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Wang TN, Woelfel IA, Huang E, Pieper H, Meara MP, Chen X(P. Behind the pattern: General surgery residsent autonomy in robotic surgery. Heliyon 2024; 10:e31691. [PMID: 38841510 PMCID: PMC11152925 DOI: 10.1016/j.heliyon.2024.e31691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 05/12/2024] [Accepted: 05/20/2024] [Indexed: 06/07/2024] Open
Abstract
Objective Robotic surgery is increasingly utilized and common in general surgery training programs. This study sought to better understand the factors that influence resident operative autonomy in robotic surgery. We hypothesized that resident seniority, surgeon work experience, surgeon robotic-assisted surgery (RAS) case volume, and procedure type influence general surgery residents' opportunities for autonomy in RAS as measured by percentage of resident individual console time (ICT). Methods General surgery resident ICT data for robotic cholecystectomy (RC), inguinal hernia (RIH), and ventral hernia (RVH) operations performed on the dual-console Da Vinci surgical robotic system between July 2019 and June 2021 were extracted. Cases with postgraduate year (PGY) 2-5 residents participating as a console surgeon were included. A sequential explanatory mixed-methods approach was undertaken to explore the ICT results and we conducted secondary qualitative interviews with surgeons. Descriptive statistics and thematic analysis were applied. Results Resident ICT data from 420 robotic cases (IH 200, RC 121, and VH 99) performed by 20 junior residents (PGY2-3), 18 senior residents (PGY4-5), and 9 attending surgeons were extracted. The average ICT per case was 26.8 % for junior residents and 42.4 % for senior residents. Compared to early-career surgeons, surgeons with over 10 years' work experience gave less ICT to junior (18.2 % vs. 32.0 %) and senior residents (33.9 % vs. 56.6 %) respectively. Surgeons' RAS case volume had no correlation with resident ICT (r = 0.003, p = 0.0003). On average, residents had the most ICT in RC (45.8 %), followed by RIH (36.7 %) and RVH (28.6 %). Interviews with surgeons revealed two potential reasons for these resident ICT patterns: 1) Surgeon assessment of resident training year/experience influenced decisions to grant ICT; 2) Surgeons' perceived operative time pressure inversely affected resident ICT. Conclusions This study suggests resident ICT/autonomy in RC, RIH, and RVH are influenced by resident seniority level, surgeon work experience, and procedure type, but not related to surgeon RAS case volume. Design and implementation of an effective robotic training program must consider the external pressures at conflict with increased resident operative autonomy and seek to mitigate them.
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Affiliation(s)
- Theresa N. Wang
- The Ohio State University Wexner Medical Center, Department of Surgery, Columbus, OH, USA
| | - Ingrid A. Woelfel
- The Ohio State University Wexner Medical Center, Department of Surgery, Columbus, OH, USA
| | - Emily Huang
- The Ohio State University Wexner Medical Center, Department of Surgery, Columbus, OH, USA
| | - Heidi Pieper
- The Ohio State University Wexner Medical Center, Department of Surgery, Columbus, OH, USA
| | - Michael P. Meara
- The Ohio State University Wexner Medical Center, Department of Surgery, Columbus, OH, USA
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Ahmad QA, Mahboob U, Khan RA, Waheed K, Fahim A. Factors necessary for entrustment decision-making in surgical operating rooms: A modified Delphi study. J Taibah Univ Med Sci 2024; 19:611-618. [PMID: 38800351 PMCID: PMC11126524 DOI: 10.1016/j.jtumed.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 03/18/2024] [Accepted: 05/03/2024] [Indexed: 05/29/2024] Open
Abstract
Objective Resident autonomy in an operation theatre has been directly linked with patient safety in healthcare. The objective of this study was to identify the factors necessary for making resident-entrustment decisions from the perspective of a supervisor/consultant viewpoint. The second objective was to develop a checklist for assessing resident readiness for independent work. Materials and methods This study employed a mixed-method Delphi approach. In the first stage, a comprehensive literature review and a qualitative exploratory study produced a list of factors related to residents. The second phase involved content validation by a panel of experts, followed by a two-round Delphi study with 20 expert panelists. Results A total of 49 resident-related factors for entrustment were identified, which were reduced to 46 after content validation. During Delphi Round I, 17 factors were fully accepted, 7 were rejected and 22 items were partially accepted. Out of the 39 items sent to Delphi Round II, 23 items were accepted and 16 were rejected. A final 23-item checklist was formed based on the following factors; 6 Cognitive (knowledgeable, risk manager, safe doctor, general manager, field of interest, communicator), 5 Psychomotor (past performer, competent, ability to pick critical findings, ability to act situationally, decision maker) and 12 affective (responsible, leader, honest, empathetic, ethical, receptive, humble, emotionally intelligent, motivated, accountable, team player, disciplined) factors. Conclusion The study resulted in the formation of a checklist based on the factors necessary for entrustment decision-making in surgical operating rooms. Some of the novel contextual factors were 'general manager', 'field of interest', 'ability to pick critical findings', 'accountable', 'risk manager', and 'past performer'. This framework offers a guideline for supervisors and residents to evaluate progress throughout the residency program. The developed tool demonstrates good content validity and is suitable for entrustment assessment following construct validation.
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Affiliation(s)
- Qamar A. Ahmad
- Department of Medical Education, The University of Lahore, Lahore, Pakistan
- Department of Surgery, Post Graduate Medical Institute, Ameer-u-din Medical College Lahore, Pakistan
| | - Usman Mahboob
- Department of Medical Education, Institute of Health Professions Education & Research, Khyber Medical University, Peshawar, Pakistan
| | - Rehan A. Khan
- Department of Medical Education, Islamic International Medical College, Riphah International University, Islamabad, Pakistan
| | - Khadija Waheed
- Department of Obstetrics & Gynaecology, King Edward Medical University, Lahore, Pakistan
| | - Ayesha Fahim
- Department of Oral Biology, University College of Dentistry, The University of Lahore, Lahore, Pakistan
- Department of Health Sciences, The Equator University of Science and Technology, Uganda
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Kolcun JPG, Mazza JM, Pawlowski KD, Varela JR, Kolb B, Traynelis VC, Byrne RW, Fontes RBV. The Evolving Role of Postgraduate Year 7 in Neurological Surgery Residency. Neurosurgery 2024; 94:350-357. [PMID: 37706880 DOI: 10.1227/neu.0000000000002685] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/25/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES In 2013, all neurosurgery programs were mandated to adopt a 7-year structure. We sought to characterize how programs use the seventh year of training (postgraduate year 7 [PGY7]). METHODS We surveyed all accredited neurosurgery programs in the United States regarding the PGY7 residents' primary role and the availability of enfolded fellowships. We compiled responses from different individuals in each program: chair, program director, program coordinator, and current chiefs. RESULTS Of 120 accredited neurological surgery residency programs within the United States, 91 (76%) submitted responses. At these programs, the primary roles of the PGY7 were chief of service (COS, 71%), enfolded fellowships (EFF, 18%), transition to practice (10%), and elective time (1%). Most residencies have been 7-year programs for >10 years (52, 57%). Sixty-seven programs stated that they offer some form of EFF (73.6%). The most common EFFs were endovascular (57, 62.6%), spine (49, 53.9%), critical care (41, 45.1%), and functional (37, 40.7%). These were also the most common specialties listed as Committee on Advanced Subspecialty Training accredited by survey respondents. Spine and endovascular EFFs were most likely to be restricted to PGY7 (24.2% and 23.1%, respectively), followed by neuro-oncology (12, 13.2%). The most common EFFs reported as Committee on Advanced Subspecialty Training accredited but not restricted to PGY7 were endovascular (24, 26.4%) and critical care (23, 25.3%). CONCLUSION Most accredited neurological surgery training programs use the COS as the primary PGY7 role. Programs younger in their PGY7 structure seem to maintain the traditional COS role. Those more established seem to be experimenting with various roles the PGY7 year can fill, including enfolded fellowships and transition-to-practice years, predominantly. Most programs offer some form of enfolded fellowship. This serves as a basis for characterization of how neurological surgery training may develop in years to come.
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Affiliation(s)
- John Paul G Kolcun
- Department of Neurological Surgery, Rush University Medical Center, Chicago , Illinois , USA
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Flewelling K, Alfred A, Jose J, Elian A, Norman E, Timmons J, Munene G, Sawyer R, Shebrain S. Do Surgery Residents Prepare Enough for Surgical Cases? JOURNAL OF SURGICAL EDUCATION 2024; 81:48-55. [PMID: 38030443 DOI: 10.1016/j.jsurg.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/13/2023] [Accepted: 09/20/2023] [Indexed: 12/01/2023]
Abstract
IMPORTANCE This study aimed to identify both modifiable and nonmodifiable factors that affect intraoperative-specific surgical education and performance, with an overall goal of increasing cognizance of such factors to improve surgical training. OBJECTIVE To determine whether surgery residents prepare adequately for participation in surgical cases and to examine specific variables that affect resident preparation. DESIGN This study is a retrospective survey-based study that included data from 1945 postoperative case evaluations completed by 59 different general surgery residents over a period of 8 years (2014-2022). SETTING A Midwestern medical school's general surgery residency program. PARTICIPANTS Fifty-nine general surgery residents at Western Michigan University's medical school; 50 attending surgeons and faculty with whom residents regularly operate. The sample was comprised of residents and attendings who voluntarily filled out postoperative performance surveys after elective cases. RESULTS This retrospective survey-based study included postoperative evaluation data from 1945 procedures performed by 59 different residents and 50 attendings. Participants included 36 male residents, 23 female residents, 39 male attendings, and 11 female attendings. All included data were for elective cases. Self-reported preoperative communication was worst at the PGY1 level with positive correlation of improvement yearly (r = 0.30, p < 0.001). Positive correlation was seen between overall preparedness and case complexity (r = 0.25, p < 0.001). Positive correlation was seen between case complexity and resident perception of intraoperative teaching quality (r = 0.53, p < 0.001). Preoperative communication initiated by residents was significantly worse when the attending surgeon was female, regardless of resident gender (p < 0.001); this effect was particularly profound with male residents. Male residents overall rated themselves as more prepared compared to their female counterparts (11.13 ± 1.96 vs. 10.84 ± 2.03, p = 0.003). CONCLUSIONS AND RELEVANCE There is a need to identify and address quantifiable gaps in communication between residents and faculty to optimize surgical education; one of the first steps is characterizing nonmodifiable factors that correlate with differences in pre-operative communication and case preparation.
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Affiliation(s)
- Kayla Flewelling
- Department of Surgery, Western Michigan University, Homer Stryker MD School of Medicine, Kalamazoo, Michigan.
| | - Andrew Alfred
- Department of Surgery, Western Michigan University, Homer Stryker MD School of Medicine, Kalamazoo, Michigan
| | - Joslyn Jose
- Department of Surgery, Western Michigan University, Homer Stryker MD School of Medicine, Kalamazoo, Michigan
| | - Alain Elian
- Department of Surgery, Western Michigan University, Homer Stryker MD School of Medicine, Kalamazoo, Michigan
| | - Earl Norman
- Department of Surgery, Western Michigan University, Homer Stryker MD School of Medicine, Kalamazoo, Michigan
| | - Jennifer Timmons
- Department of Surgery, Western Michigan University, Homer Stryker MD School of Medicine, Kalamazoo, Michigan
| | - Gitonga Munene
- Department of Surgery, Western Michigan University, Homer Stryker MD School of Medicine, Kalamazoo, Michigan
| | - Robert Sawyer
- Department of Surgery, Western Michigan University, Homer Stryker MD School of Medicine, Kalamazoo, Michigan
| | - Saad Shebrain
- Department of Surgery, Western Michigan University, Homer Stryker MD School of Medicine, Kalamazoo, Michigan
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Tatebe LC, Golisch KB, Janczewski LM, Krueger M, Halverson A. Autonomy Maps: Building a Shared Mental Model for Progressive Resident Operative Autonomy on the Road to Entrustable Professional Activities (EPAs). JOURNAL OF SURGICAL EDUCATION 2023; 80:1351-1354. [PMID: 37537103 DOI: 10.1016/j.jsurg.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/12/2023] [Accepted: 07/08/2023] [Indexed: 08/05/2023]
Abstract
Our residents expressed dissatisfaction with operative autonomy and faculty feedback regarding technical skills. They reported variability among faculty regarding allowed operative autonomy. Our goals were to establish a shared mental model among residents and faculty regarding intraoperative performance expectations. We asked faculty to assign a level of expected autonomy (Zwisch scale) for various steps of common procedures according to the resident post-graduate year. Through an iterative process, the maps were standardized across service lines. The resulting "Autonomy Maps" were distributed to the faculty and residents. We held educational sessions and set expectations for use. Selected benchmarks were incorporated into resident end-of-rotation assessment forms. Initial operative case mapping identified variability in faculty expectations for a given post-graduate year and procedure. Residents reported improved satisfaction with understanding expectations regarding operative performance. Establishing autonomy benchmarks facilitated more specific feedback regarding residents' technical skills. Faculty expectations for resident operative autonomy are variable. Autonomy Maps provide structure for a shared mental model between faculty and residents for progressive operative autonomy and serve as a framework for expectations that improve resident satisfaction. Case-specific technical benchmarks are useful tools for assessing residents' technical milestones.
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Affiliation(s)
- Leah C Tatebe
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
| | | | | | - Mackenzie Krueger
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Amy Halverson
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Nguyen AT, Anjaria DJ, Sadeghi-Nejad H. Advancing Urology Resident Surgical Autonomy. Curr Urol Rep 2023; 24:253-260. [PMID: 36917339 PMCID: PMC10011787 DOI: 10.1007/s11934-023-01152-x] [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] [Accepted: 02/22/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE OF REVIEW This paper aims to survey current literature on urologic graduate medical education focusing on surgical autonomy. RECENT FINDINGS Affording appropriate levels of surgical autonomy has a key role in the education of urologic trainees and perceived preparedness for independent practice. Recent studies in surgical resident autonomy have demonstrated a reduction in autonomy for trainees in recent years. Efforts to advance the state of modern surgical training include creation of targeted curricula, enhanced with use of surgical simulation, and structured feedback. Decline in surgical autonomy for urology residents may influence confidence after completion of their residency. Further study is needed into the declining levels of urology resident autonomy, how it affects urologists entering independent practice, and what interventions can advance autonomy in modern urologic training.
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Affiliation(s)
- Anh T Nguyen
- Division of Urology Rutgers New Jersey Medical School, Newark, NJ, 07103, USA.
| | - Devashish J Anjaria
- East Orange Department of Surgery, Veteran Affairs New Jersey Healthcare System East Orange, East Orange, NJ, USA
| | - Hossein Sadeghi-Nejad
- East Orange Department of Surgery, Veteran Affairs New Jersey Healthcare System East Orange, East Orange, NJ, USA
- Hackensack University Medical Center, Hackensack, NJ, USA
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Sharma N, Steinhagen E, Marks J, Ammori J. A Comparison of Faculty and Resident Perceptions on the Qualities of Outstanding Surgical Educators. JOURNAL OF SURGICAL EDUCATION 2022; 79:e143-e150. [PMID: 35933310 DOI: 10.1016/j.jsurg.2022.06.016] [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: 03/24/2022] [Revised: 05/24/2022] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The objective of the study is to compare faculty and resident perspectives regarding the competencies of an outstanding surgical educator in practice. DESIGN An IRB-approved survey instrument using a five-point Likert scale assessing 50 competencies and behaviors of a surgical educator was sent to study participants. The competencies and behaviors examined were within the domains of: 1) medical knowledge 2) learner-centeredness 3) interpersonal and communication skills 4) professionalism and role-modeling, and 5) intraoperative teaching. Study participants were asked to rate their level of agreement or disagreement regarding each individual competency as being a requirement for an effective surgical educator. T-test was used to compare faculty surgeons' and residents' responses, and statistically significance was defined as p<0.05. SETTING University Hospitals Cleveland Medical Center, a tertiary care academic institution PARTICIPANTS: Residents, fellows, and attending surgeons in surgical specialties. RESULTS There were 115 study participants, 55 faculty and 60 residents. Twelve of 50 (24%) assessed surgical education competencies were rated significantly differently by faculty and residents, with 6 of 12 (50%) being in the category of "intraoperative teaching." There were no differences in faculty and resident responses to competencies/behaviors in the category "interpersonal and communication skills". There were differences in 2 of 7 (28.6%) competencies in the category "medical knowledge", 2 of 15 (13.3%) competencies in the category "learner centeredness", 1 of 10 (10%) in the category "professionalism and role-modeling", 1 of 9 (11.1%) in the category "professionalism and role-modeling", and 6 of 12 (50%) in the category "intraoperative teaching". CONCLUSIONS In general, there is agreement amongst surgical faculty and residents regarding the competencies and behaviors of an effective surgical educator. The main area of difference is in the perception of educator qualities and behaviors necessary for effective intraoperative teaching.
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Affiliation(s)
- Neha Sharma
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Emily Steinhagen
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio; University Hospitals Research in Surgical Outcomes and Effectiveness (UH RISES), Cleveland, Ohio
| | - Jeffrey Marks
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - John Ammori
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
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Read EK, Maxey C, Hecker KG. Longitudinal assessment of competency development at The Ohio State University using the competency-based veterinary education (CBVE) model. Front Vet Sci 2022; 9:1019305. [PMID: 36387400 PMCID: PMC9642912 DOI: 10.3389/fvets.2022.1019305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 09/29/2022] [Indexed: 09/19/2023] Open
Abstract
With the development of the American Association of Veterinary Medical Colleges' Competency-Based Veterinary Education (CBVE) model, veterinary schools are reorganizing curricula and assessment guidelines, especially within the clinical rotation training elements. Specifically, programs are utilizing both competencies and entrustable professional activities (EPAs) as opportunities for gathering information about student development within and across clinical rotations. However, what evidence exists that use of the central tenets of the CBVE model (competency framework, milestones and EPAs) improves our assessment practices and captures reliable and valid data to track competency development of students as they progress through their clinical year? Here, we report on validity evidence to support the use of scores from in-training evaluation report forms (ITERs) and workplace-based assessments of EPAs to evaluate competency progression within and across domains described in the CBVE, during the final year clinical training period of The Ohio State University's College of Veterinary Medicine (OSU-CVM) program. The ITER, used at the conclusion of each rotation, was modified to include the CBVE competencies that were assessed by identifying the stage of student development on a series of descriptive milestones (from pre-novice to competent). Workplace based assessments containing entrustment scales were used to assess EPAs from the CBVE model within each clinical rotation. Competency progression and entrustment scores were evaluated on each of the 31 rotations offered and high-stakes decisions regarding student performance were determined by a collective review of all the ITERs and EPAs recorded for each learner across each semester and the entire year. Results from the class of 2021, collected on approximately 190 students from 31 rotations, are reported with more than 55 299 total competency assessments combined with milestone placement and 2799 complete EPAs. Approximately 10% of the class was identified for remediation and received additional coaching support. Data collected longitudinally through the ITER on milestones provides initial validity evidence to support using the scores in higher stakes contexts such as identifying students for remediation and for determining whether students have met the necessary requirements to successfully complete the program. Data collected on entrustment scores did not, however, support such decision making. Implications are discussed.
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Affiliation(s)
- Emma K. Read
- College of Veterinary Medicine, The Ohio State University, Columbus, OH, United States
| | - Connor Maxey
- Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| | - Kent G. Hecker
- Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
- International Council for Veterinary Assessment, Bismarck, ND, United States
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