Panel discussion. Challenges in surgical education: competences, work hours, workforce, assessment, and adaptation

A better lifestyle during surgical clerkship may not increase application rates to general surgery

BACKGROUND

Lifestyle has been identified by numerous studies as the number one deterrent to pursuing a career in general surgery. This study tests the hypothesis that a better lifestyle during general surgery clerkship correlates with a higher application rate to general surgery.

METHODS

Canadian Residency Matching Service data from the past 10 years were used to identify institution-specific application rates to general surgery. Through a survey of all fourth-year medical students applying to general surgery in Canada and Canadian undergraduate surgery program directors, the lifestyle of each general surgery clerkship was described and given a score.

RESULTS

Multiple descriptions of the clerkship structure were obtained for every school in Canada to reduce recall bias, with an average of 4 sources per program. One school stood out as the most prolific producer of general surgery applicants, with an average of 7.9% of the total class applying to general surgery each year. This represented 80% more general surgery applicants relative to the national average (p < 0.05). Surprisingly, however, this institution also had the worst clerkship lifestyle score, having a higher call requirement, not sending their clerks home at noon post call, and placing a higher burden of responsibility on their clerks.

CONCLUSIONS

This study suggests that a lifestyle-friendly surgical clerkship may not be necessary to increase recruitment into general surgery.

Prospective evaluation of remote, interactive videoconferencing to enhance urology resident education: the genitourinary teleteaching initiative

PURPOSE

Changes in referral patterns and resource allocation into Centers of Excellence affect the educational experience of urology trainees by altering resident exposure to patients and clinicians, especially at sites where subspecialty deficiencies exist. Access to educators at Centers of Excellence using interactive videoconferencing technology may facilitate residency training objectives and enhance trainees' overall educational experience. We prospectively evaluated the implementation of this technology at tertiary care teaching centers to enhance urology resident education.

MATERIALS AND METHODS

Using videoconferencing technology, urology residents at the University of Western Ontario (London, Canada) participated in a series of didactic, interactive pediatric urology teleteaching seminars. These were presented by an expert pediatric urologist from the Hospital for Sick Children, Toronto, Canada. Using a 5-point Likert scale (1-strongly disagree, 5-strongly agree), participants responded to statements pertaining to seminar content, technology and ease of use at the completion of each session. The results were subsequently tabulated and evaluated to determine the effectiveness and accessibility of the program in providing expert pediatric urological education to residents at a remote urology training program.

RESULTS

The entire urology resident staff from postgraduate year 1 to 5 participated in the seminar program. The overall acceptance of this medium was high (mean score 4.5). The quality of presentation, as well as picture and sound quality, all received mean scores greater than 4. Participants indicated that their ability to interact with the presenter was not inhibited by using this medium. All participants agreed that they would use this technology in the future (mean score 4.5) and that the presentation would not be improved if the presenter were on-site. Due to preexisting technology at both centers, no direct cost was incurred throughout the study.

CONCLUSIONS

Our experience suggests that interactive teleteaching using readily available, existing technology, is a cost-effective and accepted method of providing trainees with an appropriate educational experience. In centers where subspecialty deficiencies exist, this medium may provide residents with the necessary education requirements of their respective programs without the need for costly teacher (or student) travel. Continual improvements in technology as well as the addition of multiple sites will increased this medium's impact in the future.

The impact of the 80-hour workweek on pediatric surgical training: an Association of Pediatric Surgery Program Directors-sponsored study

BACKGROUND/PURPOSE

The aim of this study was to determine the preliminary impact of work hour regulations on pediatric surgical training.

METHODS

An anonymous survey was sent to all program directors (PDs) and fellows to identify changes in pediatric surgery fellowship programs.

RESULTS

Ninety-three percent of programs and 87% of PDs responded. Thirty programs hired additional personnel, including nurse practitioners, physician assistants, and fellows outside the training program. Thirteen programs reported increased attending coverage. The daily composition of the surgical team has changed, with postcall fellows and residents leaving in the morning. Residents and fellows also take call less frequently. More than 50% of PDs felt that quality of care had declined and three quarters of respondents felt that continuity of care was worse. Half of the respondents feared missed educational opportunities. However, half of the fellows felt more rested, 61% reported more family time, and 22% reported increased social time. In contrast, no PDs perceived life-style improvements.

CONCLUSIONS

The work hour regulations have resulted in fundamental changes in pediatric surgical training. Ongoing assessment is needed to prioritize quality of care, improve continuity of care, and track changes in operative, clinical, and didactic experiences of the trainees. The added impact of these changes on the time spent available for commitment to teaching by the faculty should be assessed.

A template for change and response to work hour restrictions

Surgical program directors are seeking how to best meet the work hour restrictions recently mandated by the American College of Graduate Medical Education. Implementation of an 80-hour work week forces major change to graduate medical education, especially surgical education. Creative restructuring of surgical training is necessary to ensure compliance. Developing an innovative solution to meet these requirements must consider programmatic needs, requiring commitment to a change process. The Department of Surgery at Eastern Virginia Medical School experienced a 5-month strategic planning process that generated the Mendoza plan. This plan uses an every third night call model and a night float model to meet site-specific needs. The specifics of the Mendoza plan protect the cornerstone of surgical education, which is continuity of patient care and resident education. The Mendoza plan, and the process leading to its development, may provide insightful information for other surgical residency programs planning to meet work hour guidelines.