1
|
Margolin EJ, Schoenfeld D, Miles CH, Merrill SB, Raman JD, Thompson RH, Reese AC, Parekh DJ, Brown ET, Klausner A, Williams DH, Lee RK, Zaslau S, Guzzo TJ, Shenot PJ, Anderson CB, Badalato GM. Longitudinal Changes in the Operative Experience for Junior Urology Residents. Urology 2023; 179:32-38. [PMID: 37400019 DOI: 10.1016/j.urology.2023.03.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/04/2023] [Accepted: 03/29/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE To evaluate longitudinal trends in surgical case volume among junior urology residents. There is growing perception that urology residents are not prepared for independent practice, which may be linked to decreased exposure to major cases early in residency. METHODS Retrospective review of deidentified case logs from urology residency graduates from 12 academic medical centers in the United States from 2010 to 2017. The primary outcome was the change in major case volume for first-year urology (URO1) residents (after surgery internship), measured using negative binomial regression. RESULTS A total of 391,399 total cases were logged by 244 residency graduates. Residents performed a median of 509 major cases, 487 minor cases, and 503 endoscopic cases. From 2010 to 2017, the median number of major cases performed by URO1 residents decreased from 64 to 49 (annual incidence rate ratio 0.90, P < .001). This trend was limited to oncology cases, with no change in reconstructive or pediatric cases. The number of major cases decreased more for URO1 residents than for residents at other levels (P-values for interaction <.05). The median number of endoscopic cases performed by URO1 residents increased from 85 to 194 (annual incidence rate ratio 1.09, P < .001), which was also disproportionate to other levels of residency (P-values for interaction <.05). CONCLUSION There has been a shift in case distribution among URO1 residents, with progressively less exposure to major cases and an increased focus on endoscopic surgery. Further investigation is needed to determine if this trend has implications on the surgical proficiency of residency graduates.
Collapse
Affiliation(s)
- Ezra J Margolin
- Department of Urology, Columbia University Irving Medical Center, New York, NY
| | - Daniel Schoenfeld
- Department of Urology, Columbia University Irving Medical Center, New York, NY
| | - Caleb H Miles
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY
| | | | - Jay D Raman
- Department of Urology, Penn State Health, Hershey, PA
| | | | - Adam C Reese
- Department of Urology, Temple University Lewis Katz School of Medicine, Philadelphia, PA
| | - Dipen J Parekh
- Desai Sethi Urology Institute at University of Miami Miller School of Medicine, Miami, FL
| | - Elizabeth T Brown
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC
| | - Adam Klausner
- Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, VA
| | | | - Richard K Lee
- Department of Urology, Weill Cornell Medical Center, New York, NY
| | - Stanley Zaslau
- Department of Urology, West Virginia University, Morgantown, WV
| | - Thomas J Guzzo
- Division of Urology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Patrick J Shenot
- Department of Urology, Thomas Jefferson University, Philadelphia, PA
| | | | - Gina M Badalato
- Department of Urology, Columbia University Irving Medical Center, New York, NY.
| |
Collapse
|
2
|
Shah AP, Walker KA, Walker KG, Hawick L, Cleland J. "It's making me think outside the box at times": a qualitative study of dynamic capabilities in surgical training. Adv Health Sci Educ Theory Pract 2023; 28:499-518. [PMID: 36287293 PMCID: PMC9607851 DOI: 10.1007/s10459-022-10170-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 09/27/2022] [Indexed: 05/11/2023]
Abstract
Craft specialties such as surgery endured widespread disruption to postgraduate education and training during the pandemic. Despite the expansive literature on rapid adaptations and innovations, generalisability of these descriptions is limited by scarce use of theory-driven methods. In this research, we explored UK surgical trainees' (n = 46) and consultant surgeons' (trainers, n = 25) perceptions of how learning in clinical environments changed during a time of extreme uncertainty (2020/2021). Our ultimate goal was to identify new ideas that could shape post-pandemic surgical training. We conducted semi-structured virtual interviews with participants from a range of working/training environments across thirteen Health Boards in Scotland. Initial analysis of interview transcripts was inductive. Dynamic capabilities theory (how effectively an organisation uses its resources to respond to environmental changes) and its micro-foundations (sensing, seizing, reconfiguring) were used for subsequent theory-driven analysis. Findings demonstrate that surgical training responded dynamically and adapted to external and internal environmental uncertainty. Sensing threats and opportunities in the clinical environment prompted trainers' institutions to seize new ways of working. Learners gained from reconfigured training opportunities (e.g., splitting operative cases between trainees), pan-surgical working (e.g., broader surgical exposure), redeployment (e.g., to medical specialties), collaborative working (working with new colleagues and in new ways) and supervision (shifting to online supervision). Our data foreground the human resource and structural reconfigurations, and technological innovations that effectively maintained surgical training during the pandemic, albeit in different ways. These adaptations and innovations could provide the foundations for enhancing surgical education and training in the post-pandemic era.
Collapse
Affiliation(s)
- Adarsh P Shah
- Centre for Healthcare Education Research and Innovation (CHERI), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Kim A Walker
- Centre for Healthcare Education Research and Innovation (CHERI), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Kenneth G Walker
- NHS Education for Scotland, Centre for Health Science, Inverness, UK
| | - Lorraine Hawick
- Centre for Healthcare Education Research and Innovation (CHERI), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| |
Collapse
|
3
|
Hughes L, Murphy O, Lenihan M, Mhuircheartaigh RN, Wall TP. Impact of the COVID-19 pandemic on anaesthesia specialty training: a single-centre quantitative analysis. BJA Open 2023; 5:100117. [PMID: 36505902 PMCID: PMC9721281 DOI: 10.1016/j.bjao.2022.100117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
Background The COVID-19 pandemic disrupted healthcare services worldwide, with a consequent impact on the delivery of medical education and training in all acute care specialties. Anaesthesia training has been challenged by a combination of reduced elective theatre activity, redeployment of trainees to critical care units, and changes in standard anaesthetic practices. Methods The aim of this study was to quantify the impact of COVID-19 on specialist anaesthesia training at a tertiary level teaching hospital in Ireland via a retrospective analysis of data captured by electronic anaesthesia records. The anaesthetic caseloads of trainees in periods before and during the pandemic were analysed along with airway management practices, core procedural skills performed, and critical care rostering. Data relating to 145 anaesthesia trainees were captured during the study periods: pre-pandemic (January 2018 to January 2020) and pandemic (January 2020 to January 2022). Results The mean number of theatre cases logged per trainee in a 6-month period reduced from 156.8 pre-pandemic to 119.2 during the pandemic (23.9% reduction; P<0.0001). Although theatre caseload was reduced, trainees gained additional critical care experience with a significant increase in overall days spent staffing critical care wards. In the theatre setting, the number of arterial lines, central lines, neuraxial blocks, and peripheral nerve blocks performed were significantly reduced during the pandemic. Conclusions Although the COVID-19 pandemic significantly reduced anaesthesia training exposure and increased critical care exposure over an extended period, the overall long-term significance of this alteration in the anaesthesia training experience remains uncertain.
Collapse
Affiliation(s)
- Lauren Hughes
- Department of Anaesthesia, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Orla Murphy
- Department of Anaesthesia, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Martin Lenihan
- Department of Anaesthesia, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Thomas P. Wall
- Department of Anaesthesia, Mater Misericordiae University Hospital, Dublin, Ireland,University College Dublin, Dublin, Ireland,Corresponding author. Department of Anaesthesia, Mater Misericordiae University Hospital, Dublin, Ireland
| |
Collapse
|
4
|
Muacevic A, Adler JR, Hodge CB, Anders MG, Conti BM, Brookman JC, Martz DG, Hong CM, Gibbons M, Rock P. Impact of Pandemic Response on Training Experience of Anesthesiology Residents in an Academic Medical Center: A Retrospective Cohort Study. Cureus 2023; 15:e33500. [PMID: 36756025 PMCID: PMC9903179 DOI: 10.7759/cureus.33500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2023] [Indexed: 01/09/2023] Open
Abstract
Background The impact of the coronavirus disease 2019 (COVID-19) pandemic substantially altered operations at hospitals that support graduate medical education. We examined the impact of the pandemic on an anesthesiology training program with respect to overall case volume, subspecialty exposure, procedural skill experience, and approaches to airway management. Methods Data for this single center, retrospective cohort study came from an Institutional Review Board approved repository for clinical data. Date ranges were divided into the following phases in 2020: Pre-Pandemic (PP), Early Pandemic (EP), Recovery 1 (R1), and Recovery 2 (R2). All periods were compared to the same period from 2019 for case volume, anesthesia provider type, trainee exposure to Accreditation Council for Graduate Medical Education (ACGME) index case categories, airway technique, and patient variables. Results 15,087 cases were identified, with 5,598 (37.6%) in the PP phase, 1,570 (10.5%) in the EP phase, 1,451 (9.7%) in the R1 phase, and 6,269 (42.1%) in the R2 phase. There was a significant reduction in case volume during the EP phase compared to the corresponding period in 2019 (-55.3%; P < .001) that improved but did not return to baseline by the R2 phase (-17.6%; P < .001). ACGME required minimum cases were reduced during the EP phase compared to 2019 data for pediatric cases (age < 12 y, -72.1%; P < .001 and age < 3 y, -53.5%; P < .006) and cardiopulmonary bypass cases (52.3%, P < .003). Surgical subspecialty case volumes were significantly reduced in the EP phase except for transplant surgery. By the R2 phase, all subspecialty volumes had recovered except for plastic surgery (14.9 vs. 10.5 cases/week; P < .006) and surgical endoscopy (59.2 vs. 40 cases/week; P < .001). Use of video laryngoscopy (VL) and rapid sequence induction and intubation (RSII) also increased from the PP to the EP phase (24.6 vs. 79.6%; P < .001 and 10.3 vs. 52.3%; P < .001, respectively) and remained elevated into the R2 phase (35.2%; P < 0.001 and 23.1%; P < .001, respectively). Conclusions The COVID-19 pandemic produced significant changes in surgical case exposure for a relatively short period. The impact was short-lived, with sufficient remaining time to meet the annual ACGME program minimum case requirements and procedural experiences. The longer-term impact may be a shift towards the increased use of VL and RSII, which became more prevalent during the early phase of the pandemic.
Collapse
|
5
|
Gatta F, Bojanic C, Abdulla SE, Edwards C. Core training and surgical opportunities: A UK-based analysis. J Clin Transl Res 2022; 8:557-562. [PMID: 36518204 PMCID: PMC9741927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND AND AIM The COVID-19 pandemic, the new Intercollegiate Surgical Curriculum Programme curriculum and the European Work Time Directive significantly reduced surgical exposure for trainees. This study analyzed the operative experience of Phase 1 trainees (CT1/ST1 vs. CT2/ST2) against the Annual Review of Competence Progression (ARCP) criterion of 120 procedures yearly. METHODS National survey research in October 2021. Study end-point was the completion of >4 weekly procedures, equivalent to 120 cases per year. Chi-square test and multivariate regression analysis were performed. RESULTS 205 participants from 5 Deaneries were included, 48.3% were CT1/ST1 and 51.7% were CT2/ST2. About 54.5% of year-1 and 50% of year-2 trainees were 28 30 years old, 55.6% and 50.9% were male, and 39.4% and 38.7% were White British. About 39.4% of CT1/ST1 and 22.6% of CT2/ST2 performed <4 weekly procedures (P = 0.01), with no difference in the "Observed" (P = 0.6) or "Assisted" (P = 0.3) number of cases. CT2/ST2 recorded more "ST-S" (p 0.04), "S-TU" (P = 0.03), and "Performed" (P = 0.02) operations. For CT1/ST1, older age (HR 2.4, 95% CI [1.1; 5.3], P = 0.02) and southern deaneries (HR 1.7, 95% CI [1.2; 2.4], P = 0.004) were independent factor for <4 weekly procedures. For CT2/ST2, northern regions were associated with more favorable training (HR 1.4, 95% CI [1.1; 1.7], P = 0.01). CONCLUSION Over one third of Phase 1 trainees do not meet the ARCP requirement of >120 procedures annually. Age and region of training are independent factors in the number of logbook cases. RELEVANCE FOR PATIENTS This research focuses on training opportunities for junior surgical residents across the United Kingdom. The degree and type of exposure to the operating theatre have a significant impact on the development of surgical competencies. These are undoubtedly related to patient outcomes, as the quality of care delivered to patients and relatives greatly relies on the training background of future consultant surgeons.
Collapse
Affiliation(s)
- Francesca Gatta
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Christine Bojanic
- Department of General Surgery, Addenbrooke’s Hospital, Cambridge, UK
| | | | - Claire Edwards
- Department of Orthopaedic Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| |
Collapse
|
6
|
Toale C, O'Byrne A, Morris M, Kavanagh DO. Defining operative experience targets in surgical training: A systematic review. Surgery 2022:S0039-6060(22)00542-6. [PMID: 36038374 DOI: 10.1016/j.surg.2022.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/07/2022] [Accepted: 07/20/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND The surgical learning curve is an observable and measurable phenomenon. Operative experience targets are well established as a proxy measure for operative competence in surgical training across jurisdictions. The aim of this study was to critique the available evidence regarding the relationship between operative experience in surgical training and trainee competence. METHODS A systematic review of the PubMed, Embase, Web of Science, and Cochrane library databases was conducted in accordance with the Preferred Items for Systematic Reviews and Meta-Analyses guidelines. Articles were sought that defined the relationship between procedural volume in surgical training and trainee competence, proficiency, or mastery. The educational impact of included studies was evaluated using a modified Kirkpatrick model. RESULTS Of 3,672 records identified on database searching, 30 papers were ultimately included. Fourteen studies defined operative experience thresholds using operative time as a surrogate measure of competence, whereas another 8 used trainer assessments of operative performance (Kirkpatrick level 3). A further 5 studies were able to determine the relationship between trainee case volumes and subsequent patient outcomes (Kirkpatrick level 4b). CONCLUSION Many studies have recorded competent trainee performance in key index procedures after reaching experience threshold numbers in excess of currently mandated targets across jurisdictions. The evidence relating current operative experience targets to patient outcomes across a range of surgical subspecialties of surgical subspecialties is lacking. This review supports a move toward criterion-based referencing of operative performance targets in surgical training.
Collapse
|
7
|
Seow CS, Lomanto D, Ooi LL. COVID-19 and the impact on surgical training and education in Singapore. Heliyon 2022; 8:e08731. [PMID: 35036591 PMCID: PMC8748206 DOI: 10.1016/j.heliyon.2022.e08731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/12/2021] [Accepted: 01/06/2022] [Indexed: 01/22/2023] Open
Abstract
The COVID-19 pandemic has affected surgical education and training significantly. The main impact to surgical residency training is the reduction in number of patients (in caseload and case mix) and the conversion of face-to-face meetings into virtual ones for CME and clinical governance-related events. Assessment of surgical residents by examination (namely the Joint Specialty Fellowship Examination with the College of Surgeons of Hong Kong and the Royal College of Surgeons of Edinburgh) was cancelled at the peak of the pandemic, with resumption after acceptable COVID compatible adjustment was made to the format. The migration of CME events into a web-based one has resulted in greater connectivity with more audience. The potential and challenges of virtual format in surgical education include strategy and resources for sustainability; choice of optimal model for effective learning and surgical skills acquisition. In a post-COVID world, the model of blended learning is likely to remain.
Collapse
Affiliation(s)
- Choon Sheong Seow
- Department of Surgery, Ng Teng Fong General Hospital, JurongHealth Campus, National University Health System, Singapore
| | - Davide Lomanto
- Department of Surgery, Minimally Invasive Surgical Centre (MISC), Khoo Teck Puat Advanced Surgery Training Centre (ASTC), National University Hospital, Singapore
| | | |
Collapse
|
8
|
BOZBIYIK O, GÖK M. COVID-19 pandemisinin genel cerrahi uzmanlık eğitimine etkisi. Ege Tıp Dergisi 2021. [DOI: 10.19161/etd.950936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|