04/2023]
Abstract
INTRODUCTION The SARS-CoV-2 viral outbreak created unprecedented challenges in surgical education. Yet, its impact on reported case volume during orthopaedic trauma fellowship training remains poorly understood. We hypothesized that cases performed during orthopaedic trauma fellowship training would decrease by 8 %-17 % during the 2019-2020 academic year corresponding to the 1-2 month moratorium of non-essential cases during the initial SARS-CoV-2 outbreak in the United States. METHODS We designed a retrospective cohort study of orthopaedic trauma fellows at Accreditation Council for Graduate Medical Education (ACGME)-accredited training programs (2018-2019 to 2021-2022). Mean case volumes were compared by case category across academic years. RESULTS There was a -13 % year-over-year decrease in reported case volume during the 2019-2020 academic year (505 ± 126 vs 441 ± 94, P = 0.079, Fig. 1). Case categories with the greatest percentage declines were Treatment of Nonunion / Malunion (-31 %), Fasciotomy (-25 %), External Fixation (-21 %), Forearm / Wrist (-21 %), and Intra-articular Distal Humerus Fracture (-17 %). There was a 7 % year-over-year increase in case volume during the subsequent 2020-2021 academic year with near universal increases in case volume across case categories. CONCLUSION There was a 13 % decrease in orthopaedic trauma case volume during the 2019-2020 academic year, corresponding to the SARS-CoV-2 outbreak. Certain trauma case categories experienced the greatest negative impact, which subsequently recovered during the next academic year. These results may help inform accrediting bodies and surgical educators on the impact of future viral outbreaks on orthopaedic trauma fellowship training.
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Affiliation(s)
- Jason Silvestre
- Medical University of South Carolina, Charleston, SC, United States.
| | - Jaimo Ahn
- University of Michigan Medical School, Ann Arbor, MI, United States
| | - Samir Mehta
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
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Sherman NC, Haddad DJ, Bridge NW, Feldman MD. Orthopedic surgery residents reported increased shoulder procedure volumes during the COVID-19 pandemic. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:524-528. [PMID: 37928993 PMCID: PMC10624997 DOI: 10.1016/j.xrrt.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Background The purpose of this study is to evaluate the impact of the COVID-19 pandemic on shoulder procedure volumes reported to the Accreditation Council for Graduate Medical Education by orthopedic surgery residents. Methods We performed a retrospective review of Accreditation Council for Graduate Medical Education case logs reporting data from graduating orthopedic surgery residents during the academic years of 2006-2022. Data were queried for all patients for the following shoulder Current Procedural Terminology codes: incision, excision, intro or removal, repair/revision/reconstruction, fracture and/or dislocation, manipulation, arthroscopy, trauma, and total procedures performed. Individual t-tests were used to compare case log trends of graduating academic years before (classes of 2018 and 2019) and during (classes of 2020, 2021, and 2022) the COVID-19 pandemic. Statistical significance was established to be P <.05 for total procedure types, but at P <.005 during category comparisons to protect against alpha errors. Results Reported mean total shoulder procedures per resident steadily increased each year from 2017 to 2022, but the only significant increase was seen when comparing the graduating classes of 2020 to 2021 (157.9 vs. 165.7, P =.02). Stratification of these procedures by subgroup revealed a significant increase in manipulation procedures from 2021 to 2022 (7.3 vs. 8.8, P =.001). Discussion/Conclusion COVID-19 did not have a negative impact on logged shoulder procedure volume. Orthopedic surgery residents graduating during the COVID-19 pandemic reported more shoulder procedures than those graduating prepandemic. However, shoulder procedure log trends should be longitudinally investigated, as preceding years of procedural opportunities may underestimate the pandemic's impact.
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Affiliation(s)
- Nathan C. Sherman
- Department of Orthopaedic Surgery, The University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
| | - David J. Haddad
- Department of Orthopaedic Surgery, The University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
| | - Nathaniel W. Bridge
- Department of Orthopaedic Surgery, John Peter Smith Hospital, Fort Worth, TX, USA
| | - Michael D. Feldman
- Department of Orthopaedic Surgery, The University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
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Toale C, O'Byrne A, Morris M, Kavanagh DO. Characterizing individual trainee learning curves in surgical training: Challenges and opportunities. Surgeon 2023; 21:285-288. [PMID: 36446700 DOI: 10.1016/j.surge.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/09/2022] [Indexed: 11/27/2022]
Abstract
The surgical learning curve is an observable and measurable phenomenon. In the era of competency-based approaches to surgical training, monitoring the trajectory of individual trainee competence attainment could represent a meaningful method of formative and summative assessment. While technology can assist this approach, a number of significant barriers to the implementation of such assessment methods remain, including: accurate data collection, standard setting, and reliable assessment. Translating individual learning curve data into quantifiable case minimum targets in training poses further difficulties, and may not be possible for all procedures, particularly those that are less frequently performed and assessed. In spite of these challenges, significant benefits could be realized through an individualized approach to competency assessment using trainee learning curve data. Tracking competence acquisition against criterion-referenced standards could allow for targeted training and remediation, conforming with modern theories of adult education and empowering trainees to take control of their own learning. Learning curve data could also be used to assess the effects of educational interventions such as simulation-based training on subsequent competence acquisition rates. Ultimately, the individual learning curves of trainees could be used to inform personalised decisions regarding entrustment, credentialing, and certification, allowing training programmes to move beyond minimum operative experience targets as a crude proxy measure of competence.
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Affiliation(s)
- C Toale
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Ireland.
| | - A O'Byrne
- School of Medicine, Trinity College Dublin, The University of Dublin, Ireland; Department of Surgery, Tallaght University Hospital, Dublin, Ireland
| | - M Morris
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Ireland
| | - D O Kavanagh
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Ireland; Department of Surgery, Tallaght University Hospital, Dublin, Ireland
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Eurboonyanun C, Aphinives P, Wittayapairoch J, Eurboonyanun K, Srisuk T, Punchai S, Ruangwannasak S, Jenwitheesuk K, Petrusa E, Gee D, Phitayakorn R. Trend of minimally invasive and open surgery experience of general surgery residents: Accreditation Council for Graduate Medical Education general surgery case log in Thailand. JOURNAL OF MINIMALLY INVASIVE SURGERY 2023; 26:121-127. [PMID: 37712311 PMCID: PMC10505362 DOI: 10.7602/jmis.2023.26.3.121] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/17/2023] [Accepted: 09/06/2023] [Indexed: 09/16/2023]
Abstract
Purpose Minimally invasive surgery (MIS) offers patients several benefits, such as smaller incisions, and fast recovery times. General surgery residents should be trained in both open and MIS. We aimed to examine the trends of minimally invasive and open procedures performed by general surgery residents in Thailand. Methods A retrospective review of the Royal College of Surgeons of Thailand and Accreditation Council for Graduate Medical Education general surgery case logs from 2007 to 2018 was performed for common open and laparoscopic general surgery operations. The data were grouped by three time periods, which were 2007-2010, 2011-2014, and 2015-2018, and analyzed to explore changes in the operative trends. Results For Thai residents, the mean number of laparoscopic operations per person per year increased from 5.97 to 9.36 (56.78% increase) and open increased from 20.02 to 27.16 (35.67% increase). There was a significant increase in the average number of minimally invasive procedures performed among cholecystectomy (5.83, 6.57, 8.10; p < 0.001) and inguinal hernia repair (0.33, 0.35, 0.66; p < 0.001). Compared to general surgery residents in the United States, Thai residents had more experience with open appendectomy, but significantly less experience with all other operations/procedures. Conclusion The number of open and minimally invasive procedures performed or assisted by Thai general surgery residents has slowly increased, but generally lags behind residents in the United States. The Thai education program must be updated to improve residents' technical skills in open and laparoscopic surgery to remain competitive with their global partners.
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Affiliation(s)
- Chalerm Eurboonyanun
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Department of Surgery, The Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Potchavit Aphinives
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Kulyada Eurboonyanun
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Tharatip Srisuk
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Suriya Punchai
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Somchai Ruangwannasak
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Emil Petrusa
- Department of Surgery, The Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Denise Gee
- Department of Surgery, The Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Roy Phitayakorn
- Department of Surgery, The Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Silvestre J, Nelson CL, Kalyanam J, Wilson RH, Thompson TL. Variability in procedure volume of physical medicine and rehabilitation residents graduating from 2014 to 2021. PM R 2023; 15:990-998. [PMID: 36181706 DOI: 10.1002/pmrj.12885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/28/2022] [Accepted: 07/26/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Adequate exposure to commonly performed procedures during physical medicine and rehabilitation (PM&R) residency is an important issue. OBJECTIVE To assess temporal trends and variabilities in reported procedural volumes, including the number of residents achieving procedure minimum requirements as established by the Accredited Council for Graduate Medical Education (ACGME) PM&R Residency Review Committee. DESIGN This was a retrospective cohort study of PM&R residents graduating from 2013-2014 to 2020-2021. Descriptive statistics were calculated for tracked procedures and compared over time with analysis of variance (ANOVA) tests. Variability was calculated as the procedure volume difference between the 90th and 10th percentile groups. SETTING ACGME-accredited PM&R residency training programs. PARTICIPANTS A total of 3231 PM&R residents graduating from 2014 to 2021. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Reported procedure volume and number of residents achieving minimum requirements. RESULTS Total procedure volume increased over the study period (436 ± 225 to 523 ± 238, p = .013). The percentage of all procedures that were performed versus observed was stable over the study period (81%-77%, p = .234). Variability in total reported procedure volume remained stable over the study period. The percentage of PM&R residents not achieving minimum requirements ranged from 2% for peripheral joint injections to 22% for ultrasound in the contemporary training period. CONCLUSIONS The volume of reported procedures has increased along with the number of PM&R residency programs and residents. Variabilities in total reported procedure volume were stable over time, but PM&R residents struggle to obtain minimum requirements for ultrasound procedures.
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Affiliation(s)
- Jason Silvestre
- Orthopaedic Surgery and Rehabilitation, Howard University Hospital, Washington, Columbia, USA
| | - Charles L Nelson
- Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Janaki Kalyanam
- Orthopaedic Surgery and Rehabilitation, Howard University Hospital, Washington, Columbia, USA
| | - Robert H Wilson
- Orthopaedic Surgery and Rehabilitation, Howard University Hospital, Washington, Columbia, USA
| | - Terry L Thompson
- Orthopaedic Surgery and Rehabilitation, Howard University Hospital, Washington, Columbia, USA
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Sisak S, Salyer CE, Cortez AR, Vaysburg DM, Quillin RC, Van Haren RM. Experience of surgical subspecialty residents on general surgery rotations. Am J Surg 2023; 225:673-678. [PMID: 36336482 DOI: 10.1016/j.amjsurg.2022.10.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/21/2022] [Accepted: 10/17/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Surgical subspecialty residents complete 5-6 years of training which includes general surgery rotations. A lack of data exists evaluating these rotations. This study aims to identify discrepancies in subspecialty training and improve the quality of surgical education. METHODS Case logs for surgical subspecialty residents and general surgery residents at our institution were analyzed and queried for cases performed on general surgery rotations. A survey was distributed to subspecialty residents regarding their perceptions of these rotations. RESULTS 50 residents were included in the study and the majority were male (n = 27, 54%). Subspecialty residents perform fewer cases per month compared to general surgery residents (13 vs 21, p < 0.001). 75% of subspecialty residents were satisfied with their experience on general surgery rotations. CONCLUSIONS Subspecialty residents perform fewer operations on general surgery rotations. Despite this, most are satisfied with off-service rotations and believe they are an important part of their education.
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Affiliation(s)
- Stephanie Sisak
- Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Department of Surgery, 231 Albert Sabin Way, Cincinnati, OH, 45267-0558, USA
| | - Christen E Salyer
- Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Department of Surgery, 231 Albert Sabin Way, Cincinnati, OH, 45267-0558, USA
| | - Alexander R Cortez
- Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Department of Surgery, 231 Albert Sabin Way, Cincinnati, OH, 45267-0558, USA
| | - Dennis M Vaysburg
- Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Department of Surgery, 231 Albert Sabin Way, Cincinnati, OH, 45267-0558, USA
| | - R Cutler Quillin
- Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Department of Surgery, 231 Albert Sabin Way, Cincinnati, OH, 45267-0558, USA
| | - Robert M Van Haren
- Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Department of Surgery, 231 Albert Sabin Way, Cincinnati, OH, 45267-0558, USA.
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Beaulieu-Jones BR, de Geus SWL, Rasic G, Woods AP, Papageorge MV, Sachs TE. COVID-19 Did Not Stop the Rising Tide: Trends in Case Volume Logged by Surgical Residents. JOURNAL OF SURGICAL EDUCATION 2023; 80:499-510. [PMID: 36528544 PMCID: PMC9682049 DOI: 10.1016/j.jsurg.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION The coronavirus pandemic has profoundly impacted all facets of surgical care, including surgical residency training. The objective of this study was to assess the operative experience and overall case volume of surgery residents before and during the pandemic. METHODS Using data from the Accreditation Council for Graduate Medical Education annual operative log reports, operative volume for 2015 to 2021 graduates of Accreditation Council for Graduate Medical Education -accredited general, orthopedic, neuro- and plastic surgery residency programs was analyzed using nonparametric Kendall-tau correlation analysis. The period before the pandemic was defined as AY14-15 to AY18-19, and the pandemic period was defined as AY19-20 to AY20-21. RESULTS Operative data for 8556 general, 5113 orthopedic, 736 plastic, and 1278 neurosurgery residency graduates were included. Between 2015 and 2021, total case volume increased significantly for general surgery graduates (Kendall's tau-b: 0.905, p = 0.007), orthopedic surgery graduates (Kendall's tau-b: 1.000, p = 0.003), neurosurgery graduates (Kendall's tau-b: 0.905, p = 0.007), and plastic surgery graduates (Kendall's tau-b: 0.810, p = 0.016). Across all specialties, the mean total number of cases performed by residents graduating during the pandemic was higher than among residents graduating before the pandemic, though no formal significance testing was performed. Among general surgery residents, the number of cases performed as surgeon chief among residents graduating in AY19-20 decreased for the first time in 5 years, though the overall volume remained higher than the prior year, and returned to prepandemic trends in AY20-21. CONCLUSIONS Over the past 7 years, the case volume of surgical residents steadily increased. Surgical trainees who graduated during the coronavirus pandemic have equal or greater total operative experience compared to trainees who graduated prior to the pandemic.
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Affiliation(s)
- Brendin R Beaulieu-Jones
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Susanna W L de Geus
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Gordana Rasic
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Alison P Woods
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marianna V Papageorge
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Teviah E Sachs
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.
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Silvestre J, Wu HH, Thompson TL, Kang JD. Utility of Spine Surgery Fellowship Training for Orthopaedic Surgeons in the United States. J Am Acad Orthop Surg 2023; 31:335-340. [PMID: 36729747 DOI: 10.5435/jaaos-d-22-00788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 10/21/2022] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Orthopaedic spine surgeons gain surgical experience through cases conducted during residency and fellowship training. This study elucidates the incremental benefit in spine surgery volume from orthopaedic spine surgery fellowship training. METHODS This was a retrospective national cohort study of orthopaedic surgery residents and orthopaedic spine surgery fellows graduating from US Accreditation Council for Graduate Medical Education-accredited training programs during the 2017 to 2020 academic years. Comparisons in spine surgery case volume were made with parametric tests. RESULTS One hundred fourteen spine surgery fellows and 3,000 orthopaedic surgery residents were included. There was a 3.5-fold increase in total spine surgery cases conducted during fellowship versus residency (314 ± 129 vs. 89 ± 61, P < 0.001). Spine surgery fellows one standard deviation more than the mean reported 443 total spine cases. The largest differences between fellows and residents were Decompression (104 ± 48 vs. 28 ± 23, P < 0.001), Posterior Arthrodesis (94 ± 46 vs. 21 ± 18, P < 0.001), Anterior Arthrodesis (64 ± 31 vs. 13 ± 13, P < 0.001), and Instrumentation (43 ± 25 vs. 22 ± 12, P < 0.001). DISCUSSION Spine surgery fellowship training affords orthopaedic surgeons the opportunity to increase spine surgery case volume by over threefold. The greatest increases in case volume were reported for Decompression, Posterior Arthrodesis, Anterior Arthrodesis, and Instrumentation.
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Affiliation(s)
- Jason Silvestre
- From Howard University College of Medicine, Washington, DC (Silvestre and Thompson), University of California San Francisco School of Medicine, San Francisco, CA (Wu), and Brigham and Women's Hospital, Boston, MA (Kang)
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13
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Silvestre J, Nelson CL, Kelly JD, Thompson TL. Impact of COVID-19 on the Reported Case Volume of Orthopaedic Sports Medicine Fellows in the United States. Orthop J Sports Med 2023; 11:23259671221149061. [PMID: 36814773 PMCID: PMC9940181 DOI: 10.1177/23259671221149061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Background The impact of the coronavirus 2019 (COVID-19) pandemic on reported case volume during orthopaedic sports medicine fellowship training remains poorly understood from a national perspective. Hypothesis It was hypothesized that reported case volume during orthopaedic sports medicine fellowship training would decrease during the 2019-2020 academic year, which corresponded to the COVID-19 outbreak. It was also hypothesized that there would be a subsequent rebound in case volume during the 2020-2021 academic year. Study Design Cohort study. Methods Reported mean case volumes were extracted for 4 academic years (2017-2018, 2018-2019, 2019-2020, and 2020-2021), and year-over-year percentage changes were calculated. Parametric tests were used for interyear comparisons. Results There was a 7% decrease in mean ± SD case volume between the 2018-2019 and 2019-2020 academic years (339 ± 123 vs 316 ± 108; P = .042). Case categories with the greatest percentage declines were foot and ankle (-20%), knee instability (-11%), meniscus (-8%), and glenohumeral instability (-7%). There was a 13% year-over-year increase in case volume between the 2019-2020 and 2020-2021 academic years (316 ± 108 vs 357 ± 117; P < .001). Conclusion There was a slight decrease in total orthopaedic sports medicine case volume during the 2019-2020 academic year, corresponding to widespread lockdowns during the COVID-19 outbreak. Certain case categories experienced the greatest negative impact. Results from this study may inform accrediting bodies and surgical educators on the impact of future disruptions to health care delivery.
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Affiliation(s)
- Jason Silvestre
- Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Jason Silvestre, MD, Department of Orthopedic Surgery, Howard University Hospital, 2041 Georgia Avenue NW, Washington, DC 20040, USA ()
| | | | - John D. Kelly
- Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Discordance in current procedural terminology coding for pediatric orthopaedic surgeries between residents and attending surgeons: a retrospective comparative study. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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15
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Surgical Benchmarks for ACGME-accredited Adult Reconstructive Orthopaedic Fellowship Training. J Am Acad Orthop Surg 2022; 30:999-1004. [PMID: 35947830 DOI: 10.5435/jaaos-d-22-00162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/11/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Higher case volumes correlate with improved outcomes in total joint arthroplasty surgery. The purpose of this study was to understand the effect of adult reconstruction fellowship training on reported case volume in a contemporary cohort of orthopaedic surgeons. METHODS The Accreditation Council for Graduate Medical Education provided case logs for orthopaedic surgery residents and adult reconstructive orthopaedic fellows from 2017 to 2018 to 2020 to 2021. Reported case volumes for total joint arthroplasty surgeries were compared using Student t tests. RESULTS One hundred eighty-three adult reconstructive orthopaedic fellows and 3,000 orthopaedic surgery residents were included. Residents reported more total hip arthroplasty cases (98.9 ± 30 to 106.1 ± 33, 7.3% increase, P < 0.05) and total knee arthroplasty cases (126.0 ± 41 to 136.5 ± 44, 8.3% increase, P < 0.05) over the study period. On average, fellows reported 439.6 total cases: primary total knee arthroplasty, 164.9 cases (37.5%); primary total hip arthroplasty, 146.8 cases (33.4%); revision total knee arthroplasty, 35.2 cases (8.0%); revision total hip arthroplasty, 33.0 cases (7.5%); unicompartmental knee arthroplasty, 4.4 cases (1.0%); and other, 55.0 cases (12.5%). Overall, adult reconstructive orthopaedic fellowship reported between 1.7- and 2.0-fold more joint arthroplasty cases during 1 year of fellowship training than 5 years of residency ( P < 0.001). DISCUSSION Adult reconstructive orthopaedic fellowship training provides notable exposure to additional cases after residency training. The results from this study may inform prospective applicants on the effect of fellowship training in total joint arthroplasty and help establish benchmarks in case volume for independent practice.
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Silvestre J, Thompson TL, Nelson CL. The Impact of COVID-19 on Total Joint Arthroplasty Fellowship Training. J Arthroplasty 2022; 37:1640-1644.e2. [PMID: 35390456 PMCID: PMC8979627 DOI: 10.1016/j.arth.2022.03.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND COVID-19 created unprecedented challenges in surgical training especially in specialties with high elective case volume. We hypothesized that case volume during total joint arthroplasty fellowship training would decrease by 25% given widespread economic shutdowns encountered during the fourth quarter of the 2019-2020 academic year. METHODS Case logs from the Accreditation Council for Graduate Medical Education were obtained for accredited total joint arthroplasty fellowships (2017-2018 to 2020-2021). Case volumes were extracted and summarized as means ± SD. Student's t tests were used for inter-year comparisons. RESULTS One hundred and eighty three arthroplasty fellows from 24 accredited fellowships were included. There was a 14% year-over-year decrease in total case volume during the 2019-2020 academic year (390 ± 108 vs 453 ± 128, P < .001). Case volume rebounded during the 2020-2021 academic year to 465 ± 93 (19% increase, P < .001). Case categories with the most significant percentage declines in 2019-2020 were primary total knee arthroplasty (TKA, -23%), revision total hip arthroplasty (THA, -19%), revision TKA (rTKA, -11%), and primary THA (-10%). CONCLUSION There was a 14% overall decrease in arthroplasty case volume during the 2019-2020 academic year, which correlated with the widespread economic shutdowns during the COVID-19 pandemic. Certain elective case categories like primary TKA experienced the greatest negative impact. Results from this study may inform prospective trainees and faculty during future national emergencies.
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Affiliation(s)
| | | | - Charles L. Nelson
- Perelman School of Medicine, Philadelphia, PA,Address correspondence to: Charles L. Nelson, MD, Joint Replacement Service, Professor of Orthopedic Surgery, Perelman School of Medicine, 3737 Market St, Philadelphia, PA 19104
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17
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Analysis of Strengths in Exposure to Cases During Plastic and Orthopaedic Hand Surgery Fellowships. J Am Acad Orthop Surg 2022; 30:721-727. [PMID: 35333806 DOI: 10.5435/jaaos-d-22-00118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 02/19/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Prospective residents interested in hand surgery must decide to apply for hand surgery fellowships sponsored by different specialties. This study compares case volumes reported during plastic surgery and orthopaedic hand surgery fellowships. METHODS The American Council for Graduate Medical Education case logs of accredited hand surgery fellowships were analyzed for hand surgery cases (2012 to 2013 to 2020 to 2021). The reported case volume was compared by specialty. Temporal trends were described, intrapathway variabilities calculated, and interpathway differences calculated with Student t -tests. RESULTS Two hundred plastic surgery (13%) and 1,323 orthopaedic (87%) hand surgery fellows were included. The number of orthopaedic hand surgery fellowships increased from 58 in 2012 to 2013 to 70 in 2020 to 2021 (21% increase), whereas the number of plastic surgery fellowships was stable at 16. Orthopaedic hand surgery fellows reported more hand surgery cases (764 ± 22 versus 628 ± 226), arthroscopy cases (53 ± 54 versus 23 ± 38), and miscellaneous hand surgery cases (42 ± 23 versus 31 ± 18) than plastic surgery hand fellows. Plastic surgery hand fellows reported more cases in wound closure with graft, wound reconstruction with flap, nerve injury, and vascular repair. Overall, orthopaedic surgery offered more experience in 15 case categories (58%), while plastic surgery offered more experience in five case categories (19%). Six case categories (23%) had no difference between specialties. DISCUSSION Although orthopaedic hand surgery fellowship affords more cases overall, plastic surgery hand fellowships have unique strengths in wound reconstruction with grafts and flaps, nerve injury, and vascular repair. Ultimately, results from this study create a benchmark to improve future training opportunities for hand surgery fellows and orthopaedic surgery residents.
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18
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Xiao G, Sikder S, Woreta F, Boland MV. Implementation and Evaluation of Integrating an Electronic Health Record With the ACGME Case Log System. J Grad Med Educ 2022; 14:482-487. [PMID: 35991093 PMCID: PMC9380618 DOI: 10.4300/jgme-d-22-00021.1] [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] [Received: 01/05/2022] [Revised: 02/23/2022] [Accepted: 05/09/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND It is essential to log resident-performed procedures to assess training programs and fulfill specialty requirements, but resident case numbers are often underreported. Current systems require inefficient data entry steps, and residents and fellows report that user interfaces and administrative burden contribute to logging inaccuracy. OBJECTIVE To determine the accuracy, feasibility, and acceptability of a single logging approach for resident case logging. METHODS In 2018, we implemented a case logging system integrated with the institutional electronic health record (EHR) and the Accreditation Council for Graduate Medical Education (ACGME) case log system to record procedures performed by ophthalmology residents. We compared the proportion of resident-performed cataract extractions in the EHR that were reported to ACGME for 3 periods: before the deployment of the new system (6 months), during the transition (6 months), and after the change (2 years). Resident satisfaction with the new system was evaluated using surveys. RESULTS An analysis of resident cataract surgeries showed that the percentage of resident cases logged increased from 85% prior to implementation to 91% after implementation. The integrated system became the preferred case logging method, with 100% of all logged cases being entered using the new platform. Surveys showed that the percentage of trainees who were moderately or very satisfied with the case log process increased from 55% before implementation to 100% after implementation. CONCLUSIONS A resident case log system integrated with an EHR more accurately reflects resident operative volume and increases trainee satisfaction with the logging process.
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Affiliation(s)
- Grace Xiao
- Grace Xiao, BA, is a Medical Student, Johns Hopkins University School of Medicine
| | - Shameema Sikder
- Shameema Sikder, MD, is Associate Professor of Ophthalmology, Johns Hopkins University School of Medicine and Johns Hopkins Wilmer Eye Institute
| | - Fasika Woreta
- Fasika Woreta, MD, MPH, is Ophthalmology Residency Program Director and Associate Professor of Ophthalmology, Johns Hopkins University School of Medicine and Johns Hopkins Wilmer Eye Institute
| | - Michael V. Boland
- Michael V. Boland, MD, PhD, is Medical Director of Practice Innovation and Associate Professor of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School
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Thanawala R, Jesneck J, Shelton J, Rhee R, Seymour NE. Overcoming Systems Factors in Case Logging with Artificial Intelligence Tools. JOURNAL OF SURGICAL EDUCATION 2022; 79:1024-1030. [PMID: 35193831 DOI: 10.1016/j.jsurg.2022.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 11/03/2021] [Accepted: 01/30/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Case logs are foundational data in surgical education, yet cases are consistently under-reported. Logging behavior is driven by multiple human and systems factors, including time constraints, ease of case data retrieval, access to data-entry tools, and procedural code decision tools. METHODS We examined case logging trends at three mid-sized, general surgery training programs from September 2016-October 2020, January 2019-October 2020 and May 2019-October 2020, respectively. Across the programs we compared the number of cases logged per week when residents logged directly to ACGME versus via a resident education platform with machine learning-based case logging assistance tools. We examined case logging patterns across 4 consecutive phases: baseline default ACGME logging prior to platform access (P0 "Manual"), full platform logging assistance (P1 "Assisted"), partial platform assistance requiring manual data entry without data integrations (P2 "Notebook"), and resumed fully integrated platform with logging assistance (P3 "Resumed"). RESULTS 31,385 cases were logged utilizing the platform since 2016 by 171 residents across the 3 programs.Intelligent case logging assistance significantly increased case logging rates, from 1.44 ± 1.48 cases by manual entry in P0 to 4.77 ± 2.45 cases per resident per week via the platform in P1 (p-value < 0.00001). Despite the burden of manual data entry when the platform's data connectivity was paused, the tool helped to increase overall case logging into ACGME to 2.85 ± 2.37 cases per week (p-value = 0.0002). Upon resuming the data connectivity, case logging levels rose to 4.54 ± 3.33 cases per week via the platform, equivalent to P1 levels (insignificant difference, p-value = 0.57). CONCLUSIONS Mapping the influence of systems and human factors in high-quality case logs allows us to target interventions to continually improve the training of surgical residents. System level factors such as access to alternate automation-drive tools and operative schedule integrated platforms to assist in ACGME case log has a significant impact on the number of cases captured in logs.
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Affiliation(s)
- Ruchi Thanawala
- Department of Surgery, Division of Cardiothoracic Surgery, Oregon Health and Science University, Section Thoracic Surgery, Portland, Oregon.
| | | | - Julia Shelton
- Department of Surgery, Division of Pediatric Surgery, University of Iowa, Iowa City, Iowa
| | - Rebecca Rhee
- Department of Surgery, Division of Colorectal Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Neal E Seymour
- Department of Surgery, University of Massachusetts Medical School-Baystate Medical Center, Springfield, Massachusetts
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20
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Hartnett DA, Lama CJ, Garcia-Lopez E, Daniels AH, Richardson DR. Volume and Variability of Foot and Ankle Case Exposure During Orthopaedic Residency: 2014-2019. Foot Ankle Spec 2022:19386400221106889. [PMID: 35773780 DOI: 10.1177/19386400221106889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Exposure to a comprehensive breadth and volume of surgical cases is a fundamental component of orthopaedic education, though standardization of case exposures across residency programs is limited to a small amount of required case minimums. Significant variability in exposure to subspecialty cases, such as foot and ankle surgeries, can create distinctly different residency experiences. METHODS Accreditation Council for Graduate Medical Education (ACGME) surgical case logs from 2014 to 2019 for leg/ankle and foot/toes were examined following the 2013 implementation of case minimums. Average surgical case volume across subcategories and the average volume of different residency percentiles were analyzed to assess variability. RESULTS The mean total volume of case exposure for graduating orthopaedic residents has increased significantly since 2014 for both leg/ankle cases (28.6%) and foot/toes (27.8%), though totals were still down compared with when ACGME reporting began in 2007. Arthrodesis exposures have increased significantly for leg/ankle (69.2%) and foot/toes (93.8%) cases since 2014, and ankle arthroscopy has increased 20.7%. Disparities in total cases between 10th and 90th percentile programs have shown a nonsignificant decrease over time, with significant differences between leg/ankle arthrodesis (8-fold), leg/ankle arthroscopy (13-fold), and foot/toe arthrodesis (3.5-fold) in 2019. CONCLUSION The mean volume of foot and ankle case exposures among graduating residents has continued to rise since the implementation of case minimums in 2013 but disparities in volume are present, most notably concerning arthrodesis and arthroscopy. Recognition and future attention toward addressing this variability can be meaningful in promoting a more comprehensive, standardized orthopaedics education. LEVEL OF EVIDENCE Level III: Retrospective comparative study.
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Affiliation(s)
- Davis A Hartnett
- University Warren Alpert School of Medicine, Providence, Rhode Island
| | | | | | - Alan H Daniels
- University Warren Alpert School of Medicine, Providence, Rhode Island
| | - David R Richardson
- Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, Tennessee
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21
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Eruchalu CN, He K, Etheridge JC, Wu C, Ashley SW, Nitzschke SL, Smink DS, Cho NL. Gender and Racial/Ethnic Disparities in Operative Volumes of Graduating General Surgery Residents. J Surg Res 2022; 279:104-112. [PMID: 35759927 DOI: 10.1016/j.jss.2022.05.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/25/2022] [Accepted: 05/22/2022] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Gender disparities in resident operative experience have been described; however, their etiology is poorly understood, and racial/ethnic disparities have not been explored. This study investigated the relationship between gender, race/ethnicity, and surgery resident case volumes. MATERIALS AND METHODS A retrospective analysis of graduating general surgery resident case logs (2010-2020) at an academic medical center was performed. Self-reported gender and race/ethnicity data were collected from program records. Residents were categorized as underrepresented in medicine (URM) (Black, Hispanic, Native American) or non-URM (White, Asian). Associations between gender and URM status and major, chief, and teaching assistant (TA) mean case volumes were analyzed using t-tests. RESULTS The cohort included 80 residents: 39 female (48.8%) and 17 URM (21.3%). Compared to male residents, female residents performed fewer TA cases (33 versus 47, P < 0.001). Compared to non-URM residents, URM residents graduated with fewer major (948 versus 1043, P = 0.008) and TA cases (32 versus 42, P = 0.038). Male URM residents performed fewer TA cases than male non-URM residents (32 versus 50, P = 0.031). Subanalysis stratified by graduation year demonstrated that from 2010 to 2015, female residents performed fewer chief (218 versus 248, P = 0.039) and TA cases (29 versus 50, P = 0.001) than male residents. However, from 2016 to 2020, when gender parity was achieved, no significant associations were observed between gender and case volumes. CONCLUSIONS Female and URM residents perform fewer TA and major cases than male non-URM residents, which may contribute to reduced operative autonomy, confidence, and entrustment. Prioritizing gender and URM parity may help decrease case volume gaps among underrepresented residents.
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Affiliation(s)
- Chukwuma N Eruchalu
- Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Katherine He
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - James C Etheridge
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Ariadne Labs, Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Christine Wu
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stanley W Ashley
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stephanie L Nitzschke
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Douglas S Smink
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nancy L Cho
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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22
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Jain G, Are C, Agrawal V, Agarwal P. General Surgery Training in the USA, UK, and India: a Scrutiny of Strength and Challenges. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03226-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Chen JX, Deng F, Filimonov A, Shuman EA, Marchiano E, George BC, Thorne M, Pletcher SD, Platt M, Teng MS, Kozin ED, Gray ST. Multi-institutional Study of Otolaryngology Resident Intraoperative Experiences for Key Indicator Procedures. Otolaryngol Head Neck Surg 2021; 167:268-273. [PMID: 34609936 DOI: 10.1177/01945998211050350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There is concern that current otolaryngology residents may not receive adequate surgical training. We aimed to characterize residents' surgical experiences at 5 academic centers performing the 14 key indicator procedures (KIPs) outlined by the Accreditation Council for Graduate Medical Education. STUDY DESIGN Prospective study. SETTING Five otolaryngology training programs. METHODS Data were gathered from December 2019 to December 2020 with a smartphone application from the Society for Improving Medical Professional Learning. After each operation, residents and faculty rated trainee autonomy on a 4-level Zwisch scale and performance on a 5-level modified Dreyfus scale. RESULTS Residents and attendings (n = 92 and 78, respectively) logged 2984 evaluations. Attending ratings of resident autonomy and performance increased with training level (P < .001). Resident self-assessments of autonomy and performance were lower than paired attending assessments (P < .001). Among attending evaluations of KIPs performed by senior residents (postgraduate year 4 or 5), 55% of cases were performed with meaningful autonomy (passive help or supervision only). Similarly, attendings rated 55% of these cases as a practice-ready or exceptional performance. Senior residents had meaningful autonomy for ≥50% of cases for most KIPs, with the exception of flaps and grafts (40%), pediatric/adult airway (39%), and stapedectomy/ossiculoplasty (33%). Similarly, senior residents received practice-ready or exceptional performance ratings for ≥50% of cases across all KIPs other than pediatric/adult airway (42%) and stapedectomy/ossiculoplasty (33%). CONCLUSION In this multicenter study, resident surgical autonomy and performance varied across otolaryngology KIPs. The development of nationwide benchmarks will help programs and residents set educational goals. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Jenny X Chen
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Francis Deng
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrey Filimonov
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York City, New York, USA
| | - Elizabeth A Shuman
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Emily Marchiano
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Brian C George
- Center for Surgical Training and Research, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Marc Thorne
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Steven D Pletcher
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Michael Platt
- Department of Otolaryngology-Head and Neck Surgery, Boston University Medical Center, Boston, Massachusetts, USA
| | - Marita S Teng
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York City, New York, USA
| | - Elliott D Kozin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Stacey T Gray
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
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24
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Cryer CM, Murayama KM. Paradox of Surgical Resident Case Numbers: Is There a Number That Quantifies Competence? JAMA Surg 2021; 156:774. [PMID: 33929511 DOI: 10.1001/jamasurg.2021.1982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Chad M Cryer
- Department of Surgery, University of Hawaii John A. Burns School of Medicine, Honolulu
| | - Kenric M Murayama
- Department of Surgery, University of Hawaii John A. Burns School of Medicine, Honolulu
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