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Sample records for canadian surgery resident

  1. Endoscopy training in Canadian general surgery residency programs.

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    Bradley, Nori L; Bazzerelli, Amy; Lim, Jenny; Wu Chao Ying, Valerie; Steigerwald, Sarah; Strickland, Matt

    2015-06-01

    Currently, general surgeons provide about 50% of endoscopy services across Canada and an even greater proportion outside large urban centres. It is essential that endoscopy remain a core component of general surgery practice and a core competency of general surgery residency training. The Canadian Association of General Surgeons Residents Committee supports the position that quality endoscopy training for all Canadian general surgery residents is in the best interest of the Canadian public. However, the means by which quality endoscopy training is achieved has not been defined at a national level. Endoscopy training in Canadian general surgery residency programs requires standardization across the country and improved measurement to ensure that competency and basic credentialing requirements are met.

  2. Evolving attitudes toward robotic surgery among Canadian urology residents.

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    Locke, Jennifer; Robinson, Michael; MacNeily, Andrew; Goldenberg, S Larry; Black, Peter C

    2017-07-01

    Robotic-assisted laparoscopic surgery (RAS) has not been adopted as rapidly or widely in Canada as in the U.S. In 2011, Canadian urology residents felt that RAS represented an expanding field that could potentially negatively impact their training. We re-evaluate trainee exposure and attitudes to RAS in Canadian residency training five years later. All Canadian urology residents were asked to participate in an online survey designed to assess current resident exposure to and perception of RAS. The response rate was 39% (61/157). Seventy-seven percent of residents reported being involved in at least one RAS procedure (52% in 2011), and the majority had exposure to <10 cases. For those in hospitals with access to RAS, 96% desired more console time, while only 50% of those without access wanted more console experience. Of all residents, 50% felt that RAS will become the gold standard in certain urological surgeries (34% in 2011), but only 28% felt that RAS would play an increasingly important role in urology (59% in 2011). Despite an increase in exposure to RAS in residency programs over the past five years, console experience remains limited. Although these residents desire more access to RAS, many voice uncertainty of the role of RAS in Canada. We cannot conclude whether RAS is perceived by residents to be beneficial or detrimental to their training nationwide. Moving forward in the robotic era, it will be important to either modify residency curricula to address RAS experience or to limit RAS to fellowship training.

  3. Cosmetic surgery training in Canadian plastic surgery residencies: are we training competent surgeons?

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    Chivers, Quinton J; Ahmad, Jamil; Lista, Frank; Warren, Richard J; Arkoubi, Amr Y; Mahabir, Raman C; Murray, Kenneth A; Islur, Avinash

    2013-01-01

    With the demand for cosmetic surgery continuing to rise, it is necessary to reevaluate the current state of cosmetic surgery training during plastic surgery residency. An evaluation of cosmetic surgery training in US plastic surgery residency programs in 2006 identified several areas for improvement, resulting in changes to both the duration and content of training. The authors assess the current state of cosmetic surgery training in Canadian plastic surgery residency programs. A paper survey of all graduating Canadian plastic surgery residents eligible to complete the 2009 Royal College of Physicians and Surgeons of Canada fellowship examinations was performed (N = 29). The survey was conducted primarily at the Canadian Plastic Surgery Review Course in February 2009, with surveys collected from absent residents by e-mail within 1 month after the course. The survey covered 2 broad areas: (1) specifics regarding resident cosmetic surgery training and (2) confidence and satisfaction associated with this experience. Of the 29 residents surveyed, 28 responded (96%). The majority of Canadian plastic surgery residency programs (75%) have a designated cosmetic surgery rotation, but 90% of respondents felt it has become increasingly difficult to gain exposure to cosmetic procedures as most are performed at private surgery centers. Elective rotations at cosmetic surgery practices and resident cosmetic clinics were considered the most beneficial for cosmetic surgery education. Residents considered cosmetic surgery procedures of the face (such as rhinoplasty and facelift) more challenging, but they had more confidence with breast and body contouring procedures. Canadian plastic surgery residency programs need to ensure that residents continue to receive comprehensive exposure to both surgical and nonsurgical cosmetic procedures to ensure our specialty's continued leadership in this evolving and highly competitive field. A multidimensional approach utilizing a variety of

  4. Canadian vascular surgery residents' perceptions regarding future job opportunities.

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    Cooper, Joel A; Dubois, Luc; Power, Adam H; DeRose, Guy; MacKenzie, Kent S; Forbes, Thomas L

    2015-06-01

    The objective was to determine the employment environment for graduates of Canadian vascular surgery training programs. A cross-sectional survey of residents and graduates (2011-2012) was used. Thirty-seven residents were invited with a response rate of 57%, and 14 graduates with a response rate of 71%; 70% of graduates felt the job market played an important role in their decision to pursue vascular surgery as a career compared to 43% of trainees. The top three concerns were the lack of surgeons retiring, the overproduction of trainees, and saturation of the job market. The majority (62%) of trainees see themselves extending their training due to lack of employment. All of the graduates obtained employment, with 50% during their second year (of two years) of training and 30% after training was completed. Graduates spent an average of 12 ± 10.6 months seeking a position and applied to 3.3 ± 1.5 positions, with a mean of 1.9 ± 1.3 interviews and 2 ± 1.2 offers. There was a discrepancy between the favorable employment climate experienced by graduates and the pessimistic outlook of trainees. We must be progressive in balancing the employment opportunities with the number of graduates. Number and timing of job offers is a possible future metric of the optimal number of residents. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  5. Resident continuity of care experience in a Canadian general surgery training program

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    Sidhu, Ravindar S.; Walker, G. Ross

    Objectives To provide baseline data on resident continuity of care experience, to describe the effect of ambulatory centre surgery on continuity of care, to analyse continuity of care by level of resident training and to assess a resident-run preadmission clinic’s effect on continuity of care. Design Data were prospectively collected for 4 weeks. All patients who underwent a general surgical procedure were included if a resident was present at operation. Setting The Division of General Surgery, Queen’s University, Kingston, Ont. Outcome measures Preoperative, operative and inhospital postoperative involvement of each resident with each case was recorded. Results Residents assessed preoperatively (before entering the operating room) 52% of patients overall, 20% of patients at the ambulatory centre and 83% of patients who required emergency surgery. Of patients assessed by the chief resident, 94% were assessed preoperatively compared with 32% of patients assessed by other residents ( p 0.1). Conclusions This study serves as a reference for the continuity of care experience in Canadian surgical programs. Residents assessed only 52% of patients preoperatively, and only 40% of patients had complete continuity of care. Factors such as ambulatory surgery and junior level of training negatively affected continuity experience. Such factors must be taken into account in planning surgical education. PMID:10526519

  6. Resident laser refractive surgery training.

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    Madu, Assumpta A; Ali, Tofik

    2010-07-01

    The Residency Review Committee Ophthalmology of the Accreditation Council for Graduate Medical Education has recently established guidelines pertaining to the minimum operative requirements for training ophthalmology residents in refractive surgery. Despite being one of the most frequently performed ophthalmic surgical procedures, there is a paucity of literature on residency training in refractive surgery. Moreover, the literature indicates that only half of training programs offer surgical exposure to trainees. The purpose of this article is to review recent research on training ophthalmology residents in refractive surgery and offer an approach to incorporating laser refractive surgery curriculum in residency education. Kwon et al. performed a national survey to evaluate current trends in resident laser in-situ keratomileusis (LASIK) training in the USA. The result shows that 54% of respondents had resident-performed LASIK surgery with 9.1% of surveyed programs not offering any LASIK experience. In addition, residents in the study performed a mean of 4.4 LASIK surgeries (range 1-10) during residency training starting during the second year. The data emerging from the survey show that refractive surgery experience is fundamental to the education of the ophthalmology resident. Although the demand for refractive surgery continues to gain pace with millions of such procedures performed worldwide, only a little over half of ophthalmology residency programs offer residents the opportunity to gain surgical experience. With the current mandate, programs must now look for strategies to provide laser refractive surgical experience to residents.

  7. Abortion training in Canadian obstetrics and gynecology residency programs.

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    Liauw, J; Dineley, B; Gerster, K; Hill, N; Costescu, D

    2016-11-01

    To evaluate the current state of abortion training in Canadian Obstetrics and Gynecology residency programs. Surveys were distributed to all Canadian Obstetrics and Gynecology residents and program directors. Data were collected on inclusion of abortion training in the curriculum, structure of the training and expected competency of residents in various abortion procedures. We distributed and collected surveys between November 2014 and May 2015. In total, 301 residents and 15 program directors responded, giving response rates of 55% and 94%, respectively. Based on responses by program directors, half of the programs had "opt-in" abortion training, and half of the programs had "opt-out" abortion training. Upon completion of residency, 66% of residents expected to be competent in providing first-trimester surgical abortion in an ambulatory setting, and 35% expected to be competent in second-trimester surgical abortion. Overall, 15% of residents reported that they were not aware of or did not have access to abortion training within their program, and 69% desired more abortion training during residency. Abortion training in Canadian Obstetrics and Gynecology residency programs is inconsistent, and residents desire more training in abortion. This suggests an ongoing unmet need for training in this area. Policies mandating standardized abortion training in obstetrics and gynecology residency programs are necessary to improve delivery of family planning services to Canadian women. Abortion training in Canadian Obstetrics and Gynecology residency programs is inconsistent, does not meet resident demand and is unlikely to fulfill the Royal College of Physicians and Surgeons of Canada objectives of training in the specialty. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Supplementary Educational Models in Canadian Neurosurgery Residency Programs.

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    Ryu, Won Hyung A; Chan, Sonny; Sutherland, Garnette R

    2017-03-01

    The proposed implementation of work hour restrictions has presented a significant challenge of maintaining the quality of resident education and ensuring adequate hands-on experience that is essential for novice surgeons. To maintain the level of resident surgical competency, revision of the apprentice model of surgical education to include supplementary educational methods, such as laboratory and virtual reality (VR) simulations, have become frequent topics of discussion. We aimed to better understand the role of supplementary educational methods in Canadian neurosurgery residency training. An online survey was sent to program directors of all 14 Canadian neurosurgical residency programs and active resident members of the Canadian Neurosurgical Society (N=85). We asked 16 questions focusing on topics of surgeon perception, current implementation and barriers to supplementary educational models. Of the 99 surveys sent, 8 out of 14 (57%) program directors and 37 out of 85 (44%) residents completed the survey. Of the 14 neurosurgery residency programs across Canada, 7 reported utilizing laboratory-based teaching within their educational plan, while only 3 programs reported using VR simulation as a supplementary teaching method. The biggest barriers to implementing supplementary educational methods were resident availability, lack of resources, and cost. Work-hour restrictions threaten to compromise the traditional apprentice model of surgical training. The potential value of supplementary educational methods for surgical education is evident, as reported by both program directors and residents across Canada. However, availability and utilization of laboratory and VR simulations are limited by numerous factors such as time constrains and lack of resources.

  9. Thoughts of Quitting General Surgery Residency: Factors in Canada.

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    Ginther, David Nathan; Dattani, Sheev; Miller, Sarah; Hayes, Paul

    2016-01-01

    Attrition rates in general surgery training are higher than other surgical disciplines. We sought to determine the prevalence with which Canadian general surgery residents consider leaving their training and the contributing factors. An anonymous survey was administered to all general surgery residents in Canada. Responses from residents who considered leaving their training were assessed for importance of contributing factors. The study was conducted at the Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada, a tertiary academic center. The response rate was approximately 34.0%. A minority (32.0%) reported very seriously or somewhat seriously considering leaving their training, whereas 35.2% casually considered doing so. Poor work-life balance in residency (38.9%) was the single-most important factor, whereas concern about future unemployment (16.7%) and poor future quality of life (15.7%) were next. Enjoyment of work (41.7%) was the most frequent mitigating factor. Harassment and intimidation were reported factors in 16.7%. On analysis, only intention to practice in a nonacademic setting approached significant association with thoughts of leaving (odds ratio = 1.92, CI = 0.99-3.74, p = 0.052). There was no association with sex, program, postgraduate year, relationship status, or subspecialty interest. There was a nonsignificant trend toward more thoughts of leaving with older age. Canadian general surgery residents appear less likely to seriously consider quitting than their American counterparts. Poor work-life balance in residency, fear of future unemployment, and anticipated poor future quality of life are significant contributors to thoughts of quitting. Efforts to educate prospective residents about the reality of the surgical lifestyle, and to assist residents in securing employment, may improve completion rates. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  10. Cosmetic Surgery Training in Plastic Surgery Residency Programs.

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    McNichols, Colton H L; Diaconu, Silviu; Alfadil, Sara; Woodall, Jhade; Grant, Michael; Lifchez, Scott; Nam, Arthur; Rasko, Yvonne

    2017-09-01

    Over the past decade, plastic surgery programs have continued to evolve with the addition of 1 year of training, increase in the minimum number of required aesthetic cases, and the gradual replacement of independent positions with integrated ones. To evaluate the impact of these changes on aesthetic training, a survey was sent to residents and program directors. A 37 question survey was sent to plastic surgery residents at all Accreditation Council for Graduate Medical Education-approved plastic surgery training programs in the United States. A 13 question survey was sent to the program directors at the same institutions. Both surveys were analyzed to determine the duration of training and comfort level with cosmetic procedures. Eighty-three residents (10%) and 11 program directors (11%) completed the survey. Ninety-four percentage of residents had a dedicated cosmetic surgery rotation (an increase from 68% in 2015) in addition to a resident cosmetic clinic. Twenty percentage of senior residents felt they would need an aesthetic surgery fellowship to practice cosmetic surgery compared with 31% in 2015. Integrated chief residents were more comfortable performing cosmetic surgery cases compared with independent chief residents. Senior residents continue to have poor confidence with facial aesthetic and body contouring procedures. There is an increase in dedicated cosmetic surgery rotations and fewer residents believe they need a fellowship to practice cosmetic surgery. However, the comfort level of performing facial aesthetic and body contouring procedures remains low particularly among independent residents.

  11. Experience with emergency ultrasound training by Canadian emergency medicine residents.

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    Kim, Daniel J; Theoret, Jonathan; Liao, Michael M; Kendall, John L

    2014-05-01

    Starting in 2008, emergency ultrasound (EUS) was introduced as a core competency to the Royal College of Physicians and Surgeons of Canada (Royal College) emergency medicine (EM) training standards. The Royal College accredits postgraduate EM specialty training in Canada through 5-year residency programs. The objective of this study is to describe both the current experience with and the perceptions of EUS by Canadian Royal College EM senior residents. This was a web-based survey conducted from January to March 2011 of all 39 Canadian Royal College postgraduate fifth-year (PGY-5) EM residents. Main outcome measures were characteristics of EUS training and perceptions of EUS. Survey response rate was 95% (37/39). EUS was part of the formal residency curriculum for 86% of respondents (32/37). Residents most commonly received training in focused assessment with sonography for trauma, intrauterine pregnancy, abdominal aortic aneurysm, cardiac, and procedural guidance. Although the most commonly provided instructional material (86% [32/37]) was an ultrasound course, 73% (27/37) of residents used educational resources outside of residency training to supplement their ultrasound knowledge. Most residents (95% [35/37]) made clinical decisions and patient dispositions based on their EUS interpretation without a consultative study by radiology. Residents had very favorable perceptions and opinions of EUS. EUS training in Royal College EM programs was prevalent and perceived favorably by residents, but there was heterogeneity in resident training and practice of EUS. This suggests variability in both the level and quality of EUS training in Canadian Royal College EM residency programs. [West J Emerg Med. 2014;15(3):306-311.].

  12. Surgery resident learning styles and academic achievement.

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    Contessa, Jack; Ciardiello, Kenneth A; Perlman, Stacie

    2005-01-01

    To determine if surgical residents share a preferred learning style as measured by Kolb's Learning Style Inventory (LSI) and if a relationship exists between resident learning style and achievement as measured by a standardized examination (AME). Also, core faculty learning styles were assessed to determine if faculty and residents share a preferred learning style. Kolb's LSI, Version 3, was administered to 16 surgical residents and the residency program's core faculty of 6 attending physicians. To measure academic achievement, the American Medical Education (AME) examination was administered to residents. The Hospital of Saint Raphael, General Surgery Residency Program, New Haven, Connecticut. Both instruments were administered to residents during protected core curriculum time. Core faculty were administered the LSI on an individual basis. Surgical residents of the Hospital of Saint Raphael's General Surgery Residency Program and 6 core faculty members Analysis of resident learning style preference revealed Converging as the most commonly occurring style for residents (7) followed by Accommodating (5), Assimilating (3), and Diverging (1). The predominant learning style for core faculty was also Converging (4) with 2 Divergers. The average score for the Convergers on the AME was 62.6 compared with 42 for the next most frequently occurring learning style, Accommodators. In this surgical residency program, a preferred learning style for residents seems to exist (Converging), which confirms what previous studies have found. Additionally, residents with this learning style attained a higher average achievement score as measured by the AME. Also, core faculty share the same preferential learning style as this subset of residents.

  13. General Surgery Resident Satisfaction on Cardiothoracic Rotations.

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    Lussiez, Alisha; Bevins, Jack; Plaska, Andrew; Rosin, Vadim; Reddy, Rishindra M

    2016-01-01

    General surgery residents' exposure to cardiothoracic (CT) surgery rotations has decreased, which may affect resident satisfaction. We surveyed general surgery graduates to assess the relationships among rotation satisfaction, CT disease exposure, rotation length, mentorship, and mistreatment. A survey assessing CT curriculum, exposure, mentorship, and satisfaction was forwarded to general surgery graduates from 17 residency programs. A Wilcoxon rank-sum test was used to assess statistical significance of ordinal level data. Statistical significance was defined as p surgery residency programs who graduated between the years of 1999 to 2014. A total of 94 responses were completed and received. Receiving adequate exposure to CT procedures and disease management was significantly associated with higher satisfaction ratings for all procedures, particularly thoracotomy incisions (p Surgery. Published by Elsevier Inc. All rights reserved.

  14. The quality of aesthetic surgery training in plastic surgery residency: a survey among residents in Germany.

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    Momeni, Arash; Goerke, Sebastian M; Bannasch, Holger; Arkudas, Andreas; Stark, G Björn

    2013-06-01

    The importance of providing high-quality exposure and training in aesthetic and reconstructive surgery during residency has come to the forefront of plastic surgery education. Adequate training in aesthetic surgery, however, has traditionally been challenging. The authors were interested in how these challenges were met abroad. A 17-item online survey was developed to assess the quality of training in aesthetic surgery in Germany. The survey had 3 distinct sections: demographic information, current state of aesthetic surgery training, and residents' opinions about the perceived quality of aesthetic surgery training. Only responses of senior residents were included in the final analysis. A total of 112 residents responded (30% response rate), of which 88 were senior plastic surgery residents. Ninety percent (n = 79) reported that a resident aesthetic surgery clinic was not part of their training experience. Eighty-eight percent (n = 77) reported that they did not have a dedicated aesthetic surgery rotation during their residency training. According to 69.3% (n = 61), no didactic training in aesthetic surgery was provided. Fifty-six percent (n = 49) of senior plastic surgery residents had performed only a maximum of 10 aesthetic surgery procedures at the time of the survey. Although only 43.2% of senior residents claimed to be interested in a predominantly aesthetic surgery practice, 90.9% (n = 80) felt that they require further training in aesthetic surgery (ie, fellowship). Deficiencies exist with respect to aesthetic surgery training among senior plastic surgery residents in Germany. Structural improvements in residency training with formal exposure and teaching in aesthetic surgery are warranted. The German Society of Plastic, Reconstructive and Aesthetic Surgeons is actively addressing deficiencies identified with the goal of improving the quality of training.

  15. Stroke Education in Canadian Emergency Medicine Residency Programs.

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    Harris, Devin R; Teal, Philip; Turton, Matthew; Lahiffe, Brian; Pulfrey, Simon

    2016-07-01

    Stroke and transient ischemic attack (TIA) are common disorders treated by Canadian emergency physicians. The diagnosis and management of these conditions is time-sensitive and complex, requiring that emergency physicians have adequate training. This study sought to determine the extent of stroke and TIA training in Canadian emergency medicine residency programs. A two-page survey was emailed to directors of all English-speaking emergency medicine residency programs in Canada. This included both the Fellow of the Royal College of Physicians of Canada (FRCPC) and the College of Family Physicians Enhanced Training [CCFP(EM)] residency programs. The number of mandatory and elective rotations, lectures, and examinations relevant to stroke and TIA were assessed. Nine FRCPC programs responded (of 11; RR=82%) and 11 CCFP(EM) programs responded (of 18; RR=61%), representing 20 of 29 programs in Canada (RR: 20/29=69%). Mandatory general neurology (3/9) and stroke neurology (2/9) rotations were offered in a minority of FRCPC programs and not at all in CCFP(EM) programs (0/11). Neuroradiology rotations were mandatory in 1/9 FRCPC programs and no CCFP(EM) programs (0/11). Acute ischemic stroke was allocated 3 hours of lecture time per year in all residency programs, regardless of route of training. Despite the fact that 100% of respondents train residents in facilities that administer thrombolysis for stroke, only 1/11 (9%) CCFP(EM) programs and 0/9 FRCPC programs have residents act as stroke team leaders. Formal training in stroke and TIA is limited in Canadian emergency medicine residency programs. Enhanced training opportunities should be developed as this disease is sudden, life-threatening, and can have disabling or fatal consequences, and therapeutic options are time sensitive.

  16. Update on cardiothoracic surgery resident job opportunities.

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    Cooke, David T; Kerendi, Faraz; Mettler, Brett A; Boffa, Daniel J; Mehall, John R; Merrill, Walter H; Higgins, Robert S D

    2010-06-01

    Concerns regarding ample employment opportunities for graduating cardiothoracic surgery residents may affect perceptions of the field and recruitment into residency programs. We present the results of the Thoracic Surgery Residents Association/Thoracic Surgery Directors Association (TSRA/TSDA) 2008 Resident Survey, and compare them with the 2007 TSRA/TSDA survey and the 2006 interim report of the Society of Thoracic Surgeons Task Force on Job Opportunities. In April 2008, the TSRA/TSDA conducted an anonymous survey, linked to the cardiothoracic surgery resident online In-training Exam, with questions germane to resident job seeking and perceptions of the specialty. Results were compared with resident surveys from 2007 and 2006. Response rates for the 2008 and 2007 surveys were 100%, and 54.2% for 2006. Of graduating residents looking for employment, 61.6% had one or more job offers, compared with 64.6% and 83.5% from the 2007 and 2006 surveys, respectively. Of the respondents completing their job search, 24.5% entered private practice and 26.3% academia, compared with 12.1% and 30.1%, respectively, in the 2007 survey. Overall, 57.7% of all respondents had more than $50,000 education-related debt, compared with 54.2% of 2007 respondents. However, 71.5% of all 2008 respondents would recommend cardiothoracic surgery to a potential trainee, compared with 63.7% and 46.0% from 2007 and 2006 survey respondents, respectively. The 2008 survey suggests that although the majority of respondents found employment on completing residency, the percentage is less than 65%, reinforcing a need for formal networking programs or changes in residency training. Despite continued limited employment opportunities, resident impressions of cardiothoracic surgery have improved from 2006 to 2008. 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  17. Evolution of gender representation among Canadian OTL-HNS residents: a 27-year analysis.

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    Chorfi, Sarah; Schwartz, Joseph S; Verma, Neil; Young, Meredith; Joseph, Lawrence; Nguyen, Lily H P

    2017-08-29

    The proportion of females enrolling into medical schools has been growing steadily. However, the representation of female residents among individual specialties has shown considerable variation. The purpose of this study was to compare the trends of gender representation in Otolaryngology - Head and Neck Surgery (OTL-HNS) residency programs with other specialty training programs in Canada. In order to contextualize these findings, a second phase of analysis examined the success rate of applicants of different genders to OTL-HNS residency programs. Anonymized data were obtained from the Canadian Residency Matching Service (CaRMS) and from the Canadian Post-M.D. Education Registry (CAPER) from 1988 to 2014. The differences in gender growth rates were compared to other subspecialty programs of varying size. Descriptive analysis was used to examine gender representation among OTL-HNS residents across years, and to compare these trends with other specialties. Bayesian hierarchical models were fit to analyze the growth in program rates in OTL-HNS based on gender. CaRMS and CAPER data over a 27 year period demonstrated that OTL-HNS has doubled its female representation from 20% to 40% between 1990 and 1994 and 2010-2014. The difference in annual growth rate of female representation versus male representation in OTL-HNS over this time period was 2.7%, which was similar to other large specialty programs and surgical subspecialties. There was parity in success rates of female and male candidates ranking OTL-HNS as their first choice specialty for most years. Female representation in Canadian OTL-HNS residency programs is steadily increasing over the last 27 years. Large variation in female applicant acceptance rates was observed across Canadian universities, possibly attributable to differences in student body or applicant demographics. Factors influencing female medical student career selection to OTL-HNS require further study to mitigate disparities in gender

  18. Career Interests of Canadian Psychiatry Residents: What Makes Residents Choose a Research Career?

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    Laliberté, Vincent; Rapoport, Mark J; Andrew, Melissa; Davidson, Marla; Rej, Soham

    2016-02-01

    Training future clinician-researchers remains a challenge faced by Canadian psychiatry departments. Our objectives were to determine the prevalence of residents interested in pursuing research and other career options as part of their practice, and to identify the factors associated with interest in research. Data from a national online survey of 207 Canadian psychiatry residents from a total of 853 (24.3% response rate) were examined. The main outcome was interest in research as part of residents' future psychiatrist practice. Bivariate and multivariate analyses were performed to identify demographic and vocational variables associated with research interest. Interest in research decreases by 76% between the first and fifth year of psychiatry residency (OR 0.76 per year, 95% CI 0.60 to 0.97). Training in a department with a residency research track did not correlate with increased research interest (χ2 = 0.007, df = 1, P = 0.93). Exposing and engaging psychiatry residents in research as early as possible in residency training appears key to promoting future research interest. Psychiatry residency programs and research tracks could consider emphasizing research training initiatives and protected research time early in residency. © The Author(s) 2015.

  19. Spirituality and religion in Canadian psychiatric residency training.

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    Grabovac, Andrea D; Ganesan, Soma

    2003-04-01

    Mental health professionals are increasingly aware of the need to incorporate a patient's religious and spiritual beliefs into mental health assessments and treatment plans. Recent changes in assessment and treatment guidelines in the US have resulted in corresponding curricular changes, with at least 16 US psychiatric residency programs now offering formal training in religious and spiritual issues. We present a survey of training currently available to Canadian residents in psychiatry and propose a lecture series to enhance existing training. We surveyed all 16 psychiatry residency programs in Canada to determine the extent of currently available training in religion and spirituality as they pertain to psychiatry. We received responses from 14 programs. Of these, 4 had no formal training in this area. Another 4 had mandatory academic lectures dedicated to the interface of religion, spirituality, and psychiatry. Nine programs offered some degree of elective, case-based supervision. Currently, most Canadian programs offer minimal instruction on issues pertaining to the interface of religion, spirituality, and psychiatry. A lecture series focusing on religious and spiritual issues is needed to address this apparent gap in curricula across the country. Therefore, we propose a 10-session lecture series and outline its content. Including this lecture series in core curricula will introduce residents in psychiatry to religious and spiritual issues as they pertain to clinical practice.

  20. Emotional intelligence in orthopedic surgery residents.

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    Chan, Kevin; Petrisor, Brad; Bhandari, Mohit

    2014-04-01

    Emotional intelligence (EI) is the ability to understand and manage emotions in oneself and others. It was originally popularized in the business literature as a key attribute for success that was distinct from cognitive intelligence. Increasing focus is being placed on EI in medicine to improve clinical and academic performance. Despite the proposed benefits, to our knowledge, there have been no previous studies on the role of EI in orthopedic surgery. We evaluated baseline data on EI in a cohort of orthopedic surgery residents. We asked all orthopedic surgery residents at a single institution to complete an electronic version of the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT). We used completed questionnaires to calculate total EI scores and 4 branch scores. Data were analyzed according to a priori cutoff values to determine the proportion of residents who were considered competent on the test. Data were also analyzed for possible associations with age, sex, race and level of training. Thirty-nine residents (100%) completed the MSCEIT. The mean total EI score was 86 (maximum score 145). Only 4 (10%) respondents demonstrated competence in EI. Junior residents (p = 0.026), Caucasian residents (p = 0.009) and those younger than 30 years (p = 0.008) had significantly higher EI scores. Our findings suggest that orthopedic residents score low on EI based on the MSCEIT. Optimizing resident competency in noncognitive skills may be enhanced by dedicated EI education, training and testing.

  1. Trends in urology resident exposure to minimally invasive surgery for index procedures: a tale of two countries.

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    Hoag, Nathan A; Mamut, Adiel; Afshar, Kourosh; Amling, Christopher; Mickelson, Jennifer J; Macneily, Andrew E

    2012-01-01

    To interrogate case-log data for American and Canadian urology residents to define trends in minimally invasive surgery (MIS) and open surgery and compare operative experiences between these 2 groups. Case-log data from 2004 to 2009 for American urology residents was compared with Canadian residents for 8 index cases, which are routinely performed in both an MIS and open approach. These included nephrectomy (donor, radical, simple, partial), prostatectomy (radical), adrenalectomy, pyeloplasty, and nephroureterectomy. Linear regression analysis demonstrated a significant increase in the percentage of MIS radical prostatectomies performed by American residents (11.2%-52%), compared with Canadian residents (0.74%-11.2%). There was also a significant increase in the percentage of MIS donor nephrectomies by Canadian residents (5.6%-68.7%), compared with American residents (70.1%-89.1%). For Canadian residents, exposure to the following 3 MIS procedures increased significantly over open approaches: adrenalectomy, radical prostatectomy, and donor nephrectomy. For American residents, all index procedures with the exception of adrenalectomy underwent a significant increasing trend (all p < 0.05). Trends for 8 index procedures confirm a continuing shift towards MIS for the majority of procedures in both countries. Differences may be only temporal and relate to dissimilar health care delivery models with a resultant lag in the adoption of laparoscopy and robotics in Canada. The impact of these trends upon ultimate surgical competence of graduates remains to be seen. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  2. Perception of Canadian training programs by Saudi resident trainees.

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    Assiri, Abdullah S; Al-Jarallah, Abdullah S; Al-Amari, Omar; Turnbull, Jeff

    2002-01-01

    The aim of the study was to determine how Saudi medical trainees in Canada perceive their training programs with regards to educational, ethnic and socio-cultural issues, and if different factors such as the chosen field of training, place or level of training make any difference to this perception. All Saudi residents in training programs in Canada in the 1996/1997 academic year were surveyed using a written anonymous self-administered questionnaire, evaluating educational, ethnic and socio-cultural aspects of various training programs. The response rate was 72.5% (185/255). Most of the respondents were in the fourth year of training. Overall, the level of stress was rated as tolerable in 154 (83%), and 179 respondents (96.8%) described the educational aspects of their program positively. Furthermore, 154 (83%) of the respondents agreed that they were treated fairly in the distribution of job functions with regards to Canadian residents, and 133 (72%) did not face any major difficulty in practicing their religion. The sites of training, type of specialty and the level of training made significant impact on the perceived educational, social, religious and administrative aspects of training. The majority of Saudi medical trainees in Canada perceived the educational aspects of their training as a positive experience. Major problems faced were mainly related to administrative matters and to some extent, social adjustment. Issues that affect the training process need to be tackled by the concerned authorities to ensure the success of the training programs.

  3. What Makes Residents Interested in Geriatric Psychiatry? A Pan-Canadian Online Survey of Psychiatry Residents.

    Science.gov (United States)

    Rej, Soham; Laliberté, Vincent; Rapoport, Mark J; Seitz, Dallas; Andrew, Melissa; Davidson, Marla

    2015-07-01

    In spite of a rapidly increasing need, there remains a shortage of geriatric psychiatrists in North America. The factors associated with psychiatric residents' interest in geriatric psychiatry have not yet been examined in a nationally representative sample. Cross-sectional study. Web-based online survey of Canadian psychiatry residents. 207 psychiatry residents (24.3% response rate). The main outcome was interest in becoming a geriatric psychiatrist. Bivariate and multivariate analyses were performed to better understand what demographic, educational, and vocational variables were associated with interest in becoming a geriatric psychiatrist. A number of respondents had an interest in becoming a geriatric psychiatrist (29.0%, N = 60); in doing a geriatric psychiatry fellowship (20.3%, N = 42); or an interest in doing geriatric psychiatry as a part of the clinical practice (60.0%, N = 124). Demographic characteristics (age, gender, ethnicity) did not correlate with interest in geriatric psychiatry. The variables most robustly associated with interest in geriatric psychiatry were: 1) completion of geriatric psychiatry rotation(s) before the third year of residency (OR: 5.13, 95% CI: 1.23-21.4); 2) comfort working with geriatric patients and their families (OR: 18.6, 95% CI: 2.09-165.3); 3) positive experiences caring for older adults prior to medical school (OR: 12.4, 95% CI: 1.07-144.5); and 4) the presence of annual conferences in the resident's field of interest (OR: 4.50, 95% CI: 1.12-18.2). Exposing medical students and junior psychiatry residents to clinical geriatric psychiatry rotations that increase comfort in working with older adults may be potential future strategies to improve recruitment of geriatric psychiatrists. Copyright © 2015 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

  4. Disparities in Aesthetic Procedures Performed by Plastic Surgery Residents.

    Science.gov (United States)

    Silvestre, Jason; Serletti, Joseph M; Chang, Benjamin

    2017-05-01

    Operative experience in aesthetic surgery is an important issue affecting plastic surgery residents. This study addresses the variability of aesthetic surgery experience during plastic surgery residency. National operative case logs of chief residents in independent/combined and integrated plastic surgery residency programs were analyzed (2011-2015). Fold differences between the bottom and top 10th percentiles of residents were calculated for each aesthetic procedure category and training model. The number of residents not achieving case minimums was also calculated. Case logs of 818 plastic surgery residents were analyzed. There was marked variability in craniofacial (range, 6.0-15.0), breast (range, 2.4-5.9), trunk/extremity (range, 3.0-16.0), and miscellaneous (range, 2.7-22.0) procedure categories. In 2015, the bottom 10th percentile of integrated and independent/combined residents did not achieve case minimums for botulinum toxin and dermal fillers. Case minimums were achieved for the other aesthetic procedure categories for all graduating years. Significant variability persists for many aesthetic procedure categories during plastic surgery residency training. Greater efforts may be needed to improve the aesthetic surgery experience of plastic surgery residents.

  5. A national survey of Canadian emergency medicine residents' comfort with geriatric emergency medicine.

    Science.gov (United States)

    Snider, Tristan; Melady, Don; Costa, Andrew P

    2017-01-01

    Geriatric patients represent a large and complex subgroup seen in emergency departments (EDs). Competencies in geriatric emergency medicine (EM) training have been established. Our objectives were to examine Canadian postgraduate year (PGY)-5 EM residents' comfort with the geriatric EM competency domains, assess whether Canadian EM residents become more comfortable through residency, and determine whether geriatric educational exposures are correlated with resident comfort with geriatric EM. A national, cross-sectional study of PGY-1 and PGY-5 Royal College EM residents was conducted to determine their comfort in geriatric EM clinical competency domains. Residents reported their level of comfort in satisfying each competency domain using a seven-point Likert scale. Residents were also asked about the location of their medical education as well as the type and number of different geriatric exposures that they had received to date. Of the 141 eligible residents from across Canada, 77% (109) consented to participate. None of the PGY-1 EM residents and 34% (14) of PGY-5 EM residents reported that they were comfortable with all eight geriatric EM competency domains. PGY-5 EM residents were significantly more comfortable than PGY-1 EM residents. Residents reported a highly variable range of geriatric educational exposures obtained during training. No relationship was found between resident-reported comfort and the nature or number of geriatric exposures that they had received. Current Royal College EM residency training in Canada may not be adequately preparing graduates to be comfortable with defined competencies for the care of older ED patients.

  6. National efforts to reform residency education in surgery.

    Science.gov (United States)

    Sachdeva, Ajit K; Bell, Richard H; Britt, L D; Tarpley, John L; Blair, Patrice Gabler; Tarpley, Margaret J

    2007-12-01

    Major changes in surgical practice and myriad external mandates have affected residency education in surgery. The traditional surgery residency education and training model has come under scrutiny, and calls for major reform of this model have been made by a variety of stakeholders. The American Surgical Association appointed a Blue Ribbon Committee in 2002 to consider the recent changes in surgical practice and surgical education and propose solutions that would ensure a well-educated and well-trained surgical workforce for the future. This committee included representatives from the American Surgical Association, the American College of Surgeons, the American Board of Surgery, and the Residency Review Committee for Surgery. The committee made several far-reaching recommendations relating to residency education in surgery. After the Blue Ribbon Committee completed its task in 2004, representatives from the aforementioned four organizations, the Association of Program Directors in Surgery, and the Association for Surgical Education created a national consortium called the Surgical Council on Resident Education (SCORE). This consortium is pursuing efforts to reform residency education in surgery and implement several key recommendations of the Blue Ribbon Committee. The principal area of focus of SCORE is the development of a national curriculum for surgery residency education and training. Other activities of SCORE include the development of a Web site to support surgery residency education and pursuit of international collaboration. SCORE's efforts will be key to offering surgery residents the best educational experiences, preparing residents for future practice, and supporting delivery of surgical care of the highest quality. The authors examine the current state of residency education in surgery and explore efforts underway to reform this educational model.

  7. Implementing a resident acute care surgery service: Improving resident education and patient care.

    Science.gov (United States)

    Kantor, Olga; Schneider, Andrew B; Rojnica, Marko; Benjamin, Andrew J; Schindler, Nancy; Posner, Mitchell C; Matthews, Jeffrey B; Roggin, Kevin K

    2017-03-01

    To simulate the duties and responsibilities of an attending surgeon and allow senior residents more intraoperative and perioperative autonomy, our program created a new resident acute care surgery consult service. We structured resident acute care surgery as a new admitting and inpatient consult service managed by chief and senior residents with attending supervision. When appropriate, the chief resident served as a teaching assistant in the operation. Outcomes were recorded prospectively and reviewed at weekly quality improvement conferences. The following information was collected: (1) teaching assistant case logs for senior residents preimplentation (n = 10) and postimplementation (n = 5) of the resident acute care surgery service; (2) data on the proportion of each case performed independently by residents; (3) resident evaluations of the resident acute care surgery versus other general operative services; (4) consult time for the first 12 months of the service (June 2014 to June 2015). During the first year after implementation, the number of total teaching assistant cases logged among graduating chief residents increased from a mean of 13.4 ± 13.0 (range 4-44) for preresident acute care surgery residents to 30.8 ± 8.8 (range 27-36) for postresident acute care surgery residents (P surgery (n = 27) in comparison with other general operative services (n = 127). In addition, creation of a 1-team consult service resulted in a more streamlined consult process with average consult time of 22 minutes for operative consults and 25 minutes for nonoperative consults (range 5-90 minutes). The implementation of a resident acute care surgery service has increased resident autonomy, teaching assistant cases, and satisfaction with operative case variety, as well as the efficiency of operative consultation at our institution. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Operative experience of surgery residents: trends and challenges.

    Science.gov (United States)

    Malangoni, Mark A; Biester, Thomas W; Jones, Andrew T; Klingensmith, Mary E; Lewis, Frank R

    2013-01-01

    To evaluate trends in operative experience and to determine the effect of establishing the Surgical Council on Resident Education (SCORE) operative classification system on changes in operative volume among graduating surgery residents. The general surgery operative logs of graduating surgery residents from 2005 were retrospectively compared with residents who completed training in 2010 and 2011. Nonparametric statistical analyses were used (Mann-Whitney and median test) with significance set at psurgical residents has increased by 21% since 2005; however, the number of operations done 10 times or greater has not changed. Although open cavitary procedures continue to decline, there has been a large increase in endoscopy, complex laparoscopic, and other major operations. Some essential-common operations continue to be performed infrequently. These results suggest that education in the operating room must improve and alternate methods for teaching infrequently performed procedures are needed. © 2013 Published by Association of Program Directors in Surgery on behalf of Association of Program Directors in Surgery.

  9. Residents' Perceptions of Plastic Surgeons as Craniofacial Surgery Specialists.

    Science.gov (United States)

    Denadai, Rafael; Muraro, Carlos Alberto Salomão; Raposo-Amaral, Cassio Eduardo

    2015-11-01

    To assess residents' perceptions of plastic surgeons as craniofacial surgery specialists in Brazil. Brazilian residents were asked to choose 1 or 2 specialists that they perceived to be an expert for 14 craniofacial surgery-related scenarios. Both an overall analysis (all 14 scenarios) and subanalysis (each scenario separately) were performed. Response patterns were distributed as "plastic surgeons alone," "plastic surgeons combined with other specialists," or "without plastic surgeons." Overall, plastic surgeons were chosen more (all P plastic surgeons were chosen more (all P surgery-related scenarios and also demonstrated that "plastic surgeons alone" and "without plastic surgeons" were selected more (all P surgery residents and male residents chose more (all P plastic surgeons as experts than their peers. Residents' perceptions of plastic surgeons as craniofacial surgery specialists are limited in Brazil.

  10. Plastic surgery chief resident clinics: the current state of affairs.

    Science.gov (United States)

    Neaman, Keith C; Hill, Brian C; Ebner, Ben; Ford, Ronald D

    2010-08-01

    One of the goals of plastic surgery residency programs is to provide effective training in aesthetic surgery. Recently, programs have adopted the idea of chief clinics to provide senior residents with the opportunity to perform cosmetic surgery with an increased level of autonomy. The goal of this article is to characterize chief clinics currently in place and their usefulness in providing effective training in plastic surgery under the precepts set forth by the Accreditation Council for Graduate Medical Education. A survey was created focusing on six broad categories: respondent identifier, clinic structure, clinic monetary earnings, patient demographics, procedures, and educational utility. Surveys were distributed to all plastic surgery residency programs targeting current and recently graduated chief residents, and program directors. A total of 123 surveys were returned. Eighty of the 88 plastic surgery residency programs (91 percent) were represented. Of the programs responding, 71.3 percent (57 programs) had a chief resident clinic. Thirty-two of the respondents (43.8 percent) reported that 100 percent of the procedures performed were cosmetic in nature. Programs differed widely on their frequency of occurrence and support staff available. A majority of respondents felt these clinics enhanced resident understanding of the six Accreditation Council for Graduate Medical Education core competencies. A majority of plastic surgery training programs use the chief clinic model to enhance resident education. These clinics vary in makeup and case distribution but serve as an effective way of teaching autonomy, surgical maturity, and the six Accreditation Council for Graduate Medical Education core competencies.

  11. Mentorship in anesthesia: a survey of perspectives among Canadian anesthesia residents.

    Science.gov (United States)

    Ergun, Suzan; Busse, Jason W; Wong, Anne

    2017-04-01

    Mentorship is important for professional and academic growth; however, the role of mentorship in anesthesia is still being defined. We surveyed Canadian anesthesia residents to explore their perceptions of mentorship relationships. We administered a 20-item cross-sectional survey to program directors and anesthesia residents in all Canadian departments of anesthesia. Program directors were asked about their mentorship programs, and residents were asked about their perceptions of benefits and barriers to effective mentoring. Sixteen of 17 (94%) program directors and 189 of 585 (32%) anesthesia residents responded to our survey. While 143 of 180 (79%) residents agreed that mentorship was beneficial to overall success as an anesthesiologist, only 11 of 16 (69%) program directors reported formal mentorship as part of their residency program, and only 119 of 189 (63%) residents reported access to a mentor. Barriers reported by residents included insufficient time with mentors, lack of formalized meeting times and objectives, mentor-mentee incompatibility (personal or professional), and lack of resident choice in mentor selection. Our study confirms that, despite positive perceptions among residents, mentorship remains underutilized in anesthesia programs. We identify barriers to effective mentorship, including the need to consider resident choice as a means to improve formal anesthesia mentorship programs.

  12. Surgical case volume in Canadian urology residency: a comparison of trends in open and minimally invasive surgical experience.

    Science.gov (United States)

    Mamut, Adiel E; Afshar, Kourosh; Mickelson, Jennifer J; Macneily, Andrew E

    2011-06-01

    The application of minimally invasive surgery (MIS) has become increasingly common in urology training programs and clinical practice. Our objective was to review surgical case data from all 12 Canadian residency programs to identify trends in resident exposure to MIS and open procedures. Every year, beginning in 2003, an average of 41 postgraduate year 3 to 5 residents reported surgical case data to a secure internet relational database. Data were anonymized and extracted for the period 2003 to 2009 by measuring a set of 11 predefined index cases that could be performed in both an open and MIS fashion. 16,687 index cases were recorded by a total of 198 residents. As a proportion, there was a significant increase in MIS from 12% in 2003 to 2004 to 32% in 2008 to 2009 (P=0.01). A significant decrease in the proportion of index cases performed with an open approach was also observed from 88% in 2003 to 2004 to 68% in 2008 to 2009 (P=0.01). The majority of these shifts were secondary to the increased application of MIS for nephrectomies of all type (29%-45%), nephroureterectomy (27%-76%), adrenalectomy (15%-71%), and pyeloplasty (17%-54%) (P<0.0001 for all). While there was a significant increase in MIS experience with radical prostatectomy (2%-18%, P<0.0001), the majority of these were still taught in an open fashion during the study period. MIS constitutes an increasingly significant component of surgical volume in Canadian urology residencies with a reciprocal decrease in exposure to open surgery. These trends necessitate ongoing evaluation to maintain the integrity of postgraduate urologic training.

  13. [Training of residents in abdominal wall surgery in Spain].

    Science.gov (United States)

    Miguelena Bobadilla, J M; Morales García, D; Serra Aracil, X; Sanz Sánchez, M; Iturburu, I; Docobo Durántez, F; Jover Navalón, J M; López De Cenarruzabeitia, I; Lobo Martínez, E

    2013-02-01

    The training of residents in abdominal wall surgery is a fundamental aspect of surgical training, representing globally 20% of its activity. In this paper, we analyze the current state of resident training in this kind of surgery in Spain, taking into account the broad spectrum it covers: general services, specific functional units, ambulatory surgery programs. To do this, based on the specifications of the specialty program, specific data were used from several different sources of direct information and a review of the results obtained by residents in hernia surgery. In general, our residents agree with their training and the recorded results are in line with objectives outlined in the program. However, it would be important to structure their teaching schedules, a rotation period in any specific unit and their involvement in outpatient surgery programs. Copyright © 2011 AEC. Published by Elsevier Espana. All rights reserved.

  14. Impact of implementation of a pediatric surgery fellowship on general surgery resident operative volume.

    Science.gov (United States)

    Snyder, Rebecca A; Phillips, Sharon E; Terhune, Kyla P

    2012-01-01

    The purpose of this study was to determine the impact of the initiation of a pediatric surgery fellowship on general surgery resident operative volume at 1 major academic institution. Retrospective review of operative records obtained from the Accreditation Council for Graduate Medical Education (ACGME) general surgery resident and pediatric surgery fellow case logs. Data collected included number and type of pediatric index cases per year, number of total pediatric surgery cases per year, and number of total cases logged as primary surgeon to date. Vanderbilt University School of Medicine Department of Surgery, which has an accredited general surgery program, finishes 7 chief residents per year during the study period, and instituted a new pediatric surgery fellowship in 2007. Case logs submitted by third and fourth year general surgery residents and first and second year pediatric surgery fellows were studied. The number of pediatric attending surgeons, relative value units (RVUs), and hospital admissions increased from 2003 to 2011. The median number of pediatric index cases performed by a resident decreased after the onset of fellowship from 34 cases to 23.5 cases per year (p pediatric surgery rotation also decreased from 74 to 53 cases per year after onset of the fellowship (p surgery resident index and overall case volume in pediatric surgery. Although operative volume is only 1 measure of surgical educational value, these findings suggest that the addition of surgical fellowships affects the educational experience of general surgery residents. We recommend that residency programs establish goals and calculate any potential impact on general surgery resident case volume before initiating a new surgical fellowship. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  15. Effect of minimally invasive surgery fellowship on residents' operative experience.

    Science.gov (United States)

    Altieri, Maria S; Frenkel, Catherine; Scriven, Richard; Thornton, Deborah; Halbert, Caitlin; Talamini, Mark; Telem, Dana A; Pryor, Aurora D

    2017-01-01

    There is an increased need for surgical trainees to acquire advanced laparoscopic skills as laparoscopy becomes the standard of care in many areas of general surgery. Since the introduction of minimally invasive surgery (MIS) fellowships, there has been a continuing debate as to whether these fellowships adversely affect general surgery resident exposure to laparoscopic cases. The aim of our study was to examine whether the introduction of an MIS fellowship negatively impacts general surgery residents' experience at a single academic center. We describe the changes following establishment of MIS fellowship at an academic center. Resident case log system from the Accreditation Council for Graduate Medical Education was queried to obtain all PGY 1-5 resident operative case logs. Two-year time period preceding and following the institution of an MIS fellowship at our institution in 2012 was compared. P values less than 0.05 were considered statistically significant. Following initiation of the MIS fellowship, an MIS service was established. The service comprised of a fellow, midlevel resident, and intern. Operative experience was examined. From 2010-2012 to 2012-2014, residents logged a total of 272 and 585 complex laparoscopic cases, respectively. There were 43 residents from 2010 to 2013 and 44 residents from 2013 to 2014. When the two time periods were compared, a trend of increased numbers for all procedures was noted, except laparoscopic GYN/genito-urinary procedures. Average percent increase in complex general surgery procedures was 249 ± 179.8 %. Following establishment of a MIS fellowship, reported cases by residents were higher or similar to those reported nationally for laparoscopic procedures. Institution of an MIS fellowship had a favorable effect on general surgery resident operative education at a single academic training center. Residents may benefit from the presence of a fellowship at an academic center because they are able to participate in an

  16. Education on the Business of Plastic Surgery During Training: A Survey of Plastic Surgery Residents.

    Science.gov (United States)

    Ovadia, Steven A; Gishen, Kriya; Desai, Urmen; Garcia, Alejandro M; Thaller, Seth R

    2018-02-14

    Entrepreneurial skills are important for physicians, especially plastic surgeons. Nevertheless, these skills are not typically emphasized during residency training. Evaluate the extent of business training at plastic surgery residency programs as well as means of enhancing business training. A 6-question online survey was sent to plastic surgery program directors for distribution to plastic surgery residents. Responses from residents at the PGY2 level and above were included for analysis. Tables were prepared to present survey results. Hundred and sixty-six residents including 147 PGY2 and above residents responded to our survey. Only 43.5% reported inclusion of business training in their plastic surgery residency. A majority of residents reported they do not expect on graduation to be prepared for the business aspects of plastic surgery. Additionally, a majority of residents feel establishment of a formal lecture series on the business of plastic surgery would be beneficial. Results from our survey indicate limited training at plastic surgery programs in necessary business skills. Plastic surgery residency programs should consider incorporating or enhancing elements of business training in their curriculum. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  17. Training general surgery residents in pediatric surgery: educational value vs time and cost.

    Science.gov (United States)

    Lee, Steven L; Sydorak, Roman M; Applebaum, Harry

    2009-01-01

    This study evaluated the educational value of pediatric surgery rotations, the likelihood of performing pediatric operations upon completing general surgery (GS) residency, and time and cost of training GS residents in pediatric surgery. A survey was administered to GS residents that evaluated the pediatric surgery rotation and anticipated practice intentions. A retrospective analysis (2005-2006) of operative times for unilateral inguinal hernia repair, bilateral inguinal hernia repair, and umbilical hernia repair was also performed. Procedure times were compared for operations performed by a pediatric surgeon with and without GS residents. Cost analysis was based on time differences. General surgery residents (n = 19) considered the pediatric surgery rotation to have high educational value (4.7 +/- 0.6 of 5) with extensive teaching (4.6 +/- 0.7) and operative experience (4.4 +/- 0.8). Residents listed pediatric surgery exposure, operative technique, and observed work ethic as most valuable. Upon graduation, residents expect to perform pediatric operations 2 to 3 times annually. Thirty-seven percent of residents felt competent to perform appendectomy (patients >5 years), 32% appendectomy (3-5 years), 21% gastrostomy (>1 year), and 11% inguinal herniorrhaphy (>1 year). Operative times and costs were significantly higher in operative procedures performed with a GS resident. General surgery residents considered pediatric surgery as a valuable educational experience. Residents anticipate performing pediatric operations a few times annually. Training GS residents in pediatric surgery increased operative time and cost. This information may be useful in determining the appropriate setting for resident education as well as budget planning for pediatric surgical practices.

  18. How Useful are Orthopedic Surgery Residency Web Pages?

    Science.gov (United States)

    Oladeji, Lasun O; Yu, Jonathan C; Oladeji, Afolayan K; Ponce, Brent A

    2015-01-01

    Medical students interested in orthopedic surgery residency positions frequently use the Internet as a modality to gather information about individual residency programs. Students often invest a painstaking amount of time and effort in determining programs that they are interested in, and the Internet is central to this process. Numerous studies have concluded that program websites are a valuable resource for residency and fellowship applicants. The purpose of the present study was to provide an update on the web pages of academic orthopedic surgery departments in the United States and to rate their utility in providing information on quality of education, faculty and resident information, environment, and applicant information. We reviewed existing websites for the 156 departments or divisions of orthopedic surgery that are currently accredited for resident education by the Accreditation Council for Graduate Medical Education. Each website was assessed for quality of information regarding quality of education, faculty and resident information, environment, and applicant information. We noted that 152 of the 156 departments (97%) had functioning websites that could be accessed. There was high variability regarding the comprehensiveness of orthopedic residency websites. Most of the orthopedic websites provided information on conference, didactics, and resident rotations. Less than 50% of programs provided information on resident call schedules, resident or faculty research and publications, resident hometowns, or resident salary. There is a lack of consistency regarding the content presented on orthopedic residency websites. As the competition for orthopedic websites continues to increase, applicants flock to the Internet to learn more about orthopedic websites in greater number. A well-constructed website has the potential to increase the caliber of students applying to a said program. Copyright © 2015 Association of Program Directors in Surgery. Published by

  19. Assessment of Surgery Resident Competency Provided by Patients.

    Science.gov (United States)

    Zhu, Yaxin; Yan, Tingmei; Qu, Bo

    2016-11-01

    The objective of this study was to assess the competency of surgery residents from the patient perspective in the current healthcare environment in China. The authors performed an assessment of 508 surgery residents in Liaoning province. Seven patients were as a group to complete the self-administered questionnaires on the survey for each individual corresponding resident. A 5-point rating scale with an unable-to-evaluate category was used to assess surgery resident competency by patients. Reliability and validity were assessed by Cronbach alpha (α) and exploratory factor analysis, respectively. Statistical analysis was performed using SPSS 13.0. The surveys on 421 residents were valid, and the valid response rate was 82.8%. A total of 2947 questionnaires from patients were analyzed in this study. The Cronbach α coefficient was 0.92. The 4 factors emerging in the exploratory factor analysis reached a cumulative contribution rate of 66.98%. The items of "promotes health maintenance (talks about preventive care)" (206/7.0%), "tells me about any side effects of the medicine" (177/6.0%), "spends enough time with me" (189/6.4%), and "answers my questions thoroughly" (168/5.7%) were scored <4 by higher percentage of patients. The instrument provided an acceptable means for patients to evaluate the competency of Chinese surgery residents. Surgery residents should improve their competencies on preventive care, patient safety, and communication skills.

  20. Learning preferences of surgery residents: a multi-institutional study.

    Science.gov (United States)

    Kim, Roger H; Viscusi, Rebecca K; Collier, Ashley N; Hunsinger, Marie A; Shabahang, Mohsen M; Fuhrman, George M; Korndorffer, James R

    2018-01-22

    The VARK model categorizes learners by preferences for 4 modalities: visual, aural, read/write, and kinesthetic. Previous single-institution studies found that VARK preferences are associated with academic performance. This multi-institutional study was conducted to test the hypothesis that the VARK learning preferences of residents differ from the general population and that they are associated with performance on the American Board of Surgery In-Training Examination (ABSITE). The VARK inventory was administered to residents at 5 general surgery programs. The distribution of the VARK preferences of residents was compared with the general population. ABSITE results were analyzed for associations with VARK preferences. χ2, Analysis of variance, and multiple linear regression were used for statistical analysis. A total of 132 residents completed the VARK inventory. The distribution of the VARK preferences of residents was different than the general population (P VARK inventory was an independent predictor of ABSITE percentile rank (P = .03), percent of questions correct (P = .01), and standard score (P = .01). This study represents the first multi-institutional study to examine VARK preferences among surgery residents. The distribution of preferences among residents was different than that of the general population. Residents with a greater number of aural responses on VARK had greater ABSITE scores. The VARK model may have potential to improve learning efficiency among residents. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Social problems in plastic surgery residents: a management perspective.

    Science.gov (United States)

    Verheyden, Charles N; McGrath, Mary H; Simpson, Peggy; Havens, Lisa

    2015-04-01

    It is presumed that plastic surgery residents experience various social problems, just as do their peers in other specialty training programs and in the general public. These issues can occasionally disrupt the resident's personal training experience and sometimes the program as a whole. A survey was performed to assess the magnitude of the problem, and the issues revealed were assessed to assist the program director and the resident in reaching successful completion of the residency. A survey was designed by the executive committee and staff of the American Council of Academic Plastic Surgeons and sent to all plastic surgery training programs in the United States. A response rate of 66 percent was achieved. The programs reported on the social issues occurring in their residents over the preceding 5 years. The results were presented at a business meeting of the Council. Thirty-seven percent of programs reported that at least one resident had left their program during the study period. Twenty percent reported that a resident had been asked to leave the program. The frequency of social problems resulting in disruption of the training program was tabulated in the following areas: divorce; pregnancy/parturition; financial, legal, or family issues; drug or alcohol abuse; illness/injury; and interpersonal conflicts. Plastic surgery residents experience social problems that can affect the timely completion of their training. Attention to these issues requires patience, creativity, sensitivity, and a commitment to the residents' ultimate success, and adherence to institutional, legal, and accreditation body mandates.

  2. Future Career Plans and Practice Patterns of Canadian Obstetrics and Gynaecology Residents in 2011.

    Science.gov (United States)

    Burrows, Jason; Coolen, Jillian

    2016-01-01

    The practice patterns of Obstetricians and Gynaecologists continue to evolve with each new generation of physicians. Diversifying subspecialties, changes in resident duty hours, job market saturation, and desire for work-life balance are playing stronger roles. Professional practice direction and needs assessment may be aided by awareness of future Obstetrics and Gynaecology physician career plans and expectations. The objective of this study was to determine the expected career plans and practice patterns of Canadian Obstetrics and Gynaecology residents following residency. The SOGC Junior Member Committee administered its third career planning survey to Canadian Obstetrics and Gynaecology residents electronically in December 2011. The data collected was statistically analyzed and compared to previous surveys. There were 183 responses giving a response rate of 43%. More than one half of all residents were considering postgraduate training (58%). Projected practice patterns included: 84% maintaining obstetrical practice, 60% locuming, and 50% job-sharing. The majority of residents expected to work in a 6 to 10 person call group (48%), work 3 to 5 call shifts per month (72%), work 41 to 60 hours weekly (69%), and practise in a city with a population greater than 500 000 (45%). Only 18% of residents surveyed were in favour of streaming residency programs in Obstetrics and Gynaecology. Canadian resident career plan and expected practice pattern assessment remains an important tool for aiding in resource allocation and strategic development of care and training in Obstetrics and Gynaecology in Canada. Copyright © 2016 Society of Obstetricians and Gynaecologists of Canada. Published by Elsevier Inc. All rights reserved.

  3. History of Argentine surgery, abaut general surgery residents

    Directory of Open Access Journals (Sweden)

    A. Jankilevich

    2015-04-01

    Full Text Available This work, as its title indicates, is targeted to young general surgery residents, who have been kind enough to open their journal for this collaboration. A gesture that I appreciate and I’ll try to give back narrating some facts of the first century of our independence. The story starts a few decades before 1810, especially with the institution of the Viceroyalty of Rio de la Plata, and ends at 1880, when indigenous peoples are submited, traditional estate, the gaucho gerrillas and the last caudillos (the pattern and the National Guards pawns are extinguished, agriculture and industry develops, the railroad replaces the wagons, is mass immigration and techniques of exploitation of natural resources strengthens social and economic structure, policy that starts the National Organization bequeathed to us Eighty generation. Two figures are presented as conclusion and synthesis of this period and serve as a bridge that starts from 1880: Francisco Javier Muñiz and Manuel Augusto Montes de Oca. The first such example of a surgeon in the wars of independence, internal frontier garrisons, the vicissitudes of the early university studies and creative work in the solitude of the peoples of campaign not only providing a commendable assistance but researching and discovering the first indigenous smallpox vaccine, rectifying errors jennerianos concept of cows pox disease of horses were infected, combating epidemics and initiating scientific research, natural sciences and producing valued communications throughout the world, as in the case of Darwin himself, who makes the research Muñiz as one of the foundations of his theory of evolution of species. The second: Montes de Oca, is the archetype and the teacher of those surgeons of the eighties generation. He gather in his person a more advanced knowledge and understanding of their subject, son of exile and disagreements before the national organization, contact to Europe, but attached to the reality of

  4. Psychosomatic medicine and psychiatry residents: a pan-Canadian survey.

    Science.gov (United States)

    Nguyen, Tuong-Vi; Sockalingam, Sanjeev; Granich, Annette; Chan, Peter; Abbey, Susan; Galbaud du Fort, Guillaume

    2011-01-01

    Psychosomatic medicine (PM) is recognized as a psychiatric subspecialty in the US, but continues to be considered a focused area of general psychiatric practice in Canada. Due to the unclear status of PM in Canada, a national survey was designed to assess the perception of and training experiences in PM among psychiatry residents. Residents enrolled at one of 13 psychiatry programs in Canada participated in the study. Logistic regression analyses were conducted to assess the effect of PM training experiences and career interest in PM on the perception of PM, controlling for number of months already completed in PM, training level, and residency program. The response rate was 35%, n = 199. 68% of respondents identified PM as a definite subspecialty, with the majority of respondents believing that PM was as important a subspecialty as child (53%), forensic (67%) and geriatric psychiatry (75%). Eighty percent of the respondents believed a PM specialist should complete more than 3 months of additional training to be competent/qualified. There was significant heterogeneity in training experiences across programs, with a differential effect of certain training components-seminar, journal club-associated with a more favorable perception of PM as a subspecialty. The above results challenge the notion that PM represents only a focused area of general psychiatric practice in Canada. PM appears to require additional training beyond residency for trainees to feel competent and qualified. Results from this survey suggest Canada should follow the US lead on recognizing PM as a subspecialty. Copyright © 2011 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

  5. Workplace bullying of general surgery residents by nurses.

    Science.gov (United States)

    Schlitzkus, Lisa L; Vogt, Kelly N; Sullivan, Maura E; Schenarts, Kimberly D

    2014-01-01

    Workplace bullying is at the forefront of social behavior research, garnering significant media attention. Most of the medical research has addressed bullying of nurses by physicians and demonstrates that patient care and outcomes may suffer. The intent of this study was to determine if general surgery residents are bullied by nurses. A survey instrument previously validated (Negative Acts Questionnaire-Revised) to evaluate for workplace bullying was modified to reflect the resident-nurse relationship. After institutional review board approval, the piloted online survey was sent to general surgery program directors to forward to general surgery residents. Demographic data are presented as percentages, and for negative acts, percentages of daily, weekly, and monthly frequencies are combined. Allopathic general surgery residencies in the United States. General surgery residents. The response rate was 22.1% (n = 452). Most respondents were men (55%) and had a mean age of 29 years (standard deviation = 7). Although 27.0% of the respondents were interns, the remaining classes were equally represented (12%-18% of responses/class). The respondents were primarily from medium-sized residency programs (45%), in the Midwest (28%), training in university programs (72%), and rotating primarily in a combined private and county hospital that serves both insured and indigent patients (59%). The residents had experienced each of the 22 negative acts (11.5%-82.5%). Work-related bullying occurs more than person-related bullying and physical intimidation. Ignoring of recommendations or orders by nurses occurs on a daily, weekly, or monthly basis for 30.2% of residents (work-related bullying). The most frequent person-related bullying act is ignoring the resident when they approach or reacting in a hostile manner (18.0%), followed by ignoring or excluding the resident (17.1%). Workplace bullying of general surgery residents by nurses is prominent. Future research is needed to determine

  6. Can robotic surgery be done efficiently while training residents?

    Science.gov (United States)

    Honaker, Michael Drew; Paton, Beverly L; Stefanidis, Dimitrios; Schiffern, Lynnette M

    2015-01-01

    Robotic surgery is a rapidly growing area in surgery. In an era of emphasis on cost reduction, the question becomes how do you train residents in robotic surgery? The aim of this study was to determine if there was a difference in operative time and complications when comparing general surgery residents learning robotic cholecystectomies to those learning standard laparoscopic cholecystectomies. A retrospective analysis of adult patients undergoing robotic and laparoscopic cholecystectomy by surgical residents between March 2013 and February 2014 was conducted. Demographic data, operative factors, length of stay (LOS), and complications were examined. Univariate and multivariate analyses were performed. The significance was set at p robotic cholecystectomy group and 40 in the laparoscopic group). Age, diagnosis, and American Society of Anesthesiologists score were not significantly different between groups. There was only 1 complication in the standard laparoscopic group in which a patient had to be taken back to surgery because of an incarcerated port site. LOS was significantly higher in the standard laparoscopic group (mean = 2.28) than in the robotic group (mean = 0.56; p robotic group (mean = 97.00 minutes; p = 0.4455). When intraoperative cholangiogram was evaluated, OR time was shorter in the robotic group. Robotic training in general surgery residency does not amount to extra OR time. LOS in our study was significantly longer in the standard laparoscopic group. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  7. Assessment of resident training and preparedness for cataract surgery.

    Science.gov (United States)

    Puri, Sidharth; Srikumaran, Divya; Prescott, Christina; Tian, Jing; Sikder, Shameema

    2017-03-01

    To assess which surgical teaching methods are used for residency surgical training and which methods residents find most useful. Wilmer Eye Institute, Baltimore, Maryland, USA. Retrospective observational cross-sectional study. A survey was developed and sent to residents at accredited ophthalmology training programs in the United States. The survey asked about demographics, program characteristics, surgical training methods, perceived initial preparedness, eventual competence, and difficulty with the steps of cataract surgery. The correlation between surgical training methods was compared with perceived preparedness, competence, and difficulty. One hundred sixteen residents completed the survey. Discussing surgical procedures with senior surgeons or using surgical simulators preoperatively improved resident-perceived surgical competency in several areas, such as paracentesis. Residents who had preoperative discussions with senior surgeons were statistically less likely to report difficulty with surgical procedures, such as performing a clear corneal incision. The presence of a supervised wet lab or surgical simulator in a residency was also associated with improved resident-perceived surgical competency. Educational resources, such as surgical simulators and supervised wet labs, tended to be associated with greater resident-perceived competency for steps in cataract surgery. Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  8. Reconstructive surgery training: increased operative volume in plastic surgery residency programs.

    Science.gov (United States)

    Tanna, Neil; Boyd, J Brian; Kawamoto, Henry K; Miller, Timothy A; Da Lio, Andrew L; Azhar, Hamdan; Bradley, James P

    2012-03-01

    Practitioners in other surgical specialties have increasingly advanced their volume of reconstructive procedures traditionally served by plastic surgeons. Because there has not been a previous specialty training comparison, the average operative reconstructive volume of graduating plastic surgery residents was formally compared with that of other specialties. The authors review the case log statistical reports of the Accreditation Council for Graduate Medical Education. For each specialty, this annual report highlights the average number of cases performed for all graduating residents. The national case log reports were reviewed for orthopedic surgery, otolaryngology, and plastic surgery. Six procedures were compared for residents graduating in the 2006 to 2010 academic years and are reviewed. A two-sample Welch-Satterthwaite t test for independent samples with heterogeneous variance was conducted to compare the average number of procedures performed per graduating resident. Graduates of plastic surgery residencies compared with graduates of other specialties performed more cleft lip and palate repairs, hand amputation, hand fracture, and nasal fracture procedures. This difference showed statistical significance for all years examined (2006 to 2010). For repair of mandible fractures, plastic surgery trainees had significantly more cases for 2006 to 2009 but not 2010. The quantitative operative experience of graduating plastic surgery residents for selected reconstructive cases is above that of the average graduating trainee outside of plastic surgery. Given the exposure and strength of plastic surgery training, plastic surgeons should remain at the forefront of reconstructive surgery.

  9. Variability in Trauma Case Volume in Orthopedic Surgery Residents.

    Science.gov (United States)

    Blood, Travis D; Gil, Joseph A; Born, Christopher T; Daniels, Alan H

    2017-02-20

    Orthopedic trauma surgery is a critical component of resident education. Surgical case logs obtained from the Accreditation Council of Graduate Medical Students from 2009 to 2013 for orthopedic surgery residents were examined for variability between the 90th and 10th percentiles in regards to the volume of cases performed. There was an upward trend in the mean number of cases performed by senior residents from 484.4 in 2009 to 534.5 in 2013, representing a 10.3% increase. There was a statistically significant increase in the number of cases performed for humerus/elbow, forearm/wrist, and pelvis/hip during this period (Ppercentile case volumes narrowed over the study period, the difference between these groups remained significant in 2013 (P=0.02). In 2013, all categories of trauma cases had a greater than 2.2-fold difference between the 10th and 90th percentile of residents for numbers of trauma cases performed. Although case volume is not the sole determinant of residency education and competency, evidence suggests that case volume plays a crucial role in surgeon confidence and efficiency in performing surgery. Further studies are needed to better understand the effect of this variability seen among residents performing orthopedic trauma surgery.

  10. Variability in trauma case volume in orthopedic surgery residents

    Directory of Open Access Journals (Sweden)

    Travis D. Blood

    2017-02-01

    Full Text Available Orthopedic trauma surgery is a critical component of resident education. Surgical case logs obtained from the Accreditation Council of Graduate Medical Students from 2009 to 2013 for orthopedic surgery residents were examined for variability between the 90th and 10th percentiles in regards to the volume of cases performed. There was an upward trend in the mean number of cases performed by senior residents from 484.4 in 2009 to 534.5 in 2013, representing a 10.3% increase. There was a statistically significant increase in the number of cases performed for humerus/elbow, forearm/wrist, and pelvis/hip during this period (Pth and 90th percentile case volumes narrowed over the study period, the difference between these groups remained significant in 2013 (P=0.02. In 2013, all categories of trauma cases had a greater than 2.2-fold difference between the 10th and 90th percentile of residents for numbers of trauma cases performed. Although case volume is not the sole determinant of residency education and competency, evidence suggests that case volume plays a crucial role in surgeon confidence and efficiency in performing surgery. Further studies are needed to better understand the effect of this variability seen among residents performing orthopedic trauma surgery.

  11. Global opportunities on 239 general surgery residency Web sites.

    Science.gov (United States)

    Wackerbarth, Joel J; Campbell, Timothy D; Wren, Sherry; Price, Raymond R; Maier, Ronald V; Numann, Patricia; Kushner, Adam L

    2015-09-01

    Many general surgical residency programs lack a formal international component. We hypothesized that most surgery programs do not have international training or do not provide the information to prospective applicants regarding electives or programs in an easily accessible manner via Web-based resources. Individual general surgery program Web sites and the American College of Surgeons residency tool were used to identify 239 residencies. The homepages were examined for specific mention of international or global health programs. Ease of access was also considered. Global surgery specific pages or centers were noted. Programs were assessed for length of rotation, presence of research component, and mention of benefits to residents and respective institution. Of 239 programs, 24 (10%) mentioned international experiences on their home page and 42 (18%) contained information about global surgery. Of those with information available, 69% were easily accessible. Academic programs were more likely than independent programs to have information about international opportunities on their home page (13.7% versus 4.0%, P = 0.006) and more likely to have a dedicated program or pathway Web site (18.8% versus 2.0%, P Web sites. Benefits to high-income country residents were discussed more than benefits to low- and middle-income country residents (57% versus 17%). General surgery residency programs do not effectively communicate international opportunities for prospective residents through Web-based resources and should seriously consider integrating international options into their curriculum and better present them on department Web sites. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Readiness of US General Surgery Residents for Independent Practice.

    Science.gov (United States)

    George, Brian C; Bohnen, Jordan D; Williams, Reed G; Meyerson, Shari L; Schuller, Mary C; Clark, Michael J; Meier, Andreas H; Torbeck, Laura; Mandell, Samuel P; Mullen, John T; Smink, Douglas S; Scully, Rebecca E; Chipman, Jeffrey G; Auyang, Edward D; Terhune, Kyla P; Wise, Paul E; Choi, Jennifer N; Foley, Eugene F; Dimick, Justin B; Choti, Michael A; Soper, Nathaniel J; Lillemoe, Keith D; Zwischenberger, Joseph B; Dunnington, Gary L; DaRosa, Debra A; Fryer, Jonathan P

    2017-10-01

    This study evaluates the current state of the General Surgery (GS) residency training model by investigating resident operative performance and autonomy. The American Board of Surgery has designated 132 procedures as being "Core" to the practice of GS. GS residents are expected to be able to safely and independently perform those procedures by the time they graduate. There is growing concern that not all residents achieve that standard. Lack of operative autonomy may play a role. Attendings in 14 General Surgery programs were trained to use a) the 5-level System for Improving and Measuring Procedural Learning (SIMPL) Performance scale to assess resident readiness for independent practice and b) the 4-level Zwisch scale to assess the level of guidance (ie, autonomy) they provided to residents during specific procedures. Ratings were collected immediately after cases that involved a categorical GS resident. Data were analyzed using descriptive statistics and supplemented with Bayesian ordinal model-based estimation. A total of 444 attending surgeons rated 536 categorical residents after 10,130 procedures. Performance: from the first to the last year of training, the proportion of Performance ratings for Core procedures (n = 6931) at "Practice Ready" or above increased from 12.3% to 77.1%. The predicted probability that a typical trainee would be rated as Competent after performing an average Core procedure on an average complexity patient during the last week of residency training is 90.5% (95% CI: 85.7%-94%). This falls to 84.6% for more complex patients and to less than 80% for more difficult Core procedures. Autonomy: for all procedures, the proportion of Zwisch ratings indicating meaningful autonomy ("Passive Help" or "Supervision Only") increased from 15.1% to 65.7% from the first to the last year of training. For the Core procedures performed by residents in their final 6 months of training (cholecystectomy, inguinal/femoral hernia repair, appendectomy, ventral

  13. Self-Appraised Readiness of Senior and Graduating General Surgery Residents to Perform Thoracic Surgery.

    Science.gov (United States)

    DeBoard, Zachary M; Paisley, Michael; Thomas, Donald D

    2017-12-19

    General surgeons perform up to 50% of noncardiac thoracic surgery (TS). Although data show consistent TS case volume during general surgery (GS) residency it is unknown whether this operative trend will persist given potentially limited subspecialty exposure. We sought to determine if certain aspects of residency programs and resident characteristics were associated with trainees' perceived comfort in performing certain basic TS procedures. An anonymous survey was distributed to GS residents regarding program characteristics, presence of a TS residency, and intent to pursue thoracic surgical training, and estimated case volumes of individual procedures. Comfort levels for performing video-assisted thoracoscopic surgical (VATS) procedures, open lobectomy, elective thoracotomy, and sternotomy were attained through a 5-point Likert-type scale. This survey was administered at 50 training programs with responses recorded via an online form. Fourth- and fifth-year GS residents in the United States. Of 272 respondents 58% were fourth-year residents, 62% of residents trained at university-affiliated programs, and 64% reported a TS residency program at their institution and 16% stated intent to pursue TS. Fifth-year residents performed significantly more cases than fourth-year residents despite no difference in median comfort levels. Residents intending to pursue TS performed significantly more cases and were more comfortable performing a thoracotomy, sternotomy, VATS wedge resection/biopsy, and VATS decortication/pleurodesis (p = 0.044, Surgery. Published by Elsevier Inc. All rights reserved.

  14. Are there enough jobs in cardiothoracic surgery? The thoracic surgery residents association job placement survey for finishing residents.

    Science.gov (United States)

    Salazar, Jorge D; Lee, Richard; Wheatley, Grayson H; Doty, John R

    2004-11-01

    Applications to cardiothoracic surgery training programs have declined. Anecdotal evidence suggests limited job availability for residents completing cardiothoracic training, which may contribute to this decline. This survey sought to document the experience of current, graduating residents. In June 2003, the Thoracic Surgery Residents Association surveyed residents completing accredited cardiothoracic training or additional subspecialization, utilizing a web-based survey hosted by CTSNet. Resident participation was voluntary and anonymous. Of the estimated 140 graduates, 89 responded. The majority were male (91.0%, n = 81), married (80.0%, n = 71), and had children (61.0%, n = 54). Average age was 36.2 years old, and mean educational debt was less than 50K dollars. Of the 89 respondents, 77 initially sought jobs and 12 sought additional training. For residents seeking jobs, 19.5% (n = 15) received no offers and 13 of these ultimately pursued additional training. Acquired jobs were in private (53.0%, n = 34) or academic practice (47.0%, n = 30), with 73.4% (n = 47) involving general thoracic surgery. Most would again choose cardiothoracic surgery as a career (75.5%, n = 67), and 62.0% (n = 55) would again submit the same match list. However, 87.0% (n = 77) believed that the number of trainees should be decreased, 81.0% (n = 72) believed that reimbursement for cardiothoracic surgery is inadequate, and 77.5% (n = 69) believed that excessively low reimbursement will result in restricted access or decreased quality for patients. Most cardiothoracic residents were successful in finding employment after training. A substantial percentage, however, pursued additional training due to lack of job opportunities. Although most finishing residents were satisfied with training and career choice, significant concerns exist regarding job opportunities and compensation. These conditions may lead to difficulty in recruitment to the specialty.

  15. General surgery training and robotics: Are residents improving their skills?

    Science.gov (United States)

    Finnerty, Brendan M; Afaneh, Cheguevara; Aronova, Anna; Fahey, Thomas J; Zarnegar, Rasa

    2016-02-01

    While robotic-assisted operations have become more prevalent, many general surgery residencies do not have a formal robotic training curriculum. We sought to ascertain how well current general surgery training permits acquisition of robotic skills by comparing robotic simulation performance across various training levels. Thirty-six participants were categorized by level of surgical training: eight medical students (MS), ten junior residents (JR), ten mid-level residents (MLR), and eight senior residents (SR). Participants performed three simulation tasks on the da Vinci (®) Skills Simulator (MatchBoard, EnergyDissection, SutureSponge). Each task's scores (0-100) and cumulative scores (0-300) were compared between groups. There were no differences in sex, hand dominance, video gaming history, or prior robotic experience between groups; however, SR was the oldest (p surgery residency show minimal improvement during the course of training, although laparoscopic experience is correlated with advanced robotic task performance. Changes in residency curricula or pursuit of fellowship training may be warranted for surgeons seeking proficiency.

  16. Electrocardiography teaching in Canadian family medicine residency programs: a national survey.

    Science.gov (United States)

    Paul, Baldeep; Baranchuk, Adrian

    2011-04-01

    Electrocardiography (ECG) interpretation is an essential skill for a family physician. Teaching and learning electrocardiography is a difficult task, in part due to the erosion of knowledge when interpretation is not part of a daily activity. The objective of this study was to assess the current status of electrocardiography teaching in Canadian family medicine residency programs. A national survey was designed to specifically address the status of the ECG teaching curricula. This national survey was electronically sent to the family medicine program directors of all 17 Canadian accredited medical schools. Approximately 75% of the schools responded to the survey. There was a great variance among Canadian family medicine residency programs with respect to the time allotment, ECG training location, training faculty, and teaching methods utilized. The goals of each respective program are also quite wide-ranging. Family medicine residency programs across Canada are quite diverse regarding ECG training curricula and its goals. The need for a homogeneous way of teaching and evaluating has been identified.

  17. Should general surgery residents be taught laparoscopic pyloromyotomies? An ethical perspective.

    Science.gov (United States)

    Escobar, Mauricio A; Hartin, Charles W; McCullough, Laurence B

    2014-01-01

    The authors examine the ethical implications of teaching general surgery residents laparoscopic pyloromyotomy. Using the authors' previously presented ethical framework, and examining survey data of pediatric surgeons in the United States and Canada, a rigorous ethical argument is constructed to examine the question: should general surgery residents be taught laparoscopic pyloromyotomies? A survey was constructed that contained 24 multiple-choice questions. The survey included questions pertaining to surgeon demographics, if pyloromyotomy was taught to general surgery and pediatric surgery residents, and management of complications encountered during pyloromyotomy. A total of 889 members of the American Pediatric Surgical Association and Canadian Association of Paediatric Surgeons were asked to participate. The response rate was 45% (401/889). The data were analyzed within the ethical model to address the question of whether general surgery residents should be taught laparoscopic pyloromyotomies. From an ethical perspective, appealing to the ethical model of a physician as a fiduciary, the answer is no. We previously proposed an ethical model based on 2 fundamental ethical principles: the ethical concept of the physician as a fiduciary and the contractarian model of ethics. The fiduciary physician practices medicine competently with the patient’s best interests in mind. The role of a fiduciary professional imposes ethical standards on all physicians, at the core of which is the virtue of integrity, which requires the physician to practice medicine to standards of intellectual and moral excellence. The American College of Surgeons recognizes the need for current and future surgeons to understand professionalism, which is one of the 6 core competencies specified by the Accreditation Council for Graduate Medical Education. Contracts are models of negotiation and ethically permissible compromise. Negotiated assent or consent is the core concept of contractarian

  18. An Informed Consent Program Enhances Surgery Resident Education.

    Science.gov (United States)

    Koller, Sarah E; Moore, Ryan F; Goldberg, Michael B; Zhang, Jeanette; Yu, Daohai; Conklin, Charles B; Milner, Richard E; Goldberg, Amy J

    First-year residents often obtain informed consent from patients. However, they typically receive no formal training in this area before residency. We wished to determine whether an educational program would improve residents' comfort with this process. Our institution created an informed consent educational program, which included a didactic component, a role-play about informed consent, and a simulation exercise using standardized patients. Residents completed surveys before and after the intervention, and responses to survey questions were compared using the signed-rank test. This study took place at Temple University Hospital, a tertiary care institution in Philadelphia, PA. First-year surgery and emergency medicine residents at Temple University Hospital in 2014 participated in this study. Thirty-two residents completed the preintervention survey and 27 residents completed the educational program and postintervention survey. Only 37.5% had ever received formal training in informed consent before residency. After participating in the educational program, residents were significantly more confident that they could correctly describe the process of informed consent, properly fill out a procedure consent form, and properly obtain informed consent from a patient. Their comfort level in obtaining informed consent significantly increased. They found the educational program to be very effective in improving their knowledge and comfort level in obtaining informed consent. In all, 100% (N = 27) of residents said they would recommend the use of the program with other first-year residents. Residents became more confident in their ability to obtain informed consent after participating in an educational program that included didactic, role-play, and patient simulation elements. Copyright © 2017. Published by Elsevier Inc.

  19. The effect of limiting residents' work hours on their surgical training: a Canadian perspective.

    Science.gov (United States)

    Romanchuk, Ken

    2004-05-01

    Restrictions in residents' work hours have been in place in Canada for roughly a decade, having been negotiated rather than imposed. The changes in residents' schedules that resulted are roughly equivalent to the limitation of 80 duty hours per week in the United States. When work-hours restrictions began, surgery faculty were worried that residents' experience would be compromised. But these fears have not materialized. Why? The author maintains there are many reasons. (1) Most surgical procedures are now faster, and lengthy inpatient care has diminished, all of which saves time. (2) Formerly difficult or risky procedures are now performed more frequently and safely, which increases residents' education about difficult conditions. (3) A variety of resources (e.g., skills-transfer courses, surgical simulators, etc.) are now available for residents to learn and evolve surgical techniques, and residents take advantage of these resources, being highly motivated to learn the best in the time available to them. (4) There have been positive changes in residents' education that have helped them become more efficient learners than before, with improved resources and skills for faster access to information. The author maintains that in his present surgery residency program, the residents still work extremely hard but are more protected from the unending demands for patient care. They have more time for orderly study and greater opportunities to develop skills other than technical ones. They are in a happier work setting, which the author strongly believes facilitates improved patient care.

  20. Teaching the Surgical Craft: Surgery Residents Perception of the ...

    African Journals Online (AJOL)

    These include concerns about time management (e.g., patient cancellation), availability of resources (e.g., equipment allocation), roles (e.g., responsibilities), patient safety and sterility (e.g., aseptic. Teaching the Surgical Craft: Surgery Residents. Perception of the Operating Theater Educational. Environment in a Tertiary ...

  1. Association of General Surgery Resident Remediation and Program Director Attitudes With Resident Attrition.

    Science.gov (United States)

    Schwed, Alexander C; Lee, Steven L; Salcedo, Edgardo S; Reeves, Mark E; Inaba, Kenji; Sidwell, Richard A; Amersi, Farin; Are, Chandrakanth; Arnell, Tracey D; Damewood, Richard B; Dent, Daniel L; Donahue, Timothy; Gauvin, Jeffrey; Hartranft, Thomas; Jacobsen, Garth R; Jarman, Benjamin T; Melcher, Marc L; Mellinger, John D; Morris, Jon B; Nehler, Mark; Smith, Brian R; Wolfe, Mary; Kaji, Amy H; de Virgilio, Christian

    2017-12-01

    Previous studies of resident attrition have variably included preliminary residents and likely overestimated categorical resident attrition. Whether program director attitudes affect attrition has been unclear. To determine whether program director attitudes are associated with resident attrition and to measure the categorical resident attrition rate. This multicenter study surveyed 21 US program directors in general surgery about their opinions regarding resident education and attrition. Data on total resident complement, demographic information, and annual attrition were collected from the program directors for the study period of July 1, 2010, to June 30, 2015. The general surgery programs were chosen on the basis of their geographic location, previous collaboration with some coauthors, prior work in surgical education and research, or a program director willing to participate. Only categorical surgical residents were included in the study; thus, program directors were specifically instructed to exclude any preliminary residents in their responses. Five-year attrition rates (2010-2011 to 2014-2015 academic years) as well as first-time pass rates on the General Surgery Qualifying Examination and General Surgery Certifying Examination of the American Board of Surgery (ABS) were collected. High- and low-attrition programs were compared. The 21 programs represented different geographic locations and 12 university-based, 3 university-affiliated, and 6 independent program types. Programs had a median (interquartile range [IQR]) number of 30 (20-48) categorical residents, and few of those residents were women (median [IQR], 12 [5-17]). Overall, 85 of 966 residents (8.8%) left training during the study period: 15 (17.6%) left after postgraduate year 1, 34 (40.0%) after postgraduate year 2, and 36 (42.4%) after postgraduate year 3 or later. Forty-four residents (51.8%) left general surgery for another surgical discipline, 21 (24.7%) transferred to a different surgery

  2. National Survey of Burnout among US General Surgery Residents

    Science.gov (United States)

    Elmore, Leisha C; Jeffe, Donna B; Jin, Linda; Awad, Michael M; Turnbull, Isaiah R

    2017-01-01

    Background Burnout is a complex syndrome of emotional distress that can disproportionately affect individuals who work in healthcare professions. Study Design For a national survey of burnout in US general surgery residents, we asked all Accreditation Council for Graduate Medical Education-accredited general surgery program directors to email their general surgery residents an invitation to complete an anonymous, online survey. Burnout was assessed with the Maslach Burnout Inventory; total scores for Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA) subscales were calculated. Burnout was defined as having a score in the highest tertile for EE or DP or lowest tertile for PA. Chi-square tests and one-way analyses of variance were used to test associations between burnout tertiles for each subscale and various resident and training-program characteristics as appropriate. Results From April–December, 2014, 665 residents actively engaged in clinical training had data for analysis; 69% met the criterion for burnout on at least one subscale. Higher burnout on each subscale was reported by residents planning private practice compared with academic careers. A greater proportion of women than men reported burnout on EE and PA. Higher burnout on EE and DP was associated with greater work hours per week. Having a structured mentoring program was associated with lower burnout on each subscale. Conclusions The high rates of burnout among general surgery residents are concerning given the potential impact of burnout on the quality of patient care. Efforts to identify at-risk populations and to design targeted interventions to mitigate burnout in surgical trainees are warranted. PMID:27238875

  3. Culture in medical education: comparing a Thai and a Canadian residency programme.

    Science.gov (United States)

    Wong, Anne K

    2011-12-01

    Globalisation initiatives in medical education are premised on a universal model of medical education. This study was conducted to challenge this premise by empirically examining the impact of culture on the practice of medical education in anaesthesia residency training programmes in Thailand and Canada. Using a mixed-methods comparative case study research approach, one Thai and one Canadian anaesthesia residency training programme were examined with respect to curriculum, educational practices and teacher beliefs. Data sources included observations of academic and clinical teaching, programme document analysis, surveys and faculty interviews. Recruitment resulted in a 76% survey response rate and 13 interview participants at the Thai site and a 61% survey response rate and 16 interview participants at the Canadian site. Multiple linear regression analysis was used to compare survey responses between the two programmes. The qualitative analysis consisted of primary coding, clustering into pattern codes, and identifying themes and sub-themes. The integration of quantitative and qualitative data for each case was followed by a cross-case analysis. The two programmes were similarly organised and had similar curricular content. However, important differences emerged in curricular emphasis, educational practices, and teacher beliefs and values. Thai faculty staff emphasised knowledge and scholarship, described the faculty-resident relationship as 'familial' and focused on 'teaching methods'. Canadian faculty members emphasised clinical abilities, described the faculty-resident relationship as 'collegial' and focused on 'learning environments'. These findings were related to broader cultural differences that influenced how the curriculum was interpreted and enacted at each site. This study shows that although the scientific and knowledge base of medical education is universal, its enactment may be influenced by culture and context. Globalisation initiatives in medical

  4. General surgery training without laparoscopic surgery fellows: the impact on residents and patients.

    Science.gov (United States)

    Linn, John G; Hungness, Eric S; Clark, Sara; Nagle, Alexander P; Wang, Edward; Soper, Nathaniel J

    2011-10-01

    To evaluate resident case volume after discontinuation of a laparoscopic surgery fellowship, and to examine disparities in patient care over the same time period. Resident case logs were compared for a 2-year period before and 1 year after discontinuing the fellowship, using a 2-sample t test. Databases for bariatric and esophageal surgery were reviewed to compare operative time, length of stay (LOS), and complication rate by resident or fellow over the same time period using a 2-sample t test. Increases were seen in senior resident advanced laparoscopic (Mean Fellow Year = 21 operations vs Non Fellow Year = 61, P surgery. Operative time for complex operations may increase in the absence of a fellow. Other patient outcomes are not affected by this change. Copyright © 2011 Mosby, Inc. All rights reserved.

  5. Teaching and evaluation of ethics and professionalism: in Canadian family medicine residency programs.

    Science.gov (United States)

    Pauls, Merril A

    2012-12-01

    To document the scope of the teaching and evaluation of ethics and professionalism in Canadian family medicine postgraduate training programs, and to identify barriers to the teaching and evaluation of ethics and professionalism. A survey was developed in collaboration with the Committee on Ethics of the College of Family Physicians of Canada. The data are reported descriptively and in aggregate. Canadian postgraduate family medicine training programs. Between June and December of 2008, all 17 Canadian postgraduate family medicine training programs were invited to participate. The first part of the survey explored the structure, resources, methods, scheduled hours, and barriers to teaching ethics and professionalism. The second section focused on end-of-rotation evaluations, other evaluation strategies, and barriers related to the evaluation of ethics and professionalism. Eighty-eight percent of programs completed the survey. Most respondents (87%) had learning objectives specifically for ethics and professionalism, and 87% had family doctors with training or interest in the area leading their efforts. Two-thirds of responding programs had less than 10 hours of scheduled instruction per year, and the most common barriers to effective teaching were the need for faculty development, competing learning needs, and lack of resident interest. Ninety-three percent of respondents assessed ethics and professionalism on their end-of-rotation evaluations, with 86% assessing specific domains. The most common barriers to evaluation were a lack of suitable tools and a lack of faculty comfort and interest. By far most Canadian family medicine postgraduate training programs had learning objectives and designated faculty leads in ethics and professionalism, yet there was little curricular time dedicated to these areas and a perceived lack of resident interest and faculty expertise. Most programs evaluated ethics and professionalism as part of their end-of-rotation evaluations, but

  6. Residents' response to bleeding during a simulated robotic surgery task.

    Science.gov (United States)

    Walker, Jessica L; Nathwani, Jay N; Mohamadipanah, Hossein; Laufer, Shlomi; Jocewicz, Frank F; Gwillim, Eran; Pugh, Carla M

    2017-12-01

    The aim of this study was to assess performance measurement validity of our newly developed robotic surgery task trainer. We hypothesized that residents would exhibit wide variations in their intercohort performance as well as a measurable difference compared to surgeons in fellowship training. Our laboratory synthesized a model of a pelvic tumor that simulates unexpected bleeding. Surgical residents and fellows of varying specialties completed a demographic survey and were allowed 20 minutes to resect the tumor using the da Vinci robot and achieve hemostasis. At a standardized event in the simulation, venous bleeding began, and participants attempted hemostasis using suture ligation. A motion tracking system, using electromagnetic sensors, recorded participants' hand movements. A postparticipation Likert scale survey evaluated participants' assessment of the model's realism and usefulness. Three of the seven residents (postgraduate year 2-5), and the fellow successfully resected the tumor in the allotted time. Residents showed high variability in performance and blood loss (125-700 mL) both within their cohort and compared to the fellow (150 mL blood). All participants rated the model as having high realism and utility for trainees. The results support that our bleeding pelvic tumor simulator has the ability to discriminate resident performance in robotic surgery. The combination of motion, decision-making, and blood loss metrics offers a multilevel performance assessment, analyzing both technical and decision-making abilities. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Resident surgeon efficiency in femtosecond laser-assisted cataract surgery

    Directory of Open Access Journals (Sweden)

    Pittner AC

    2017-01-01

    Full Text Available Andrew C Pittner,1 Brian R Sullivan2 1Department of Ophthalmology, Stritch School of Medicine, Loyola University Chicago, Maywood, 2Edward Hines Jr VA Hospital, Ophthalmology Section, Hines, IL, USA Purpose: Comparison of resident surgeon performance efficiencies in femtosecond laser-assisted cataract surgery (FLACS versus conventional phacoemulsification.Patients and methods: A retrospective cohort study was conducted on consecutive patients undergoing phacoemulsification cataract surgery performed by senior ophthalmology residents under the supervision of 1 attending physician during a 9-month period in a large Veterans Affairs medical center. Medical records were reviewed for demographic information, preoperative nucleus grade, femtosecond laser pretreatment, operative procedure times, total operating room times, and surgical complications. Review of digital video records provided quantitative interval measurements of core steps of the procedures, including completion of incisions, anterior capsulotomy, nucleus removal, cortical removal, and intraocular lens implantation.Results: Total room time, operation time, and corneal incision completion time were found to be significantly longer in the femtosecond laser group versus the traditional phacoemulsification group (each P<0.05. Mean duration for manual completion of anterior capsulotomy was shorter in the laser group (P<0.001. There were no statistically significant differences in the individual steps of nucleus removal, cortical removal, or intraocular lens placement. Surgical complication rates were not significantly different between the groups.Conclusion: In early cases, resident completion of femtosecond cataract surgery is generally less efficient when trainees have more experience with traditional phacoemulsification. FLACS was found to have a significant advantage in completion of capsulotomy, but subsequent surgical steps were not shorter or longer. Resident learning curve for the

  8. Progressive Surgical Autonomy in a Plastic Surgery Resident Clinic

    Science.gov (United States)

    Scott, Jillian K.; Gao, Lani; Lee, Tara M.; Waldrop, Jimmy L.; Sargent, Larry A.; Kennedy, J. Woody; Rehm, Jason P.; Brzezienski, Mark A.

    2017-01-01

    Background: Resident clinics are thought to catalyze educational milestone achievement through opportunities for progressively autonomous surgical care, but studies are lacking for general plastic surgery resident clinics (PSRCs). We demonstrate the achievement of increased surgical autonomy and continuity of care in a PSRC. Methods: A retrospective review of all patients seen in a PSRC from October 1, 2010, to October 1, 2015, was conducted. Our PSRC is supervised by faculty plastic surgery attendings, though primarily run by chief residents in an accredited independent plastic surgery training program. Surgical autonomy was scored on a 5-point scale based on dictated operative reports. Graduated chief residents were additionally surveyed by anonymous online survey. Results: Thousand one hundred forty-four patients were seen in 3,390 clinic visits. Six hundred fifty-three operations were performed by 23 total residents, including 10 graduating chiefs. Senior resident autonomy averaged 3.5/5 (SD = 1.5), 3.6/5 (SD = 1.5), to 3.8/5 (SD = 1.3) in postgraduate years 6, 7, and 8, respectively. A linear mixed model analysis demonstrated that training level had a significant impact on operative autonomy when comparing postgraduate years 6 and 8 (P = 0.026). Graduated residents’ survey responses (N = 10; 100% response rate) regarded PSRC as valuable for surgical experience (4.1/5), operative autonomy (4.4/5), medical knowledge development (4.7/5), and the practice of Accreditation Council of Graduate Medical Education core competencies (4.3/5). Preoperative or postoperative continuity of care was maintained in 93.5% of cases. Conclusion: The achievement of progressive surgical autonomy may be demonstrated within a PSRC model. PMID:28607848

  9. Objective Assessment of General Surgery Residents Followed by Remediation.

    Science.gov (United States)

    Gas, Becca L; Buckarma, EeeLN H; Mohan, Monali; Pandian, T K; Farley, David R

    Surgical training programs often lack objective assessment strategies. Complicated scheduling characteristics frequently make it difficult for surgical residents to undergo formal assessment; actually having the time and opportunity to remediate poor performance is an even greater problem. We developed a novel methodology of assessment for residents and created an efficient remediation system using a combination of simulation, online learning, and self-assessment options. Postgraduate year (PGY) 2 to 5 general surgery (GS) residents were tested in a 5 station, objective structured clinical examination style event called the Surgical X-Games. Stations were 15 minutes in length and tested both surgical knowledge and technical skills. Stations were scored on a scale of 1 to 5 (1 = Fail, 2 = Mediocre, 3 = Pass, 4 = Good, and 5 = Stellar). Station scores ≤ 2 were considered subpar and required remediation to a score ≥ 4. Five remediation sessions allowed residents the opportunity to practice the stations with staff surgeons. Videos of each skill or test of knowledge with clear instructions on how to perform at a stellar level were offered. Trainees also had the opportunity to checkout take-home task trainers to practice specific skills. Residents requiring remediation were then tested again in-person or sent in self-made videos of their performance. Academic medical center. PGY2, 3, 4, and 5 GS residents at Mayo Clinic in Rochester, MN. A total of, 35 residents participated in the Surgical X-Games in the spring of 2015. Among all, 31 (89%) had scores that were deemed subpar on at least 1 station. Overall, 18 (58%) residents attempted remediation. All 18 (100%) achieved a score ≥ 4 on the respective stations during a makeup attempt. Overall X-Games scores and those of PGY2s, 3s, and 4s were higher after remediation (p < 0.05). No PGY5s attempted remediation. Despite difficulties with training logistics and busy resident schedules, it is feasible to objectively

  10. Surgical Residents are Excluded From Robot-assisted Surgery

    DEFF Research Database (Denmark)

    Broholm, Malene; Rosenberg, Jacob

    2015-01-01

    PURPOSE: Implementation of a robotic system may influence surgical training. The aim was to report the charge of the operating surgeon and the bedside assistant at robot-assisted procedures in urology, gynecology, and colorectal surgery. MATERIALS AND METHODS: A review of hospital charts from...... surgical procedures during a 1-year period from October 2013 to October 2014. All robot-assisted urologic, gynecologic, and colorectal procedures were identified. Charge of both operating surgeon in the console and bedside assistant were registered. RESULTS: A total of 774 robot-assisted procedures were...... performed. In 10 (1.3%) of these procedures, a resident attended as bedside assistant and never as operating surgeon in the console. CONCLUSIONS: Our results demonstrate a severe problem with surgical education. Robot-assisted surgery is increasingly used; however, robotic surgical training during residency...

  11. Surgery resident selection and evaluation. A critical incident study.

    Science.gov (United States)

    Edwards, J C; Currie, M L; Wade, T P; Kaminski, D L

    1993-03-01

    This article reports a study of the process of selecting and evaluating general surgery residents. In personnel psychology terms, a job analysis of general surgery was conducted using the Critical Incident Technique (CIT). The researchers collected 235 critical incidents through structured interviews with 10 general surgery faculty members and four senior residents. The researchers then directed the surgeons in a two-step process of sorting the incidents into categories and naming the categories. The final essential categories of behavior to define surgical competence were derived through discussion among the surgeons until a consensus was formed. Those categories are knowledge/self-education, clinical performance, diagnostic skills, surgical skills, communication skills, reliability, integrity, compassion, organization skills, motivation, emotional control, and personal appearance. These categories were then used to develop an interview evaluation form for selection purposes and a performance evaluation form to be used throughout residency training. Thus a continuum of evaluation was established. The categories and critical incidents were also used to structure the interview process, which has demonstrated increased interview validity and reliability in many other studies. A handbook for structuring the interviews faculty members conduct with applicants was written, and an interview training session was held with the faculty. The process of implementation of the structured selection interviews is being documented currently through qualitative research.

  12. The Current State of Global Surgery Training in Plastic Surgery Residency.

    Science.gov (United States)

    Nayar, Harry S; Salyapongse, A Neil; Mount, Delora L; Bentz, Michael L

    2015-12-01

    The current state of global surgery training in U.S. plastic surgery residency programs remains largely undefined. An electronic survey was distributed to Accreditation Council for Graduate Medical Education-certified plastic surgery residency programs. Programs with global health curricula were queried regarding classification, collaboration details, regions visited, conditions/procedures encountered, costs, accreditation, and personal sentiment. Residencies without global health curricula were asked to select barriers. Sixty-four of 81 residency programs returned questionnaires (response rate, 79 percent). Twenty-six programs (41 percent) reported including a formal global health curriculum; 38 did not (59 percent). When asked to classify this curriculum, most selected clinical care experience [n = 24 (92 percent)], followed by educational experience [n = 19 (73 percent)]. Personal reference was the most common means of establishing the international collaboration [n = 19 (73 percent)]. The most commonly encountered conditions were cleft lip-cleft palate [n = 26 (100 percent)], thermal injury [n = 17 (65 percent)], and posttraumatic reconstruction [n = 15 (57 percent)]. Dominant funding sources were primarily nonprofit organizations [n = 14 (53 percent)]. Although the majority of programs had not applied for residency review committee accreditation [n = 23 (88 percent)], many considered applying [n = 16 (62 percent)]. Overall, 96 percent of programs (n = 25) supported global health training in residency, choosing exposure to different health systems [n = 22 (88 percent)] and surgical education [n = 17 (68 percent)] as reasons. Programs not offering a global health experience most commonly reported lack of residency review committee/plastic surgery operative log recognition of cases performed abroad [n = 27 (71 percent)], funding for trip expenses [n = 25 (66 percent)], and salary support [n = 24 (63 percent)] as barriers. Residencies incorporating global health

  13. A national review of the frequency of minimally invasive surgery among general surgery residents: assessment of ACGME case logs during 2 decades of general surgery resident training.

    Science.gov (United States)

    Richards, Morgan K; McAteer, Jarod P; Drake, F Thurston; Goldin, Adam B; Khandelwal, Saurabh; Gow, Kenneth W

    2015-02-01

    Minimally invasive surgery (MIS) has created a shift in how many surgical diseases are treated. Examining the effect on resident operative experience provides valuable insight into trends that may be useful for restructuring the requirements of resident training. To evaluate changes in general surgery resident operative experience regarding MIS. Retrospective review of the frequency of MIS relative to open operations among general surgery residents using the Accreditation Council for Graduate Medical Education case logs for academic years 1993-1994 through 2011-2012. General surgery residency training among accredited programs in the United States. We analyzed the difference in the mean number of MIS techniques and corresponding open procedures across training periods using 2-tailed t tests with statistical significance set at P technique throughout the study period (P enterectomy (5.2% MIS), vagotomy (1.8% MIS), and pediatric antireflux procedures (35.9% MIS); P surgical therapy for many common diseases. The open approach, however, still predominates in all but 5 procedures. Residents today must become efficient at performing multiple techniques for a single procedure, which demands a broader skill set than in the past.

  14. 0 + 5 Vascular Surgery Residents' Operative Experience in General Surgery: An Analysis of Operative Logs from 12 Integrated Programs.

    Science.gov (United States)

    Smith, Brigitte K; Kang, P Chulhi; McAninch, Chris; Leverson, Glen; Sullivan, Sarah; Mitchell, Erica L

    2016-01-01

    Integrated (0 + 5) vascular surgery (VS) residency programs must include 24 months of training in core general surgery. The Accreditation Council for Graduate Medical Education currently does not require specific case numbers in general surgery for 0 + 5 trainees; however, program directors have structured this time to optimize operative experience. The aim of this study is to determine the case volume and type of cases that VS residents are exposed to during their core surgery training. Accreditation council for graduate medical education operative logs for current 0 + 5 VS residents were obtained and retrospectively reviewed to determine general surgery case volume and distribution between open and laparoscopic cases performed. Standard statistical methods were applied. A total of 12 integrated VS residency programs provided operative case logs for current residents. A total of 41 integrated VS residents in clinical years 2 through 5. During the postgraduate year-1 training year, residents participated in significantly more open than laparoscopic general surgery cases (p surgery cases are hernia repair (20%), skin and soft tissue (7.4%), and breast (6.3%). Residents in programs with core surgery over 3 years participated in significantly more general surgery operations compared with residents in programs with core surgery spread out over 4 years (p = 0.035). 0 + 5 VS residents perform significantly more open operations than laparoscopic operations during their core surgery training. The majority of these operations are minor, nonabdominal procedures. The 0 + 5 VS residency program general surgery operative training requirements should be reevaluated and case minimums defined. The general surgery training component of 0 + 5 VS residencies may need to be restructured to meet the needs of current and future trainees. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  15. How Competitive Is the Canadian Diagnostic Radiology Residency Match? Application and Matching Trends From 1991-2014.

    Science.gov (United States)

    Kenny, Stephanie A; Esmail, Kaisra; Hibbert, Rebecca M; McInnes, Matthew D F

    2016-05-01

    The study sought to evaluate application trends in Canadian diagnostic radiology residency programs and to assess the relative competitiveness of radiology as a specialty. The Canadian Residency Matching Service Reports from 1991-2014 for Canadian graduates were used to extract the total residency positions and radiology residency positions, number of applicants to all specialties and to radiology, number of first-choice radiology applicants, number of unmatched radiology positions, and number of positions and applicants to each specialty. Ratios were calculated: radiology positions to applicants and first-choice applicants, first-choice radiology applicants to applicants for all specialties, and training positions to applicants in each specialty. Data trends and correlation coefficients were analysed. The number of radiology residency positions offered increased, with strong positive correlation (r = 0.91, P competitive in 1997, with a ratio of 0.32 positions/applicant. There was an increase of positions/applicant over time (decreasing competitiveness; r = 0.76, P competitive for positions/overall applicants and very competitive for positions/first-choice applicants compared to other specialties. The number of radiology residency positions has increased while the number of applicants has not grown commensurately. The match was most competitive in 1997, and decreased in subsequent years. Possible reasons include job market, reimbursement, and work environment. Copyright © 2016 Canadian Association of Radiologists. Published by Elsevier Inc. All rights reserved.

  16. Determinants of internal medicine residents' choice in the canadian R4 Fellowship Match: A qualitative study

    Directory of Open Access Journals (Sweden)

    Kassam Narmin

    2011-06-01

    Full Text Available Abstract Background There is currently a discrepancy between Internal Medicine residents' decisions in the Canadian subspecialty fellowship match (known as the R4 match and societal need. Some studies have been published examining factors that influence career choices. However, these were either demographic factors or factors pre-determined by the authors' opinion as possibly being important to incorporate into a survey. Methods A qualitative study was undertaken to identify factors that determine the residents choice in the subspecialty (R4 fellowship match using focus group discussions involving third and fourth year internal medicine residents Results Based on content analysis of the discussion data, we identified five themes: 1 Practice environment including acuity of practice, ability to do procedures, lifestyle, job prospects and income 2 Exposure in rotations and to role models 3 Interest in subspecialty's patient population and common diseases 4 Prestige and respect of subspecialty 5 Fellowship training environment including fellowship program resources and length of training Conclusions There are a variety of factors that contribute to Internal Medicine residents' fellowship choice in Canada, many of which have been identified in previous survey studies. However, we found additional factors such as the resources available in a fellowship program, the prestige and respect of a subspecialty/career, and the recent trend towards a two-year General Internal Medicine fellowship in our country.

  17. Factors affecting residency rank-listing: A Maxdiff survey of graduating Canadian medical students

    Directory of Open Access Journals (Sweden)

    Forgie Melissa

    2011-08-01

    Full Text Available Abstract Background In Canada, graduating medical students consider many factors, including geographic, social, and academic, when ranking residency programs through the Canadian Residency Matching Service (CaRMS. The relative significance of these factors is poorly studied in Canada. It is also unknown how students differentiate between their top program choices. This survey study addresses the influence of various factors on applicant decision making. Methods Graduating medical students from all six Ontario medical schools were invited to participate in an online survey available for three weeks prior to the CaRMS match day in 2010. Max-Diff discrete choice scaling, multiple choice, and drop-list style questions were employed. The Max-Diff data was analyzed using a scaled simple count method. Data for how students distinguish between top programs was analyzed as percentages. Comparisons were made between male and female applicants as well as between family medicine and specialist applicants; statistical significance was determined by the Mann-Whitney test. Results In total, 339 of 819 (41.4% eligible students responded. The variety of clinical experiences and resident morale were weighed heavily in choosing a residency program; whereas financial incentives and parental leave attitudes had low influence. Major reasons that applicants selected their first choice program over their second choice included the distance to relatives and desirability of the city. Both genders had similar priorities when selecting programs. Family medicine applicants rated the variety of clinical experiences more importantly; whereas specialty applicants emphasized academic factors more. Conclusions Graduating medical students consider program characteristics such as the variety of clinical experiences and resident morale heavily in terms of overall priority. However, differentiation between their top two choice programs is often dependent on social/geographic factors

  18. An evaluation of plastic surgery resident selection factors.

    Science.gov (United States)

    Liang, Fan; Rudnicki, Pamela A; Prince, Noah H; Lipsitz, Stuart; May, James W; Guo, Lifei

    2015-01-01

    article provides a framework for plastic surgery resident selection and a guide for applicants to ascertain which qualities are highly regarded by programs. Although these attributes are highly desirable, future studies could identify if they are predictive of successful and productive plastic surgery residencies and careers. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  19. Reconstructive or cosmetic plastic surgery? Factors influencing the type of practice established by Canadian plastic surgeons.

    Science.gov (United States)

    McInnes, Colin W; Courtemanche, Douglas J; Verchere, Cynthia G; Bush, Kevin L; Arneja, Jugpal S

    2012-01-01

    Some argue that the specialty of plastic surgery is facing a changing identity. Challenged by factors such as increasing competition in the cosmetic marketplace and decreasing reimbursement for reconstructive procedures, many American plastic surgeons have increasingly adopted cosmetic-focused practices. The present study investigated the currently unknown practice profiles of Canadian plastic surgeons to determine the reconstructive-cosmetic mix, as well as factors that influence practice type to determine whether a similar pattern exists in Canada. An anonymous online survey regarding practice profiles was distributed to all 352 Canadian plastic surgeons with e-mail accounts registered with the Canadian Society of Plastic Surgeons and/or the Canadian Society for Aesthetic Plastic Surgery. The survey response rate was 34% (120 responses), of which 75% of respondents currently had a reconstructive practice and 25% had a cosmetic practice. Reconstructive surgeons had more educational debt following their training, spent more time on emergency call, academics and teaching and, when deciding which type of practice to establish, were more influenced by academic opportunities and less influenced by financial and nonfinancial metrics. Similarities between the groups included hours worked per week and academic achievements. The field of reconstructive plastic surgery appears to be thriving in Canada. While a transition from reconstructive to cosmetic practice is common, compared with their American colleagues, a greater proportion of Canadian plastic surgeons maintain reconstructive practices. Differences between reconstructive and cosmetic plastic surgeons are discussed.

  20. Self-evaluation: how well do surgery residents judge performance on a rotation?

    Science.gov (United States)

    Gow, Kenneth W

    2013-05-01

    Surgical trainees are evaluated based on the Accreditation Council for Graduate Medical Education 6 core competencies. The ability for a learner to recognize strengths and weaknesses in these areas allows for critical self-improvement. Surgery residents rotating on a pediatric surgery rotation for 1 academic year were asked at an exit interview to provide a self-evaluation within the 6 core competencies on a Likert scale from 1 to 5. Self-evaluation scores were compared with a final group consensus attending evaluation. Further analyses included comparing residents as follows: less than R3 (junior residents) versus R3 (senior residents) residents, general surgery versus non-general surgery residents, university versus community residents, residents in the first half of the academic year versus residents in the second half, and top one third- and lowest one third-performing residents. Statistical analysis was performed using Student t tests with significance at P surgery residents, and highest one third-performing residents compared with junior residents, non-general surgery residents, and lowest one third-performing residents. There were no differences between self-evaluations and attending evaluations when comparing university with community residents and residents in the first half of the academic year with residents in the second half of the academic year. Residents appear to have a more critical self-analysis than attending surgeons, with senior residents, general surgery residents, and highest one third-performing residents being the most critical of their own performance. Poorly performing residents appeared to lack insight into their abilities. This method of self-evaluation helps trainees reflect on their performance and highlights trainees who lack self-awareness and need counseling for improvement. Copyright © 2013 Elsevier Inc. All rights reserved.

  1. The relative influence of available resources during the residency match: a national survey of canadian medical students.

    Science.gov (United States)

    Blissett, Sarah; Law, Christine; Morra, Dante; Ginsburg, Shiphra

    2011-12-01

    Many medical students find choosing a residency challenging. There are several steps involved, including determining one's own priorities, arranging electives, choosing a training program and site, and preparing an in-depth application and a rank order list. Many resources are available to assist students, including the Canadian Resident Matching Service website, program websites, career counselors, career information sessions, mentors, peers, family/friends, and the Canadian Medical Residency Guide. Our study explored the relative impact of these resources on the career decision-making process. We invited medical students in their final year at 12 Canadian medical schools to complete an online survey. Questions included identifying the relative utility of resources in the context of each component of the decision-making process. Responses were analyzed using descriptive statistics. The response rate was 71% (1076 of 1518). Overall, mentors, family/friends, and peers had the most impact on students' decision making. Career counselors, websites, and the Canadian Medical Residency Guide had much less impact. Family/friends were most frequently cited as essential to the process; however, family/friends and peers were equal in having some impact. Our findings suggest that students are most influenced by family, friends, and peers, who are not involved in the formal residency selection effort. Appreciating the impact of these influences on students' decision making is important to understanding how they decide on their future careers. The study supports continuation of mentorship programs. Future work could focus on qualitative research to further characterize resource use.

  2. Analysis of clinical bioethics teaching in pediatric surgery residency.

    Science.gov (United States)

    Robin, M L; Caniano, D A

    1998-02-01

    Although clinical bioethics teaching (CBT) is not a required component of the essential curriculum for pediatric surgery residency, ethical considerations often accompany surgical decision making for infants and children. This study was designed to quantitate CBT during pediatric surgery residency (PSR) and to determine preferences about formal bioethics instruction. An 80-item questionnaire was mailed to 140 graduates of accredited PSR in the United States and Canada. Questions included demographic data, experience in CBT during and after PSR, preferred topics and teaching methods, and self-assessed and objective competency in bioethics. The response rate was 78% (n = 109); 72% completed PSR between 1990 and 1995 (mean, 1991). Formal CBT within the curriculum of PSR was reported by 9% of respondents; lecture and consultation with an ethicist were the most frequent teaching methods. Informal CBT was noted by 88% of pediatric surgeons; observation of patient cases with ethical dilemmas was the primary mode of instruction. Quality of life, withholding/withdrawal of care, informed consent, child abuse, and economics ranked highest for most important CBT topics, while euthanasia, clinical research trials, and cultural diversity were given low priority. The preferred teaching methods were case-based discussions and consultation with an ethicist. Although 97% favored additional CBT in all postgraduate training, respondents who completed advanced study in medical ethics (P < .05), were women (P < .05), or were members of a hospital ethics committee (P < .05) were more likely to advocate a standardized bioethics curriculum during PSR. A majority (86%) expressed competency in handling ethical problems in clinical practice, however, 47% gave incorrect responses or were unsure about routine bioethics questions. Formal instruction in clinical bioethics is not included in the curriculum of most residencies in pediatric surgery. Recent graduates of PSR favor case-based and

  3. Barriers to efficiency in robotic surgery: the resident effect.

    Science.gov (United States)

    Jain, Monica; Fry, Brian T; Hess, Luke W; Anger, Jennifer T; Gewertz, Bruce L; Catchpole, Ken

    2016-10-01

    Robotic surgery offers advantages over conventional operative approaches but may also be associated with higher costs and additional risks. Analyzing surgical flow disruptions (FDs), defined as "deviations from the natural progression of an operation," can help target training techniques and identify opportunities for improvement. Thirty-two robotic surgery operations were observed over a 6-wk period at one 900-bed surgical center. FDs were recorded in detail and classified into one of 11 different categories. Procedure type, robot model, and resident involvement were also recorded. Linear regression analyses were used to evaluate the effects of these parameters on FDs and operative duration. Twenty-one prostatectomies, eight sacrocolpopexies, and three nephrectomies were observed. The mean number of FDs was 48.2 (95% confidence interval [CI] 38.6-54.8 FDs), and mean operative duration was 163 min (95% CI 148-179 min). Each FD added 2.4 min (P = 0.025) to a case's total operative duration. The number and rate of FDs were significantly affected by resident involvement (P = 0.008 and P = 0.006, respectively). Resident cases demonstrated mostly training, equipment, and robot switch FDs, whereas nonresident cases demonstrated mostly equipment, instrument changes, and external factor FDs. Although the FDs encountered in resident training are more frequent, they may not significantly increase operative duration. Other FDs, such as equipment or external factors, may be more impactful. Limiting these specific FDs should be the focus of performance improvement efforts. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Emotional intelligence in surgery is associated with resident job satisfaction.

    Science.gov (United States)

    Hollis, Robert H; Theiss, Lauren M; Gullick, Allison A; Richman, Joshua S; Morris, Melanie S; Grams, Jayleen M; Porterfield, John R; Chu, Daniel I

    2017-03-01

    Emotional intelligence (EI) has been associated with improved work performance and job satisfaction in several industries. We evaluated whether EI was associated with higher measures of work performance and job satisfaction in surgical residents. We distributed the validated Trait EI Questionnaire and job satisfaction survey to all general surgery residents at a single institution in 2015. EI and job satisfaction scores were compared with resident performance using faculty evaluations of clinical competency-based surgical milestones and standardized test scores including the United States Medical Licensing Examination (USMLE) and American Board of Surgery In-Training Examination (ABSITE). Statistical comparison was made using Pearson correlation and simple linear regression adjusting for postgraduate year level. The survey response rate was 68.9% with 31 resident participants. Global EI was associated with scores on USMLE Step 2 (r = 0.46, P = 0.01) and Step 3 (r = 0.54, P = 0.01) but not ABSITE percentile scores (r = 0.06, P = 0.77). None of the 16 surgical milestone scores were significantly associated with global EI or EI factors before or after adjustment for postgraduate level. Global EI was associated with overall job satisfaction (r = 0.37, P = 0.04). Of the facets of job satisfaction, global EI was significantly associated with views of supervision (r = 0.42, P = 0.02) and nature of work (r = 0.41, P = 0.02). EI was associated with job satisfaction and USMLE performance but not ACGME competency-based milestones or ABSITE scores. EI may be an important factor for fulfillment in surgical training that is not currently captured with traditional in-training performance measures. Published by Elsevier Inc.

  5. Variability in Accreditation Council for Graduate Medical Education Resident Case Log System practices among orthopaedic surgery residents.

    Science.gov (United States)

    Salazar, Dane; Schiff, Adam; Mitchell, Erika; Hopkinson, William

    2014-02-05

    The Accreditation Council for Graduate Medical Education (ACGME) Resident Case Log System is designed to be a reflection of residents' operative volume and an objective measure of their surgical experience. All operative procedures and manipulations in the operating room, Emergency Department, and outpatient clinic are to be logged into the Resident Case Log System. Discrepancies in the log volumes between residents and residency programs often prompt scrutiny. However, it remains unclear if such disparities truly represent differences in operative experiences or if they are reflections of inconsistent logging practices. The purpose of this study was to investigate individual recording practices among orthopaedic surgery residents prior to August 1, 2011. Orthopaedic surgery residents received a questionnaire on case log practices that was distributed through the Council of Orthopaedic Residency Directors list server. Respondents were asked to respond anonymously about recording practices in different clinical settings as well as types of cases routinely logged. Hypothetical scenarios of common orthopaedic procedures were presented to investigate the differences in the Current Procedural Terminology codes utilized. Two hundred and ninety-eight orthopaedic surgery residents completed the questionnaire; 37% were fifth-year residents, 22% were fourth-year residents, 18% were third-year residents, 15% were second-year residents, and 8% were first-year residents. Fifty-six percent of respondents reported routinely logging procedures performed in the Emergency Department or urgent care setting. Twenty-two percent of participants routinely logged procedures in the clinic or outpatient setting, 20% logged joint injections, and only 13% logged casts or splints applied in the office setting. There was substantial variability in the Current Procedural Terminology codes selected for the seven clinical scenarios. There has been a lack of standardization in case

  6. Opportunities to Create New General Surgery Residency Programs to Alleviate the Shortage of General Surgeons.

    Science.gov (United States)

    Meagher, Ashley D; Beadles, Christopher A; Sheldon, George F; Charles, Anthony G

    2016-06-01

    To estimate the capacity for supporting new general surgery residency programs among U.S. hospitals that currently do not have such programs. The authors compiled 2011 American Hospital Association data regarding the characteristics of hospitals with and without a general surgery residency program and 2012 Accreditation Council for Graduate Medical Education data regarding existing general surgery residencies. They performed an ordinary least squares regression to model the number of residents who could be trained at existing programs on the basis of residency program-level variables. They identified candidate hospitals on the basis of a priori defined criteria for new general surgery residency programs and an out-of-sample prediction of resident capacity among the candidate hospitals. The authors found that 153 hospitals in 39 states could support a general surgery residency program. The characteristics of these hospitals closely resembled the characteristics of hospitals with existing programs. They identified 435 new residency positions: 40 hospitals could support 2 residents per year, 99 hospitals could support 3 residents, 12 hospitals could support 4 residents, and 2 hospitals could support 5 residents. Accounting for progressive specialization, new residency programs could add 287 additional general surgeons to the workforce annually (after an initial five- to seven-year lead time). By creating new general surgery residency programs, hospitals could increase the number of general surgeons entering the workforce each year by 25%. A challenge to achieving this growth remains finding new funding mechanisms within and outside Medicare. Such changes are needed to mitigate projected workforce shortages.

  7. Pediatric fractures – an educational needs assessment of Canadian pediatric emergency medicine residents

    Directory of Open Access Journals (Sweden)

    Dixon AC

    2015-06-01

    Full Text Available Andrew C Dixon Department of Pediatrics, University of Alberta, Edmonton, AB, Canada Objectives: To determine the gaps in knowledge of Canadian pediatric emergency medicine residents with regards to acute fracture identification and management. Due to their predominantly medical prior training, fractures may be an area of weakness requiring a specific curriculum to meet their needs. Methods: A questionnaire was developed examining comfort level and performance on knowledge based questions of trainees in the following areas: interpreting musculoskeletal X-rays; independently managing pediatric fractures, physical examination techniques, applied knowledge of fracture management, and normal development of the bony anatomy. Using modified Dillman technique the instrument was distributed to pediatric emergency medicine residents at seven Canadian sites. Results: Out of 43 potential respondents, 22 (51% responded. Of respondents, mean comfort with X-ray interpretation was 69 (62–76 95% confidence interval [CI] while mean comfort with fracture management was only 53 (45–63 95% CI; mean comfort with physical exam of shoulder 60 (53–68 95% CI and knee 69 (62–76 95% CI was low. Less than half of respondents (47%; 95% CI 26%–69% could accurately identify normal wrist development, correctly manage a supracondylar fracture (39%; 95% CI 20%–61%, or identify a medial epicondyle fracture (44%; 95% CI 24%–66%. Comfort with neurovascular status of the upper (mean 82; 95% CI 75–89 and lower limb (mean 81; 95% CI 74–87 was high. Interpretation: There are significant gaps in knowledge of physical exam techniques, fracture identification and management among pediatric emergency medicine trainees. A change in our current teaching methods is required to meet this need. Keywords: pediatric, fractures, education, radiologic interpretation

  8. The happy docs study: a Canadian Association of Internes and Residents well-being survey examining resident physician health and satisfaction within and outside of residency training in Canada

    Directory of Open Access Journals (Sweden)

    Ramchandar Kevin

    2008-10-01

    Full Text Available Abstract Background Few Canadian studies have examined stress in residency and none have included a large sample of resident physicians. Previous studies have also not examined well-being resources nor found significant concerns with perceived stress levels in residency. The goal of "The Happy Docs Study" was to increase knowledge of current stressors affecting the health of residents and to gather information regarding the well-being resources available to them. Findings A questionnaire was distributed to all residents attending all medical schools in Canada outside of Quebec through the Canadian Association of Internes and Residents (CAIR during the 2004–2005 academic years. In total 1999 resident physicians responded to the survey (35%, N = 5784 residents. One third of residents reported their life as "quite a bit" to "extremely" stressful (33%, N = 656. Time pressure was the most significant factor associated with stress (49%, N = 978. Intimidation and harassment was experienced by more than half of all residents (52%, N = 1050 with training status (30%, N = 599 and gender (18%, N = 364 being the main perceived sources. Eighteen percent of residents (N = 356 reported their mental health as either "fair" or "poor". The top two resources that residents wished to have available were career counseling (39%, N = 777 and financial counseling (37%, N = 741. Conclusion Although many Canadian resident physicians have a positive outlook on their well-being, residents experience significant stressors during their training and a significant portion are at risk for emotional and mental health problems. This study can serve as a basis for future research, advocacy and resource application for overall improvements to well-being during residency.

  9. Current Practices in Assessing Professionalism in United States and Canadian Allopathic Medical Students and Residents

    Science.gov (United States)

    Nittur, Nandini

    2017-01-01

    Professionalism is a critically important competency that must be evaluated in medical trainees but is a complex construct that is hard to assess. A systematic review was undertaken to give insight into the current best practices for assessment of professionalism in medical trainees and to identify new research priorities in the field. A search was conducted on PubMed for behavioral assessments of medical students and residents among the United States and Canadian allopathic schools in the last 15 years. An initial search yielded 594 results, 28 of which met our inclusion criteria. Our analysis indicated that there are robust generic definitions of the major attributes of medical professionalism. The most commonly used assessment tools are survey instruments that use Likert scales tied to attributes of professionalism. While significant progress has been made in this field in recent years, several opportunities for system-wide improvement were identified that require further research. These include a paucity of information about assessment reliability, the need for rater training, a need to better define competency in professionalism according to learner level (preclinical, clerkship, resident etc.) and ways to remediate lapses in professionalism. Student acceptance of assessment of professionalism may be increased if assessment tools are shifted to better incorporate feedback. Tackling the impact of the hidden curriculum in which students may observe lapses in professionalism by faculty and other health care providers is another priority for further study. PMID:28652951

  10. The impact of an acute care surgery team on general surgery residency.

    Science.gov (United States)

    Hatch, Quinton; McVay, Derek; Johnson, Eric K; Maykel, Justin A; Champagne, Bradley J; Steele, Scott R

    2014-11-01

    Acute care surgical teams (ACSTs) have limited data in residency. We sought to determine the impact of an ACST on the depth and breadth of general surgery resident training. One year prior to and after implementation of an ACST, Accreditation Council for Graduate Medical Education case logs spanning multiple postgraduate year levels were compared for numbers, case types, and complexity. We identified 6,009 cases, including 2,783 after ACST implementation. ACSTs accounted for 752 cases (27%), with 39.2% performed laparoscopically. ACST cases included biliary (19.4%), skin/soft tissue (10%), hernia (9.8%), and appendix (6.5%). Second-year residents performed a lower percentage of laparoscopic cases after the creation of the ACST (20.4% vs 26.3%; P = .003), while chief residents performed a higher percentage (42.1 vs 37.4; P = .04). Case numbers and complexity following ACST development were unchanged within all year groups (P > .1). ACST in a residency program does not sacrifice resident case complexity, diversity, or volume. Published by Elsevier Inc.

  11. Innovation in Pediatric Surgical Education for General Surgery Residents: A Mobile Web Resource.

    Science.gov (United States)

    Rouch, Joshua D; Wagner, Justin P; Scott, Andrew; Sullins, Veronica F; Chen, David C; DeUgarte, Daniel A; Shew, Stephen B; Tillou, Areti; Dunn, James C Y; Lee, Steven L

    2015-01-01

    General surgery residents lack a standardized educational experience in pediatric surgery. We hypothesized that the development of a mobile educational interface would provide general surgery residents broader access to pediatric surgical education materials. We created an educational mobile website for general surgery residents rotating on pediatric surgery, which included a curriculum, multimedia resources, the Operative Performance Rating Scale (OPRS), and Twitter functionality. Residents were instructed to consult the curriculum. Residents and faculty posted media using the Twitter hashtag, #UCLAPedSurg, and following each surgical procedure reviewed performance via the OPRS. Site visits, Twitter posts, and OPRS submissions were quantified from September 2013 to July 2014. The pediatric surgery mobile website received 257 hits; 108 to the homepage, 107 to multimedia, 28 to the syllabus, and 19 to the OPRS. All eligible residents accessed the content. The Twitter hashtag, #UCLAPedSurg, was assigned to 20 posts; the overall audience reach was 85 individuals. Participants in the mobile OPRS included 11 general surgery residents and 4 pediatric surgery faculty. Pediatric surgical education resources and operative performance evaluations are effectively administered to general surgery residents via a structured mobile platform. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  12. General surgery resident rotations in surgical critical care, trauma, and burns: what is optimal for residency training?

    Science.gov (United States)

    Napolitano, Lena M; Biester, Thomas W; Jurkovich, Gregory J; Buyske, Jo; Malangoni, Mark A; Lewis, Frank R

    2016-10-01

    There are no specific Accreditation Council for Graduate Medical Education General Surgery Residency Program Requirements for rotations in surgical critical care (SCC), trauma, and burn. We sought to determine the experience of general surgery residents in SCC, trauma, and burn rotations. Data analysis of surgical rotations of American Board of Surgery general surgery resident applicants (n = 7,299) for the last 8 years (2006 to 2013, inclusive) was performed through electronic applications to the American Board of Surgery Qualifying Examination. Duration (months) spent in SCC, trauma, and burn rotations, and postgraduate year (PGY) level were examined. The total months in SCC, trauma and burn rotations was mean 10.2 and median 10.0 (SD 3.9 months), representing approximately 16.7% (10 of 60 months) of a general surgery resident's training. However, there was great variability (range 0 to 29 months). SCC rotation duration was mean 3.1 and median 3.0 months (SD 2, min to max: 0 to 15), trauma rotation duration was mean 6.3 and median 6.0 months (SD 3.5, min to max: 0 to 24), and burn rotation duration was mean 0.8 and median 1.0 months (SD 1.0, min to max: 0 to 6). Of the total mean 10.2 months duration, the longest exposure was 2 months as PGY-1, 3.4 months as PGY-2, 1.9 months as PGY-3, 2.2 months as PGY-4 and 1.1 months as PGY-5. PGY-5 residents spent a mean of 1 month in SCC, trauma, and burn rotations. PGY-4/5 residents spent the majority of this total time in trauma rotations, whereas junior residents (PGY-1 to 3) in SCC and trauma rotations. There is significant variability in total duration of SCC, trauma, and burn rotations and PGY level in US general surgery residency programs, which may result in significant variability in the fund of knowledge and clinical experience of the trainee completing general surgery residency training. As acute care surgery programs have begun to integrate emergency general surgery with SCC, trauma, and burn rotations

  13. Does intentional support of degree programs in general surgery residency affect research productivity or pursuit of academic surgery?

    Science.gov (United States)

    Joshua Smith, Jesse; Patel, Ravi K; Chen, Xi; Tarpley, Margaret J; Terhune, Kyla P

    2014-01-01

    Many residents supplement general surgery training with years of dedicated research, and an increasing number at our institution pursue additional degrees. We sought to determine whether it was worth the financial cost for residency programs to support degrees. We reviewed graduating chief residents (n = 69) in general surgery at Vanderbilt University from 2001 to 2010 and collected the data including research time and additional degrees obtained. We then compared this information with the following parameters: (1) total papers, (2) first-author papers, (3) Journal Citation Reports impact factors of journals in which papers were published, and (4) first job after residency or fellowship training. The general surgery resident training program at Vanderbilt University is an academic program, approved to finish training 7 chief residents yearly during the time period studied. Chief residents in general surgery at Vanderbilt who finished their training 2001 through 2010. We found that completion of a degree during residency was significantly associated with more total and first-author publications as compared with those by residents with only dedicated research time (p = 0.001 and p = 0.017). Residents completing a degree also produced publications of a higher caliber and level of authorship as determined by an adjusted resident impact factor score as compared with those by residents with laboratory research time only (p = 0.005). Degree completion also was significantly correlated with a first job in academia if compared to those with dedicated research time only (p = 0.046). Our data support the utility of degree completion when economically feasible and use of dedicated research time as an effective way to significantly increase research productivity and retain graduates in academic surgery. Aggregating data from other academic surgery programs would allow us to further determine association of funding of additional degrees as a means to encourage academic

  14. Analysis and implications of changing hepatopancreatobiliary (HPB) case loads in general surgery residency training for HPB surgery accreditation

    Science.gov (United States)

    Daee, Sally Sayeh; Flynn, Jeffrey C; Jacobs, Michael J; Mittal, Vijay K

    2013-01-01

    Objective This study was conducted to determine whether residents are receiving enough hepatopancreatobiliary (HPB) training during general surgery residencies to exclude the necessity of pursuing formal fellowships in HPB surgery. Methods Trends in HPB surgery training were examined using Accreditation Council for Graduate Medical Education (ACGME) operative log data for the academic years 1999/2000 to 2009/2010. Results Of 800 000 HPB operations performed annually in the USA, the proportion of HPB procedures performed by general surgery residents increased from 15% (122 007) to 18% (143 000) between the periods under study. Numbers of pancreatic, liver and biliary procedures performed by graduating general surgery residents increased by 47% (from 8185 to 12 006), 31% (from 7468 to 9765), and 14% (from 106 354 to 121 239), respectively. The mean number of operations undertaken by a graduating resident increased from 8.3 to 11.5 (38% increase) for pancreatic surgeries, from 7.6 to 9.4 (24% increase) for liver surgeries, and from 107.5 to 116.6 (8% increase) for biliary surgeries. Total numbers of complex pancreatic, liver and biliary procedures increased by 91% (from 4768 to 9129) and 24% (from 6649 to 8233), and decreased by 29% (from 6581 to 4648), respectively. Conclusions The overall trend shows an increase in the number of HPB procedures undertaken by graduating general surgery residents. The mean number of procedures exceeds ACGME requirements, but falls short of association guidelines. However, certain residents exceed International Hepato-Pancreato-Biliary Association (IHPBA) fellowship requirements for total and complex procedures during residency. Consideration should be given to those residents to allow them to bypass fellowship training provided that they meet other IHPBA standards. PMID:23521184

  15. Association of the 2011 ACGME resident duty hour reform with general surgery patient outcomes and with resident examination performance.

    Science.gov (United States)

    Rajaram, Ravi; Chung, Jeanette W; Jones, Andrew T; Cohen, Mark E; Dahlke, Allison R; Ko, Clifford Y; Tarpley, John L; Lewis, Frank R; Hoyt, David B; Bilimoria, Karl Y

    2014-12-10

    In 2011, the Accreditation Council for Graduate Medical Education (ACGME) restricted resident duty hour requirements beyond those established in 2003, leading to concerns about the effects on patient care and resident training. To determine if the 2011 ACGME duty hour reform was associated with a change in general surgery patient outcomes or in resident examination performance. Quasi-experimental study of general surgery patient outcomes 2 years before (academic years 2009-2010) and after (academic years 2012-2013) the 2011 duty hour reform. Teaching and nonteaching hospitals were compared using a difference-in-differences approach adjusted for procedural mix, patient comorbidities, and time trends. Teaching hospitals were defined based on the proportion of cases at which residents were present intraoperatively. Patients were those undergoing surgery at hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). General surgery resident performance on the annual in-training, written board, and oral board examinations was assessed for this same period. National implementation of revised resident duty hour requirements on July 1, 2011, in all ACGME accredited residency programs. Primary outcome was a composite of death or serious morbidity; secondary outcomes were other postoperative complications and resident examination performance. In the main analysis, 204,641 patients were identified from 23 teaching (n = 102,525) and 31 nonteaching (n = 102,116) hospitals. The unadjusted rate of death or serious morbidity improved during the study period in both teaching (11.6% [95% CI, 11.3%-12.0%] to 9.4% [95% CI, 9.1%-9.8%], P oral board examinations during this period. Implementation of the 2011 ACGME duty hour reform was not associated with a change in general surgery patient outcomes or differences in resident examination performance. The implications of these findings should be considered when

  16. Bariatric surgery and the changing current scope of general surgery practice: implications for general surgery residency training.

    Science.gov (United States)

    Mostaedi, Rouzbeh; Ali, Mohamed R; Pierce, Jonathan L; Scherer, Lynette A; Galante, Joseph M

    2015-02-01

    The scope of general surgery practice has evolved tremendously in the last 20 years. However, clinical experience in general surgery residency training has undergone relatively little change. To evaluate the current scope of academic general surgery and its implications on surgical residency. The University HealthSystem Consortium and Association of American Medical Colleges established the Faculty Practice Solution Center (FPSC) to characterize physician productivity. The FPSC is a benchmarking tool for academic medical centers created from revenue data collected from more than 90,000 physicians who practice at 95 institutions across the United States. The FPSC database was queried to evaluate the annual mean procedure frequency per surgeon (PFS) in each calendar year from 2006 through 2011. The associated work relative value units (wRVUs) were also examined to measure physician effort and skill. During the 6-year period, 146 distinct Current Procedural Terminology codes were among the top 100 procedures, and 16 of these procedures ranked in the top 10 procedures in at least 1 year. The top 10 procedures accounted for more than half (range, 52.5%-57.2%) of the total 100 PFS evaluated for each year. Laparoscopic Roux-en-Y gastric bypass was consistently among the top 10 procedures in each year (PFS, 18.2-24.6). The other most frequently performed procedures included laparoscopic cholecystectomy (PFS, 30.3-43.5), upper gastrointestinal tract endoscopy (PFS, 26.5-34.3), mastectomy (PFS, 16.5-35.0), inguinal hernia repair (PFS, 15.5-22.1), and abdominal wall hernia repair (PFS, 21.6-26.1). In all years, laparoscopic Roux-en-Y gastric bypass generated the highest number of wRVUs (wRVUs, 491.0-618.2), and laparoscopic cholecystectomy was regularly the next highest (wRVUs, 335.8-498.7). A significant proportion of academic general surgery is composed of bariatric surgery, yet surgical training does not sufficiently emphasize the necessary exposure to technical expertise

  17. Determining preferred educational methods for neurological surgery residents regarding organ donation.

    Science.gov (United States)

    Taylor, G; McGaw, J

    1998-03-01

    Design and implementation of professional education, especially physician education, continues to challenge procurement professionals. At the request of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons, the United Network for Organ Sharing undertook a project to develop educational materials for neurological surgery residents. A survey tool was developed and administered on site at 11 neurological surgery residency programs in the United States. The survey explored the types of learning environments, teaching methods, educational resources, and audiovisual aids that neurological surgery residents typically experience during their residency programs. In addition, the survey sought to uncover the residents' informational needs regarding organ and tissue donation presentations as well as their educational program preferences. Based on our findings, neurological surgery residents prefer presentations that are brief and to the point, that are easily understood, that require no reading, that contain limited important information, and that always include food.

  18. Comparative Assessment of Grit, Conscientiousness, and Self-Control in Applicants Interviewing for Residency Positions and Current Orthopaedic Surgery Residents.

    Science.gov (United States)

    Kelly, Anne M; Townsend, Kimberly W; Davis, Shauna; Nouryan, Lola; Bostrom, Mathias P G; Felix, Karla J

    2017-09-27

    The purpose of this study was to quantify grit, conscientiousness, and self-control in orthopaedic residency applicants and current orthopaedic surgery residents. As part of a continual reassessment of the selection process, this study will help to improve this process by assessing the introduction of these non-cognitive assessments. This is the first study to both evaluate and compare the applicants' scores to those of current residents. This introduction will allow selection of not only the current top performers but those who have the wherewithal (read grit) to sustain their efforts throughout their residency. A cross-sectional study composed of a confidential electronic survey consisting of a 17-item Grit scale, 10-item Self-control scale, and 9-item Conscientiousness scale was completed by medical school applicants and orthopaedic residents. Department of Orthopaedic Surgery, Hospital for Special Surgery. Fifty-six (100%) medical student applicants (mean age = 27) were invited to participate in our study following a full day of interviews. Forty-five residents (mean age = 31) were asked and 32 (72%) completed the same surveys 4 months later. There was a significant difference in grit for medical students (M = 4.19, SD = 0.34) and residents (M =3.86, SD = 0.48); t(86) = 3.76, p = 0.000. All grit subscales were also significantly different for medical students versus residents. Medical students (conscientiousness M = 4.60, SD = 0.41; self-control M = 3.51, SD = 0.30) and residents (conscientiousness M = 4.42, SD = 0.53; self-control M = 3.31, SD = 0.73) scored similarly in the conscientiousness t(86) = 1.75, p = 0.084 and self-control scales t(86) = 1.74, p = 0.086. Academic performance indicators such as the USMLE scores and residency ranking were also compared among medical student applicants. The similar and above average levels of conscientiousness and self-control demonstrate the persevering nature of the individual who elects to pursue an orthopaedic

  19. The ACGME case log: General surgery resident experience in pediatric surgery

    Science.gov (United States)

    Gow, Kenneth W.; Drake, F. Thurston; Aarabi, Shahram; Waldhausen, John H.

    2014-01-01

    Background General surgery (GS) residents in ACGME programs log cases performed during their residency. We reviewed designated pediatric surgery (PS) cases to assess for changes in performed cases over time. Methods The ACGME case logs for graduating GS residents were reviewed from academic year (AY) 1989–1990 to 2010–2011 for designated pediatric cases. Overall and designated PS cases were analyzed. Data were combined into five blocks: Period I (AY1989–90 to AY1993–94), Period II (AY1994–95 to AY1998–99), Period III (AY1999–00 to AY2002–03), Period IV (AY2003–04 to AY2006–07), and Period V (AY2007–08 to AY2010–11). Periods IV and V were delineated by implementation of duty hour restrictions. Student t-tests compared averages among the time periods with significance at P < .05. Results Overall GS case load remained relatively stable. Of total cases, PS cases accounted for 5.4% in Period I and 3.7% in Period V. Designated pediatric cases declined for each period from an average of 47.7 in Period I to 33.8 in Period V. These changes are due to a decline in hernia repairs, which account for half of cases. All other cases contributed only minimally to the pediatric cases. The only laparoscopic cases in the database were anti-reflux procedures, which increased over time. Conclusions GS residents perform a diminishing number of designated PS cases. This decline occurred before the onset of work-hour restrictions. These changes have implications on the capabilities of the current graduating workforce. However, the case log does not reflect all cases trainees may be exposed to, so revision of this list is recommended. PMID:23932601

  20. The ACGME case log: general surgery resident experience in pediatric surgery.

    Science.gov (United States)

    Gow, Kenneth W; Drake, F Thurston; Aarabi, Shahram; Waldhausen, John H

    2013-08-01

    General surgery (GS) residents in ACGME programs log cases performed during their residency. We reviewed designated pediatric surgery (PS) cases to assess for changes in performed cases over time. The ACGME case logs for graduating GS residents were reviewed from academic year (AY) 1989-1990 to 2010-2011 for designated pediatric cases. Overall and designated PS cases were analyzed. Data were combined into five blocks: Period I (AY1989-90 to AY1993-94), Period II (AY1994-95 to AY1998-99), Period III (AY1999-00 to AY2002-03), Period IV (AY2003-04 to AY2006-07), and Period V (AY2007-08 to AY2010-11). Periods IV and V were delineated by implementation of duty hour restrictions. Student t-tests compared averages among the time periods with significance at P pediatric cases declined for each period from an average of 47.7 in Period I to 33.8 in Period V. These changes are due to a decline in hernia repairs, which account for half of cases. All other cases contributed only minimally to the pediatric cases. The only laparoscopic cases in the database were anti-reflux procedures, which increased over time. GS residents perform a diminishing number of designated PS cases. This decline occurred before the onset of work-hour restrictions. These changes have implications on the capabilities of the current graduating workforce. However, the case log does not reflect all cases trainees may be exposed to, so revision of this list is recommended. Copyright © 2013 Elsevier Inc. All rights reserved.

  1. Gender Distribution of General Surgery Residents at the University of Puerto Rico.

    Science.gov (United States)

    Cruz, Norma I; Rivera, Fernando; Santiago, Elvis

    2016-03-01

    To determine whether the number of women accepted to the University of Puerto Rico (UPR) general surgery residency program has increased in recent years. We examined the gender distribution of residents accepted in their first postgraduate year (PGY-1) by the UPR Surgery Department from 1958 to 2014. This information was obtained from the database of graduate residents, which collects information on gender, medical school from which they graduated, the years in which they were in the residency program, and, their specialty. We evaluated all the residents admitted to PGY-1 positions in surgery (1958-2014) and of those admitted to PGY-1 categorical general surgery positions (1983-2014). The study was IRB approved. Since 1958 the number of female residents admitted as PGY-1s to the UPR Surgery Department has augmented, starting with 2% in the 1960s and rising to 36% in 2014. The percentage of categorical female residents was 11% in the 1983 to 1990 period, 14% in the 1991 to 2000 period, 18% in the 2001 to 2010 period, and 35% in the 2011 to 2014 period. We found an increase in the number of women admitted to the general surgery program over the last several years. However, despite this increase some degree of gender inequality remains in most surgery programs. Currently, 60% of undergraduate students and 50% of medical students are women, but only 36% of surgical residents are women. Future studies need to address the reasons for the small number of women in surgical programs.

  2. The Canadian Urology Fair: a model for minimizing the financial and academic costs of the residency selection process

    Science.gov (United States)

    Grober, Ethan D.; Matsumoto, Edward D.; Jewett, Michael A.S.; Chin, Joseph L.

    2003-01-01

    Introduction In 1994, the Canadian urology residency training programs designed the “Canadian Urology Fair” — a single-site (Toronto, Ont.), 1-day fair to conduct the personal interview portion of the residency selection process. The objective of the current study was to evaluate the success of the Urology Fair in achieving its original goals of decreasing the financial burden and minimizing time away from medical training for applicants and faculty. Methods Both candidates and Canadian urology training programs were surveyed regarding the financial and academic costs (days absent) of attending the 2001 Urology Fair. Data from the 2001 Canadian Resident Matching Service (CaRMS) was used to compare the financial and academic costs of attending personal interviews incurred by candidates declaring urology as their first-choice discipline to candidates interviewing with other surgical specialties throughout Canada. Results Financial costs incurred by candidates to attend the Urology Fair (mean Can$367) were significantly lower than candidates' estimated costs of attending on-site interviews at the individual programs (mean Can$2065). The financial costs of attending personal interviews by CaRMS applicants declaring urology as their first-choice discipline (mean Can$2002) were significantly lower than the costs incurred by applicants interviewing with other surgical disciplines (meanCan$2744). Financial costs to urology programs attending the fair (mean Can$1931) were not significantly greater than the programs' estimated costs of conducting on-site interviews at their respective program locations (mean Can$1825). Days absent from medical school to attend interviews were significantly lower among CaRMS applicants declaring urology as their first-choice discipline (3 d) compared with applicants who interviewed with other surgical specialties (9.1 d). Conclusion The Canadian Urology Fair represents an innovative and efficient method for residency programs to conduct

  3. Measuring general surgery residents' communication skills from the patient's perspective using the Communication Assessment Tool (CAT).

    Science.gov (United States)

    Stausmire, Julie M; Cashen, Constance P; Myerholtz, Linda; Buderer, Nancy

    2015-01-01

    The Communication Assessment Tool (CAT) has been used and validated to assess Family and Emergency Medicine resident communication skills from the patient's perspective. However, it has not been previously reported as an outcome measure for general surgery residents. The purpose of this study is to establish initial benchmarking data for the use of the CAT as an evaluation tool in an osteopathic general surgery residency program. Results are analyzed quarterly and used by the program director to provide meaningful feedback and targeted goal setting for residents to demonstrate progressive achievement of interpersonal and communication skills with patients. The 14-item paper version of the CAT (developed by Makoul et al. for residency programs) asks patients to anonymously rate surgery residents on discrete communication skills using a 5-point rating scale immediately after the clinical encounter. Results are reported as the percentage of items rated as "excellent" (5) by the patient. The setting is a hospital-affiliated ambulatory urban surgery office staffed by the residency program. Participants are representative of adult patients of both sexes across all ages with diverse ethnic backgrounds. They include preoperative and postoperative patients, as well as those needing diagnostic testing and follow-up. Data have been collected on 17 general surgery residents from a single residency program representing 5 postgraduate year levels and 448 patient encounters since March 2012. The reliability (Cronbach α) of the tool for surgery residents was 0.98. The overall mean percentage of items rated as excellent was 70% (standard deviations = 42%), with a median of 100%. The CAT is a useful tool for measuring 1 facet of resident communication skills-the patient's perception of the physician-patient encounter. The tool provides a unique and personalized outcome measure for identifying communication strengths and improvement opportunities, allowing residents to receive

  4. Perceptions and opinions of Canadian pet owners about anaesthesia, pain and surgery in small animals.

    Science.gov (United States)

    Steagall, P V; Monteiro, B P; Ruel, H L M; Beauchamp, G; Luca, G; Berry, J; Little, S; Stiles, E; Hamilton, S; Pang, D

    2017-07-01

    The aim of this study was to evaluate the perceptions and opinions of Canadian pet owners about anaesthesia, pain and surgery in dogs and cats. Six Canadian veterinary hospitals participated. Each practice received 200 copies of a questionnaire that were distributed to pet owners. Questions regarding the use of analgesics, anaesthesia, surgery and onychectomy (cats) were included. Responses were transformed into ordinal scores and analysed with a Cochran-Mantel-Haenszel test. A total of 849 out of 1200 questionnaires were returned. Owners believed more frequently that analgesics are needed for surgical procedures than for the medical conditions. Owners rated as very important/important: "knowing what to expect during illness/injury/surgery" (99·3%), "being assured that all necessary analgesic drugs/techniques will be used" (98·6%), "being informed about procedures/risk" (98·5%), and having a board-certified anaesthesiologist (90·5%). Most owners agreed/partly agreed that pain impacts quality of life (94·2%), and affects their pet's behaviour (89·5%). Most respondents (69%) were women; they were significantly more concerned than men about anaesthesia, pain, cost and client-communication. Cat owners believed that analgesics were necessary for some procedures/conditions significantly more often than canine-only owners. Pet owners with previous surgery disagreed more frequently that "pain after surgery can be helpful" and that "pain in animals is easy to recognize" than those without previous surgery. Most owners think onychectomy should be banned in cats (56·4%). This study identified important areas of client communication regarding pain and its control in pets. © 2017 British Small Animal Veterinary Association.

  5. Progressive Entrustment to Achieve Resident Autonomy in the Operating Room: A National Qualitative Study With General Surgery Faculty and Residents.

    Science.gov (United States)

    Sandhu, Gurjit; Magas, Christopher P; Robinson, Adina B; Scally, Christopher P; Minter, Rebecca M

    2017-06-01

    The purpose of this study was to identify behaviors that faculty and residents exhibit during intraoperative interactions, which support or inhibit progressive entrustment leading to operative autonomy. In the operating room, a critical balance is sought between direct faculty supervision and appropriate increase in resident autonomy with indirect faculty supervision. Little is known regarding perspectives of faculty and residents about how attendings increasingly step back and safely delegate autonomy to trainees. Understanding the context in which these decisions are made is critical to achieving a safe strategy for imparting progressive responsibility. A qualitative study was undertaken from January 2014 to February 2015. Semistructured interviews were conducted with 37 faculty and 59 residents from 14 and 41 institutions, respectively. Participants were selected using stratified random sampling from general surgery residency programs across the United States to represent a range of university, university-affiliated, and community programs, and geographic regions. Audio recordings of interviews were transcribed, iteratively analyzed, and emergent themes identified. Six themes were identified as influencing progressive entrustment in the operating room: optimizing faculty intraoperative feedback; policies and regulations affecting role of resident in the operating room; flexible faculty teaching strategies; context-specific variables; leadership opportunities for resident in the case; and safe struggle for resident when appropriate. Perspectives of faculty and residents while overlapping were different in emphasis. Better understanding faculty-resident interactions, individual behaviors, contextual influences, and national regulations that influence intraoperative education have the potential to significantly affect progressive entrustment in training paradigms.

  6. Satisfaction with civilian family medicine residency training: Perspectives from serving general duty medical officers in the Canadian Armed Forces.

    Science.gov (United States)

    Wolfrom, Brent; Hodgetts, Geoff; Kotecha, Jyoti; Pollock, Emily; Martin, Mary; Han, Han; Morissette, Pierre

    2016-09-01

    To evaluate satisfaction with civilian residency training programs among serving general duty medical officers within the Canadian Armed Forces. A 23-item, cross-sectional survey face-validated by the office of the Surgeon General of the Canadian Armed Forces. Canada. General duty medical officers serving in the Canadian Armed Forces as of February 2014 identified through the Directorate of Health Services Personnel of the Canadian Forces Health Services Group Headquarters. Satisfaction with and time spent in 7 domains of training: trauma, critical care, emergency medicine, psychiatry, occupational health, sports medicine, and base clinic training. Overall preparedness for leading a health care team, caring for a military population, working in isolated and challenging environments, and being deployed were evaluated on a 5-point Likert scale. Among the survey respondents (n = 135, response rate 54%), 77% agreed or strongly agreed that their family medicine residency training was relevant to their role as a general duty medical officer. Most respondents were either satisfied or very satisfied with their emergency medicine training (77%) and psychiatry training (63%), while fewer were satisfied or very satisfied with their sports medicine (47%), base clinic (41%), and critical care (43%) training. Even fewer respondents were satisfied or very satisfied with their trauma (26%) and occupational health (12%) training. Regarding overall preparedness, 57% believed that they were adequately prepared to care for a military patient population, and 52% of respondents believed they were prepared for their first posting. Fewer respondents (38%) believed they were prepared to work in isolated, austere, or challenging environments, and even fewer (32%) believed that residency training prepared them to lead a health care team. General duty medical officers were satisfied with many aspects of their family medicine residency training; however, military-specific areas for improvement

  7. Support infrastructure available to Canadian residents completing post-graduate global health electives: current state and future directions

    Science.gov (United States)

    Sivakumaran, Lojan; Ayinde, Tasha; Hamadini, Fadi; Meterissian, Sarkis; Razek, Tarek; Puckrin, Robert; Munoz, Johanna; O’Hearn, Shawna; Deckelbaum, Dan L

    2016-01-01

    Background Global health electives offer medical trainees the opportunity to broaden their clinical horizons. Canadian universities have been encouraged by regulatory bodies to offer institutional support to medical students going abroad; however, the extent to which such support is available to residents has not been extensively studied. Methods We conducted a survey study of Canadian universities examining the institutional support available to post-graduate medical trainees before, during, and after global health electives. Results Responses were received from 8 of 17 (47%) Canadian institutions. Results show that trainees are being sent to diverse locations around the world with more support than recommended by post-graduate regulatory bodies. However, we found that the content of the support infrastructure varies amongst universities and that certain components—pre-departure training, best practices, risk management, and post-return debriefing—could be more thoroughly addressed. Conclusion Canadian universities are encouraged to continue to send their trainees on global health electives. To address the gaps in infrastructure reported in this study, the authors suggest the development of comprehensive standardized guidelines by post-graduate regulatory/advocacy bodies to better ensure patient and participant safety. We also encourage the centralization of infrastructure management to the universities’ global health departments to aid in resource management. PMID:28344708

  8. Resident Cosmetic Clinic: Practice Patterns, Safety, and Outcomes at an Academic Plastic Surgery Institution.

    Science.gov (United States)

    Qureshi, Ali A; Parikh, Rajiv P; Myckatyn, Terence M; Tenenbaum, Marissa M

    2016-10-01

    Comprehensive aesthetic surgery education is an integral part of plastic surgery residency training. Recently, the ACGME increased minimum requirements for aesthetic procedures in residency. To expand aesthetic education and prepare residents for independent practice, our institution has supported a resident cosmetic clinic for over 25 years. To evaluate the safety of procedures performed through a resident clinic by comparing outcomes to benchmarked national aesthetic surgery outcomes and to provide a model for resident clinics in academic plastic surgery institutions. We identified a consecutive cohort of patients who underwent procedures through our resident cosmetic clinic between 2010 and 2015. Major complications, as defined by CosmetAssure database, were recorded and compared to published aesthetic surgery complication rates from the CosmetAssure database for outcomes benchmarking. Fisher's exact test was used to compare sample proportions. Two hundred and seventy-one new patients were evaluated and 112 patients (41.3%) booked surgery for 175 different aesthetic procedures. There were 55 breast, 19 head and neck, and 101 trunk or extremity aesthetic procedures performed. The median number of preoperative and postoperative visits was 2 and 4 respectively with a mean follow-up time of 35 weeks. There were 3 major complications (2 hematomas and 1 infection requiring IV antibiotics) with an overall complication rate of 1.7% compared to 2.0% for patients in the CosmetAssure database (P = .45). Surgical outcomes for procedures performed through a resident cosmetic clinic are comparable to national outcomes for aesthetic surgery procedures, suggesting this experience can enhance comprehensive aesthetic surgery education without compromising patient safety or quality of care. 4 Risk. © 2016 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

  9. Robotic-assisted thoracoscopic surgery for lung resection: the first Canadian series.

    Science.gov (United States)

    Fahim, Christine; Hanna, Waël; Waddell, Thomas; Shargall, Yaron; Yasufuku, Kazuhiro

    2017-08-01

    Robotic surgery was introduced as a platform for minimally invasive lung resection in Canada in October 2011. We present the first Canadian series of robotic pulmonary resection for lung cancer. Prospective databases at 2 institutions were queried for patients who underwent robotic resection for lung cancer between October 2011 and June 2015. To examine the effect of learning curves on patient and process outcomes, data were organized into 3 temporal tertiles, stratified by surgeon. A total of 167 consecutive patients were included in the study. Median age was 66 (range 27-88) years, and 46.1% ( n = 77) of patients were men. The majority of patients ( n = 141, 84%) underwent robotic lobectomy. Median duration of surgery was 270 (interquartile range [IQR] 233-326) minutes, and median length of stay (LOS) was 4 (IQR 3-6) days. Twelve patients (7%) were converted to thoracotomy. Total duration of surgery and console time decreased significantly ( p < 0.001) across tertiles, with a steady decline until case 20, followed by a plateau effect. Across tertiles, there was no significant difference in LOS, number of lymph node stations removed, or perioperative complications. The results of this case series are comparable to those reported in the literature. A prospective study to examine the outcomes and cost of robotic pulmonary resection compared with video-assisted thoracoscopic surgery should be done in the context of the Canadian health care system. We have presented the first consecutive case series of robotic lobectomy in Canada. Outcomes compare favourably to other series in the literature.

  10. Relationship of procedural numbers with meaningful procedural autonomy in general surgery residents.

    Science.gov (United States)

    Stride, Herbert P; George, Brian C; Williams, Reed G; Bohnen, Jordan D; Eaton, Megan J; Schuller, Mary C; Zhao, Lihui; Yang, Amy; Meyerson, Shari L; Scully, Rebecca; Dunnington, Gary L; Torbeck, Laura; Mullen, John T; Mandell, Samuel P; Choti, Michael; Foley, Eugene; Are, Chandrakanth; Auyang, Edward; Chipman, Jeffrey; Choi, Jennifer; Meier, Andreas; Smink, Douglas; Terhune, Kyla P; Wise, Paul; DaRosa, Debra; Soper, Nathaniel; Zwischenberger, Jay B; Lillemoe, Keith; Fryer, Jonathan P

    2017-12-23

    Concerns exist regarding the competency of general surgery graduates with performing core general surgery procedures. Current competence assessment incorporates minimal procedural numbers requirements. Based on the Zwisch scale we evaluated the level of autonomy achieved by categorical PGY1-5 general surgery residents at 14 U.S. general surgery resident training programs between September 1, 2015 and December 31, 2016. With 5 of the most commonly performed core general surgery procedures, we correlated the level of autonomy achieved by each resident with the number of procedures they had performed before the evaluation period, with the intent of identifying specific target numbers that would correlate with the achievement of meaningful autonomy for each procedure with most residents. Whereas a definitive target number was identified for laparoscopic appendectomy (i.e. 25), for the other 4 procedures studied (i.e. laparoscopic cholecystectomy, 52; open inguinal hernia repair, 42; ventral hernia repair, 35; and partial colectomy, 60), target numbers identified were less definitive and/or were higher than many residents will experience during their surgical residency training. We conclude that procedural target numbers are generally not effective in predicting procedural competence and should not be used as the basis for determining residents' readiness for independent practice. Copyright © 2017. Published by Elsevier Inc.

  11. Impact of a Strabismus Surgery Suture Course for First- and Second-Year Ophthalmology Residents.

    Science.gov (United States)

    Vagge, Aldo; Gunton, Kammi; Schnall, Bruce

    2017-11-01

    To investigate the effectiveness of an eye muscle surgery course on first- and second-year postgraduate ophthalmology residents. This prospective cohort pilot study invited first- and second-year ophthalmology residents to participate in a 2-hour strabismus surgery course at Wills Eye Hospital. The course consisted of a didactic session followed by a wet laboratory session. The wet laboratory session simulated strabismus surgery using a model constructed of chicken breast followed by partial-thickness scleral suture passes in pig eyes. A structured self-assessment evaluation form and a questionnaire in the validated Ophthalmology Surgical Competency Assessment Rubric approved by the International Council of Ophthalmology (ICO-OSCAR:strabismus) were used to assess the effectiveness of the course. A total of 12 residents, 8 (67%) first-year and 4 (33%) second-year, were enrolled for this survey. Following the course, most residents felt less anxious (73%). All residents responded that the course was helpful or somewhat helpful in preparation for strabismus surgery. Regarding the distribution of ratings on questions of subjective experience, knowledge of steps, and understanding of potential complications, the residents gave significantly higher ratings after the course (P < .029). The change in the modified ICO-OSCAR:strabismus assessment's mean score was statistically significant before and after training (P = .038). A strabismus course can play an important role in preparing residents for strabismus surgery. [J Pediatr Ophthalmol Strabismus. 2017;54(6):339-345.]. Copyright 2017, SLACK Incorporated.

  12. Learning styles and teaching perspectives of Canadian pharmacy practice residents and faculty preceptors.

    Science.gov (United States)

    Loewen, Peter S; Jelescu-Bodos, Anca

    2013-10-14

    To characterize and compare learning styles of pharmacy practice residents and their faculty preceptors, and identify teaching perspectives of faculty preceptors. Twenty-nine pharmacy residents and 306 pharmacy faculty members in British Columbia were invited to complete the Pharmacists' Inventory of Learning Styles (PILS). Faculty preceptors also were asked to complete the Teaching Perspectives Inventory (TPI). One hundred percent of residents and 61% of faculty members completed the PILS, and 31% of faculty members completed the TPI. The most common dominant learning style among residents and faculty preceptors was assimilator, and 93% were assimilators, convergers, or both. The distribution of dominant learning styles between residents and faculty members was not different (p=0.77). The most common dominant teaching perspective among faculty members was apprenticeship. Residents and preceptors mostly exhibited learning styles associated with abstract over concrete thinking or watching over doing. Residency programs should steer residents more toward active learning and doing, and maximize interactions with patients and other caregivers.

  13. Learning styles of medical students, general surgery residents, and general surgeons: implications for surgical education.

    Science.gov (United States)

    Engels, Paul T; de Gara, Chris

    2010-06-30

    Surgical education is evolving under the dual pressures of an enlarging body of knowledge required during residency and mounting work-hour restrictions. Changes in surgical residency training need to be based on available educational models and research to ensure successful training of surgeons. Experiential learning theory, developed by David Kolb, demonstrates the importance of individual learning styles in improving learning. This study helps elucidate the way in which medical students, surgical residents, and surgical faculty learn. The Kolb Learning Style Inventory, which divides individual learning styles into Accommodating, Diverging, Converging, and Assimilating categories, was administered to the second year undergraduate medical students, general surgery resident body, and general surgery faculty at the University of Alberta. A total of 241 faculty, residents, and students were surveyed with an overall response rate of 73%. The predominant learning style of the medical students was assimilating and this was statistically significant (p learning style found in the residents and faculty. The predominant learning styles of the residents and faculty were convergent and accommodative, with no statistically significant differences between the residents and the faculty. We conclude that medical students have a significantly different learning style from general surgical trainees and general surgeons. This has important implications in the education of general surgery residents.

  14. Smoking Cessation Rates among Patients Undergoing Vascular Surgery in a Canadian Center.

    Science.gov (United States)

    McHugh, Seamus Mark; Eisenberg, Naomi; Montbriand, Janice; Roche-Nagle, Graham

    2017-11-01

    Smoking is the single most important modifiable risk factor for patients with vascular disease. The aim of this study was to determine the prevalence of smoking and cessation rates among patients undergoing vascular surgery in a Canadian center. As part of the Vascular Quality Initiative, a prospectively maintained database was used to identify the patients undergoing vascular surgery between 2010 and 2013. Smoking prevalence data were collated preprocedure, postprocedure, and at year follow-up after intervention at a median of 13 months (mean = 14.4 ± 7.8 months). Cessation rates at 13-month follow-up were assessed to determine any statistically significant univariate factors. These factors were then used to build a model through backwards logistic regression. Multicollinearity was tested by assessing both variance inflation factors and tolerance. Overall, 624 patients had complete follow-up data. Of these, 209 (33.5%) were smokers presurgically. At 1-year follow-up, of those 209 patients who were smokers preoperatively, 87 (41.6%) had stopped smoking while 122 (58.4%) had not. Patients who were male and aged >70 years were more likely to be smokers preoperatively (P = 0.001 and P 70 years (P = 0.005) and in those with chronic obstructive pulmonary disease (P = 0.016). Gender was also statistically associated, with cessation rates higher in females (P = 0.011). More than one-third of patients who underwent surgery in a Canadian vascular center continue to smoke. Uniquely, we report a statistically significant association between gender and postoperative cessation rates. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Psychological Effect of a Mass Casualty Event on General Surgery Residents.

    Science.gov (United States)

    Havron, William S; Safcsak, Karen; Corsa, Joshua; Loudon, Andrew; Cheatham, Michael L

    To evaluate the psychological effect of a mass casualty shooting event on general surgery residents. Three and 7 months following the Pulse nightclub mass casualty shooting, the mental well-being of general surgery residents employed at the receiving institution was evaluated. A voluntary and anonymous screening questionnaire for posttraumatic stress disorder (PTSD) and major depression (MD) was administered. Responses were stratified into 2 groups; residents who worked (ON-CALL) and residents who did not work (OFF-CALL) the night of the event. Data were analyzed using Mann-Whitney U and Fisher's exact tests and are reported as median with interquartile range (IQR) or percentage. Level I trauma center. Thirty-one general surgery residents. Twenty-four residents (77%) returned the 3-month questionnaire: 10 ON-CALL and 14 OFF-CALL. There was no difference in PTSD and MD between the 2 groups (30% vs. 14%; p = 0.61) and (30% vs. 7%; p = 0.27), respectively. Twenty-three of the 24 residents responded to the 7-month questionnaire. Over time, the incidence of PTSD did not resolve in the ON-CALL group, but did resolve in the OFF-CALL group (30% vs. 0%; p = 0.07). There was no significant change in the incidence of MD in either group (30% vs. 8%; p = 0.28). At 7 months postevent, more residents in both groups stated that they had sought counseling (30% vs. 44%; p = 0.65) and (0% vs. 15%; p = 0.22). The emotional toll associated with this mass casualty event had a substantial effect upon the general surgery residents involved. With the incidence of PTSD and MD identified, we believe that all residents should be provided with counseling following such events. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  16. Are Nursing Students Appropriate Partners for the Interdisciplinary Training of Surgery Residents?

    Science.gov (United States)

    Stefanidis, Dimitrios; Ingram, Katherine M; Williams, Kristy H; Bencken, Crystal L; Swiderski, Dawn

    2015-01-01

    Interdisciplinary team training in a simulation center recreates clinical team interactions and holds promise in improving teamwork of clinicians by breaking down educational silos. The objective of our study was to assess the appropriateness of interdisciplinary training with general surgery residents and nursing students. Over 2 consecutive academic years (2012-2013 and 2013-2014), general surgery residents participated in interdisciplinary team-training simulation-based sessions with senior nursing students. Scenario objectives included demonstration of appropriate teamwork and communication, and clinical decision making; sessions incorporated interdisciplinary debriefing of the scenarios. Participants were asked to assess their team-training experience and the appropriateness of their team-training partner. Responses were compared. A total of 16 team-training sessions were conducted during the study period. Overall, 12 surgery residents (67%) and 44 nursing students (63%) who had participated in at least 1 session responded to the survey. Although both residents and nursing students indicated that the knowledge and team skills acquired during these sessions were useful to them in clinical practice (73% vs 86%, respectively; p = not significant), residents rated their educational value lower (3.3 vs 4.3 on a 5-point scale, respectively; p students (p students, debriefing (91%), observation of others (68%), and interaction with resident physicians (66%) ranked highest; 48% of student nurses preferred residents as team-training partners whereas 100% residents preferred practicing nurses and 0% with nursing students owing to their limited clinical experience. Interdisciplinary team training and debriefing of surgery residents with nursing students is feasible and highly valued by nursing students. Nevertheless, our experience indicates that residents do not prefer nursing students as team-training partners owing to their limited clinical experience and would rather

  17. Training our future endocrine surgeons: a look at the endocrine surgery operative experience of U.S. surgical residents.

    Science.gov (United States)

    Zarebczan, Barbara; McDonald, Robert; Rajamanickam, Victoria; Leverson, Glen; Chen, Herbert; Sippel, Rebecca S

    2010-12-01

    During the last 10 years, the number of endocrine procedures performed in the United States has increased significantly. We sought to determine whether this has translated into an increase in operative volume for general surgery and otolaryngology residents. We evaluated records from the Resident Statistic Summaries of the Residency Review Committee (RRC) for U.S. general surgery and otolaryngology residents for the years 2004-2008, specifically examining data on thyroidectomies and parathyroidectomies. Between 2004 and 2008, the average endocrine case volume of U.S. general surgery and otolaryngology residents increased by approximately 15%, but otolaryngology residents performed more than twice as many operations as U.S. general surgery residents. The growth in case volume was mostly from increases in the number of thyroidectomies performed by U.S. general surgery and otolaryngology residents (17.9 to 21.8, P = .007 and 46.5 to 54.4, P = .04). Overall, otolaryngology residents also performed more parathyroidectomies than their general surgery counterparts (11.6 vs 8.8, P = .007). Although there has been an increase in the number of endocrine cases performed by graduating U.S. general surgery residents, this is significantly smaller than that of otolaryngology residents. To remain competitive, general surgery residents wishing to practice endocrine surgery may need to pursue additional fellowship training. Copyright © 2010 Mosby, Inc. All rights reserved.

  18. Open abdominal surgical training differences experienced by integrated vascular and general surgery residents.

    Science.gov (United States)

    Tanious, Adam; Wooster, Mathew; Jung, Andrew; Nelson, Peter R; Armstrong, Paul A; Shames, Murray L

    2017-10-01

    As the integrated vascular residency program reaches almost a decade of maturity, a common area of concern among trainees is the adequacy of open abdominal surgical training. It is our belief that although their overall exposure to open abdominal procedures has decreased, integrated vascular residents have an adequate and focused exposure to open aortic surgery during training. National operative case log data supplied by the Accreditation Council for Graduate Medical Education were compiled for both graduating integrated vascular surgery residents (IVSRs) and graduating categorical general surgery residents (GSRs) for the years 2012 to 2014. Mean total and open abdominal case numbers were compared between the IVSRs and GSRs, with more in-depth exploration into open abdominal procedures by organ system. Overall, the mean total 5-year case volume of IVSRs was 1168 compared with 980 for GSRs during the same time frame (P surgery, representing 57% of all open abdominal cases. GSRs completed an average of 116 open alimentary tract surgeries during their training. Open abdominal surgery represented an average of 7.1% of the total vascular case volume for the vascular residents, whereas open abdominal surgery represented 21% of a GSR's total surgical experience. IVSRs reported almost double the number of total cases during their training, with double chief-level cases. Sixty-five percent of open abdominal surgeries performed by IVSRs involved the aorta or its renovisceral branches. Whereas open abdominal surgery represented 7.1% of an IVSR's surgical training, GSRs had a far broader scope of open abdominal procedures, completing nearly double those of IVSRs. The differences in open abdominal procedures pertain to the differing diseases treated by GSRs and IVSRs. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  19. Are 2 Years Enough? Exploring Technical Skills Acquisition Among General Surgery Residents in Brazil.

    Science.gov (United States)

    Santos, Elizabeth G; Salles, Gil F

    2016-01-01

    Phenomenon: Recent studies have shown that up to 40% of the General Surgery (GS) residents are not confident with their surgical skills. There is concern that residents are at risk of receiving inadequate training due to the low number of operations they perform. In Brazil, although all GS residents receive by law the Board Certification at the end of their programs, the assessment of their technical skills is not mandatory in Medical Residency programs' training. Consequently, our concern was that current GS medical residency format might be insufficient to create competent and autonomous general surgery residents after 2 years of regular training. Hence, the aim was to assess GS residents' surgical skills in their final months of training to evaluate the present format of GS residency programs in Brazil. Trained surgical faculty members directly observed 11 operations of varying difficulty performed by 2nd-year regular GS residents and by 4th-year residents in the optional Advanced Program in General Surgery. Participants were located at 3 university and 3 nonuniversity hospitals in Rio de Janeiro and Sao Paulo (Brazil's largest cities). Surgical skills were assessed using an internally developed observation checklist reviewed by subject matter experts. Sixty residents (46 regular 2nd-year trainees and 14 advanced 4th-year trainees) were assessed on performing 499 operations. Only 10 residents (17%), all advanced 4th-year residents, satisfactorily performed all operations and were considered eligible for the Board Certification. Even after excluding the 2 operations of greatest difficulty, only 24 regular 2nd-year residents (52%) satisfactorily performed the other 9 operations. Residents from hospitals with open Emergency Departments performed better than those from hospitals without Emergency Departments. Insights: The results of this pilot study suggest that residents with 2 years of training are not prepared for independent high-level surgical practice. The

  20. A survey of current state of training of plastic surgery residents.

    Science.gov (United States)

    Hashmi, Asra; Khan, Faraz A; Herman, Floyd; Narasimhan, Nathan; Khan, Shaher; Kubiak, Carrie; Gursel, Eti; Edelman, David A

    2017-06-27

    Plastic surgery training is undergoing major changes however there is paucity of data detailing the current state of training as perceived by plastic surgical trainees. Our aim was to determine the quality of training as perceived by the current trainee pool and their future plans. A 25-item anonymous survey with three discrete sections (demographics, quality of training, and post-graduate career plans) was developed and distributed to plastic surgery residents during the academic year 2013. With the confidence interval of 95% and margin of error of 10%, our target response rate was 87 responders. We received a total of 114 respondents with all levels of Post Graduate Year in training represented. Upon comparison of residents with debt of 250,000, those with higher debt were significantly less interested in fellowship training (p value 0.05) and were more likely to pursue private practice (p value plastic surgery least offered as a separate rotation were microsurgery (45%) followed by aesthetic surgery (33%). 53.7% of the residents felt that they were least trained in aesthetic surgery followed by burn surgery 45.4%. Of note 56.4% intended to seek additional training after residency. Moreover residents with an average of 6.4 months of experience in an individual subspecialty were more likely to feel comfortable with that specialty. This survey highlights the areas and subspecialties that deserve attention as perceived by the current trainee pool.

  1. Intraoperative flap complications in lasik surgery performed by ophthalmology residents

    Directory of Open Access Journals (Sweden)

    Lorena Romero-Diaz-de-Leon

    2016-01-01

    Conclusion: Flap-related complications are common intraoperative event during LASIK surgery performed by in-training ophthalmologists. Keratometries and surgeon's first procedure represent a higher probability for flap related complications than some other biometric parameters of patient's eye.

  2. Trainee satisfaction in surgery residency programs: modern management tools ensure trainee motivation and success.

    Science.gov (United States)

    von Websky, Martin W; Oberkofler, Christian E; Rufibach, Kaspar; Raptis, Dimitri A; Lehmann, Kuno; Hahnloser, Dieter; Clavien, Pierre-Alain

    2012-11-01

    To assess trainee satisfaction in their surgery residency with a validated instrument and identify the contributing factors. Currently, surgery is deemed unattractive by medical students and ignored by many candidates planning to enter an academic career. New insights on the rational for such lack of interest are needed. Job satisfaction is a central concept in organizational and behavioral research that is well understood by large companies such as Google, IBM, and Toyota. Similar assessment can likewise be used to improve trainee satisfaction in surgery residency. A survey among 2039 surgery residents was conducted in three European countries analyzing satisfaction at work using the Global Job Satisfaction Instrument (validated in Emergency Room physicians). Crucial factors covering different aspects of surgery residency where identified using the GJS instrument combined with multiple logistic regression analysis. With an overall response rate of 23%, we identified trainee dissatisfaction in one third of residents. Factors affecting satisfaction related almost exclusively to training issues, such as assignment of surgery procedures according to skills (OR 4.2), training courses (OR 2.7), availability of a structured training curriculum (OR 2.4), bedside teaching, and availability of morbidity-mortality conferences (OR 2.3). A good working climate among residents (OR 3.7) and the option for part time work (OR 2.1) were also significant factors for trainee satisfaction. Increased working hours had a modest (OR 0.98)-though cumulative- negative effect. The sex of the trainee was not related to trainee satisfaction. Validated measurement of job satisfaction as used in the industry appears to be an efficient tool to assess trainee satisfaction in surgery residency and thereby identify the key contributing factors. Improvement of conceptual training structures and working conditions might facilitate recruitment, decrease drop-out, and attract motivated candidates with

  3. Teaching the Surgical Craft: Surgery Residents Perception of the ...

    African Journals Online (AJOL)

    Background: The transformation of a surgical trainee into a surgeon is strongly influenced by the quality of teaching in the operating theater. This study investigates the perceptions of residents about the educational environment of the operating theater and identifies variables that may improve the operating theater ...

  4. Open tracheostomy training: a nationwide survey among Otolaryngology-Head and Neck Surgery residents.

    Science.gov (United States)

    Muallem-Kalmovich, Limor; Pitaro, Jacob; Asaly, Ayman; Kessler, Alex; Eviatar, Ephraim; Shteiner, Moran; Marom, Tal

    2017-11-01

    The aim of this study was to examine the training methods and needs of Otolaryngology-Head and Neck Surgery (OTO-HNS) residents to independently perform open tracheostomy (OT). An anonymous 26-items questionnaire pertaining to OT teaching aspects was distributed to all 93 Israeli OTO-HNS residents during March-June 2016. Residents were categorized as 'juniors,' if they were in their post-graduate year (PGY)-1 and PGY-2; 'mid-residency' (PGY-3 and PGY-4); or 'seniors' (PGY-5 and PGY-6). Response rate was 74% (n = 69). There were 25 'juniors' (36%), 24 'mid-residency' (35%) and 20 'seniors' (29%). Overall, the responses of the 3 groups were similar. Forty-seven (68%) residents estimated that there are ≥ 50 tracheostomies/year in their hospital, which roughly corresponds to an exposure of ~ 8 tracheostomies/year/resident. There was an inconsistency between the number of teaching hours given and the number of hours requested for OT training (23% received ≥ 5 h, but 82% declared they needed ≥ 5 h). Eighty-two percentage reported that their main training was conducted during surgery with peer residents or senior physicians. Forty-five (65%) feel competent to perform OT, including juniors. Due to the need to perform OT in urgent scenarios, the competency of OTO-HNS resident is crucial. Training for OT in Israeli OTO-HNS residency programs is not well structured. Yet, residents reported they feel confident to perform OT, already in the beginning of their residency. Planned educational programs to improve OT training should be done in the beginning of the residency and may include designated 'hands-on' platforms; objective periodic surgical competence assessments; and specialist's feedback, using structured assessment forms.

  5. Adoption of robotics in a general surgery residency program: at what cost?

    Science.gov (United States)

    Mehaffey, J Hunter; Michaels, Alex D; Mullen, Matthew G; Yount, Kenan W; Meneveau, Max O; Smith, Philip W; Friel, Charles M; Schirmer, Bruce D

    2017-06-01

    Robotic technology is increasingly being utilized by general surgeons. However, the impact of introducing robotics to surgical residency has not been examined. This study aims to assess the financial costs and training impact of introducing robotics at an academic general surgery residency program. All patients who underwent laparoscopic or robotic cholecystectomy, ventral hernia repair (VHR), and inguinal hernia repair (IHR) at our institution from 2011-2015 were identified. The effect of robotic surgery on laparoscopic case volume was assessed with linear regression analysis. Resident participation, operative time, hospital costs, and patient charges were also evaluated. We identified 2260 laparoscopic and 139 robotic operations. As the volume of robotic cases increased, the number of laparoscopic cases steadily decreased. Residents participated in all laparoscopic cases and 70% of robotic cases but operated from the robot console in only 21% of cases. Mean operative time was increased for robotic cholecystectomy (+22%), IHR (+55%), and VHR (+61%). Financial analysis revealed higher median hospital costs per case for robotic cholecystectomy (+$411), IHR (+$887), and VHR (+$1124) as well as substantial associated fixed costs. Introduction of robotic surgery had considerable negative impact on laparoscopic case volume and significantly decreased resident participation. Increased operative time and hospital costs are substantial. An institution must be cognizant of these effects when considering implementing robotics in departments with a general surgery residency program. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Plastic surgery training: evaluating patient satisfaction with facial fillers in a resident clinic.

    Science.gov (United States)

    Iorio, Matthew L; Stolle, Ellen; Brown, Benjamin J; Christian, Cathalene Blake; Baker, Stephen B

    2012-12-01

    Resident cosmetic surgery clinics, or "chief clinics," are arguably the most effective way to provide cosmetic surgery training. Approximately 70 % of plastic surgery training programs utilize a "chief resident clinic" to augment their cosmetic surgery experience, even though a quantitative outcome scale is lacking to guide education. We report the use of the FACE-Q, a novel patient outcome tool, to evaluate patients' satisfaction with nonsurgical facial rejuvenation performed by residents. The FACE-Q "Satisfaction with Facial Appearance Overall Scale" was administered to patients prior to and 1 week after undergoing nonsurgical facial rejuvenation performed by plastic surgery residents. All patients received nonsurgical facial rejuvenation with botulinum toxin A and hyaluronic acid as part of resident facial aesthetics training. Eleven patients completed the pre- and postinjection FACE-Q survey. Average overall facial appearance satisfaction scores of 47.6 pre- and 51.1 postinjection were found (p < 0.037), with a total possible score of 68. Ten patients (91 %) reported feeling satisfied or very satisfied with the overall appearance of their face following injection. Despite resident inexperience and patient awareness that novices were performing the procedures, our experience supports use of the FACE-Q to optimize and endorse resident cosmetic surgery clinics. The learning curve for facial cosmetic procedures can be adversely affected by limited time available or exposure to improvement variables when initially performing the procedure. It is imperative to any technique that direct, and preferably quantitative, feedback is given so that an immediate modification can be generated and successive patient outcomes improved. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  7. A survey of the pediatric surgery program directors: optimizing resident research to make pediatric surgery training more efficient.

    Science.gov (United States)

    Markel, Troy A; Rescorla, Frederick J

    2015-06-01

    Resident Research (RR) has been a presumed requirement for pediatric surgery fellowship candidates. We hypothesized that: 1) pediatric surgery leaders would no longer feel that RR was necessary for fellowship candidates, 2) the type of study performed would not impact a program's opinion of candidates, and 3) the timing of RR could be altered for those interested in a research career. An anonymous survey was sent to pediatric surgery fellowship program directors (PDs). Sixty-three percent responded, and answers were compared via Chi square analysis with ppediatric surgery fellowship candidates. Seventy-five percent had no preference between one or two years of research (p=0.0005), 79% placed no heavier weight on basic or clinical research (psurgery may not be necessary. Pediatric surgery candidates who partake in RR are not penalized for their choice of study. Increasing efficiency of training is important in today's era of medical training. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. The effect of a focused instructional session on knowledge of surgical staplers in general surgery residents.

    Science.gov (United States)

    McColl, Ryan J; Karmali, Shahzeer; Reso, Artan; Paolucci, Elizabeth; Sherman, Vadim

    2009-01-01

    Surgical stapling devices have been used for a variety of purposes in both laparoscopic and open surgery. Nevertheless, trainees rarely receive any focused instruction on their application and use. This study attempts to determine the baseline knowledge of surgical stapling devices possessed by surgical residents. Furthermore, we attempt to evaluate the effectiveness of a short didactic session in improving the trainee's knowledge of the use and function of surgical staplers. A 20-question multiple-choice test was created to evaluate a general surgery resident's knowledge on the design and use of circular, linear, and laparoscopic surgical staplers. The test was administered before and after attending a 40-minute instructional session on surgical stapling devices. The tests were then scored by a data analyst. A total of 26 residents of 39 in the residency program (26/39, 67%) participated. The pretest mean was 10.62/20 (53%), whereas the posttest mean was 15.38/20 (77%). These results were significantly different on paired samples t-test analysis (t((25)) = -10.3; p 0.05). There is a deficiency of knowledge of surgical staplers in general surgery residents, more so in junior residents. Didactic instruction is effective in raising the level of knowledge of surgical staplers in all residents, up to a similar level. Surgical educators should consider implementing programs like these for staplers and other types of surgical equipment.

  9. Orthopedic Surgery Resident Debt Load and Its Effect on Career Choice.

    Science.gov (United States)

    Johnson, Joey P; Cassidy, Dale B; Tofte, Josef N; Bariteau, Jason T; Daniels, Alan H

    2016-05-01

    Student loan debt has become a topic of discussion and debate among physicians and legislators. This study seeks to assess the level of debt of orthopedic surgery residents and to determine whether debt burden affects the career choice of orthopedic trainees. A 26-question, anonymous survey was distributed via email to resident trainees enrolled in different medical and surgical specialty training programs across the United States. Orthopedic trainees were compared with trainees in other specialties using comparative statistics. Of the approximately 13,503 residents who were sent the survey, a total of 3076 responded, including 167 of an estimated 580 orthopedic residents, for approximate response rates of 22.8% and 28.8%, respectively. On average, orthopedic surgery residents were at a later post-graduate year than overall respondents (Porthopedic surgery residents (57.21% vs 49.08%, respectively; P=.041). More than 50% of all respondents agreed that student loan debt would affect their type or location of practice. The majority of orthopedic residents take student loan debt into consideration when determining their final location and type of practice, although less so for orthopedic trainees compared with other specialties. As medical education continues to become more expensive and the threat of dropping physician reimbursement looms on the horizon, student debt may become a primary driving factor for young American physicians' career plans. [Orthopedics. 2016; 39(3):e438-e443.]. Copyright 2016, SLACK Incorporated.

  10. Expert consensus of general surgery residents' proficiency with common endocrine operations.

    Science.gov (United States)

    Phitayakorn, Roy; Kelz, Rachel R; Petrusa, Emil; Sippel, Rebecca S; Sturgeon, Cord; Patel, Kepal N; Perrier, Nancy D

    2017-01-01

    Proficiency with common endocrine operations is expected of graduating, general surgery residents. However, no expert consensus guidelines exist about these expectations. Members of the American Association of Endocrine Surgeons were surveyed about their opinions on resident proficiency with common endocrine operations. Overall response rate was 38%. A total of 92% of the respondents operate with residents. On average, they believed that the steps of a total thyroidectomy for benign disease and a well-localized parathyroidectomy could be performed by a postgraduate year 4 surgery resident. Specific steps that they thought might require more training included decisions to divide the strap muscles or leaving a drain. Approximately 66% of respondents thought that a postgraduate year 5 surgery resident could independently perform a total thyroidectomy for benign disease, but only 45% felt similarly for malignant thyroid disease; 79% thought that a postgraduate year 5 surgery resident could independently perform a parathyroidectomy. Respondents' years of experience correlated with their opinions about resident autonomy for total thyroidectomy (benign r = 0.38, P < .001; malignant r = 0.29, P = .001) but not parathyroidectomy. On multivariate analysis, sex and years of experience of the respondents were independently associated with opinions on autonomy but only for total thyroidectomy for benign disease (P = .001). Annual endocrine volume of the respondents did not correlate with beliefs in autonomy. There was general agreement among responding members of the AAES about resident proficiency and autonomy with common endocrine operations. As postgraduate year 5 residents may not be proficient in advanced endocrine operations, opportunities exist to improve training prior to the transition to independent practice for graduates that anticipate performing endocrine operations routinely. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Resident operative experience in general surgery, plastic surgery, and urology 5 years after implementation of the ACGME duty hour policy.

    Science.gov (United States)

    Simien, Christopher; Holt, Kathleen D; Richter, Thomas H; Whalen, Thomas V; Coburn, Michael; Havlik, Robert J; Miller, Rebecca S

    2010-08-01

    Resident duty hour restrictions were implemented in 2002-2003. This study examines changes in resident surgical experience since these restrictions were put into place. Operative log data for 3 specialties were examined: general surgery, urology, and plastic surgery. The academic year immediately preceding the duty hour restrictions, 2002-2003, was used as a baseline for comparison to subsequent academic years. Operative log data for graduating residents through 2007-2008 were the primary focus of the analysis. Examination of associated variables that may moderate the relationship between fewer duty hours and surgical volume was also included. Plastic surgery showed no changes in operative volume following duty hour restrictions. Operative volume increased in urology programs. General surgery showed a decrease in volume in some operative categories but an increase in others. Specifically the procedures in vascular, plastic, and thoracic areas showed a consistent decrease. There was no increase in the percentage of programs' graduates falling below minimum requirements. Procedures in pancreas, endocrine, and laparoscopic areas demonstrated an increase in volume. Graduates in larger surgical programs performed fewer procedures than graduates in smaller programs; this was not the case for urology or plastic surgery programs. The reduction of duty hours has not resulted in an across the board decrease in operative volume. Factors other than duty hour reforms may be responsible for some of the observed findings.

  12. Validity of ophthalmology surgical competency assessment rubric for strabismus surgery in resident training.

    Science.gov (United States)

    Motley, W Walker; Golnik, Karl C; Anteby, Irene; Atilla, Huban; Gole, Glen A; Murillo, Claudia; Olitsky, Scott E; Pilling, Rachel F; Reddy, Aravind R; Sharma, Pradeep; Siatkowski, R Michael; Yadarola, Maria B

    2016-04-01

    The Accreditation Council for Graduate Medical Education (ACGME) requires US residency programs to assess ophthalmology residents for competency in 6 core areas. Ophthalmic surgical skills are currently part of the ACGME "Patient Care" competency, although some have advocated for a seventh competency, "Surgical Skills." The Ophthalmology Surgical Competency Assessment Rubric for Strabismus Surgery in Resident Training ( Strabismus) tool was designed to aid in the assessment of surgical skills using procedure specific behavioral anchors. The present study evaluated inter-rater agreement of the Strabismus tool in the assessment of resident performance. Strabismus evaluations of resident surgical strabismus cases were performed by a multinational group of faculty strabismus surgeons. Cronbach α statistical analysis of the completed evaluations revealed high inter-rater agreement, indicating the Strabismus is a reliable tool to facilitate assessment of resident strabismus surgical skills. Copyright © 2016 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.

  13. Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery.

    Science.gov (United States)

    Duceppe, Emmanuelle; Parlow, Joel; MacDonald, Paul; Lyons, Kristin; McMullen, Michael; Srinathan, Sadeesh; Graham, Michelle; Tandon, Vikas; Styles, Kim; Bessissow, Amal; Sessler, Daniel I; Bryson, Gregory; Devereaux, P J

    2017-01-01

    The Canadian Cardiovascular Society Guidelines Committee and key Canadian opinion leaders believed there was a need for up to date guidelines that used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system of evidence assessment for patients who undergo noncardiac surgery. Strong recommendations included: 1) measuring brain natriuretic peptide (BNP) or N-terminal fragment of proBNP (NT-proBNP) before surgery to enhance perioperative cardiac risk estimation in patients who are 65 years of age or older, are 45-64 years of age with significant cardiovascular disease, or have a Revised Cardiac Risk Index score ≥ 1; 2) against performing preoperative resting echocardiography, coronary computed tomography angiography, exercise or cardiopulmonary exercise testing, or pharmacological stress echocardiography or radionuclide imaging to enhance perioperative cardiac risk estimation; 3) against the initiation or continuation of acetylsalicylic acid for the prevention of perioperative cardiac events, except in patients with a recent coronary artery stent or who will undergo carotid endarterectomy; 4) against α2 agonist or β-blocker initiation within 24 hours before surgery; 5) withholding angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker starting 24 hours before surgery; 6) facilitating smoking cessation before surgery; 7) measuring daily troponin for 48 to 72 hours after surgery in patients with an elevated NT-proBNP/BNP measurement before surgery or if there is no NT-proBNP/BNP measurement before surgery, in those who have a Revised Cardiac Risk Index score ≥1, age 45-64 years with significant cardiovascular disease, or age 65 years or older; and 8) initiating of long-term acetylsalicylic acid and statin therapy in patients who suffer myocardial injury/infarction after surgery. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  14. Early Reoperation Rate, Complication, and Outcomes in Resident-performed Glaucoma Surgery.

    Science.gov (United States)

    Hsia, Yen C; Lee, Jun Hui; Cui, Qi N; Stewart, Jay M; Naseri, Ayman; Porco, Travis; Stamper, Robert L; Han, Ying

    2017-02-01

    The purpose of the study was to examine reoperation rate and complications of resident-performed glaucoma surgeries within the first 90 postoperative days. A retrospective study of resident-performed glaucoma filtering surgeries at the San Francisco Veterans Affairs Medical Center between 2002 and 2014 was performed. Patients requiring reoperation within 90 days of the initial surgery were included in our study. Combined surgeries were excluded. Complications and the rates of reoperation within the first 90 days were evaluated. Clinical outcomes for those who needed reoperations were evaluated at the 1-year follow-up. Total of 180 cases were reviewed [34 trabeculectomy, 85 Ex-PRESS shunt, and 61 Ahmed glaucoma valve (AGV)]. One hundred and four eyes developed complications, most commonly choroidal effusion (65.3%), followed by hypotony (45.2%) and wound leak (32.7%). Complications were comparable among the 3 groups, except that filtering surgery had significantly more wound leak than AGV (Pglaucoma surgery (Pglaucoma medications and stable visual acuity. Glaucoma incisional surgeries performed by third-year ophthalmology residents had acceptable and comparable reoperation rates and complication rates for patients with trabeculectomy, Ex-PRESS, and AGV. Clinical outcomes for the patients requiring reoperation were favorable.

  15. Implementation of an objective structured clinical exam (OSCE) into orthopedic surgery residency training.

    Science.gov (United States)

    Griesser, Michael J; Beran, Matthew C; Flanigan, David C; Quackenbush, Michael; Van Hoff, Corey; Bishop, Julie Y

    2012-01-01

    While the musculoskeletal (MSK) physical examination (PE) is an essential part of a patient encounter, we believe it is an underemphasized component of orthopedic residency education and that resident PE skills may be lacking. The purpose of this investigation was to (1) assess the attitudes regarding PE teaching in orthopedic residencies today; (2) develop an MSK objective structured clinical examination (OSCE) to assess the MSK PE knowledge and skills of our orthopedic residents. Prospective, uncontrolled, observational. A major Midwestern tertiary referral center and academic medical center. The orthopedic surgery residents in our program. Twenty-two of 24 completed the OSCE. Surveys showed that residents agreed that although learning the PE is important, there is not enough time in clinic to actually observe and critique a resident examining a patient. For the 22 residents (postgraduate year [PGY] 2-5) who participated in the OSCE, the overall score was 66%. Scores were significantly better for the trauma scenario (78%; p training. We hope that our efforts will encourage other programs to assess their PE curriculum and perhaps prompt change. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  16. Career and parenting satisfaction among medical students, residents and physician teachers at a Canadian medical school

    OpenAIRE

    Cujec, B; Oancia, T; Bohm, C; Johnson, D.

    2000-01-01

    BACKGROUND: Studies of career and parenting satisfaction have focused separately on medical students, residents and practising physicians. The objective of this study was to compare satisfaction across a spectrum of stages of medical career. METHODS: A survey of incoming medical students, current medical students, residents and physician teachers at the University of Saskatchewan was conducted in the spring of 1997. Response rates were 77% (43/56), 81% (177/218), 65% (134/206) and 39% (215/55...

  17. Complications of Gamma Knife surgery: an early report from 2 Canadian centers.

    Science.gov (United States)

    Vachhrajani, Shobhan; Fawaz, Charbel; Mathieu, David; Ménard, Cynthia; Cusimano, Michael D; Gentili, Fred; Hodaie, Mojgan; Kenny, Brendan; Kulkarni, Abhaya V; Laperriere, Normand; Schwartz, Michael; Tsao, May; Bernstein, Mark

    2008-12-01

    Gamma Knife surgery (GKS) is used to treat benign and malignant brain tumors, arteriovenous malformations, trigeminal neuralgia, and other conditions. Patients experience reduced neurological morbidity from GKS compared with open microneurosurgery, but risks of radiation injury and technical limitations persist. The authors report treatment complications from the early experience of 2 Canadian GKS programs in Toronto and Sherbrooke. In Toronto, a prospective administrative database was searched for adverse events and incomplete treatment administrations. In Sherbrooke, data were acquired by chart review. Patients were accrued until August 1, 2007, and a total of 973 patients were included in this report. During the radiosurgical procedure, 19 patients (2%) suffered anxiety or syncopal episodes, and 2 patients suffered acute coronary events. Treatments were incompletely administered in 12 patients (1.2%). Severe pain was a delayed complication: 8 patients suffered unexpected headaches, and 9 patients developed severe facial pain. New motor deficits developed in 11 patients, including edema-induced ataxia in 4 and one case of facial weakness after treatment of a vestibular schwannoma. Four patients required shunt placement for symptomatic hydrocephalus, and 16 patients suffered delayed seizures. Gamma Knife surgery is a minimally invasive treatment modality for many intracranial diseases. Treatment is not risk free, and some patients will develop complications; these are likely to decrease as institutional experience matures. Expanding availability and indications necessitate discussion of these risks with patients considering treatment.

  18. The predictive value of general surgery application data for future resident performance.

    Science.gov (United States)

    Alterman, Daniel Mark; Jones, Thomas M; Heidel, Robert E; Daley, Brian J; Goldman, Mitchell H

    2011-01-01

    The predictive value of application data for future general surgery resident performance and attrition are poorly understood. We sought to determine what variables obtained in the application process might predict future resident success. We performed an 18-year review (1990-2008) of all matched residents (n = 101) to a university program. Both categorical graduates (CG) and nongraduates (CNG) and nondesignated preliminaries matching (PM) and preliminaries nonmatching (PNM) were evaluated. We also screened for previous high-performance accomplishments outside of the medical field such as in the performing arts or collegiate athletics (SKILL). Outcome data include graduation or match status, American Board of Surgery In-service Training Examination (ABSITE), and faculty Accreditation Council for Graduate Medical Education (ACGME) core competency evaluations. Background data from the Electronic Residency Application Service (ERAS) application between the various groups was compared with univariate analysis and logistic regression. There were significant differences between the groups on the measures of USMLE step 1 (STEP1) (p = 0.001), medical school grade point average (GPA) (p = 0.023), interview data (INTERVIEW) (p SKILL predict successful completion of a general surgery residency. In contrast to prior reports, female sex, ethnicity, medical school grades, or Alpha Omega Alpha Honor Society (AOA) status were not significant. The variable SKILL is novel and highlights the importance of nonacademic background data. Our data indicate STEP1 is an independent predictor of resident success in general surgery and should maintain an important role in general surgery applicant screening. The ideal screening threshold is likely > 215. Copyright © 2011 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  19. The Teaching of Ethics and Professionalism in Plastic Surgery Residency: A Cross-Sectional Survey.

    Science.gov (United States)

    Bennett, Katelyn G; Ingraham, John M; Schneider, Lisa F; Saadeh, Pierre B; Vercler, Christian J

    2017-05-01

    The ethical practice of medicine has always been of utmost importance, and plastic surgery is no exception. The literature is devoid of information on the teaching of ethics and professionalism in plastic surgery. In light of this, a survey was sent to ascertain the status of ethics training in plastic surgery residencies. A 21-question survey was sent from the American Council of Academic Plastic Surgeons meeting to 180 plastic surgery program directors and coordinators via email. Survey questions inquired about practice environment, number of residents, presence of a formal ethics training program, among others. Binary regression was used to determine if any relationships existed between categorical variables, and Poisson linear regression was used to assess relationships between continuous variables. Statistical significance was set at a P value of 0.05. A total of 104 members responded to the survey (58% response rate). Sixty-three percent were program directors, and most (89%) practiced in academic settings. Sixty-two percent in academics reported having a formal training program, and 60% in private practice reported having one. Only 40% of programs with fewer than 10 residents had ethics training, whereas 78% of programs with more than 20 residents did. The odds of having a training program were slightly higher (odds ratio, 1.1) with more residents (P = 0.17). Despite the lack of information in the literature, formal ethics and professionalism training does exist in many plastic surgery residencies, although barriers to implementation do exist. Plastic surgery leadership should be involved in the development of standardized curricula to help overcome these barriers.

  20. Urology residents training in laparoscopic surgery. Development of a virtual reality model.

    Science.gov (United States)

    Gutiérrez-Baños, J L; Ballestero-Diego, R; Truan-Cacho, D; Aguilera-Tubet, C; Villanueva-Peña, A; Manuel-Palazuelos, J C

    2015-11-01

    The training and learning of residents in laparoscopic surgery has legal, financial and technological limitations. Simulation is an essential tool in the training of residents as a supplement to their training in laparoscopic surgery. The training should be structured in an appropriate environment, with previously established and clear objectives, taught by professionals with clinical and teaching experience in simulation. The training should be conducted with realistic models using animals and ex-vivo tissue from animals. It is essential to incorporate mechanisms to assess the objectives during the residents' training progress. We present the training model for laparoscopic surgery for urology residents at the University Hospital Valdecilla. The training is conducted at the Virtual Hospital Valdecilla, which is associated with the Center for Medical Simulation in Boston and is accredited by the American College of Surgeons. The model is designed in 3 blocks, basic for R1, intermediate for R2-3 and advanced for R4-5, with 9 training modules. The training is conducted in 4-hour sessions for 4 afternoons, for 3 weeks per year of residence. Residents therefore perform 240 hours of simulated laparoscopic training by the end of the course. For each module, we use structured objective assessments to measure each resident's training progress. Since 2003, 9 urology residents have been trained, in addition to the 5 who are currently in training. The model has undergone changes according to the needs expressed in the student feedback. The acquisition of skills in a virtual reality model has enabled the safe transfer of those skills to actual practice. A laparoscopic surgery training program designed in structured blocks and with progressive complexity provides appropriate training for transferring the skills acquired using this model to an actual scenario while maintaining patient safety. Copyright © 2015 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. Targeted needs assessment for a transitional "boot camp" curriculum for pediatric surgery residents.

    Science.gov (United States)

    Blackmore, Christopher; Lopushinsky, Steve; Lockyer, Jocelyn; Paolucci, Elizabeth Oddone

    2015-05-01

    Transition periods in medical education are associated with increased risk for learners and patients. For pediatric surgery residents, the transition to training is especially difficult as learners must adjust to new patient populations. In this study we perform a targeted needs assessment to determine the ideal content and format of a pediatric surgery boot camp to facilitate the transition to residency. A needs assessment survey was developed and distributed to pediatric surgery residents and staff across North America. The survey asked participants to rank 30 pediatric surgical diagnoses, 20 skills, and 11 physiological topics on "frequency" and "importance". Items were then ranked using empirical methods. The survey also evaluated the preferred boot camp format. In total, 12 residents and 23 staff completed the survey. No significant differences were identified between staff and residents in survey responses. The top 5 topics identified for inclusion in a boot camp were: (1) fluid and electrolyte management, (2) appendicitis, (3) pediatric hernias, (4) nutrition and (5) pain management. The preferred format for a boot camp was 3-4days in duration applying a blend of educational methods. Based on the results of the needs assessment survey, a novel pediatric surgery boot camp curriculum can be developed. Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.

  2. The refinement of a cultural standardized patient examination for a general surgery residency program.

    Science.gov (United States)

    Chun, Maria B J; Deptula, Peter; Morihara, Sarah; Jackson, David S

    2014-01-01

    Recent articles have documented the importance of cultural competency in surgery. Surgical residency programs have used the Objective Structured Clinical Examinations or cultural standardized patient examinations as a training tool. Past studies evaluating cultural competency have noted the importance of including an observational (control) arm, which would allow for a more objective assessment of a resident's competency in this area. The purpose of our article is to present the results of a follow-up study to a pilot cultural standardized patient examination for surgery residents. All first-year surgery residents were required to participate in the videotaped cultural SP examination as part of the general surgery residency curriculum. Two measures were used to assess resident performance. On the day of the examination, the Cross-Cultural Care Survey was administered. The examination was assessed by the residents themselves, faculty observers, and standardized patients, using a written checklist that was developed to evaluate residents on all 6 Accreditation Council for Graduate Medical Education competencies. The current study includes 20 first-year surgery residents from academic years 2011 to 2012 and 2012 to 2013. The examination of pretest differences in groups found that students born outside of the United States had significantly higher scores on attitude (t = -2.68, df = 18, p = 0.02), but no statistically significant differences were found in skillfulness or knowledge or in the overall rating scale. For the overall rating scale, change from pretest to posttest was statistically significant (t = -2.25, df = 18, p = 0.04). Further analysis revealed that students who were born in the United States demonstrated a significant increase in ratings (t = -3.08, df = 10, p = 0.01) whereas students who were not born in the United States showed little change (t = -0.35, df = 7, p = 0.74). These results show that the means in attitude scales changed little for all

  3. IOP Elevation After Cataract Surgery: Results for Residents and Senior Staff at Henry Ford Health System.

    Science.gov (United States)

    Elfersy, Adrian J; Prinzi, Robert A; Peracha, Zuhair H; Kim, Daniel D; Crandall, David A; Darnley-Fisch, Deborah A; Imami, Nauman R

    2016-10-01

    To determine the incidence of intraocular pressure (IOP) elevation on postoperative day 1 (POD1) after cataract surgery performed by resident surgeons compared with attending surgeons and to examine the influence of associated variables on the incidence of postoperative IOP elevation. Retrospective review of 2472 consecutive 2.2 to 2.8 mm temporal clear corneal cataract extractions by phacoemulsification performed by either residents or attending surgeons at Henry Ford Health System. Fellow eyes were excluded, resulting in 1847 eyes. IOP measurements of >40, >30, and >23 mm Hg were noted along with incremental IOP elevations of ≥10 and 20 mm Hg over preoperative/baseline IOP. Associated variables included: age, sex, diabetes mellitus, hypertension, glaucoma, glaucoma suspect, uveitis, prior ocular trauma, and vitreous loss at surgery. Resident-performed cataract surgery was associated with statistically significant higher rates of IOP elevation in all categories and in all clinical situations known to be associated with postoperative IOP spike, that is, vitreous loss at surgery, prior ocular trauma, and preexisting glaucoma. The incidence of postoperative day 1 IOP elevation after phacoemulsification performed by resident surgeons was 2 to 5 times that of experienced cataract surgeons. Variables including vitreous loss at surgery, prior ocular trauma, preexisting glaucoma, glaucoma suspect status, and male sex were significant contributors. Consideration for prophylactic IOP lowering is advised in high-risk patients.

  4. Learning styles of medical students, general surgery residents, and general surgeons: implications for surgical education

    Directory of Open Access Journals (Sweden)

    de Gara Chris

    2010-06-01

    Full Text Available Abstract Background Surgical education is evolving under the dual pressures of an enlarging body of knowledge required during residency and mounting work-hour restrictions. Changes in surgical residency training need to be based on available educational models and research to ensure successful training of surgeons. Experiential learning theory, developed by David Kolb, demonstrates the importance of individual learning styles in improving learning. This study helps elucidate the way in which medical students, surgical residents, and surgical faculty learn. Methods The Kolb Learning Style Inventory, which divides individual learning styles into Accommodating, Diverging, Converging, and Assimilating categories, was administered to the second year undergraduate medical students, general surgery resident body, and general surgery faculty at the University of Alberta. Results A total of 241 faculty, residents, and students were surveyed with an overall response rate of 73%. The predominant learning style of the medical students was assimilating and this was statistically significant (p Conclusions We conclude that medical students have a significantly different learning style from general surgical trainees and general surgeons. This has important implications in the education of general surgery residents.

  5. Trends and Predictors of National Institutes of Health Funding to Plastic Surgery Residency Programs.

    Science.gov (United States)

    Silvestre, Jason; Abbatematteo, Joseph M; Chang, Benjamin; Serletti, Joseph M

    2017-12-01

    Recent studies have demonstrated low levels of National Institutes of Health funding for surgical research. The authors compared the funding in plastic surgery with the funding for other surgical specialties. A query of National Institutes of Health grants awarded to departments of surgical specialties was performed using the National Institutes of Health RePORTER database (2008 to 2016). Trends in funding were compared by specialty and adjusted for the number of active physicians in each specialty. Plastic surgery residency program characteristics were correlated with funding procurement. Eight hundred eighty-nine faculty at 94 plastic surgery residency programs were queried. Forty-eight investigators (5.4 percent) at 23 programs (24.4 percent) had National Institutes of Health funding. From 2008 to 2016, a total of $84,142,138 was awarded through 81 grants. Funding supported translational (44.6 percent), clinical (26.4 percent), basic science (27.2 percent), and educational (1.7 percent) research. In 2016, plastic surgery received the least amount of National Institutes of Health funding per active physician ($1,530) relative to orthopedic surgery ($3124), obstetrics and gynecology ($3885), urology ($5943), otolaryngology ($9999), general surgery ($11,649), ophthalmology ($11,933), and neurologic surgery ($20,874). Plastic surgery residency program characteristics associated with National Institutes of Health funding were high ranking and had more than 10 clinical faculty (p Plastic surgery receives the least National Institutes of Health funding among the surgical specialties. Departments and divisions of plastic surgery should support investigators applying for research grants to increase future National Institutes of Health funding.

  6. Identifying and Eliminating Deficiencies in the General Surgery Resident Core Competency Curriculum.

    Science.gov (United States)

    Tapia, Nicole M; Milewicz, Allen; Whitney, Stephen E; Liang, Michael K; Braxton, Carla C

    2014-06-01

    Although the Accreditation Council for Graduate Medical Education has defined 6 core competencies required of resident education, no consensus exists on best practices for reaching resident proficiency. Surgery programs must develop resourceful methods to incorporate learning. While patient care and medical knowledge are approached with formal didactics and traditional Halstedian educational formats, other core competencies are presumed to be learned on the job or emphasized in conferences. To test the hypothesis that our residents lack a foundation in several of the nonclinical core competencies and to seek to develop a formal curriculum that can be integrated into our current didactic time, with minimal effect on resident work hours and rest hours. Anonymous Likert-type scale needs assessment survey requesting residents within a large single general surgery residency program to rate their understanding, working knowledge, or level of comfort on the following 10 topics: negotiation and conflict resolution; leadership styles; health care legislation; principles of quality delivery of care, patient safety, and performance improvement; business of medicine; clinical practice models; role of advocacy in health care policy and government; personal finance management; team building; and roles of innovation and technology in health care delivery. Proportions of resident responses scored as positive (agree or strongly agree) or negative (disagree or strongly disagree). In total, 48 surgery residents (70%) responded to the survey. Only 3 topics (leadership styles, team building, and roles of innovation and technology in health care delivery) had greater than 70% positive responses, while 2 topics (negotiation and conflict resolution and principles of quality delivery of care, patient safety, and performance improvement) had greater than 60% positive responses. The remaining topics had less than 40% positive responses, with the least positive responses on the topics

  7. Benchmarking quality for renal cancer surgery: Canadian Kidney Cancer information system (CKCis) perspective.

    Science.gov (United States)

    Lawson, Keith A; Saarela, Olli; Liu, Zhihui; Lavallée, Luke T; Breau, Rodney H; Wood, Lori; Jewett, Michael A S; Kapoor, Anil; Tanguay, Simon; Moore, Ronald B; Rendon, Ricardo; Pouliot, Frederic; Black, Peter C; Kawakami, Jun; Drachenberg, Darrel; Finelli, Antonio

    2017-08-01

    There is a lack of validated quality metrics to evaluate the care of patients receiving surgery for renal cell carcinoma (RCC). To address this, the Kidney Cancer Research Network of Canada defined a list of quality indicators (QI) to assess hospital-level performance. We have case-mix adjusted these QIs to benchmark RCC surgical care at Canadian academic centres. The Canadian Kidney Cancer information system (CKCis) was used to measure six QIs: laparoscopic approach proportion (LA), partial nephrectomy proportion (PN), partial nephrectomy in patients with chronic kidney disease (CKDPN), positive margin rate (PMR), partial nephrectomy complication rate (PNCx), and warm ischemia time (WIT). To benchmark performance, indirect standardization (observed-to-expected ratio) methodology was employed using multivariate regression models. Multivariate models for LA, PN, and CKDPN demonstrated good discrimination and were used for benchmarking. National averages of 74% (70-78%), 73% (70-75%), and 70% (67-74%) for the LA, PN, and CKDPN QIs, respectively, were determined and used to benchmark individual hospital performance. Overall, three (23%), two (15%), and two (15%) hospitals performed below expected for LA, PN, and CKDPN, respectively. Hospital identity was an independent predictor of LA, PN, and CKDPN (p<0.001). Significant variability between CKCis hospitals for three RCC surgical QIs exists. Using the CKCis infrastructure may provide a framework for institution-level audit feedback for quality improvement. Greater CKCis capture rates and further data supporting the construct validity of these QIs are required to extend the use of this dataset to real-world quality initiatives.

  8. Career and parenting satisfaction among medical students, residents and physician teachers at a Canadian medical school.

    Science.gov (United States)

    Cujec, B; Oancia, T; Bohm, C; Johnson, D

    2000-03-07

    Studies of career and parenting satisfaction have focused separately on medical students, residents and practising physicians. The objective of this study was to compare satisfaction across a spectrum of stages of medical career. A survey of incoming medical students, current medical students, residents and physician teachers at the University of Saskatchewan was conducted in the spring of 1997. Response rates were 77% (43/56), 81% (177/218), 65% (134/206) and 39% (215/554) respectively. Factors assessed in the stepwise regression analysis were the effect of sex, parenting and level of training on the likelihood of recommending parenting to medical students or residents, and on parenting dissatisfaction, job dissatisfaction, career dissatisfaction and the importance of flexibility within the college program to accommodate family obligations. More male than female physician teachers had partners (92% v. 81%, p teachers spent equal hours per week at work compared with their male counterparts (mean 52 and 58 hours respectively) and more than double the weekly time on family and household work (36 v. 14 hours, p teachers were the most likely respondents to recommend parenting to residents and their peers. Residents were the most dissatisfied with their parenting time. At all career stages women were less likely than men to recommend parenting, were more dissatisfied with the amount of time spent as parents and were more likely to regard flexibility within the college program as beneficial. There were no sex-related differences in job dissatisfaction and career dissatisfaction. However, married women were more dissatisfied with their jobs than were married men. Job dissatisfaction was greatest among medical students, and career dissatisfaction was greatest among residents. The optimal timing of parenthood appears to be upon completion of medical training. Women were less likely to recommend parenting, less satisfied with the time available for parenting and more likely

  9. Effect of protected research time on ABSITE scores during general surgery residency.

    Science.gov (United States)

    Orkin, Bruce A; Poirier, Jennifer; Kowal-Vern, Areta; Chan, Edie; Ohara, Karen; Mendoza, Brian

    2017-11-03

    Objective - To determine whether residents with one or more years of dedicated research time (Research Residents, RR) improved their ABSITE scores compared to those without (Non-Research Residents, N-RR). A retrospective review of general surgery residents' ABSITE scores from 1995 to 2016 was performed. RR were compared to N-RR. Additional analysis of At Risk (AR) v Not At Risk residents (NAR) (35th percentile as PGY1-2) was also performed. Cohort - 147 residents (34 RR and 113 N-RR). There were no differences in initial ABSITE scores (p = 0.47). By definition, the AR group had lower scores than NAR. Overall, post-research RR v PGY-4 N-RR scores did not differ (p = 0.84). Only the AR residents improved their scores (p = 0.0009 v NAR p = 0.42), regardless of research group (p = 0.70). Protected research time did not improve residents' ABSITE scores, regardless of initial scores. At Risk residents improved regardless of research group status. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Assessment of open operative vascular surgical experience among general surgery residents.

    Science.gov (United States)

    Krafcik, Brianna M; Sachs, Teviah E; Farber, Alik; Eslami, Mohammad H; Kalish, Jeffrey A; Shah, Nishant K; Peacock, Matthew R; Siracuse, Jeffrey J

    2016-04-01

    General surgeons have traditionally performed open vascular operations. However, endovascular interventions, vascular residencies, and work-hour limitations may have had an impact on open vascular surgery training among general surgery residents. We evaluated the temporal trend of open vascular operations performed by general surgery residents to assess any changes that have occurred. The Accreditation Council for Graduate Medical Education's database was used to evaluate graduating general surgery residents' cases from 1999 to 2013. Mean and median case volumes were analyzed for carotid endarterectomy, open aortoiliac aneurysm repair, and lower extremity bypass. Significance of temporal trends were identified using the R(2) test. The average number of carotid endarterectomies performed by general surgery residents decreased from 23.1 ± 14 (11.6 ± 9 chief, 11.4 + 10 junior) cases per resident in 1999 to 10.7 ± 9 (3.4 ± 5 chief, 7.3 ± 6 junior) in 2012 (R(2) = 0.98). Similarly, elective open aortoiliac aneurysm repairs decreased from 7.4 ± 5 (4 ± 4 chief, 3.4 ± 4 junior) in 1999 to 1.3 ± 2 (0.4 ± 1 chief, 0.8 ± 1 junior) in 2012 (R(2) = 0.98). The number of lower extremity bypasses decreased from 21 ± 12 (9.5 ± 7 chief, 11.8 ± 9 junior) in 1999 to 7.6 ± 2.6 (2.4 ± 1.3 chief, 5.2 + 1.8 junior) in 2012 (R(2) = 0.94). Infrapopliteal bypasses decreased from 8.1 ± 3.8 (3.5 ± 2.2 chief, 4.5 ± 2.9 junior) in 2001 to 3 ± 2.2 (1 ± 1.6 chief, 2 ± 1.6 junior) in 2012 (R(2) = 0.94). General surgery resident exposure to open vascular surgery has significantly decreased. Current and future graduates may not have adequate exposure to open vascular operations to be safely credentialed to perform these procedures in future practice without advanced vascular surgical training. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  11. A comparison of surgery and family medicine residents' perceptions of cross-cultural care training.

    Science.gov (United States)

    Chun, Maria B J; Jackson, David S; Lin, Susan Y; Park, Elyse R

    2010-12-01

    The need for physicians formally trained to deliver care to diverse patient populations has been widely advocated. Utilizing a validated tool, Weissman and Betancourt's Cross-Cultural Care Survey, the aim of this current study was to compare surgery and family medicine residents' perceptions of their preparedness and skillfulness to provide high quality cross-cultural care. Past research has documented differences between the two groups' reported impressions of importance and level of instruction received in cross-cultural care. Twenty surgery and 15 family medicine residents participated in the study. Significant differences were found between surgery and family medicine residents on most ratings of the amount of training they received in cross-cultural skills. Specifically, family medicine residents reported having received more training on: 1) determining how patients want to be addressed, 2) taking a social history, 3) assessing their understanding of the cause of illness, 4) negotiating their treatment plan, 5) assessing whether they are mistrustful of the health care system and÷or doctor, 6) identifying cultural customs, 7) identifying how patients make decisions within the family, and 8) delivering services through a medical interpreter. One unexpected finding was that surgery residents, who reported not receiving much formal cultural training, reported higher mean scores on perceived skillfulness (i.e. ability) than family medicine residents. The disconnect may be linked to the family medicine residents' training in cultural humility - more knowledge and understanding of cross-cultural care can paradoxically lead to perceptions of being less prepared or skillful in this area. Hawaii Medical Journal Copyright 2010.

  12. Significance of Objective Structured Clinical Examinations to Plastic Surgery Residency Training.

    Science.gov (United States)

    Simmons, Brian J; Zoghbi, Yasmina; Askari, Morad; Birnbach, David J; Shekhter, Ilya; Thaller, Seth R

    2017-09-01

    Objective structured clinical examinations (OSCEs) have proven to be a powerful tool. They possess more than a 30-year track record in assessing the competency of medical students, residents, and fellows. Objective structured clinical examinations have been used successfully in a variety of medical specialties, including surgery. They have recently found their way into the subspecialty of plastic surgery. This article uses a systematic review of the available literature on OSCEs and their recent use in plastic surgery. It incorporates survey results assessing program directors' views on the use of OSCEs. Approximately 40% of programs surveyed use OSCEs to assess the Accreditation Council for Graduate Medical Education core competencies. We found that 40% use OSCEs to evaluate specific plastic surgery milestones. Objective structured clinical examinations are usually performed annually. They cost anywhere between $100 and more than $1000 per resident. Four milestones giving residents the most difficulties on OSCEs were congenital anomalies, noncancer breast surgery, breast reconstruction, and practice-based learning and improvement. It was determined that challenges with milestones were due to lack of adequate general knowledge and surgical ward patient care, as well as deficits in professionalism and system-based problems. Programs were able to remediate weakness found by OSCEs using a variety of methods. Objective structured clinical examinations offer a unique tool to objectively assess the proficiency of residents in key areas of the Accreditation Council for Graduate Medical Education core competencies. In addition, they can be used to assess the specific milestones that plastic surgery residents must meet. This allows programs to identify and improve identified areas of weakness.

  13. Evaluating the impact of a Canadian national anatomy and radiology contouring boot camp for radiation oncology residents.

    Science.gov (United States)

    Jaswal, Jasbir; D'Souza, Leah; Johnson, Marjorie; Tay, KengYeow; Fung, Kevin; Nichols, Anthony; Landis, Mark; Leung, Eric; Kassam, Zahra; Willmore, Katherine; D'Souza, David; Sexton, Tracy; Palma, David A

    2015-03-15

    Radiation therapy treatment planning has advanced over the past 2 decades, with increased emphasis on 3-dimensional imaging for target and organ-at-risk (OAR) delineation. Recent studies suggest a need for improved resident instruction in this area. We developed and evaluated an intensive national educational course ("boot camp") designed to provide dedicated instruction in site-specific anatomy, radiology, and contouring using a multidisciplinary (MDT) approach. The anatomy and radiology contouring (ARC) boot camp was modeled after prior single-institution pilot studies and a needs-assessment survey. The boot camp incorporated joint lectures from radiation oncologists, anatomists, radiologists, and surgeons, with hands-on contouring instruction and small group interactive seminars using cadaveric prosections and correlative axial radiographs. Outcomes were evaluated using pretesting and posttesting, including anatomy/radiology multiple-choice questions (MCQ), timed contouring sessions (evaluated relative to a gold standard using Dice similarity metrics), and qualitative questions on satisfaction and perceived effectiveness. Analyses of pretest versus posttest scores were performed using nonparametric paired testing. Twenty-nine radiation oncology residents from 10 Canadian universities participated. As part of their current training, 29%, 75%, and 21% receive anatomy, radiology, and contouring instruction, respectively. On posttest scores, the MCQ knowledge scores improved significantly (pretest mean 60% vs posttest mean 80%, Pradiology in addition to enhancing their confidence and accuracy in contouring. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Confidence Crisis Among General Surgery Residents: A Systematic Review and Qualitative Discourse Analysis.

    Science.gov (United States)

    Elfenbein, Dawn M

    2016-12-01

    In the surgical community, there is concern that general surgery residents are choosing subspecialty training in large numbers because of a crisis in confidence at the end of training. Confidence is an essential quality of surgeons, and recent studies have attempted to quantify and measure it in graduating general surgery residents. To systematically review the quality of evidence provided and to critically analyze the language used to describe the findings using quantitative methods. A systematic review of the PubMed indexed literature on general surgery resident confidence was performed in March 2015. A summative table of each study's hypothesis, definition of confidence, quality using the Medical Education Research Study Quality Instrument, influence using Web of Science citations, results, and conclusions was created, and qualitative coding was applied to identify emerging themes. No date restrictions were used in the search. Fifteen survey studies have been performed that measure confidence or readiness to practice. Although 5 studies had neutral or positive conclusions, most studies reported low confidence in general surgery graduates. There are conflicting data about definitions of confidence. The relationships between confidence, autonomy, and competence are varied and complex. Comparisons with the past are frequent. Confidence is difficult to define and measure. Despite limitations, survey studies are used to shape discourse and influence policies. Social and cultural factors influence self-efficacy, and focusing on operative volume and autonomy alone may not address all of the reasons that some residents express concerns about readiness to practice.

  15. [Chances and risks of a new residency program for orthopedics and trauma surgery].

    Science.gov (United States)

    2013-04-01

    The residency program for a specialist in orthopedics and trauma surgery is facing fundamental changes based on an initiative originating from the working group "medical training" of the German Medical Association (GMA). A survey indicated that 50 % of all trainees are dissatisfied with their current situation. It appears important to integrate the ideas and wishes of current orthopedic residents in a novel training concept. To assess this a survey was performed by the Young Forum of the German Society for Orthopedics und Trauma Surgery. The internet-based short survey was conducted in January 2013 among members of the professional societies (DGU, DGOU and DGOOC). 408 physicians participated. The majority of the participating physicians is interested in a career in orthopedics and trauma surgery with primarily operative contents. Accordingly the majority (62 %, n = 253) voted against a reduction of numbers of surgical interventions with 86 % (n = 351) confirming the necessity that these operations must be carried out by the trainee himself. The upcoming changes in residency program for orthopedics and trauma surgery offer the opportunity for a well structured and practical oriented residency program. It could be a further step in increasing satisfaction in this profession. Georg Thieme Verlag KG Stuttgart · New York.

  16. The University of Pennsylvania curriculum for training otorhinolaryngology residents in transoral robotic surgery.

    Science.gov (United States)

    Sperry, Steven M; O'Malley, Bert W; Weinstein, Gregory S

    2014-01-01

    To define a curriculum for the development of robotic surgical skills in otorhinolaryngology residency training. A systematic review of the current literature on robotic surgery training was performed. Based on prior reports in other specialties, a curriculum for otorhinolaryngology residents was created that progresses through several modules, including didactics, inanimate skills laboratory, and operative experience. The curriculum for residents in otorhinolaryngology was designed as follows: didactics include an overview of the robotic device and instruments, a tutorial in basic controls and function, and a room setup and positioning. The anatomy and steps of transoral procedures are taught through books, videos, operative observations, and cadaver dissections. Skills are developed with a virtual reality robotic simulator and robotics labs. The operative experience progresses from case observation to bedside assistant to console surgeon. The role of the console surgeon progresses in a stepwise fashion, and the procedures of radical tonsillectomy, supraglottic partial laryngectomy, and base of tongue resection have been organized as a series of steps. A structured curriculum for training residents in transoral robotic surgery was developed. This training is important for otorhinolaryngology residents to acquire the knowledge and skills to perform robotic surgery safely. © 2015 S. Karger AG, Basel.

  17. Prospective evaluation of surgical palliative care immersion training for general surgery residents.

    Science.gov (United States)

    Raoof, Mustafa; O'Neill, Lisa; Neumayer, Leigh; Fain, Mindy; Krouse, Robert

    2017-08-01

    Palliative care competencies in surgical training are recognized to improve the care of surgical patients with advanced or life-threatening illnesses. Formal programs to teach these competencies are lacking. The study aims to assess the feasibility and utility of a unique surgical palliative care immersion training program. A half-day Surgical Palliative Care Immersion Training (SPCIT) was developed using the American College of Surgeon's manual titled "Surgical Palliative Care: A Resident's Guide" as a framework. The training format was modeled after the highly successful University of Arizona Center on Aging's Interprofessional Chief Resident Immersion Training (IP-CRIT) Program to teach palliative care competencies to general surgery residents. Objective and self-assessments were performed at baseline, immediately post training and 5-months after training. For all pre-test, post-test comparisons on Likert scale, Wilcoxon Signed Rank Test was used. For aggregate scores a repeated-measures analysis of variance was used. Forty of the forty-eight residents (83%) completed the learner's needs assessment survey. Thirty-four (71%) of the forty-eight residents in the residency program participated in the SPCIT. Significant improvement was noted in objective assessment of post-test aggregate scores (Mean difference 2.15, 95% CI 0.52-3.77, p = 0.0083). There was a significant increase in proportion of residents who felt confident in discussing palliative care options (96.5% vs. 27.5%, p support (79.2% vs. 45%, p = 0.0059) with patient/families after the SPCIT. The newly developed SPCIT program drastically improves knowledge, attitudes and perceived skills of general surgery residents. Similar training can be implemented in other surgical residency programs. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Reducing oral and maxillofacial surgery resident risk exposure: lessons from graduate medical education reform.

    Science.gov (United States)

    Buhrow, Suzanne Morse; Buhrow, Jack A

    2013-12-01

    It is estimated that, in the United States, more than 40,000 patients are injured each day because of preventable medical errors. Although numerous studies examine the causes of medical trainee errors and efforts to mitigate patient injuries in this population, little research exists on adverse events experienced by oral and maxillofacial surgery (OMFS) residents or strategies to improve patient safety awareness in OMFS residency programs. The authors conducted a retrospective literature review of contemporary studies on medical trainees' reported risk exposure and the impact of integrating evidence-based patient safety training into residency curricula. A review of the literature suggests that OMFS residents face similar risks as medical trainees in medical, surgical, and anesthesia residency programs and may benefit from integrating competency-based safety training in the OMFS residency curriculum. OMFS trainees face particular challenges when transitioning from dental student to surgical resident, particularly related to their limited clinical exposure to high-reliability organizations, which may place them at higher risk than other medical trainees. OMFS educators should establish resident competence in patient safety principles and system improvement strategies throughout the training period.

  19. Weekly e-mailed teaching tips and reading material influence teaching among general surgery residents.

    Science.gov (United States)

    Watkins, Ammara A; Gondek, Stephen P; Lagisetty, Kiran H; Castillo-Angeles, Manuel; Gangadharan, Sidharta P; Cahalane, Michael J; Kent, Tara S

    2017-01-01

    A nonintrusive e-mail reminder incorporating teaching tips and manuscripts was developed to supplement resident-as-teacher curricula. Ten high-yield manuscripts and 10 teaching tips exemplifying the themes of mentorship or role modeling, teaching methods, adult learning theory, feedback, and the resident role of teaching were distributed to general surgery house staff through a weekly e-mail series. House staff completed surveys before and after the 20-week e-mail series. Thirty (43%) and 28 (40%) respondents completed the pre-e-mail and post-e-mail survey, respectively. Residents found teaching tips to be more helpful than manuscripts. Weekly e-mail reminders were "just right" in frequency according to 74% of respondents. Forty percent of residents felt the weekly e-mails helped them teach more often and 50% of residents changed their teaching style. Weekly reminders are an easy way to encourage resident teaching without a significant resident time commitment. Residents typically find teaching tips to be more useful than manuscripts. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Does operative experience during residency correlate with reported competency of recent general surgery graduates?

    Science.gov (United States)

    Safavi, Arash; Lai, Sarah; Butterworth, Sonia; Hameed, Morad; Schiller, Dan; Skarsgard, Erik

    2012-01-01

    Background Identification of attributes of residency training that predict competency would improve surgical education. We hypothesized that case experience during residency would correlate with self-reported competency of recent graduates. Methods Aggregate case log data of residents enrolled in 2 general surgery programs were collected over a 12-month period and stratified into Surgical Council on Resident Education (SCORE) categories. We surveyed recent (plastic surgery (4, 0.04%), and the least common EU procedure was abdomen–spleen (1, 0.1%). The questionnaire response rate was 45%. For EC procedures, self-reported competency was highest in skin and soft tissue, thoracic and head and neck (each 100%) and lowest in vascular–venous (54%), whereas for EU procedures it was highest in abdomen–general (100%) and lowest in vascular–arterial (62%). The correlation between case volume and self-reported competency was poor (R = 0.2 for EC procedures). Conclusion Self-reported competency correlates poorly with operative case experience during residency. Other curriculum factors, including specific rotations and timing, balance between inpatient and outpatient surgical experience and competition for cases, may contribute to procedural competency acquisition during residency. PMID:22854144

  1. Assessing Interest and Barriers for Resident and Faculty Involvement in Global Surgery.

    Science.gov (United States)

    Cheung, Maija; Healy, James M; Hall, Michael R; Ozgediz, Doruk

    2017-07-17

    Multiple institutions have developed international electives and sustainable global surgery initiatives to facilitate clinical, research, and outreach opportunities with hospitals in resource-poor areas. Despite increasing interest among programs, many institutions have not successfully reached potential involvement. This study evaluates the experiences of Yale residents and faculty, measures interest in the development of an international surgical elective, and enumerates barriers to developing or participating in these opportunities. This was performed to develop a formalized elective and assess interest and capacity for surgical global health initiatives, as a seemingly increasing number of trainee applicants and residents were expressing interest in working in resource-poor settings. Electronic survey of Yale Surgery residents and faculty analyzed using SPSS and Graphpad Prism. Among residents, previous global experience correlates with current interest in international opportunities, with 100% remaining interested, and 78% of those without prior experience also expressing interest (p = 0.018). Barriers to pursuing these activities included the use of vacation time, funding, scheduling, family obligations, and concern for personal safety. Among faculty, 28% of respondents have been involved internationally, and most (86%) expressed interest in additional opportunities and all were willing to take residents. Barriers to faculty participation included funding, relative value unit target reduction, protected time, and the desire for institutional support for such activities. A substantial proportion of residents and faculty have experience in global health and motivation to pursue additional opportunities. The main barriers to participation are not a lack of interest, but rather needs for funding support, protected time, and institutional recognition of academic contributions. These findings are being used to develop a global surgery elective and establish long

  2. Personality Factors Associated With Resident Performance: Results From 12 Accreditation Council for Graduate Medical Education Accredited Orthopaedic Surgery Programs.

    Science.gov (United States)

    Phillips, Donna; Egol, Kenneth A; Maculatis, Martine C; Roloff, Kathryn S; Friedman, Alan M; Levine, Brett; Garfin, Steven; Schwartz, Alexandra; Sterling, Robert; Kuivila, Thomas; Paragioudakis, Steve J; Zuckerman, Joseph D

    2017-07-05

    To understand the personality factors associated with orthopedic surgery resident performance. A prospective, cross-sectional survey of orthopedic surgery faculty that assessed their perceptions of the personality traits most highly associated with resident performance. Residents also completed a survey to determine their specific personality characteristics. A subset of faculty members rated the performance of those residents within their respective program on 5 dimensions. Multiple regression models tested the relationship between the set of resident personality measures and each aspect of performance; relative weights analyses were then performed to quantify the contribution of the individual personality measures to the total variance explained in each performance domain. Independent samples t-tests were conducted to examine differences between the personality characteristics of residents and those faculty identified as relevant to successful resident performance. Data were collected from 12 orthopedic surgery residency programs1 throughout the United States. The level of clinical care provided by participating institutions varied. Data from 175 faculty members and 266 residents across 12 programs were analyzed. The personality features of residents were related to faculty evaluations of resident performance (for all, p performance. Particularly, the characteristics of agreeableness, neuroticism, and learning approach were found to be most important for explaining resident performance. Additionally, there were significant differences between the personality features that faculty members identified as important for resident performance and the personality features that residents possessed. Personality assessments can predict orthopedic surgery resident performance. However, results suggest the traits that faculty members value or reward among residents could be different from the traits associated with improved resident performance. Copyright © 2017 Association

  3. Relationships between study habits, burnout, and general surgery resident performance on the American Board of Surgery In-Training Examination.

    Science.gov (United States)

    Smeds, Matthew R; Thrush, Carol R; McDaniel, Faith K; Gill, Roop; Kimbrough, Mary K; Shames, Brian D; Sussman, Jeffrey J; Galante, Joseph M; Wittgen, Catherine M; Ansari, Parswa; Allen, Steven R; Nussbaum, Michael S; Hess, Donald T; Knight, David C; Bentley, Frederick R

    2017-09-01

    The American Board of Surgery In-Training Examination (ABSITE) is used by programs to evaluate the knowledge and readiness of trainees to sit for the general surgery qualifying examination. It is often used as a tool for resident promotion and may be used by fellowship programs to evaluate candidates. Burnout has been associated with job performance and satisfaction; however, its presence and effects on surgical trainees' performance are not well studied. We sought to understand factors including burnout and study habits that may contribute to performance on the ABSITE examination. Anonymous electronic surveys were distributed to all residents at 10 surgical residency programs (n = 326). Questions included demographics as well as study habits, career interests, residency characteristics, and burnout scores using the Oldenburg Burnout Inventory, which assesses burnout because of both exhaustion and disengagement. These surveys were then linked to the individual's 2016 ABSITE and United States Medical Licensing Examination (USMLE) step 1 and 2 scores provided by the programs to determine factors associated with successful ABSITE performance. In total, 48% (n = 157) of the residents completed the survey. Of those completing the survey, 48 (31%) scored in the highest ABSITE quartile (≥75th percentile) and 109 (69%) scored less than the 75th percentile. In univariate analyses, those in the highest ABSITE quartile had significantly higher USMLE step 1 and step 2 scores (P burnout scores (disengagement, P Burnout Inventory exhaustion (P = 0.02), and USMLE step 1 and 2 scores (P = 0.007 and 0.0001, respectively). Residents who perform higher on the ABSITE have a regular study schedule throughout the year, report less burnout because of exhaustion, study away from home, and have shown success in prior standardized tests. Further study is needed to determine the effects of burnout on clinical duties, career advancement, and satisfaction. Copyright © 2017

  4. Insta-grated Plastic Surgery Residencies: The Rise of Social Media Use by Trainees and Responsible Guidelines for Use.

    Science.gov (United States)

    Chandawarkar, Akash A; Gould, Daniel J; Stevens, W Grant

    2018-02-21

    Ethical guidelines for appropriate use of social media are beginning to be delineated. As social media becomes ingrained in plastic surgery culture, education of residents on appropriate use of social media is increasingly important. Recently, plastic surgery residency programs have begun to utilize social media. This study characterizes the trends and content of plastic surgery residency-associated Instagram accounts. Active individual residency program Instagram accounts were identified for integrated plastic surgery programs. Metrics for each account were retrieved on September 16, 2017, including date of first post, number of posts, and followers. Individual posts were analyzed for content of post. Fourteen of 67 (21%) integrated plastic surgery programs were found to have active Instagram accounts. There has been an exponential growth of programs adopting Instagram since August 2015. A total of 806 posts were created. Thirty-two (3.97%) posts had intraoperative photos and only one (0.12%) showed a patient image. There were 4466 followers of plastic surgery residency programs. A linear correlation was found between number of posts and number of followers, while there was no correlation of number of followers and time since account start. Instagram use by plastic surgery integrated programs continues to grow exponentially, and programs are appropriately using the platform. Active use of the resident social media results in increased influence. Resident use of social media has many benefits. We propose social media guidelines for plastic surgery trainees and advocate for continued appropriate use and auto-regulation by plastic surgery trainees.

  5. Evaluating the Impact of a Canadian National Anatomy and Radiology Contouring Boot Camp for Radiation Oncology Residents

    Energy Technology Data Exchange (ETDEWEB)

    Jaswal, Jasbir [Department of Radiation Oncology, London Health Sciences Centre, London, Ontario (Canada); D' Souza, Leah; Johnson, Marjorie [Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, London, Ontario (Canada); Tay, KengYeow [Department of Diagnostic Radiology, London Health Sciences, London, Ontario (Canada); Fung, Kevin; Nichols, Anthony [Department of Otolaryngology, Head & Neck Surgery, Victoria Hospital, London, Ontario (Canada); Landis, Mark [Department of Diagnostic Radiology, London Health Sciences, London, Ontario (Canada); Leung, Eric [Department of Radiation Oncology, London Health Sciences Centre, London, Ontario (Canada); Kassam, Zahra [Department of Diagnostic Radiology, St. Joseph' s Health Care London, London, Ontario (Canada); Willmore, Katherine [Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, London, Ontario (Canada); D' Souza, David; Sexton, Tracy [Department of Radiation Oncology, London Health Sciences Centre, London, Ontario (Canada); Palma, David A., E-mail: david.palma@lhsc.on.ca [Department of Radiation Oncology, London Health Sciences Centre, London, Ontario (Canada)

    2015-03-15

    Background: Radiation therapy treatment planning has advanced over the past 2 decades, with increased emphasis on 3-dimensional imaging for target and organ-at-risk (OAR) delineation. Recent studies suggest a need for improved resident instruction in this area. We developed and evaluated an intensive national educational course (“boot camp”) designed to provide dedicated instruction in site-specific anatomy, radiology, and contouring using a multidisciplinary (MDT) approach. Methods: The anatomy and radiology contouring (ARC) boot camp was modeled after prior single-institution pilot studies and a needs-assessment survey. The boot camp incorporated joint lectures from radiation oncologists, anatomists, radiologists, and surgeons, with hands-on contouring instruction and small group interactive seminars using cadaveric prosections and correlative axial radiographs. Outcomes were evaluated using pretesting and posttesting, including anatomy/radiology multiple-choice questions (MCQ), timed contouring sessions (evaluated relative to a gold standard using Dice similarity metrics), and qualitative questions on satisfaction and perceived effectiveness. Analyses of pretest versus posttest scores were performed using nonparametric paired testing. Results: Twenty-nine radiation oncology residents from 10 Canadian universities participated. As part of their current training, 29%, 75%, and 21% receive anatomy, radiology, and contouring instruction, respectively. On posttest scores, the MCQ knowledge scores improved significantly (pretest mean 60% vs posttest mean 80%, P<.001). Across all contoured structures, there was a 0.20 median improvement in students' average Dice score (P<.001). For individual structures, significant Dice improvements occurred in 10 structures. Residents self-reported an improved ability to contour OARs and interpret radiographs in all anatomic sites, 92% of students found the MDT format effective for their learning, and 93% found the boot camp

  6. Increased Academic Productivity of Orthopaedic Surgery Residents Following 2011 Duty Hour Reform.

    Science.gov (United States)

    Johnson, Joey P; Savage, Kevin; Gil, Joseph A; Eberson, Craig P; Mulcahey, Mary K

    2017-12-19

    In 2003 and again in 2011, the Accreditation Council for Graduate Medical Education (ACGME) mandated increasingly stringent resident duty hour restrictions. With less time required at the hospital, residents theoretically have more time for other academic activities, such as research. Our study seeks to examine whether the number of research publications by orthopaedic residents increased following implementation of the 2011 ACGME duty hour restrictions. Pubmed was queried using publicly available alumni lists from programs across the United States. The years 2008 to 2011 were included to assess pre-2011 productivity. The years 2012 to 2015 were included in the post 2011 group. Paired t tests were used to assess differences between groups. Statistical significance was set to p < 0.05 a priori. A total of 10 orthopedic surgery residency programs across the United States. The study group was composed of 5 of the 2015 top 20 National Institutes of Health (NIH) funded programs and 5 programs without NIH funding. When corrected for number of residents per year, there were 0.290 publications per resident/year from 2008 to 2011 increasing to 0.528 publications per resident/year from 2012 to 2015 following implementation of the 2011 work hour restrictions (p = 0.033). When corrected for number of residents per year, there remained no difference in publications per resident from 2008 to 2011 (p = 0.81) or from 2012 to 2015 (p = 0.10) between NIH and non-NIH funded programs. There has been little data to support the theory that resident work hour restrictions have improved education or patient care in any meaningful way. In our study, there was a statistically significant increase in publications after 2011; however, the number of publications between NIH funded and non-NIH funded programs did not differ. Our study is the first to demonstrate that with increasing duty hour restrictions, orthopaedic surgery residents may be using more of their free time to conduct research

  7. Attitudes and practices of surgery residency program directors toward the use of social networking profiles to select residency candidates: a nationwide survey analysis.

    Science.gov (United States)

    Go, Pauline H; Klaassen, Zachary; Chamberlain, Ronald S

    2012-01-01

    To determine whether residency program directors (PDs) of general surgery and surgical subspecialties review social networking (SN) websites during resident selection. A 16-question survey was distributed via e-mail (Survey Monkey, Palo Alto, California) to 641 PDs of general surgery and surgical subspecialty residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME). Institutions with ACGME-accredited general surgery and surgical subspecialty residency programs. PDs of ACGME-accredited general surgery and surgical subspecialty residency programs. Two hundred fifty (39%) PDs completed the survey. Seventeen percent (n = 43) of respondents reported visiting SN websites to gain more information about an applicant during the selection process, leading 14 PDs (33.3%) to rank an applicant lower after a review of their SN profile. PDs who use SN websites currently are likely to continue (69%), whereas those who do not use SN currently might do so in the future (yes 5.4%, undecided 44.6%). Online profiles displayed on SN websites provide surgery PDs with an additional avenue with which to evaluate highly competitive residency applicants. Applicants should be aware of the expansion of social media into the professional arena and the increasing use of these tools by PDs. SN profiles should reflect the professional standards to which physicians are held while highlighting an applicant's strengths and academic achievements. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  8. Does general surgery residency prepare surgeons for community practice in British Columbia?

    Science.gov (United States)

    Hwang, Hamish

    2009-06-01

    Preparing surgeons for clinical practice is a challenging task for postgraduate training programs across Canada. The purpose of this study was to examine whether a single surgeon entering practice was adequately prepared by comparing the type and volume of surgical procedures experienced in the last 3 years of training with that in the first year of clinical practice. During the last 3 years of general surgery training, I logged all procedures. In practice, the Medical Services Plan (MSP) of British Columbia tracks all procedures. Using MSP remittance reports, I compiled the procedures performed in my first year of practice. I totaled the number of procedures and broke them down into categories (general, colorectal, laparoscopic, endoscopic, hepatobiliary, oncologic, pediatric, thoracic, vascular and other). I then compared residency training with community practice. I logged a total of 1170 procedures in the last 3 years of residency. Of these, 452 were performed during community rotations. The procedures during residency could be broken down as follows: 392 general, 18 colorectal, 242 laparoscopic, 103 endoscopic, 85 hepatobiliary, 142 oncologic, 1 pediatric, 78 thoracic, 92 vascular and 17 other. I performed a total of 1440 procedures in the first year of practice. In practice the break down was 398 general, 15 colorectal, 101 laparoscopic, 654 endoscopic, 2 hepatobiliary, 77 oncologic, 10 pediatric, 0 thoracic, 70 vascular and 113 other. On the whole, residency provided excellent preparation for clinical practice based on my experience. Areas of potential improvement included endoscopy, pediatric surgery and "other," which comprised mostly hand surgery.

  9. Declining Operative Experience for Junior-Level Residents: Is This an Unintended Consequence of Minimally Invasive Surgery?

    Science.gov (United States)

    Mullen, Matthew G; Salerno, Elise P; Michaels, Alex D; Hedrick, Traci L; Sohn, Min-Woong; Smith, Philip W; Schirmer, Bruce D; Friel, Charles M

    2016-01-01

    Our group has previously demonstrated an upward shift from junior to senior resident participation in common general surgery operations, traditionally performed by junior-level residents. The objective of this study was to evaluate if this trend would correct over time. We hypothesized that junior resident case volume would improve. A sample of essential laparoscopic and open general surgery procedures (appendectomy, inguinal herniorrhaphy, cholecystectomy, and partial colectomy) was chosen for analysis. The American College of Surgeons National Surgical Quality Improvement Program Participant Use Files were queried for these procedures between 2005 and 2012. Cases were stratified by participating resident post-graduate year with "junior resident" defined as post-graduate year1-3. Logistic regression was performed to determine change in junior resident participation for each type of procedure over time. A total of 185,335 cases were included in the study. For 3 of the operations we considered, the prevalence of laparoscopic surgery increased from 2005-2012 (all p surgeries performed by junior-level residents decreased for appendectomy by 2.6%/y (p surgeries, with appendectomy decreasing by 9.4%/y (p surgery resident education. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  10. Indications and outcomes of resident-performed cataract surgery requiring return to the operating room.

    Science.gov (United States)

    Schmidt, Caroline M; Sundararajan, Miel; Biggerstaff, Kristin S; Orengo-Nania, Silvia; Coffee, Robert E; Khandelwal, Sumitra S

    2016-03-01

    To identify the clinical and operative factors predicting reoperation within 30 days of resident-performed cataract surgery and correlate them with 1-year visual outcomes. Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA. Retrospective cohort study. The study assessed patients who had resident-performed cataract surgery between 2005 and 2013 and required return to the operating room for a second surgery on the same eye within 30 days. Preoperative and intraoperative risk factors were assessed. Outcome measures included corrected distance visual acuity (CDVA) at 1 year. A review of 6644 resident-performed cataract surgeries showed that 54 eyes (0.85%) of 54 patients required a return to the operating room within 30 days. The reoperation rate was higher in the first half of the academic year (1.18%) than in the second half (0.55%) (P = .004). The mean CDVA 1 year postoperatively was 20/40, with a loss of lines of vision in 4 eyes. The mean operative time was 59.23 minutes ± 35.05 (SD). A longer intraoperative time was predictive of a worse visual outcome (P < .01). Despite the need for reoperation within 30 days, most patients achieved improved visual acuity. The reoperation rate was significantly lower in the second half of the academic year. Increased operation times correlated with worse visual acuity independent of other variables. Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  11. Burnout and Stress Among US Surgery Residents: Psychological Distress and Resilience.

    Science.gov (United States)

    Lebares, Carter C; Guvva, Ekaterina V; Ascher, Nancy L; O'Sullivan, Patricia S; Harris, Hobart W; Epel, Elissa S

    2017-10-26

    Burnout among physicians affects mental health, performance, and patient outcomes. Surgery residency is a high-risk time for burnout. We examined burnout and the psychological characteristics that can contribute to burnout vulnerability and resilience in a group of surgical trainees. An online survey was distributed in September 2016 to all ACGME-accredited general surgery programs. Burnout was assessed with an abbreviated Maslach Burnout Inventory. Stress, anxiety, depression, resilience, mindfulness, and alcohol use were assessed and analyzed for prevalence. Odds ratios (ORs) were used to determine the magnitude of presumed risk and resilience factors. Among 566 surgical residents who participated in the survey, prevalence of burnout was 69%, equally driven by emotional exhaustion and depersonalization. Perceived stress and distress symptoms (depression, suicidal ideation, and anxiety) were notably high across training levels, but improved during lab years. Higher burnout was associated with high stress (OR 7.8; p burnout (OR 0.24; p stress (OR 0.15; p burnout, severe stress, and distress symptoms are experienced throughout general surgery training, with some improvement during lab years. In this cross-sectional study, trainees with burnout and high stress were at increased risk for depression and suicidal ideation. Higher dispositional mindfulness was associated with lower risk of burnout, severe stress, and distress symptoms, supporting the potential of mindfulness training to promote resilience during surgery residency. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  12. Laparoscopic skill laboratory in urological surgery: tools and methods for resident training

    Directory of Open Access Journals (Sweden)

    Fabio C. M. Torricelli

    2011-02-01

    Full Text Available PURPOSE: Laparoscopy has certainly brought considerable benefits to patients, but laparoscopic surgery requires a set of skills different from open surgery, and learning in the operating room may increase surgical time, and even may be harmful to patients. Several training programs have been developed to decrease these potential prejudices. PURPOSES: to describe the laparoscopic training program for urological residents of the "Hospital das Clinicas" of the Sao Paulo Medical School, to report urological procedures that are feasible in dry and wet labs, and to perform a critical analysis of the cost-benefit relation of advanced laparoscopic skills laboratory. MATERIALS AND METHODS: The laparoscopic skill lab has two virtual simulators, three manual simulators, and four laparoscopic sets for study with a porcine model. The urology residents during their first year attend classes in the virtual and manual simulator and helps the senior urological resident in activities carried out with the laparoscopic sets. During the second year, the urological resident has six periods per week, each period lasting four hours, to perform laparoscopic procedures with a porcine model. Results: In a training program of ten weeks, one urological resident performs an average of 120 urological procedures. The most common procedures are total nephrectomy (30%, bladder suture (30%, partial nephrectomy (10%, pyeloplasty (10%, ureteral replacement or transuretero anastomosis (10%, and others like adrenalectomy, prostatectomy, and retroperitoneoscopy. These procedures are much quicker and caused less morbidity. CONCLUSION: Laparoscopic skills laboratory is a good method for achieving technical ability.

  13. Assessing residents' operative skills for external ventricular drain placement and shunt surgery in pediatric neurosurgery.

    Science.gov (United States)

    Aldave, Guillermo; Hansen, Daniel; Briceño, Valentina; Luerssen, Thomas G; Jea, Andrew

    2017-04-01

    OBJECTIVE The authors previously demonstrated the use of a validated Objective Structured Assessment of Technical Skills (OSATS) tool for evaluating residents' operative skills in pediatric neurosurgery. However, no benchmarks have been established for specific pediatric procedures despite an increased need for meaningful assessments that can either allow for early intervention for underperforming trainees or allow for proficient residents to progress to conducting operations independently with more passive supervision. This validated methodology and tool for assessment of operative skills for common pediatric neurosurgical procedures-external ventricular drain (EVD) placement and shunt surgery- was applied to establish its procedure-based feasibility and reliability, and to document the effect of repetition on achieving surgical skill proficiency in pediatric EVD placement and shunt surgery. METHODS A procedure-based technical skills assessment for EVD placements and shunt surgeries in pediatric neurosurgery was established through the use of task analysis. The authors enrolled all residents from 3 training programs (Baylor College of Medicine, Houston Methodist Hospital, and University of Texas-Medical Branch) who rotated through pediatric neurosurgery at Texas Children's Hospital over a 26-month period. For each EVD placement or shunt procedure performed with a resident, the faculty and resident (for self-assessment) completed an evaluation form (OSATS) based on a 5-point Likert scale with 7 categories. Data forms were then grouped according to faculty versus resident (self) assessment, length of pediatric neurosurgery rotation, postgraduate year level, and date of evaluation ("beginning of rotation," within 1 month of start date; "end of rotation," within 1 month of completion date; or "middle of rotation"). Descriptive statistical analyses were performed with the commercially available SPSS statistical software package. A p value pediatric procedures. The

  14. Are oral and maxillofacial surgery residents being adequately trained to care for pediatric patients?

    Science.gov (United States)

    Abramowicz, Shelly; Kaban, Leonard B; Wurtzel, Andrew S; Roser, Steven M

    2017-09-01

    To evaluate whether current oral and maxillofacial surgery (OMS) residents are receiving adequate training and experience to perform specific surgical procedures and anesthesia for pediatric patients. A 17-question survey was sent electronically to fellows of the American Academy of Craniomaxillofacial Surgeons. Descriptive data for individual surgeons, their associated residency programs, and the quantity of specific pediatric procedures they performed were collected. Resident case load for inpatient and outpatient procedures and overall experience in medical, surgical, and anesthetic management of pediatric OMS patients were explored. Surveys were sent to 110 active fellows; 64 completed the questionnaire (58%). There were 59 male fellows and 5 female fellows, with a mean age of 50.4 years. Of those, 68.8% practice in an academic setting. Specifically, 93.8% take after-hours emergency calls covering adult and pediatric patients and 98.4% have admitting privileges at a children's hospital or a pediatric unit in an adult hospital. Their affiliated residency programs include required rotations in pediatrics or pediatric subspecialties. In their opinion, >90% of graduating OMS residents have the appropriate skill set to perform dentoalveolar procedures, outpatient anesthesia, orthognathic procedures, and alveolar bone grafts. However, residents have limited ability to reconstruct pediatric ramus-condyle unit with a costochondral graft. Results of this study indicate that, in the opinion of the respondents, graduates of OMS residency programs have adequate training to perform dentoalveolar procedures, outpatient anesthesia, orthognathic surgery, and alveolar bone grafts in pediatric procedures, but have limited experience with reconstruction of pediatric ramus-condyle unit via costochondral graft. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Effect of the Veterans Affairs Medical System on plastic surgery residency training.

    Science.gov (United States)

    Ravin, Adam G; Gottlieb, Neil B; Wang, Howard T; Meade, Ricardo A; Humphrey, J Stewart; Schwarz, Karl W; Levin, L Scott; Tyler, Douglas S; Erdmann, Detlev

    2006-02-01

    Teaching hospitals within the Veterans Affairs Health System perform the majority of complex and high-risk surgical procedures in the veteran patient population. Residency positions in the Veterans Affairs Medical System are usually part of a rotational educational system within a university-based residency, and plastic surgeons in training are a major work force and health care provider. The purpose of this study was to evaluate the current effect of the Veterans Affairs Medical System on plastic surgery residency training. A 6-year (January of 1998 to December of 2003) review was performed of procedures completed at the Durham Veterans Affairs Medical Center, Section of Plastic Surgery. Procedures were divided into the following categories: extremities and trunk; breast and cosmetic; head and neck, including excision of skin lesions; hand surgery; craniomaxillofacial surgery; and other. Only procedures performed in the main operating room were reviewed and analyzed. In addition, a detailed review was performed of major head and neck reconstructions with free tissue transfer. A total of 1655 operative procedures were performed in 1290 patients. The ratio of men to women was 6:1 (1112 men and 178 women). Patients ranged in age from 26 to 97 years (average age, 62.7 years). Procedures in the extremities and trunk (n = 193, 11.7 percent), breast and cosmetic (n = 228, 13.8 percent), hand surgery (n = 155, 9.4 percent), and other (n = 275, 16.6 percent) categories were comparably distributed. Although the head and neck category accounted for the highest number of procedures (n = 766, 46.3 percent), the majority of these procedures were simple excisions of skin tumors (n = 612). There were significantly fewer major craniomaxillofacial cases (n = 38, 2.3 percent). Data from the retrospective analysis reveal that a broad spectrum of plastic surgical procedures is performed within the Veterans Affairs Health System, serving as a tremendous resource for resident training

  16. Outpatient surgery centers draw cases away from hospitals, impact resident training volume.

    Science.gov (United States)

    Dunning, Kyle; Liedtke, Eric; Toedter, Lori; Rohatgi, Chand

    2008-01-01

    Across the United States, ambulatory surgery centers (ASCs) are increasing in both number and surgical volume. This trend has been the focus of debate regarding reimbursement and patient safety, as well as surgical productivity and efficiency. However, the impact on surgical resident training caused by this shift toward outpatient surgery in nonhospital settings has not been studied. We reviewed data reported by our hospital and by local surgery centers as well as the case logs of the surgical residents at our institution to determine whether a negative effect on resident case volume has occurred. We conducted a retrospective review of our PGY-1 through PGY-3 level surgical residents' case logs for 3 consecutive academic years, from July 2004 through June 2007. We evaluated a group of common outpatient procedures that are now also being performed in stand-alone surgical centers in our area, such as breast biopsies, incision and drainage, hernia repair, colonoscopy, and esophagogastroduodenoscopy (EGD). The data were tallied by academic year and compared over time. In addition, we analyzed data reported to state agencies by our hospital and local surgery centers over the last 6 calendar years for any trends in case volume. By evaluating 2 different independent data sets for the same endpoint, we could evaluate our hypothesis twice. When evaluating state-reported data for the defined cases, a significant decrease was observed in the total number of cases performed at Easton Hospital, Easton, Pennsylvania, each year between 2003 and 2006 (p hernia (p = 0.04), excision of skin lesion (p = 0.0022), and incision/drainage (p outpatient surgery experience from procedures performed at our home institution. With the recent surge of stand-alone surgical centers, many outpatient procedures are being performed outside of the hospital in centers where our residents do not rotate. Although current residents in our program are performing enough cases to fulfill the ACGME required

  17. The Hidden Ethics Curriculum in Two Canadian Psychiatry Residency Programs: A Qualitative Study.

    Science.gov (United States)

    Gupta, Mona; Forlini, Cynthia; Lenton, Keith; Duchen, Raquel; Lohfeld, Lynne

    2016-08-01

    The authors describe the hidden ethics curriculum in two postgraduate psychiatry programs. Researchers investigated the formal, informal, and hidden ethics curricula at two demographically different postgraduate psychiatry programs in Canada. Using a case study design, they compared three sources: individual interviews with residents and with faculty and a semi-structured review of program documents. They identified the formal, informal, and hidden curricula at each program for six ethics topics and grouped the topics under two thematic areas. They tested the applicability of the themes against the specific examples under each topic. Results pertaining to one of the themes and its three topics are reported here. Divergences occurred between the curricula for each topic. The nature of these divergences differed according to local program characteristics. Yet, in both programs, choices for action in ethically challenging situations were mediated by a minimum standard of ethics that led individuals to avoid trouble even if this meant their behavior fell short of the accepted ideal. Effective ethics education in postgraduate psychiatry training will require addressing the hidden curriculum. In addition to profession-wide efforts to articulate high-level values, program-specific action on locally relevant issues constitutes a necessary mechanism for handling the impact of the hidden curriculum.

  18. General surgery morning report: a competency-based conference that enhances patient care and resident education.

    Science.gov (United States)

    Stiles, Brendon M; Reece, T Brett; Hedrick, Traci L; Garwood, Robert A; Hughes, Michael G; Dubose, Joseph J; Adams, Reid B; Schirmer, Bruce D; Sanfey, Hilary A; Sawyer, Robert G

    2006-01-01

    After adopting a night float system, the residency program at the University of Virginia Health System Department of Surgery initiated a daily morning report (MR). The conference was originated to sign out new admissions and consults from the previous day to the services that would assume care. Although initially oriented toward transfer of patient information, MR is also hypothesized to serve as a competency-based resident education tool. An anonymous survey was distributed to on-service residents (n = 25). Questions were asked on a 5-point Likert scale. Respondents also ranked the weekly conferences, including MR, in terms of educational benefit derived. Most residents agreed that MR is an efficient method to sign-out patient care [84% stongly agree (SA) or agree (A)] and that it provides an excellent educational experience (88% SA or A). They agreed that it is presented in an evidence-based format (88% SA or A). Regarding the core competencies, residents all asserted that MR addresses "patient care" (100% SA or A) and "medical knowledge" (100% SA or A). Most agreed that it addresses "professionalism" (60% SA or A), "interpersonal skills and communication" (76% SA or A), and "practice-based learning and improvement" (92% SA or A). The 4 most important components identified with respect to continuing to improve both patient care and resident education were the presence of the on-call attending, a review of relevant radiology, provision of follow-up on select cases, and critical review of the literature. On average, MR was seen as the most educational conference, with 52% of residents ranking it first. Although MR is ubiquitous in most primary care residency programs, such a conference has not typically been held on surgical services. The MR was developed at the University of Virginia Health System Department of Surgery as a necessity for patient sign-out. As this conference has continued to evolve, it has become an excellent tool for resident education. It now

  19. Observation, reflection, and reinforcement: surgery faculty members' and residents' perceptions of how they learned professionalism.

    Science.gov (United States)

    Park, Jason; Woodrow, Sarah I; Reznick, Richard K; Beales, Jennifer; MacRae, Helen M

    2010-01-01

    To explore perceptions of how professionalism is learned in the current academic environment. Professionalism is a core competency in surgery (as in all of medical practice), and its presence or absence affects all aspects of clinical education and practice, but the ways in which professional values and attitudes are best transmitted to developing generations of surgeons have not been well defined. The authors conducted 34 semistructured interviews of individual surgery residents and faculty members at two academic institutions from 2004 to 2006. Interviews consisted of open-ended questions on how the participants learned professionalism and what they perceived as challenges to learning professionalism. Two researchers analyzed the interview transcripts for emergent themes by using a grounded-theory approach. Faculty members' and residents' perceptions of how they learned professionalism reflected four major themes: (1) personal values and upbringing, including premedical education experiences, (2) learning by example from professional role models, (3) the structure of the surgery residency, and (4) formal instruction on professionalism. Of these, role modeling was the dominant theme: Participants identified observation, reflection, and reinforcement as playing key roles in their learning from role models and in distinguishing the sometimes blurred boundary between positive and negative role models. The theoretical framework generated out of this study proposes a focus on specific activities to improve professional education, including an active approach to role modeling through the intentional and explicit demonstration of professional behavior during the course of everyday work; structured, reflective self-examination; and timely and meaningful evaluation and feedback for reinforcement.

  20. Validation of a Web-Based Curriculum for Resident Education in Orthopedic Surgery.

    Science.gov (United States)

    Boody, Barrett; Johnson, Patrick; Pugely, Andrew; Miller, Daniel; Geller, Jeffrey; Payne, William; Boegener, James; Schafer, Michael; Beal, Matthew

    The Orthopedic In-Training Examination is an annual standardized examination with multiple-choice questions focused on application of orthopedic surgery core knowledge and principles. The outcome of this test can be used to both predict how residents are progressing in their orthopedic knowledge as well as assess their likelihood to pass the Orthopedic Board Examinations, that is the American Boards of Orthopedic Surgery Part 1, following completion of residency. Preparation for the examination can be difficult, as residents commonly have limited study time to review the vast amounts of available published literature. The objective of our study is to evaluate the effectiveness of the Orthopaedic In Training Examination (OITE) scores and the participants' perceived utility of the curriculum for OITE preparation. Residents from 5 US Orthopedic residencies (4 M.D. and 1 D.O.) were included in a pilot program of the Orthobullets PASS curriculum in the academic year 2013 to 2014. Only residents enrolled in the PASS curriculum who completed both the 2013 and 2014 OITEs were included in the final analysis (n = 71). We used the OITE 2013 and 2014 rank postgraduate year (RPGY) reported scores to assess for efficacy of the PASS curriculum, as the RPGY score provides postgraduate year-of-training matched analysis to control for expected increased levels of knowledge with subsequent retesting. While OITE scores incrementally increased for the group as a whole (n = 71, RPGY mean improvement = +2.5%, p = 0.406), the junior resident subgroup (postgraduate year 1-2) produced a statistically significant increase in scores (n = 28, RPGY mean increase = 10.1%, p = 0.0260). Nearly 90% (38/42) of curriculum participants surveyed reported a preference to complete a similar review curriculum for future OITE preparation. The participants completing greater than 150 PASS questions (n = 57) were analyzed for OITE predictive capacity of the PASS curriculum. Pearson analysis with PASS

  1. Reliability of Casting Indices Among Members of an Orthopaedic Surgery Residency.

    Science.gov (United States)

    Williams, Nathan D; Rush, Jeremy K; Schmitz, Matthew R; Johnson, Anthony E

    2017-06-01

    Multiple casting indices have been described to evaluate the adequacy of cast placement in pediatric distal forearm fractures. The aim of this study was to determine the intrarater and interrater reliability of the measurements of 5 common casting indices among members of an orthopaedic surgery residency program. The cast index, 3-point index, gap index, padding index, and Canterbury index were evaluated. This was a single-center prospective cohort reliability study that included 12 members of an orthopaedic surgery residency. Participants were placed into 1 of 4 groups by level of training: physician assistants, junior residents, senior residents, and attending orthopaedic surgeons. Twelve radiographs of casted pediatric distal forearm fractures were measured by each participant on 2 separate occasions. Statistical analysis using the intraclass correlation coefficient was used to determine the intrarater and interrater reliability. The cast index was the only casting index to meet our criteria for good intrarater and interrater reliability. Continued use of the cast index as a tool to assess pediatric distal forearm cast application is supported by this study. Level 2.

  2. Microsurgery Case Volume During Orthopedic Surgery Residency: A 7-Year Assessment.

    Science.gov (United States)

    Hinds, Richard M; Klifto, Christopher S; Guss, Michael S; Capo, John T

    2017-11-01

    Microsurgery is a specialized surgical technique with wide clinical application. The purpose of this study was to analyze case logs of graduating orthopedic surgery residents to assess trends in case volume for microsurgery procedures. Accreditation Council for Graduate Medical Education case log reports were analyzed for microsurgery experience from 2007 to 2013. The mean number of adult, pediatric, and total microsurgery cases was noted. In addition, the median number of microsurgery procedures performed by the 90th, 50th, and 10th percentiles of residents (by case volume) was recorded. Temporal changes in case volume were calculated utilizing linear regression analyses. The proportion of microsurgery procedures increased significantly (1.3% to 2%; P = .024). The mean number of adult (24.5 to 41.9; P = .01), pediatric (1.9 to 3.4; P = .011), and total (26.3 to 45.3; P = .01) microsurgery procedures also increased significantly. Similarly, residents in both the 90th (63 to 109; P = .01) and 50th (10 to 21; P = .036) percentiles sustained significant increases in the median number of microsurgery procedures. No change was noted for residents in 10th percentile (0 to 0; P > .999). Graduating residents in the 90th percentile performed over 6 times more microsurgery procedures than residents in the 50th percentile. Microsurgical caseload is increasing among graduating orthopedic residents. However, there is substantial variability in resident microsurgery case volume. Future investigations are needed to explore the educational implications of these findings and should seek to correlate microsurgical caseload with competency.

  3. Lean principles optimize on-time vascular surgery operating room starts and decrease resident work hours.

    Science.gov (United States)

    Warner, Courtney J; Walsh, Daniel B; Horvath, Alexander J; Walsh, Teri R; Herrick, Daniel P; Prentiss, Steven J; Powell, Richard J

    2013-11-01

    Lean process improvement techniques are used in industry to improve efficiency and quality while controlling costs. These techniques are less commonly applied in health care. This study assessed the effectiveness of Lean principles on first case on-time operating room starts and quantified effects on resident work hours. Standard process improvement techniques (DMAIC methodology: define, measure, analyze, improve, control) were used to identify causes of delayed vascular surgery first case starts. Value stream maps and process flow diagrams were created. Process data were analyzed with Pareto and control charts. High-yield changes were identified and simulated in computer and live settings prior to implementation. The primary outcome measure was the proportion of on-time first case starts; secondary outcomes included hospital costs, resident rounding time, and work hours. Data were compared with existing benchmarks. Prior to implementation, 39% of first cases started on time. Process mapping identified late resident arrival in preoperative holding as a cause of delayed first case starts. Resident rounding process inefficiencies were identified and changed through the use of checklists, standardization, and elimination of nonvalue-added activity. Following implementation of process improvements, first case on-time starts improved to 71% at 6 weeks (P = .002). Improvement was sustained with an 86% on-time rate at 1 year (P < .001). Resident rounding time was reduced by 33% (from 70 to 47 minutes). At 9 weeks following implementation, these changes generated an opportunity cost potential of $12,582. Use of Lean principles allowed rapid identification and implementation of perioperative process changes that improved efficiency and resulted in significant cost savings. This improvement was sustained at 1 year. Downstream effects included improved resident efficiency with decreased work hours. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All

  4. Impact of Integrated Vascular Residencies on Academic Productivity within Vascular Surgery Divisions.

    Science.gov (United States)

    Kim, Bradford J; Valsangkar, Nakul P; Liang, Tiffany W; Murphy, Michael P; Zimmers, Teresa A; Bell, Teresa M; Davies, Mark G; Koniaris, Leonidas G

    2017-02-01

    Changing training paradigms in vascular surgery have been introduced to reduce overall training time. Herein, we sought to examine how shortened training for vascular surgeons may have influenced overall divisional academic productivity. Faculty from the top 55 surgery departments were identified according to National Institutes of Health (NIH) funding. Academic metrics of 315 vascular surgery, 1,132 general surgery, and 2,403 other surgical specialties faculty were examined using institutional Web sites, Scopus, and NIH Research Portfolio Online Reporting Tools from September 1, 2014, to January 31, 2015. Individual-level and aggregate numbers of publications, citations, and NIH funding were determined. The mean size of the vascular divisions was 5 faculty. There was no correlation between department size and academic productivity of individual faculty members (R(2) = 0.68, P = 0.2). Overall percentage of vascular surgery faculty with current or former NIH funding was 20%, of which 10.8% had major NIH grants (R01/U01/P01). Vascular surgery faculty associated with integrated vascular training programs demonstrated significantly greater academic productivity. Publications and citations were higher for vascular surgery faculty from institutions with both integrated and traditional training programs (48 of 1,051) compared to those from programs with integrated training alone (37 of 485) or traditional fellowships alone (26 of 439; P productivity was improved within vascular surgery divisions with integrated training programs or both program types. These data suggest that the earlier specialization of integrated residencies in addition to increasing dedicated vascular training time may actually help promote research within the field of vascular surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Age, gender, lateral dominance, and prediction of operative skill among general surgery residents.

    Science.gov (United States)

    Schueneman, A L; Pickleman, J; Freeark, R J

    1985-09-01

    Ability patterns and surgical proficiency were examined in matched groups of general surgery residents selected on the basis of age, gender, or hand preference from a population of 141 residents who had completed neuropsychologic tests of visuospatial, psychomotor, and stress tolerance abilities and had been rated on 12 aspects of technical skill exhibited during 1480 operative procedures. Older residents (ages 28 to 42 years) exhibited less motor speed (p less than 0.05) and coordination (p less than 0.005) and more caution in avoiding psychomotor errors (p less than 0.05) than did their younger counterparts. No differences were found for visuospatial abilities, stress tolerance, or rated surgical skill. These findings indicate that although age does appear to adversely affect pure motor skills, these are not important components of operative proficiency. Female residents exhibited superior (p less than 0.05) academic achievement (MCAT, Verbal and National Boards Part II) as compared with their male counterparts. They also excelled on a signal detection task requiring identification of visual patterns. However, the women scored less well (p less than 0.05) than men on a visuomotor task demonstrated to be a significant predictor of operative skill. Greater cautiousness in avoiding errors may be a contributing factor to their reduced efficiency on this task. In comparison to male controls, female residents received consistently lower surgical skills ratings, particularly on items measuring confidence and task organization. Left-handed residents were more reactive to stress (p less than 0.03), more cautious (p less than 0.04), and more proficient on a neuropsychologic test of tactile-spatial abilities (p less than 0.03) than right-handed counterparts. Although these traits correlated positively (p less than 0.05) with rated operative skill within the left-handed group, the group received consistently lower ratings than did right-handed residents. The inconvenience of

  6. The Learning Preferences of Applicants Who Interview for General Surgery Residency: A Multiinstitutional Study.

    Science.gov (United States)

    Kim, Roger H; Kurtzman, Scott H; Collier, Ashley N; Shabahang, Mohsen M

    Learning styles theory posits that learners have distinct preferences for how they assimilate new information. The VARK model categorizes learners based on combinations of 4 learning preferences: visual (V), aural (A), read/write (R), and kinesthetic (K). A previous single institution study demonstrated that the VARK preferences of applicants who interview for general surgery residency are different from that of the general population and that learning preferences were associated with performance on standardized tests. This multiinstitutional study was conducted to determine the distribution of VARK preferences among interviewees for general surgery residency and the effect of those preferences on United States Medical Licensing Examination (USMLE) scores. The VARK learning inventory was administered to applicants who interviewed at 3 general surgery programs during the 2014 to 2015 academic year. The distribution of VARK learning preferences among interviewees was compared with that of the general population of VARK respondents. Performance on USMLE Step 1 and Step 2 Clinical Knowledge was analyzed for associations with VARK learning preferences. Chi-square, analysis of variance, and Dunnett's test were used for statistical analysis, with p VARK inventory was completed by a total of 140 residency interviewees. Sixty-four percent of participants were male, and 41% were unimodal, having a preference for a single learning modality. The distribution of VARK preferences of interviewees was different than that of the general population (p = 0.02). By analysis of variance, there were no overall differences in USMLE Step 1 and Step 2 Clinical Knowledge scores by VARK preference (p = 0.06 and 0.21, respectively). However, multiple comparison analysis using Dunnett's test revealed that interviewees with R preferences had significantly higher scores than those with multimodal preferences on USMLE Step 1 (239 vs. 222, p = 0.02). Applicants who interview for general surgery

  7. Comparison of Internal Medicine and General Surgery Residents' Assessments of Risk of Postsurgical Complications in Surgically Complex Patients.

    Science.gov (United States)

    Healy, James M; Davis, Kimberly A; Pei, Kevin Y

    2017-10-11

    Anticipating postsurgical complications is a vital physician skill, particularly when counseling surgically complex patients on their risks of intervention. Although internists and surgeons both counsel patients on surgical risks, it is uncertain who is better equipped to accurately anticipate surgical complications. To examine how internal medicine and general surgery trainees compare in their assessment of risk of surgically complex patients. General surgery and internal medicine residents (urban, tertiary, and academic medical center) answered an anonymous, online assessment of 7 real-life, complex clinical scenarios. Participants estimated the chance of any morbidity, mortality, surgical site infection, pneumonia, and cardiac complications. Scenarios represented a diverse general surgery practice, including colectomy, duodenal ulcer repair, inguinal hernia repair, perforated viscus exploration, small-bowel resection, cholecystectomy, and mastectomy in surgically complex patients likely to be comanaged by surgical and internal medicine services. Responses were compared with risk-adjusted outcomes reported by the American College of Surgeons' National Surgical Quality Improvement Project (NSQIP) online calculator. A total of 76 general surgery residents (50 [65.8%] male and 26 [34.2%] female) and 76 internal medicine residents (36 [47.4%] male and 40 [52.6%] female) participated (64% overall response rate). General surgery residents were significantly more confident with their responses (general surgery residents' mean response, 3.6 [95% CI, 3.4-2.8]; internal medicine residents' mean response, 2.8 [95% CI, 2.6-3.0]; P surgery residents' mean response, 4.3 [95% CI, 4.1-4.4]; internal medicine residents' mean response, 3.7 [95% CI, 3.4-3.9]; P = .006) but less likely to discuss code status (general surgery residents' mean response, 3.2 [95% CI, 2.9-3.4]; internal medicine residents' mean response, 3.8 [95% CI, 3.5-4.1]; P surgery residents' mean response

  8. Impact of family and gender on career goals: results of a national survey of 4586 surgery residents.

    Science.gov (United States)

    Viola, Kate V; Bucholz, Emily; Yeo, Heather; Piper, Crystal L; Piper, Crystal; Bell, Richard H; Sosa, Julie Ann

    2010-05-01

    To determine how marriage, children, and gender influence US categorical general surgery residents' perceptions of their profession and motivations for specialty training. Cross-sectional national survey administered after the January 2008 American Board of Surgery In-service Training Examination. Two hundred forty-eight US general surgery residency programs. All US categorical general surgery residents. We evaluated demographic characteristics with respect to survey responses using the chi(2) test, analysis of variance, and multivariate logistic regression. Interaction terms between variables were assessed. Perceptions of respondents regarding the future of general surgery and the role of specialty training in relation to anticipated income and lifestyle. The survey response rate was 75.0% (4586 respondents). Mean age was 30.6 years; 31.7% were women, 51.3% were married, and 25.4% had children. Of the respondents, 28.7% believed general surgery is becoming obsolete (30.1% of men and 25.9% of women; P = .004), and 55.1% believed specialty training is necessary for success (56.4% of men and 52.7% of women; P = .02). Single residents and residents without children were more likely to plan for fellowship (59.1% single vs 51.9% married, P single or had no children tended to identify lifestyle rather than income as a motivator for specialty training. Marital status, children, and gender appear to have a powerful effect on general surgery residents' career planning.

  9. Improving Communication Skills: A Course for Academic Medical Center Surgery Residents and Faculty.

    Science.gov (United States)

    Raper, Steven E; Gupta, Meera; Okusanya, Olugbenga; Morris, Jon B

    2015-01-01

    To improve physician/patient communication and familiarize surgeons with contemporary skills for and metrics assessing communication, courses were developed to provide academic general surgery residents and faculty with a toolkit of information, behaviors, and specific techniques. If academic faculty are expected to mentor residents in communication and residents are expected to learn good communication skills, then both should have the necessary education to accomplish such a goal. Didactic lectures introduced current concepts of physician-patient communication including information on better patient care, fewer malpractice suits, and the move toward transparency of communication metrics. Next, course participants viewed and critiqued "Surgi-Drama" videos, with actors simulating "before" and "after" physician-patient communication scenarios. Finally, participants were provided with a "toolkit" of techniques for improving physician-patient communication including "2-3-4"-a semiscripted short communication tool residents and other physicians can use in patient encounters-and a number of other acronymic approaches. Each participant was asked to complete an anonymous evaluation to assess course content satisfaction. Overall, 86% of residents participated (68/79), with a 52% response rate (35/68) for the evaluation tool. Overall, 88% of faculty participated (84/96), with an 84% response rate (71/84). Residents voiced satisfaction with all domains. For faculty, satisfaction was quantitatively confirmed (Likert score 4 or 5) in 4 of 7 domains, with the highest satisfaction in "communication of goals" and "understanding of the HCAHPS metric." The percentage of "top box" Doctor Communication Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores and national percentile ranking showed a sustained increase more than 1 and 2 years from the dates of the courses. The assessment of communication skills is increasing in importance in the practice of

  10. Is your graduating general surgery resident qualified to take trauma call? A 15-year appraisal of the changes in general surgery education for trauma.

    Science.gov (United States)

    Strumwasser, Aaron; Grabo, Daniel; Inaba, Kenji; Matsushima, Kazuhide; Clark, Damon; Benjamin, Elizabeth; Lam, Lydia; Demetriades, Demetrios

    2017-03-01

    Trauma training in general surgery residency is undergoing an evolution. Hour restrictions, the growth of subspecialty care, and the trend toward nonoperative management have altered resident exposure to operative trauma. We sought to identify trends in resident trauma training since the inception of the 80-hour workweek. The Accreditation Council for General Medical Education Case Log Statistical Reports for Surgery was abstracted for general surgery resident trauma operative volume for the years 1999-2014. Resident trauma experience (operative caseload [OC]) was compared before inception of the 80-hour workweek (1999-2002) to after the 80-hour workweek began (2003 to current). A trend toward decreased operative trauma for general surgery residents was observed (mean OC [before 80-hour workweek vs. 80-hour workweek], 39,252 ± 1,065.2 cases vs. 36,065 ± 1,291.8; p = 0.06). Trauma laparotomies increased (range, 5,446-9,364 cases) with corresponding decreases in vascular trauma (4,704 to 799 cases), neck explorations (1,876 to 1,370 cases), and thoracotomies (2,507 to 2,284 cases). By comparison, an increase in vascular/integrated cases was noted (mean OC [before 80-hour workweek vs. 80-hour workweek], 845 ± 44.2 vs. 1,465 ± 88.4 cases; p surgery (p surgery.

  11. Does general surgery residency prepare surgeons for community practice in British Columbia?

    Science.gov (United States)

    Hwang, Hamish

    2009-01-01

    Background Preparing surgeons for clinical practice is a challenging task for postgraduate training programs across Canada. The purpose of this study was to examine whether a single surgeon entering practice was adequately prepared by comparing the type and volume of surgical procedures experienced in the last 3 years of training with that in the first year of clinical practice. Methods During the last 3 years of general surgery training, I logged all procedures. In practice, the Medical Services Plan (MSP) of British Columbia tracks all procedures. Using MSP remittance reports, I compiled the procedures performed in my first year of practice. I totaled the number of procedures and broke them down into categories (general, colorectal, laparoscopic, endoscopic, hepatobiliary, oncologic, pediatric, thoracic, vascular and other). I then compared residency training with community practice. Results I logged a total of 1170 procedures in the last 3 years of residency. Of these, 452 were performed during community rotations. The procedures during residency could be broken down as follows: 392 general, 18 colorectal, 242 laparoscopic, 103 endoscopic, 85 hepatobiliary, 142 oncologic, 1 pediatric, 78 thoracic, 92 vascular and 17 other. I performed a total of 1440 procedures in the first year of practice. In practice the break down was 398 general, 15 colorectal, 101 laparoscopic, 654 endoscopic, 2 hepatobiliary, 77 oncologic, 10 pediatric, 0 thoracic, 70 vascular and 113 other. Conclusion On the whole, residency provided excellent preparation for clinical practice based on my experience. Areas of potential improvement included endoscopy, pediatric surgery and “other,” which comprised mostly hand surgery. PMID:19503663

  12. Impact of podiatry resident experience level in hallux valgus surgery on postoperative outcomes.

    Science.gov (United States)

    Fleischer, Adam E; Yorath, Martin C; Joseph, Robert M; Baron, Adam; Nordquist, Thomas; Moore, Braden J; Robinson, Richmond C O; Reilly, Charles H

    2014-06-15

    Despite modern advancements in transosseous fixation and operative technique, hallux valgus (i.e., bunion) surgery is still associated with a higher than usual amount of patient dissatisfaction and is generally recognized as a complex and nuanced procedure requiring precise osseous and capsulotendon balancing. It stands to reason then that familiarity and skill level of trainee surgeons might impact surgical outcomes in this surgery. The aim of this study was to determine whether podiatry resident experience level influences midterm outcomes in hallux valgus surgery (HVS). Consecutive adults who underwent isolated HVS via distal metatarsal osteotomy at a single US metropolitan teaching hospital from January 2004 to January 2009 were contacted and asked to complete a validated outcome measure of foot health (Manchester-Oxford Foot Questionnaire) regarding their operated foot. Resident experience level was quantified using the surgical logs for the primary resident of record at the time of each case. Associations were assessed using linear and logistic regression analyses. A total of 102 adult patients (n = 102 feet) agreed to participate with a mean age of 46.8 years (standard deviation 13.1, range 18-71) and average length of follow-up 6.2 y (standard deviation 1.4, range 3.6-8.6). Level of trainee experience was not associated with postoperative outcomes in either the univariate (odds ratio 0.99 [95% confidence interval, 0.98-1.01], P = 0.827) or multivariate analyses (odds ratio 1.00 [95% confidence interval, 0.97-1.02], P = 0.907). We conclude that podiatry resident level of experience in HVS does not contribute appreciably to postoperative clinical outcomes. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. National trends in minimally invasive and open operative experience of graduating general surgery residents: implications for surgical skills curricula development?

    Science.gov (United States)

    Carson, Jeffrey S; Smith, Lynette; Are, Madhuri; Edney, James; Azarow, Kenneth; Mercer, David W; Thompson, Jon S; Are, Chandrakanth

    2011-12-01

    The aim of this study was to analyze national trends in minimally invasive and open cases of all graduating residents in general surgery. A retrospective analysis was performed on data obtained from Accreditation Council for Graduate Medical Education logs (1999-2008) of graduating residents from all US general surgery residency programs. Data were analyzed using Mantel-Haenszel χ(2) tests and the Bonferroni adjustment to detect trends in the number of minimally invasive and open cases. Minimally invasive procedures accounted for an increasing proportion of cases performed (3.7% to 11.1%, P pediatric surgery (P surgery residents in the United States are performing a greater number of minimally invasive and fewer open procedures for common surgical conditions. Copyright © 2011 Elsevier Inc. All rights reserved.

  14. History of the Oral and Maxillofacial Surgery Residency Program at Universidad el Bosque, Bogotá, Colombia.

    Science.gov (United States)

    Castro-Núñez, Jaime

    2012-01-01

    The formal training of oral and maxillofacial surgeons in Colombia started in 1958 at Hospital Sanjos6, thanks to the titanic work of Waldemar Wilhelm, a German-born surgeon who settled in BogotA in 1950. Today there are seven institutions in Colombia that offer residency programs in oral and maxillofacial surgery. The aim of this article is to describe the history of the Oral and Maxillofacial Surgery Residency Program at Universidad El Bosque in Bogota.

  15. Experience of General Surgery Residents in the Creation of Small Bowel and Colon Anastomoses.

    Science.gov (United States)

    Nemeth, Zoltan H; Lazar, Eric L; Paglinco, Samantha R; Hicks, Addison S; Lei, Jason; Barratt-Stopper, Patricia A; Rolandelli, Rolando H

    2016-01-01

    With the introduction of stapling devices (SDs), the proportion of hand-sewn (HS) intestinal anastomoses (IAs) has declined. As more IAs are constructed with SDs, there are fewer opportunities for general surgery residents (GSRs) to acquire the skills for HS techniques during their training. Data for this study were extracted from an existing database of all IAs performed at the Department of Surgery of the Morristown Medical Center since 2003. For the purposes of this study, a 5.5-year timeframe was used between July 2006 and 2011, which contained 1659 IA operations on adult patients with resident involvement. GSRs of the 5-year general surgery residency program were grouped by postgraduate year (PGY) for further analysis. The number of all IAs created by each resident during the 5-year training was 67.2 on average. Most of these operations were done in the last 2 years of the training: 45.1% of all IAs in PGY5 and 37.3% of all IAs in PGY4. Of all, 1659 IAs performed in the study period, 711 (42.9% of total) were done laparoscopically and 948 (57.1% of all IAs) were done as open operations. Laparoscopic operations had a proportionally higher rate of SD use when compared to open cases (90.9% vs 82.4%). On average, each resident constructed 9.4 HS IAs (13.98% of all IAs) and 57.8 SD IAs (86.02% of total). Out of all anastomoses, ostomy reversals (30.7%) had the highest percentage of HS suturing followed by right colectomies (27.5%), ileal pouch-anal anastomoses and total colectomies and proctocolectomies (23.3%), small bowel resection (17.0%), and left colectomies (5.5%). Regardless of the location of the operation, stapled and sutured anastomoses had similar outcomes measured by the rate of anastomotic leaks. Residents used significantly more SDs in the creation of anastomoses than HS suturing in the PGY3, PGY4, and PGY5 years. We also documented that attending surgeons who are older more often used HS suturing than their younger colleagues when creating IAs. The

  16. Cardiovascular Surgery Residency Program: Training Coronary Anastomosis Using the Arroyo Simulator and UNIFESP Models

    Directory of Open Access Journals (Sweden)

    Miguel Angel Maluf

    2015-10-01

    Full Text Available ABSTRACT OBJECTIVE: Engage the UNIFESP Cardiovascular Surgery residents in coronary anastomosis, assess their skills and certify results, using the Arroyo Anastomosis Simulator and UNIFESP surgical models. METHODS: First to 6th year residents attended a weekly program of technical training in coronary anastomosis, using 4 simulation models: 1. Arroyo simulator; 2. Dummy with a plastic heart; 3. Dummy with a bovine heart; and 4. Dummy with a beating pig heart. The assessment test was comprised of 10 items, using a scale from 1 to 5 points in each of them, creating a global score of 50 points maximum. RESULTS: The technical performance of the candidate showed improvement in all items, especially manual skill and technical progress, critical sense of the work performed, confidence in the procedure and reduction of the time needed to perform the anastomosis after 12 weeks practice. In response to the multiplicity of factors that currently influence the cardiovascular surgeon training, there have been combined efforts to reform the practices of surgical medical training. CONCLUSION: 1 - The four models of simulators offer a considerable contribution to the field of cardiovascular surgery, improving the skill and dexterity of the surgeon in training. 2 - Residents have shown interest in training and cooperate in the development of innovative procedures for surgical medical training in the art.

  17. Interim Analysis of a Prospective Multi-Institutional Study of Surgery Resident Experience with Flexibility in Surgical Training.

    Science.gov (United States)

    Cullinan, Darren R; Wise, Paul E; Delman, Keith A; Potts, John R; Awad, Michael M; Eberlein, Timothy J; Klingensmith, Mary E

    2018-01-05

    The Flexibility in Surgical Training (FIST) consortium project was designed to evaluate the feasibility and resident outcomes of optional subspecialty-focused training within general surgery residency training. After approval by the American Board of Surgery, R4 and R5 residents were permitted to customize up to 12 of the final 24 months of residency for early tracking into 1 of 9 subspecialty tracks. A prospective IRB-approved study was designed across 7 institutions to evaluate the impact of this option on operative experience, in-service exam (American Board of Surgery In-Training Examination [ABSITE]) and ACGME milestone performance, and resident and program director (PD) perceptions. The FIST residents were compared with chief residents before FIST initiation (controls) as well as residents during the study period who did not participate in FIST (no specialization track, NonS). From 2013 to 2017, 122 of 214 chief residents (57%) completed a FIST subspecialty track. There were no differences in median ABSITE scores between FIST, NonS residents, and controls. The ACGME milestones at the end of the R5 year favored the FIST residents in 13 of 16 milestones compared with NonS. Case logs demonstrated an increase in track-specific cases compared with NonS residents. Resident and PD surveys reported a generally favorable experience with FIST. In this prospective study, FIST is a feasible option in participating institutions. All FIST residents, regardless of track, met requirements for ABS Board eligibility, despite modifications to rotations and case experience. Future studies will assess the impact of FIST on ABS exam results and fellowship success. Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  18. Simulation-based assessment of anesthesiology residents' competence: development and implementation of the Canadian National Anesthesiology Simulation Curriculum (CanNASC).

    Science.gov (United States)

    Chiu, Michelle; Tarshis, Jordan; Antoniou, Andreas; Bosma, T Laine; Burjorjee, Jessica E; Cowie, Neil; Crooks, Simone; Doyle, Kate; Dubois, David; Everett, Tobias; Fisher, Rachel; Hayter, Megan; McKinnon, Genevieve; Noseworthy, Diana; O'Regan, Noel; Peachey, Greg; Robitaille, Arnaud; Sullivan, Michael; Tenenbein, Marshall; Tremblay, Marie-Helene

    2016-12-01

    The specialty of anesthesiology will soon adopt the Competence By Design (CBD) approach to residency education developed by the Royal College of Physicians and Surgeons of Canada (RCPSC). A foundational component of CBD is frequent and contextualized assessment of trainees. In 2013, the RCPSC Anesthesiology Specialty Committee assembled a group of simulation educators, representing each of the 17 Canadian anesthesiology residency programs, to form the Canadian National Anesthesiology Simulation Curriculum (CanNASC) Task Force. The goals were to develop, implement, and evaluate a set of consensus-driven standardized mannequin-based simulation scenarios that every trainee must complete satisfactorily prior to completion of anesthesiology residency and certification. Curriculum development followed Kern's principles and was accomplished via monthly teleconferences and annual face-to-face meetings. The development and implementation processes included the following key elements: 1) Curriculum needs assessment: 368 of 958 invitees (38.4%) responded to a national survey resulting in 64 suggested scenario topics. Use of a modified Delphi technique resulted in seven important and technically feasible scenarios. 2) Scenario development: All scenarios have learning objectives from the National Curriculum for Canadian Anesthesiology Residency. Standardized scenario templates were created, and the content was refined and piloted. 3) Assessment: A validated Global Rating Scale (GRS) is the primary assessment tool, informed by using scenario-specific checklists (created via a modified Delphi technique) and the Anesthesia Non-Technical Skills GRS. 4) Implementation: Standardized implementation guidelines, pre-brief/debrief documents, and rater training videos, guide, and commentary were generated. National implementation of the scenarios and program evaluation is currently underway. It is highly feasible to achieve specialty-based consensus on the elements of a national

  19. Choosing a career in surgery: factors that influence Canadian medical students' interest in pursuing a surgical career.

    Science.gov (United States)

    Scott, Ian M; Matejcek, Adela N; Gowans, Margot C; Wright, Bruce J; Brenneis, Fraser R

    2008-10-01

    Interest in both general surgery and surgical subspecialties has been declining among Canadian medical students. Studies have shown that a student's desire to practise surgery is largely determined before entry into medical school. As part of a larger study of students' career preferences throughout medical school, we sought to identify the level of interest in surgical careers and the factors that influence a student's interest in pursuing a surgical career. We surveyed students from 18 different classes at Canadian medical schools at the commencement of their studies between 2001 and 2004. We asked the students to list their top career choices and the degree to which a series of variables influenced their choices. We also collected demographic data. We performed a factor analysis on the variables. Of 2420 surveys distributed, 2168 (89.6%) were completed. A total of 21.0% of respondents named a surgical specialty as their first choice of career. We found that male students were more likely to express interest in a surgical specialty than female students, who were more likely to express interest in either family medicine or a medical specialty. Compared with students interested in a career in family medicine, those interested in a surgical or medical specialty were younger, more likely to be single and more likely to be influenced by prestige when making their career choices. Students interested in a career in surgery were less influenced by medical lifestyle and a varied scope of practice, less likely to demonstrate a social orientation and more likely to be hospital-oriented than students interested in either family medicine or a medical specialty. Male students interested in a career in surgery were more hospital-oriented and less likely to demonstrate a social orientation than female students interested in surgical careers. We identified 5 factors and a number of demographic variables associated with a student's interest in a surgical career.

  20. Does implementing a general surgery residency program and resident involvement affect patient outcomes and increase care-associated charges?

    Science.gov (United States)

    Wexner, Trevor; Rosales-Velderrain, Armando; Wexner, Steven D; Rosenthal, Raul J

    2017-07-01

    Variable results regarding general surgery residency program (GSRP) impact on patient outcomes and charges are reported. The aim of this study was to determine any significant differences in patient outcomes and cost with a new GSRP. We analyzed all laparoscopic appendectomies (lap-ap), cholecystectomies (lap-chole), and inguinal hernia repairs (IHR) performed before and after implementing a GRSP. Operative time significantly increased for lap-ap (p < 0.0001), lap-chole (p < 0.0001) and IHR (p = 0.03). Time to close the incision significantly increased for lap-ap (p < 0.0001), lap-chole (p = 0.006) and IHR (p = 0.03). Length of stay only increased for lap-ap (p = 0.04). Complication rates did not increase for any procedure. However, charges significantly increased for lap-ap (p < 0.0001), lap-chole (p < 0.0001), and IHR (p = 0.03). Although a newly implemented GSRP caused increases in overall operative times, times to close incisions, and charges, it did not negatively impact patient outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Residency characteristics that matter most to plastic surgery applicants: a multi-institutional analysis and review of the literature.

    Science.gov (United States)

    Sinno, Sammy; Mehta, Karan; Squitieri, Lee; Ranganathan, Kavitha; Koeckert, Michael S; Patel, Ashit; Saadeh, Pierre B; Thanik, Vishal

    2015-06-01

    The National Residency Matching Program Match is a very unique process in which applicants and programs are coupled to each other based on a ranking system. Although several studies have assessed features plastic surgery programs look for in applicants, no study in the present plastic surgery literature identifies which residency characteristics are most important to plastic surgery applicants. Therefore, we sought to perform a multi-institutional assessment as to which factors plastic surgery residency applicants consider most important when applying for residency. A validated and anonymous questionnaire containing 37 items regarding various program characteristics was e-mailed to 226 applicants to New York University, Albany, University of Michigan, and University of Southern California plastic surgery residency programs. Applicants were asked to rate each feature on a scale from 1 to 10, with 10 being the most important. The 37 variables were ranked by the sum of the responses. The median rating and interquartile range as well as the mean for each factor was then calculated. A Wilcoxon signed rank test was used to compare medians in rank order. A total of 137 completed questionnaires were returned, yielding a 61% response rate. The characteristics candidates considered most important were impressions during the interview, experiences during away rotations, importance placed on resident training/support/mentoring by faculty, personal experiences with residents, and the amount of time spent in general surgery. The characteristics candidates considered least important were second-look experiences, compensation/benefits, program reputation from Internet forums, accessibility of program coordinator, opportunity for laboratory research, and fellowship positions available at the program. Applicants value personal contact and time spent in general surgery when selecting residency programs. As the number of integrated programs continues to grow, programs will benefit

  2. Effect of robotic surgery on hysterectomy trends: implications for resident education.

    Science.gov (United States)

    Yamasato, Kelly; Casey, Duffy; Kaneshiro, Bliss; Hiraoka, Mark

    2014-01-01

    To compare the surgical approach used for hysterectomy at 2 teaching hospitals before and after introduction of the robotic surgical system. Retrospective cohort study (Canadian Task Force classification II-3). Two gynecologic training sites at the University of Hawaii. Women who underwent hysterectomy between January 1, 2005, and December 31, 2011. ICD-9 procedural codes were used to identify hysterectomies performed between January 1, 2005, and December 31, 2011. Hysterectomies were categorized according to surgical approach: abdominal, vaginal, laparoscopic-assisted vaginal/total laparoscopic, and robotic. Each hysterectomy was also categorized according to primary preoperative diagnosis as general gynecology, gynecologic oncology, and urogynecology. The rates and numbers of hysterectomies performed during 2005-2006 (2 years before acquisition of the robot), 2007-2008 (first 2 years with the robot), and 2009-2011 (3-5 years after acquiring the robot) were compared using χ(2) tests and analysis of variance. The numbers of hysterectomies reported in resident case logs were also collected and compared. A total of 5894 hysterectomies were performed between 2005 and 2011. The total number of hysterectomies performed at Hospital A, which acquired the robotic surgical system, increased over time (p = .04) but remained stable at Hospital B, which did not acquire the robotic surgical system. At Hospital A, the number of robotic hysterectomies increased as the number of abdominal hysterectomies decreased (p robotic hysterectomies (p robotic surgical system was associated with significant changes in the numbers and types of hysterectomies performed in both general and subspecialty gynecology. Although abdominal hysterectomies decreased as robotic hysterectomies increased, other hysterectomies did not. These trends mirror reported resident surgical experience and have implications for resident education. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights

  3. Improving Resident Performance in Oculoplastic Surgery: A New Curriculum Using Surgical Wet Laboratory Videos.

    Science.gov (United States)

    Mishra, Kapil; Mathai, Mariam; Della Rocca, Robert C; Reddy, Harsha S

    To develop a new oculoplastic curriculum that incorporates learning theory of skill acquisition. To develop and evaluate the effectiveness of instructional videos for an oculoplastic surgical wet laboratory. Proof of concept, randomized controlled trial. New York Eye and Ear Infirmary of Mount Sinai-tertiary care academic institution. In total, 16 ophthalmology residents were randomly assigned to 1 of 2 groups and given either video and text or text instructions alone for the following 2 procedures: blepharoplasty and eyelid laceration repair. Operating time and esthetic result were measured, and the groups were statistically compared. A brief survey was administered. We developed a new 6 component oculoplastics curriculum that incorporates concepts of the Fitts and Posner skill acquisition model and mental imagery. In the wet laboratory pilot study, the group that watched the video of the laceration repair showed better esthetic grades than the group that received text alone (p = 0.038). This difference was not found for the blepharoplasty (p = 0.492). There was no difference between groups in operating time for the laceration repair (p = 0.722), but the group that watched the blepharoplasty video required more time to complete the task than those that reviewed text only (p = 0.023). In total, 100% of residents reported the videos augmented their learning. Methods to optimize surgical education are important given limited operating room time in oculoplastics, a subspecialty in which the number of surgeries performed during residency is relatively low. We developed a curriculum based on learning theory and sought to formally test one important aspect, surgical video for wet laboratories. Our pilot study, despite its limitations, showed that wet laboratory surgical videos can be effective tools in improving motor skill acquisition for oculoplastic surgery. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  4. Feasibility of using administrative data for identifying medical reasons to delay hip fracture surgery: a Canadian database study.

    Science.gov (United States)

    Guy, Pierre; Sheehan, Katie J; Morin, Suzanne N; Waddell, James; Dunbar, Michael; Harvey, Edward; Sirett, Susan; Sobolev, Boris; Kuramoto, Lisa; Tang, Michael

    2017-10-05

    Failure to account for medically necessary delays may lead to an underestimation of early surgery benefits. This study investigated the feasibility of using administrative data to identify the National Institute for Health and Care Excellence (NICE) 124 guideline list of conditions that appropriately delay hip fracture surgery. We assembled a list of diagnosis and procedure codes to reflect the NICE 124 conditions. The list was reviewed and updated by an advanced clinical coder. The list was refined by five clinical experts. We then screened Canadian Institute for Health Information discharge abstracts for 153 918 patients surgically treated for a non-pathological first hip fracture between 1 January 2004 and 31 December 2012 for diagnosis codes present on admission and procedure codes that antedated hip fracture surgery. We classified abstracts as having medical reasons for delaying surgery based on the presence of these codes. In total, 10 237 (6.7%; 95% CI 6.5% to 6.8%) patients had diagnostic and procedure codes indicating medical reasons for delay. The most common reasons for medical delay were exacerbation of a chronic chest condition (35.9%) and acute chest infection (23.2%). The proportion of patients with reasons for medical delays increased with time from admission to surgery: 3.9% (95% CI 3.6% to 4.1%) for same day surgery; 4.7% (95% CI 4.5% to 4.8%) for surgery 1 day after admission; 7.1% (95% CI 6.9% to 7.4%) for surgery 2 days after admission; and 15.5% (95% CI 15.1% to 16.0%) for surgery more than 2 days after admission. The trend was seen for admissions on weekday working hours, weekday after hours and on weekends. Administrative data can be considered to identify conditions that appropriately delay hip fracture surgery. Accounting for medically necessary delays can improve estimates of the effectiveness of early surgery. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights

  5. Uniting Evidence-Based Evaluation with the ACGME Plastic Surgery Milestones: A Simple and Reliable Assessment of Resident Operative Performance.

    Science.gov (United States)

    Kobraei, Edward M; Bohnen, Jordan D; George, Brian C; Mullen, John T; Lillemoe, Keith D; Austen, William G; Liao, Eric C

    2016-08-01

    Milestones evaluations in plastic surgery reflect a shift toward competency-based training but have created a number of challenges. The authors have incorporated the smartphone application evaluation tool, System for Improving and Measuring Procedural Learning (SIMPL), that was recently developed by a multi-institutional research collaborative. In this pilot study, the authors hypothesize that SIMPL can improve resident evaluation and also collect granular performance data to simplify compliance with the plastic surgery Milestones. SIMPL was prospectively piloted with a plastic surgery resident and faculty surgeon at Massachusetts General Hospital in this institutional review board-approved study. The study period was a 2-month interval corresponding to the resident's rotation. The resident-faculty combination performed 20 cases together. All cases were evaluated with SIMPL. SIMPL evaluations uniformly took under 1 minute to submit. The average time to completed evaluation from surgery completion was 5 hours (plastic surgery resident participates. SIMPL's competency-based framework can be easily scaled to facilitate data collection and reporting of mandatory Milestones evaluations at the program and national levels. This technology will support a shared vocabulary between residents and faculty to enhance intraoperative education.

  6. Academic productivity of directors of ACGME-accredited residency programs in surgery and anesthesiology.

    Science.gov (United States)

    Culley, Deborah J; Fahy, Brenda G; Xie, Zhongcong; Lekowski, Robert; Buetler, Sascha; Liu, Xiaoxia; Cohen, Neal H; Crosby, Gregory

    2014-01-01

    Scholarly activity is expected of program directors of Accreditation Council for Graduate Medical Education (ACGME)-accredited residency training programs. Anesthesiology residency programs are cited more often than surgical programs for deficiencies in academic productivity. We hypothesized that this may in part reflect differences in scholarly activity between program directors of anesthesiology and surgical trainings programs. To test the hypothesis, we examined the career track record of current program directors of ACGME-accredited anesthesiology and surgical residency programs at the same institutions using PubMed citations and funding from the National Institutes of Health (NIH) as metrics of scholarly activity. Between November 1, 2011 and December 31, 2011, we obtained data from publicly available Web sites on program directors at 127 institutions that had ACGME-accredited programs in both anesthesiology and surgery. Information gathered on each individual included year of board certification, year first appointed program director, academic rank, history of NIH grant funding, and number of PubMed citations. We also calculated the h-index for a randomly selected subset of 25 institution-matched program directors. There were no differences between the groups in number of years since board certification (P = 0.42), academic rank (P = 0.38), or years as a program director (P = 0.22). However, program directors in anesthesiology had less prior or current NIH funding (P = 0.002), fewer total and education-related PubMed citations (both P < 0.001), and a lower h-index (P = 0.001) than surgery program directors. Multivariate analysis revealed that the publication rate for anesthesiology program directors was 43% (95% confidence interval, 0.31-0.58) that of the corresponding program directors of surgical residency programs, holding other variables constant. Program directors of anesthesiology residency programs have considerably less scholarly activity in terms of

  7. Does resident participation influence otolaryngology-head and neck surgery morbidity and mortality?

    Science.gov (United States)

    Abt, Nicholas B; Reh, Douglas D; Eisele, David W; Francis, Howard W; Gourin, Christine G

    2016-10-01

    Patients may perceive resident procedural participation as detrimental to their outcome. Our objective is to investigate whether otolaryngology-head and neck surgery (OHNS) housestaff participation is associated with surgical morbidity and mortality. Case-control study. OHNS patients were analyzed from the American College of Surgeons National Surgical Quality Improvement Program 2006 to 2013 databases. We compared the incidence of 30-day postoperative morbidity, mortality, readmissions, and reoperations in patients operated on by resident surgeons with attending supervision (AR) with patients operated on by an attending surgeon alone (AO) using cross-tabulations and multivariable regression. There were 27,018 cases with primary surgeon data available, with 9,511 AR cases and 17,507 AO cases. Overall, 3.62% of patients experienced at least one postoperative complication. The AR cohort had a higher complication rate of 5.73% than the AO cohort at 2.48% (P < .001). After controlling for all other variables, there was no significant difference in morbidity (odds ratio [OR] = 1.05 [0.89 to 1.24]), mortality (OR = 0.91 [0.49 to 1.70]), readmission (OR = 1.29 [0.92 to 1.81]), or reoperation (OR = 1.28 [0.91 to 1.80]) for AR compared to AO cases. There was no difference between postgraduate year levels for adjusted 30-day morbidity or mortality. There is an increased incidence of morbidity, mortality, readmission, and reoperation in OHNS surgical cases with resident participation, which appears related to increased comorbidity with AR patients. After controlling for other variables, resident participation was not associated with an increase in 30-day morbidity, mortality, readmission, or reoperation odds. These data suggest that OHNS resident participation in surgical cases is not associated with poorer short-term outcomes. 3b Laryngoscope, 126:2263-2269, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  8. The surgical experience of general surgery residents: an analysis of the applicability of the specialty program in General and Digestive Surgery.

    Science.gov (United States)

    Targarona Soler, Eduardo Ma; Jover Navalon, Jose Ma; Gutierrez Saiz, Javier; Turrado Rodríguez, Víctor; Parrilla Paricio, Pascual

    2015-03-01

    Residents in our country have achieved a homogenous surgical training by following a structured residency program. This is due to the existence of specific training programs for each specialty. The current program, approved in 2007, has a detailed list of procedures that a surgeon should have performed in order to complete training. The aim of this study is to analyze the applicability of the program with regard to the number of procedures performed during the residency period. A data collection form was designed that included the list of procedures from the program of the specialty; it was sent in April 2014 to all hospitals with accredited residency programs. In September 2014 the forms were analysed, and a general descriptive study was performed; a subanalysis according to the resident's sex and Autonomous region was also performed. The number of procedures performed according to the number of residents in the different centers was also analyzed. The survey was sent to 117 hospitals with accredited programs, which included 190 resident places. A total of 91 hospitals responded (53%). The training offered adapts in general to the specialty program. The total number of procedures performed in the different sub-areas, in laparoscopic and emergency surgery is correct or above the number recommended by the program, with the exception of esophageal-gastric and hepatobiliary surgery. The sub-analysis according to Autonomous region did not show any significant differences in the total number of procedures, however, there were significant differences in endocrine surgery (P=.001) and breast surgery (P=.042). A total of 55% of residents are female, with no significant differences in distribution in Autonomous regions. However, female surgeons operate more than their male counterparts during the residency period (512±226 vs. 625±244; P<.01). The number of residents in the hospital correlates with the number of procedures performed; the residents with more procedures

  9. Construction and validation of a surgical skills assessment tool for general surgery residency program

    Directory of Open Access Journals (Sweden)

    Elizabeth Gomes dos Santos

    Full Text Available Objective: To develop and validate an instrument for measuring the acquisition of technical skills in conducting operations of increasing difficulty for use in General Surgery Residency (GSR programs. Methods: we built a surgical skills assessment tool containing 11 operations in increasing levels of difficulty. For instrument validation we used the face validaity method. Through an electronic survey tool (Survey MonKey(r we sent a questionnaire to Full and Emeritus members of the Brazilian College of Surgeons - CBC - all bearers of the CBC Specialist Title. Results: Of the 307 questionnaires sent we received 100 responses. For the analysis of the data collected we used the Cronbach's alpha test. We observed that, in general, the overall alpha presented with values near or greater than 0.70, meaning good consistency to assess their points of interest. Conclusion: The evaluation instrument built was validated and can be used as a method of assessment of technical skill acquisition in the General Surgery Residency programs in Brazil.

  10. The general surgery chief resident operative experience: 23 years of national ACGME case logs.

    Science.gov (United States)

    Drake, Frederick Thurston; Horvath, Karen D; Goldin, Adam B; Gow, Kenneth W

    2013-09-01

    The chief resident (CR) year is a pivotal experience in surgical training. Changes in case volume and diversity may impact the educational quality of this important year. To evaluate changes in operative experience for general surgery CRs. Review of Accreditation Council for Graduate Medical Education case logs from 1989-1990 through 2011-2012 divided into 5 periods. Graduates in period 3 were the last to train with unrestricted work hours; those in period 4 were part of a transition period and trained under both systems; and those in period 5 trained fully under the 80-hour work week. Diversity of cases was assessed based on Accreditation Council for Graduate Medical Education defined categories. Total cases and defined categories were evaluated for changes over time. The average total CR case numbers have fallen (271 in period 1 vs 242 in period 5, P surgery training may be jeopardized by reduced case diversity. Chief resident cases are crucial in surgical training and educators should consider these findings as surgical training evolves.

  11. Trends in Pediatric Surgery Operative Volume among Residents and Fellows: Improving the Experience for All.

    Science.gov (United States)

    Talutis, Stephanie; McAneny, David; Chen, Catherine; Doherty, Gerard; Sachs, Teviah

    2016-06-01

    The ACGME requires general surgery residents (GSR) to perform 20 pediatric surgery cases as part of the total 750 cases before graduation. We queried the ACGME General Surgery (1999 to 2014) and Pediatric Surgery (2003 to 2014) Case Logs for all pediatric operations performed during training. Means (±SD) and medians (10(th):90(th) percentiles) were compared, and R(2) was calculated for all trends. The number of pediatric surgery fellows (PSF) increased 63% (23 to 39; R(2) = 0.82), while GSR numbers increased 12% (989 to 1,105; R(2) = 0.77). Total and average pediatric surgery case volume for GSR decreased from 39,309 to 32,156 (R(2) = 0.90) and 39.7 ± 13 to 29.1 ± 10 (R(2) = 0.91), respectively. Meanwhile, average PSF case volume increased from 980 ± 208 to 1,137 ± 202 (R(2) = 0.83). These trends persisted for inguinal/umbilical hernia (GSR 22.1 ± 13 to 15.6 ± 10; R(2) = 0.93; PSF 90.5 ± 17.6 to 104.4 ± 20.7; R(2) = 0.34), pyloric stenosis (GSR 3.9 ± 3 to 2.8 ± 3; R(2) = 0.60; PSF 29.6 ± 15 to 39.7 ± 16.8; R(2) = 0.69), and intestinal atresia (GSR 1.3 ± 2 to 1.1 ± 2; R(2) = 0.34; PSF 4.3 ± 4 to 11.8 ± 8; R(2) = 0.21). The mean number of GSR pediatric operations diminished for both junior (37.1 ± 20 to 27.3 ± 16; R(2) = 0.88) and chief (2.6 ± 5 to 1.7 ± 5; R(2) = 0.75) years. Teaching cases in pediatric surgery decreased at all levels. Although the percentage of GSR teaching cases performed during chief years fell modestly (6.6% to 4.7%; R(2) = 0.53), median teaching cases dropped from 2 (0:11 [10(th):90(th) percentiles]) to zero (0:0 [10(th):90(th) percentiles]). Mean PSF teaching cases declined (100.7 ± 396 to 44.5 ± 42; R(2) = 0.72), while the percentage of operations that were teaching cases decreased more sharply (10.3% to 3.5%; R(2) = 0.82). Total pediatric surgery cases and PSF operative volume have increased, while GSR operative volume has decreased. Opportunities may exist to increase resident participation while

  12. Just say no to intensive care unit starvation: a nutrition education program for surgery residents.

    Science.gov (United States)

    Spear, Shawn; Sim, Vasiliy; Moore, Frederick A; Todd, S Rob

    2013-06-01

    In 2009, the Society of Critical Care Medicine (SCCM)/American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) published "Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient." To improve our surgery residents' understanding of intensive care unit (ICU) nutrition, we developed a nutrition education program based on these guidelines. The purpose of this pilot study was to assess its effectiveness. We hypothesized that our nutrition education program would improve our residents' knowledge of ICU nutrition. This was a prospective observational pilot study performed in the surgical ICU of an academic medical center. Based on the SCCM/A.S.P.E.N. nutrition guidelines, we developed a nutrition education program (lectures covering selected guidelines and interactive case studies). Pre- and posttesting were performed to assess short-term comprehension. Long-term retention was assessed 3 months after the initial education program. The primary outcome measure was the change in ICU nutrition knowledge. Significance was set at P nutrition education program. Their mean age was 27.8 ± 1.2 years, and 50% were male. The mean test scores were as follows: pretest, 45% ± 9%; posttest, 81% ± 5%; and 3-month test, 65% ± 8%. The differences between the pretest and both posttest scores were significant (P nutrition. This is confirmed by the pretest results of the current study. Our nutrition education program improved both short-term and long-term ICU nutrition knowledge of our surgery residents. Future studies should evaluate the effect such education has on the clinical outcomes of ICU patients.

  13. Initial experiences in embedding core competency education in entry-level surgery residents through a nonclinical rotation.

    Science.gov (United States)

    Kahol, Kanav; Huston, Carrie; Hamann, Jessica; Ferrara, John J

    2011-03-01

    Health care continues to expand in scope and in complexity. In this changing environment, residents are challenged with understanding its intricacies and the impact it will have on their professional activities and careers. Embedding each of the competency elements in residents in a meaningful way remains a challenge for many surgery residency program directors. We established a nonclinical rotation to provide surgery postgraduate year-1 (PGY-1) residents with a structured, multifaceted, largely self-directed curriculum into which each of the 6 core competencies are woven. Posttesting strategies were established for most curricular experiences to ensure to the greatest possible extent that each resident will have achieved an acceptable level of understanding of each of the competency areas before being given credit for the rotation. By uniformly exceeding satisfactory scores on respective objective analyses, residents demonstrated an increased (at least short-term) understanding of each of the assessed competency areas. Our project sought to address a prior lack of opportunity for our residents to develop a sound foundation for our residents in systems-based practice. Our new rotation addresses systems-based practice in several different learning environments, including emergency medical service ride-along, sentinel event participation, and hospice visits. Several research projects have enhanced the overall learning program. Our experience shows that a rotation dedicated to competency training can provide an innovative and engaging means of teaching residents the value of each element.

  14. Working and training conditions of residents in pediatric surgery: a nationwide survey in Germany.

    Science.gov (United States)

    Reismann, M; Ellerkamp, V; Dingemann, J

    2010-09-01

    As in other surgical specialties, increasing concern has been expressed worldwide about the shortage of trainees in pediatric surgery training programs. We performed a nationwide survey to investigate the current situation in Germany. An internet-based nationwide survey comprising 36 questions on training conditions in pediatric surgery was linked to the homepage of the German Society of Pediatric Surgery from June to September 2008. Statements on the following aspects were evaluated by responding residents using a scale from 1 (I do not agree at all) to 5 (I fully agree): workplace, cooperation with colleagues, head of the department, cooperation with other specialties, training and research conditions. A median value of 3 indicated an unsatisfactory assessment, with at least 50% of respondents giving an indifferent or negative response. 70 questionnaires were completed. Some of the evaluations revealed problematic areas. In particular, statements regarding working hours revealed dissatisfaction among the responding doctors. The median value accorded the statement "I am satisfied with the current working time regulation" was 2.9. With regard to departmental heads, some criticisms were directed against a perceived lack of soft skills. According to the respondents, their involvement in decision-making processes was insufficient ("We are involved in decision-making processes affecting our working conditions" - median value 2.4). Residents were also dissatisfied with the feedback they received for their work ("I get enough feedback regarding my achievement" - median value 2.6). Another problem area was career development ("I will finish my specialist training in time" - median value 2.9). However, these points did not affect overall satisfaction. Trainee satisfaction with regulations on working hours is low. Despite a general satisfaction with all fields appraised, improvements in various individual areas, e. g., the attitude of departmental heads and strategies of

  15. Accreditation Council for Graduate Medical Education (ACGME) Surgery Resident Operative Logs: The Last Quarter Century.

    Science.gov (United States)

    Drake, Frederick Thurston; Aarabi, Shahram; Garland, Brandon T; Huntington, Ciara R; McAteer, Jarod P; Richards, Morgan K; Zern, Nicole Kansier; Gow, Kenneth W

    2017-05-01

    To describe secular trends in operative experience for surgical trainees across an extended period using the most comprehensive data available, the Accreditation Council for Graduate Medical Education (ACGME) case logs. Some experts have expressed concern that current trainees are inadequately prepared for independent practice. One frequently mentioned factor is whether duty hours' restrictions (DHR) implemented in 2003 and 2004 contributed by reducing time spent in the operating room. A dataset was generated from annual ACGME reports. Operative volume for total major cases (TMC), defined categories, and four index laparoscopic procedures was evaluated. TMC dropped after implementation of DHR but rebounded after a transition period (949 vs 946 cases, P = nonsignificance). Abdominal cases increased from 22% of overall cases to 31%. Alimentary cases increased from 21% to 26%. Trauma and vascular surgery substantially decreased. For trauma, this drop took place well before DHR. The decrease in vascular surgery also began before DHR but continued afterward as well: 148 cases/resident in the late 1990s to 107 currently. Although total operative volume rebounded after implementation of DHR, diversity of operative experienced narrowed. The combined increase in alimentary and abdominal cases is nearly 13%, over a half-year's worth of operating in 5-year training programs. Bedrock general surgery cases-trauma, vascular, pediatrics, and breast-decreased. Laparoscopic operations have steadily increased. If the competence of current graduates has, in fact, diminished. Our analysis suggests that operative volume is not the problem. Rather, changing disease processes, subspecialization, reductions in resident autonomy, and technical innovation challenge how today's general surgeons are trained.

  16. Comparison of Appendectomy Outcomes Between Senior General Surgeons and General Surgery Residents.

    Science.gov (United States)

    Siam, Baha; Al-Kurd, Abbas; Simanovsky, Natalia; Awesat, Haitham; Cohn, Yahav; Helou, Brigitte; Eid, Ahmed; Mazeh, Haggi

    2017-07-01

    In some centers, the presence of a senior general surgeon (SGS) is obligatory in every procedure, including appendectomy, while in others it is not. There is a relative paucity in the literature of reports comparing the outcomes of appendectomies performed by unsupervised general surgery residents (GSRs) with those performed in the presence of an SGS. To compare the outcomes of appendectomies performed by SGSs with those performed by GSRs. A retrospective analysis was performed of all patients 16 years or older operated on for assumed acute appendicitis between January 1, 2008, and December 31, 2015. The cohort study compared appendectomies performed by SGSs and GSRs in the general surgical department of a teaching hospital. The primary outcome measured was the postoperative early and late complication rates. Secondary outcomes included time from emergency department to operating room, length of surgery, surgical technique (open or laparoscopic), use of laparoscopic staplers, and overall duration of postoperative antibiotic treatment. Among 1649 appendectomy procedures (mean [SD] patient age, 33.7 [13.3] years; 612 female [37.1%]), 1101 were performed by SGSs and 548 by GSRs. Analysis demonstrated no significant difference between the SGS group and the GSR group in overall postoperative early and late complication rates, the use of imaging techniques, time from emergency department to operating room, percentage of complicated appendicitis, postoperative length of hospital stay, and overall duration of postoperative antibiotic treatment. However, length of surgery was significantly shorter in the SGS group than in the GSR group (mean [SD], 39.9 [20.9] vs 48.6 [20.2] minutes; P < .001). This study demonstrates that unsupervised surgical residents may safely perform appendectomies, with no difference in postoperative early and late complication rates compared with those performed in the presence of an SGS.

  17. Return of the cadaver: Key role of anatomic dissection for plastic surgery resident training.

    Science.gov (United States)

    Krähenbühl, Swenn Maxence; Čvančara, Paul; Stieglitz, Thomas; Bonvin, Raphaël; Michetti, Murielle; Flahaut, Marjorie; Durand, Sébastien; Deghayli, Lina; Applegate, Lee Ann; Raffoul, Wassim

    2017-07-01

    Successful Plastic Surgery Residency training is subjected to evolving society pressure of lower hourly work weeks imposed by external committees, labor laws, and increased public awareness of patient care quality. Although innovative measures for simulation training of surgery are appearing, there is also the realization that basic anatomy training should be re-enforced and cadaver dissection is of utmost importance for surgical techniques.In the development of new technology for implantable neurostimulatory electrodes for the management of phantom limb pain in amputee patients, a design of a cadaveric model has been developed with detailed steps for innovative transfascicular insertion of electrodes. Overall design for electrode and cable implantation transcutaneous was established and an operating protocol devised.Microsurgery of the nerves of the upper extremities for interfascicular electrode implantation is described for the first time. Design of electrode implantation in cadaver specimens was adapted with a trocar delivery of cables and electrodes transcutaneous and stabilization of the electrode by suturing along the nerve. In addition, the overall operating arena environment with specific positions of the multidisciplinary team necessary for implantable electrodes was elaborated to assure optimal operating conditions and procedures during the organization of a first-in-man implantation study.Overall importance of plastic surgery training for new and highly technical procedures is of importance and particularly there is a real need to continue actual cadaveric training due to patient variability for nerve anatomic structures.

  18. How safe is it to train residents to perform mitral valve surgery?

    Science.gov (United States)

    Gabriel, Joseph; Göbölös, László; Miskolczi, Szabolcs; Barlow, Clifford

    2016-11-01

    A best evidence topic was constructed according to a structured protocol. The enquiry: In [patients undergoing mitral valve surgery] are [postoperative morbidity and mortality outcomes] acceptable when patients are operated on by [residents]? Four hundred and twenty-three were identified from the search strategy. Six articles selected as best evidence were tabulated. All current published evidence, encompassing open and minimally invasive mitral valve repair in addition to mitral valve replacement, supports the involvement of trainees in mitral procedures. Although trainees may experience longer aortic cross-clamp and cardiopulmonary bypass times than specialist surgeons, they are not associated with significantly worse perioperative or postoperative outcomes in comparable mitral procedures. Important factors in the viability of mitral valve training and its quality include the volume of cases per institution and the expertise of the supervising surgeon, and these remain largely unexplored. Overall, mitral valve surgery remains a valuable potential training opportunity, one which is perhaps underexploited. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  19. Robotic Surgery Training in an OB/GYN Residency Program: A Survey Investigating the Optimal Training and Credentialing of OB/GYN Residents.

    Science.gov (United States)

    Peterson, Shannon; Mayer, Allan; Nelson, Beth; Roland, Phillip

    2015-08-01

    Many community hospital gynecologic surgery training programs now include robotics.At St. Francis Hospital and Medical Center, we have integrated robotic surgical training since 2006. This study is designed to assess the success in training gynecology residents in robotic surgery. An anonymous web-based survey tool (www. survey monkey. com) was sent to all Ob/Gyn residency graduates from 2007-2010 (n = 17). From 2011-2014, we emailed three reevaluation questions to all 2007-2014 graduates (N = 32). Design Classification: II-3. The response rate was 95%, and 11 of 17 initial graduates (65%) indicated that they had received adequate robotic training. Currently, 24 of 32 (75%) graduates practice in hospitals with robotic availability. Twenty of the 32 graduates (63%) are using robotics in their surgical practices. Nine of these 20 graduates (45%) were fully credentialed following their residency. The other 11 graduates (55%)required further proctoring to obtain full robotic credentials. Robotic surgical training is a component of modern gynecologic surgical training. Postresidency robotic credentialing is a realistic graduation goal for residents who plan to practice gynecologic surgery.

  20. A Comparison of Matched and Unmatched Orthopaedic Surgery Residency Applicants from 2006 to 2014: Data from the National Resident Matching Program.

    Science.gov (United States)

    Schrock, John B; Kraeutler, Matthew J; Dayton, Michael R; McCarty, Eric C

    2017-01-04

    The Association of American Medical Colleges publishes residency match data and reports through the National Resident Matching Program (NRMP) every year. The purpose of this study was to analyze trends in orthopaedic surgery residency matching data and characteristics of successful applicants to counsel medical students with regard to their chances of matching. The annual reports of the NRMP were searched annually from 2006 to 2014 to determine the number of orthopaedic surgery residency positions available, the number of applicants, and the match rate among applicants. Comparisons were performed between matched applicants and unmatched applicants with regard to the number of contiguous ranks and distinct specialties, United States Medical Licensing Examination (USMLE) scores, number of research experiences and research products (abstracts, presentations, posters, publications), and proportion of Alpha Omega Alpha (AOA) Honor Medical Society members and students at a top-40, National Institutes of Health (NIH)-funded medical school. The number of orthopaedic surgery positions available and number of applicants increased at a mean rate of 9 positions and 65 applicants per year (p = 0.11). The mean number of contiguous ranks for U.S. senior medical students was 11.5 for those who matched and 5.5 for those who did not match (p students at a top-40, NIH-funded medical school (both p experiences and research products, and contiguous ranks. A higher proportion of successful applicants are AOA members and students at a top-40, NIH-funded medical school.

  1. The effect of surgical resident learning style preferences on American Board of Surgery In-training Examination scores.

    Science.gov (United States)

    Kim, Roger H; Gilbert, Timothy; Ristig, Kyle

    2015-01-01

    There is a growing body of literature that suggests that learners assimilate information differently, depending on their preferred learning style. The VARK model categorizes learners as visual (V), aural (A), read/write (R), kinesthetic (K), or multimodal (MM). We hypothesized that resident VARK learning style preferences and American Board of Surgery In-Training Examination (ABSITE) performance are associated. The Fleming VARK learning styles inventory was administered to all general surgery residents at a university hospital-based program each year to determine their preferred learning style. Resident scores from the 2012 and 2013 ABSITE were examined to identify any correlation with learning style preferences. Over a 2-year period, residents completed 53 VARK inventory assessments. Most (51%) had a multimodal preference. Dominant aural and read/write learners had the lowest and highest mean ABSITE scores, respectively (p = 0.03). Residents with dominant read/write learning preferences perform better on the ABSITE than their peers did, whereas residents with dominant aural learning preferences underperform on the ABSITE. This may reflect an inherent and inadvertent bias of the examination against residents who prefer to learn via aural modalities. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  2. Gamified Twitter Microblogging to Support Resident Preparation for the American Board of Surgery In-Service Training Examination.

    Science.gov (United States)

    Lamb, Laura C; DiFiori, Monica M; Jayaraman, Vijay; Shames, Brian D; Feeney, James M

    We sought to determine if a daily gamified microblogging project improves American Board of Surgery In-Service Training Examination (ABSITE) scores for participants. In July 2016, we instituted a gamified microblogging project using Twitter as the platform and modified questions from one of several available question banks. A question of the day was posted at 7-o׳clock each morning, Monday through Friday. Respondents were awarded points for speed, accuracy, and contribution to discussion topics. The moderator challenged respondents by asking additional questions and prompted them to find evidence for their claims to fuel further discussion. Since 4 months into the microblogging program, a survey was administered to all residents. Responses were collected and analyzed. After 6 months of tweeting, residents took the ABSITE examination. We compared participating residents׳ ABSITE percentile rank to those of their nonparticipating peers. We also compared residents׳ percentile rank from 2016 to those in 2017 after their participation in the microblogging project. The University of Connecticut general surgery residency is an integrated program that is decentralized across 5 hospitals in the central Connecticut region, including Saint Francis Hospital and Medical Center, located in Hartford. We advertised our account to the University of Connecticut general surgery residents. Out of 45 residents, 11 participated in Twitter microblogging (24.4%) and 17 responded to the questionnaire (37.8%). In all, 100% of the residents who were participating in Twitter reported that daily microblogging prompted them to engage in academic reading. Twitter participants significantly increased their ABSITE percentile rank from 2016 to 2017 by an average of 13.7% (±14.1%) while nonparticipants on average decreased their ABSITE percentile rank by 10.0% (±16.6) (p = 0.003). Microblogging via Twitter with gamification is a feasible strategy to facilitate improving performance on the ABSITE

  3. "Top Gun" competition: motivation and practice narrows the technical skill gap among new cardiothoracic surgery residents.

    Science.gov (United States)

    Enter, Daniel H; Lee, Richard; Fann, James I; Hicks, George L; Verrier, Edward D; Mark, Rebecca; Lou, Xiaoying; Mokadam, Nahush A

    2015-03-01

    Adoption of simulation skills training in cardiothoracic (CT) surgery remains a challenge. This study sought to determine whether a "Top Gun" competition would encourage simulator use and improve technical skills among first-year CT residents. A coronary anastomosis simulation module with instructional video was sent to 96 first-year CT residents in traditional programs who were then invited to participate in a Top Gun competition. Residents uploaded a video recording of their baseline anastomosis using the simulator. After 6 weeks of practice under faculty supervision, each trainee uploaded a final video. All submissions were rated in blinded fashion by three CT surgeons. Twelve components were scored on a 5-point Likert scale (1 = poor; 5 = excellent); also, an overall pass-fail grade was given. Five trainees with the highest final scores were invited to compete at a live Top Gun competition. Seventeen trainees submitted a baseline anastomosis video for evaluation; 15 submitted a final video. Overall average scores improved from 3.24 ± 0.61 to 4.01 ± 0.33 (p average time (minutes:seconds) decreased from 11:10 (range, 5:56 to 18:58) to 9:04 (range, 5:52 to 16:23; p average of 23 anastomoses (range, 10 to 40). The majority (10 of 13) agreed or strongly agreed that practicing on simulators will improve a trainee's technical skill acquisition. Focused training results in improved technical skills in vessel anastomosis, especially for residents with lower baseline skills. Simulation, as with any educational endeavor, requires the motivation of the trainee, commitment of the faculty educator, and a defined training curriculum. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  4. The importance of basic science and clinical research as a selection criterion for general surgery residency programs.

    Science.gov (United States)

    Melendez, Mark M; Xu, Xiaoti; Sexton, Thomas R; Shapiro, Marc J; Mohan, Eugene P

    2008-01-01

    The selection criteria for surgical residents applying for residency differ among programs nationwide. Factors influencing this selection process have not been well defined, and research in particular has not been evaluated fully. This study aimed to evaluate the relative importance of basic science and clinical research in the selection criteria used by program directors (PDs). A web-based survey consisting of 11 questions was sent to PDs using the list server of the Association of Program Directors in Surgery. Respondents were asked to rank selection factors using a 1-to-5 scoring system, with 5 as most important. Their responses were recorded and tabulated. University-based teaching hospital. The survey went to 251 accredited general surgery residency programs in the United States. Overall, 134 (53.3%) of the surveys were returned, representing 61 university-based programs, 57 community-based programs with university affiliation, and 16 community-based programs without university affiliation. In total, 120 PDs (89.5%) considered basic or clinical research almost always or all the time when evaluating applicants to their general surgery program. Another 73 PDs (54.5%) gave basic science and clinical research equal importance. Another 40 PDs (29.9%) rarely or never credited research unless it had been published as an abstract or paper. In ranking research, 11 (8.2%) respondents gave it the 5 score. Most respondents (n = 93; 69.4%) gave it the 3 score. An applicant's interview and interest in surgery were the factors considered most important by 93 (69.4%) and 78 (58.2%), respectively, of the PDs. Basic science and clinical research constituted an important but secondary criterion for resident selection by PDs into general surgery residency programs. PDs perceived the primary factors for residency selection to be the interview, demonstrated interest in surgery, AOA membership, letters of recommendation, and USMLE Step I scores.

  5. The Colorado Humanitarian Surgical Skills Workshop: A Cadaver-Based Workshop to Prepare Residents for Surgery in Austere Settings.

    Science.gov (United States)

    Lin, Yihan; Mukhopadhyay, Swagoto; Meguid, Robert A; Kuwayama, David P

    2017-08-29

    Interest in humanitarian surgery is high among surgical and obstetric residents. The Colorado Humanitarian Surgical Skills Workshop is an annual 2-day course exposing senior residents to surgical techniques essential in low- and middle-income countries but not traditionally taught in US residencies. We evaluated the course's ability to foster resident comfort, knowledge, and competence in these skills. The cohort of course participants was studied prospectively. Participants attended didactic sessions followed by skills sessions using cadavers. Sample areas of focus included general surgery (mesh-free hernia repair), orthopedics (powerless external fixation), and neurosurgery (powerless craniotomy). Before and after the course, participants answered a questionnaire assessing confidence with taught skills; took a knowledge-based test composed of multiple choice and open-ended questions; and participated in a manual skills test of tibial external fixation. The Center for Surgical Innovation, University of Colorado School of Medicine. A total of 12 residents (11 general surgical and 1 obstetric) from ten US institutions. After the course, participants perceived increased confidence in performing all 27 taught procedures and ability to practice in low- and middle-income countries. In knowledge-based testing, 10 of 12 residents demonstrated improvement on multiple choice questioning and 9 of 12 residents demonstrated improvement on open-ended questioning with structured scoring. In manual skills testing, all external fixator constructs demonstrated objective improvement on structured scoring and subjective improvement on stability assessment. For senior residents interested in humanitarian surgery, a combination of skills-focused teaching and manual practice led to self-perceived and objective improvement in relevant surgical knowledge and skills. The Colorado Humanitarian Surgical Skills Workshop represents an effective model for transmitting essential surgical

  6. Instituting Ultrasound-Guided FNA for Thyroid Nodules into a General Surgery Residency Program: What We Learned.

    Science.gov (United States)

    Davis, James R; Hale, Allyson L; Ewing, Joseph A; Lokey, Jonathan S

    2017-11-22

    Evaluation of a thyroid nodule is a common referral seen by surgeons and frequently requires ultrasound-guided fine needle aspiration (US-guided FNA). While surgical residents may have sufficient exposure to thyroid surgery, many lack exposure to office-based procedures, such as US-guided FNA. General surgery residents should be provided with knowledge and practical skills in the application of diagnostic and interventional neck ultrasound to manage the common workup of a thyroid nodule. This study sought to instruct and measure surgical residents' performance in thyroid US-guided FNA and evaluate their views regarding instituting such a formal curriculum. Twelve (n = 12) senior residents completed a written pretest and questionnaire, then watched an instructional video and practiced a simulated thyroid US-guided FNA on our created model. Then residents were evaluated while performing actual thyroid US-guided FNAs on patients in our clinic. Residents then completed the same written exam and questionnaire for objective measure. Eight of the chief residents (62%) felt "not comfortable" with the procedure on the pre-course survey; this was reduced to 0% on the post-course survey. Moderate comfort level increased from 15% to 50% and extreme comfort increased from 0% to 8%. From the 11 residents who completed the pre- and post-test exam, 82% (n = 9) significantly improved their score through the curriculum (pre-test: 40.9 vs. post-test: 61.8; p = 0.05). With focused instruction, residents are able to learn ultrasound-guided thyroid biopsy with improvement in subjective confidence level and objective measures. Resident feedback was positive and emphasized the importance of such training in surgical residency curriculum. Published by Elsevier Inc.

  7. Do Plastic Surgery Programs with Integrated Residencies or Subspecialty Fellowships Have Increased Academic Productivity?

    Science.gov (United States)

    Duquette, Stephen P.; Valsangkar, Nakul P.; Sood, Rajiv; Socas, Juan; Zimmers, Teresa A.

    2016-01-01

    Background: The aim of this study was to evaluate the effect of different surgical training pathways on the academic performance of plastic surgical divisions. Methods: Eighty-two academic parameters for 338 plastic surgeons (PS), 1737 general surgeons (GS), and 1689 specialist surgeons (SS) from the top 55 National Institutes of Health (NIH)-funded academic departments of surgery were examined using data gathered from websites, SCOPUS, and NIH Research Portfolio Online Reporting Tools. Results: The median size of a PS division was 7 faculty members. PS faculty had lower median publications (P)/citations (C) (ie, P/C) than GS and SS (PS: 25/328, GS: 35/607, and SS: 40/713, P < 0.05). Publication and citation differences were observed at all ranks: assistant professor (PS: 11/101, GS: 13/169, and SS: 19/249), associate professor (PS: 33/342, GS: 40/691, and SS: 44/780), and professor (PS: 57/968, GS: 97/2451, and SS: 101/2376). PS had a lower percentage of faculty with current/former NIH funding (PS: 13.5%, GS: 22.8%, and SS: 25.1%, P < 0.05). Academic productivity for PS faculty was improved in integrated programs. P/C for PS faculty from divisions with traditional 3-year fellowships was 19/153, integrated 6-year residency was 25/329, and both traditional and 6-year programs were 27/344, P < 0.05. Craniofacial and hand fellowships increased productivity within the integrated residency programs. P/C for programs with a craniofacial fellowship were 32/364 and for those that additionally had a hand fellowship were 45/536. PS faculty at divisions with integrated training programs also had a higher frequency of NIH funding. Conclusions: PS divisions vary in degree of academic productivity. Dramatically improved scholarly output is observed with integrated residency training programs and advanced specialty fellowships. PMID:27014543

  8. Attitudes of Canadian psychiatry residents if mentally ill: awareness, barriers to disclosure, and help-seeking preferences

    Directory of Open Access Journals (Sweden)

    Tariq Mahmood Hassan

    2016-10-01

    Conclusions: At the level of residency training, psychiatrists are reporting barriers to disclosure and help-seeking if they were to experience mental illness. A majority of psychiatry residents would only disclose to informal supports. Those with a history of mental illness would prefer formal treatment services over informal services.

  9. Career and Professional Satisfaction of Oral and Maxillofacial Surgery Residents, Academic Surgeons, and Private Practitioners: Does Gender Matter?

    Science.gov (United States)

    Marti, Kyriaki C; Lanzon, Jesse; Edwards, Sean P; Inglehart, Marita R

    2017-01-01

    The aims of this study were to determine whether male vs. female oral and maxillofacial surgery (OMS) residents, academic surgeons (i.e., faculty members), and private practitioners in the U.S. differed in their general career satisfaction and job/professional satisfaction. Survey data were collected in 2011-12 from 267 OMS residents (response rate 55%), 271 OMS academic surgeons (response rate 31%), and 417 OMS private practitioners (response rates 13% web-based survey and 29% postal mail survey). The results showed that while the male vs. female OMS private practitioners and academic surgeons did not differ in their career satisfaction, the female residents had a lower career satisfaction than the male residents (on four-point scale with 4=most satisfied: 3.03 vs. 3.65; pmaxillofacial surgeon, were less satisfied with their career, and were more likely to consider a career change in the next five years than the male residents. While these male and female oral and maxillofacial surgeons in private practice and academia did not differ in their career and job satisfaction, the male and female residents differed significantly, with female residents reporting a significantly poorer career and job satisfaction than male residents. Future research needs to explore ways to improve career and professional satisfaction of female OMS residents.

  10. Support infrastructure available to Canadian residents completing post-graduate global health electives: current state and future directions

    Directory of Open Access Journals (Sweden)

    Lojan Sivakumaran

    2016-12-01

    Conclusion: Canadian universities are encouraged to continue to send their trainees on global health electives. To address the gaps in infrastructure reported in this study, the authors suggest the development of comprehensive standardized guidelines by post-graduate regulatory/advocacy bodies to better ensure patient and participant safety. We also encourage the centralization of infrastructure management to the universities’ global health departments to aid in resource management.

  11. Dedicated Research Time During Surgery Residency Leads to a Significant Decline In Self-Assessed Clinical Aptitude and Surgical Skills.

    Science.gov (United States)

    Grova, Monica M; Yang, Anthony D; Humphries, Misty D; Galante, Joseph M; Salcedo, Edgardo S

    The surgical community commonly perceives a decline in surgical and patient care skills among residents who take dedicated time away from clinical activity to engage in research. We hypothesize that residents perceive a decline in their skills because of dedicated research time. UC Davis Medical Center, Sacramento, CA, an institutional tertiary care center. General surgery residents and graduates from UC Davis general surgery residency training program, who had completed at least 1 year of research during their training. A total of 35 people were asked to complete the survey, and 19 people submitted a completed survey. Participants were invited to complete an online survey. Factors associated with the decline in skills following their research years were examined. All statistical analyses were performed with IBM SPSS Statistics software. A total of 19 current or former general surgery residents responded to the survey (54% response rate). Overall, 42% described their research as "basic science." Thirteen residents (68%) dedicated 1 year to research, while the remainder spent 2 or more years. Basic science researchers were significantly more likely to report a decrease in clinical judgment (75% vs. 22%, p = 0.013) as well as a decrease in patient care skills (63% vs. 0%, p = 0.002). Residents who dedicated at least 2 years to research were more likely to perceive a decline in overall aptitude and surgical skills (100% vs. 46%, p = 0.02), and a decline in patient care skills (67% vs. 8%, p = 0.007). Most residents who dedicate time for research perceive a decline in their overall clinical aptitude and surgical skills. This can have a dramatic effect on the confidence of these residents in caring for patients and leading a care team once they re-enter clinical training. Residents who engaged in 2 or more years of research were significantly more likely to perceive these problems. Further research should determine how to keep residents who are interested in academics

  12. Presence of anesthesia resident trainees in day surgery unit has mixed effects on operating room efficiency measures.

    Science.gov (United States)

    Urman, Richard D; Sarin, Pankaj; Mitani, Aya; Philip, Beverly; Eappen, Sunil

    2012-01-01

    Three competing goals at academic medical centers are to increase efficiency, to optimize clinical care, and to train residents. The goal of this project was to compare day surgery operating room (OR) efficiency measures for anesthesiologists working alone, working with residents, and working with certified nurse anesthetists in a tertiary multisubspecialty teaching hospital to determine if trainees significantly impact OR efficiency. We retrospectively evaluated operating room times data for 2,427 day surgery cases, comparing first case on-time starts, anesthesia-controlled times, induction times, emergence times, and turnover times for the 3 anesthesiologist groups. Compared to the solo anesthesiologist group, anesthesiologists working with residents had significantly longer induction, emergence, and total anesthesia-controlled times (20.2 ± 8.0 vs 18.4 ± 7.0 minutes). However, the anesthesiologists working with residents had more on-time starts (65% vs 53%) and lower turnover times 47.3 ± 13.6 vs 50.8 ± 14.5 minutes) than the solo anesthesiologist group. The pairing of anesthesiology residents with anesthesia staff has mixed effects on OR efficiency measures in a day surgery unit.

  13. Self-reported attitudes and behaviors of general surgery residents about ethical academic practices in test taking.

    Science.gov (United States)

    Grignol, Valerie P; Gans, Alyssa; Booth, Branyan A; Markert, Ronald; Termuhlen, Paula M

    2010-08-01

    A correlation exists between people who engage in academic dishonesty as students and unethical behaviors later as professionals. Academic dishonesty has been assessed among medical students, but not among general surgery residents. We sought to describe the attitudes of general surgery residents with regard to ethical practices in test taking. A survey with 4 scenarios describing activities related to examination taking that may or may not be considered unethical was administered. Participants were asked about participation in the activities-either personally or any knowledge of others-and whether the activities were unethical. Fifty-seven of 62 residents (92%) participated. For each scenario, >70% indicated that neither they nor anyone else they knew had participated in the activities. Behaviors deemed unethical included memorizing or using memorized questions to prepare for future tests (52%), selling questions for financial gain (90%), and purchasing previously used questions (57%). No difference in attitudes was seen among incoming interns, junior-level (postgraduate year [PGY]1-3), or senior-level (PGY4-6) residents. Overall, general surgery residents indicated that they had not participated in activities they felt to be unethical. Defining what is unethical was less clear. This represents an area for further education. Copyright 2010 Mosby, Inc. All rights reserved.

  14. Getting started with robotics in general surgery with cholecystectomy: the Canadian experience

    Science.gov (United States)

    Jayaraman, Shiva; Davies, Ward; Schlachta, Christopher M.

    2009-01-01

    Background The value of robotics in general surgery may be for advanced minimally invasive procedures. Unlike other specialties, formal fellowship training opportunities for robotic general surgery are few. As a result, most surgeons currently develop robotic skills in practice. Our goal was to determine whether robotic cholecystectomy is a safe and effective bridge to advanced robotics in general surgery. Methods Before performing advanced robotic procedures, 2 surgeons completed the Intuitive Surgical da Vinci training course and agreed to work together on all procedures. Clinical surgery began with da Vinci cholecystectomy with a plan to begin advanced procedures after at least 10 cholecystectomies. We performed a retrospective review of our pilot series of robotic cholecystectomies and compared them with contemporaneous laparoscopic controls. The primary outcome was safety, and the secondary outcome was learning curve. Results There were 16 procedures in the robotics arm and 20 in the laparoscopic arm. Two complications (da Vinci port-site hernia, transient elevation of liver enzymes) occurred in the robotic arm, whereas only 1 laparoscopic patient (slow to awaken from anesthetic) experienced a complication. None was significant. The mean time required to perform robotic cholecystectomy was significantly longer than laparoscopic surgery (91 v. 41 min, p robotic procedures (14 v. 11 min, p = 0.015). We observed a trend showing longer mean anesthesia time for robotic procedures (23 v. 15 min). Regarding learning curve, the mean operative time needed for the first 3 robotic procedures was longer than for the last 3 (101 v. 80 min); however, this difference was not significant. Since this experience, the team has confidently gone on to perform robotic biliary, pancreatic, gastresophageal, intestinal and colorectal operations. Conclusion Robotic cholecystectomy can be performed reliably; however, owing to the significant increase in operating room resources, it

  15. Getting started with robotics in general surgery with cholecystectomy: the Canadian experience.

    Science.gov (United States)

    Jayaraman, Shiva; Davies, Ward; Schlachta, Christopher M

    2009-10-01

    The value of robotics in general surgery may be for advanced minimally invasive procedures. Unlike other specialties, formal fellowship training opportunities for robotic general surgery are few. As a result, most surgeons currently develop robotic skills in practice. Our goal was to determine whether robotic cholecystectomy is a safe and effective bridge to advanced robotics in general surgery. Before performing advanced robotic procedures, 2 surgeons completed the Intuitive Surgical da Vinci training course and agreed to work together on all procedures. Clinical surgery began with da Vinci cholecystectomy with a plan to begin advanced procedures after at least 10 cholecystectomies. We performed a retrospective review of our pilot series of robotic cholecystectomies and compared them with contemporaneous laparoscopic controls. The primary outcome was safety, and the secondary outcome was learning curve. There were 16 procedures in the robotics arm and 20 in the laparoscopic arm. Two complications (da Vinci port-site hernia, transient elevation of liver enzymes) occurred in the robotic arm, whereas only 1 laparoscopic patient (slow to awaken from anesthetic) experienced a complication. None was significant. The mean time required to perform robotic cholecystectomy was significantly longer than laparoscopic surgery (91 v. 41 min, p < 0.001). The mean time to clear the operating room was significantly longer for robotic procedures (14 v. 11 min, p = 0.015). We observed a trend showing longer mean anesthesia time for robotic procedures (23 v. 15 min). Regarding learning curve, the mean operative time needed for the first 3 robotic procedures was longer than for the last 3 (101 v. 80 min); however, this difference was not significant. Since this experience, the team has confidently gone on to perform robotic biliary, pancreatic, gastresophageal, intestinal and colorectal operations. Robotic cholecystectomy can be performed reliably; however, owing to the significant

  16. Comparison of pediatric appendectomy outcomes between pediatric surgeons and general surgery residents.

    Science.gov (United States)

    Mizrahi, Ido; Mazeh, Haggi; Levy, Yair; Karavani, Gilad; Ghanem, Muhammad; Armon, Yaron; Vromen, Amos; Eid, Ahmed; Udassin, Raphael

    2013-04-01

    Appendectomy is the most common urgent procedure in children, and surgical outcomes may be affected by the surgeon's experience. This study's aim is to compare appendectomy outcomes performed by pediatric surgeons (PSs) and general surgery residents (GSRs). A retrospective review of all patients younger than 16y treated for appendicitis at two different campuses of the same institution during the years 2008-2009 was performed. Appendectomies were performed by PS in one campus and GSR in the other. Primary end points included postoperative morbidity and hospital length of stay. During the study period, 246 (61%) patients were operated by senior GSR (postgraduate year 5-7) versus 157 (39%) patients by PS. There was no significant difference in patients' characteristics at presentation to the emergency room and the rate of appendeceal perforation (11% versus 15%, P=0.32), and noninfectious appendicitis (5% versus 5% P=0.78) also was similar. Laparoscopic surgery was performed more commonly by GSR (16% versus 9%, P=0.02) with shorter operating time (54±1.5 versus 60±2.1, P=0.01). Interestingly, the emergency room to operating room time was shorter for GSR group (419±14 versus 529±24min, P<0.001). The hospital length of stay was shorter for the GSR group (4.0±0.2 versus 4.5±0.2, P=0.03), and broad-spectrum antibiotics were used less commonly (20% versus 53%, P<0.0001) and so was home antibiotics continuation (13% versus 30%, P<0.0001). Nevertheless, postoperative complication rate was similar (5% versus 7%, P=0.29) and so was the rate of readmissions (2% versus 5%, P=0.52). The results of this study suggest that the presence of a PS does not affect the outcomes of appendectomies. Copyright © 2013 Elsevier Inc. All rights reserved.

  17. Comparing resident cataract surgery outcomes under novice versus experienced attending supervision

    Directory of Open Access Journals (Sweden)

    Puri S

    2015-09-01

    Full Text Available Sidharth Puri,1 Amanda E Kiely,2 Jiangxia Wang,3 Alonzo S Woodfield,4 Saras Ramanathan,5 Shameema Sikder21Johns Hopkins School of Medicine, Baltimore, MD, 2Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 3Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 4Kaiser Permanente South Sacramento Medical Center, Sacramento, 5San Francisco School of Medicine, University of California, San Francisco, CA, USAPurpose: To determine whether supervision by an attending new to surgical teaching or an experienced attending measurably influences intraoperative complications rates or outcomes in phacoemulsification performed by ophthalmology residents.Setting: Single tertiary hospital.Design: Retrospective cohort study. Methods: Resident-performed phacoemulsification cases supervised by one novice attending (N=189 and experienced attending (N=172 over 1 year were included. Data included: resident year, patient age, sex, preoperative risk factors (4+ dense/white/brunescent cataracts, Flomax, zonular dialysis, pseudoexfoliation, glaucoma risk, post-vitrectomy, intraoperative risk factors (Trypan blue, iris hooks, and intraoperative complications (capsule tears, vitreous loss, zonular dialysis, zonular dehiscence, burns, nuclear fragment loss, Descemet’s tear. Experienced attending data were compared against those of the novice attending.Results: Regarding preoperative risks, experienced attending cases more likely involved 4+ cataract (P=0.005, Flomax (P<0.001, or glaucoma risk (P=0.001. For intraoperative risks, novice attending cases more likely involved Trypan blue (P<0.001. Regarding complications, novice attending cases were associated with vitreous loss (P=0.002 and anterior capsule tears (P<0.001. When comparing total complications, the novice attending was more likely to have both increased number of cases with complications and total complications than the experienced attending. The novice

  18. NOTES: issues and technical details with introduction of NOTES into a small general surgery residency program.

    Science.gov (United States)

    Kavic, Michael S; Mirza, Brian; Horne, Walter; Moskowitz, Jesse B

    2008-01-01

    Natural orifice translumenal endoscopic surgery (NOTES) is a development of recent origin. In 2004, Kalloo et al first described NOTES investigation in an animal model. Since then, several investigators have pursued NOTES study in animal survival and nonsurvival models. Our objectives for this project included studying NOTES intervention in a laboratory environment using large animal (swine) models and learning to do so in a safe, controlled manner. Ultimately, we intend to introduce NOTES methodology into our surgical residency training program. The expertise of an experienced laparoscopic surgeon, fellowship-trained laparoendoscopic surgeon, and veterinarian along with a senior surgical resident was utilized to bring the input of several disciplines to this study. The Institutional Animal Care and Use Committee (IACUC) of Northeastern Ohio Universities College of Medicine and Pharmacy (NEOUCOM/COP) approved this study. A series of 5 laboratory sessions using mixed breed farm swine varying in weight from 37 kg to 43.1 kg was planned for the initial phase of NOTES introduction into our residency program. Animals were not kept alive in this investigation. All animals were anesthetized using a standard swine protocol and euthanized following guidelines issued by the American Veterinary Medical Association Panel on Euthanasia. Equipment included a Fujinon EVE endoscope 0.8 cm in diameter with a suction/irrigation channel and one working channel. Initially, a US Endoscopy gastric overtube, 19.5 mm OD and 50 cm in length, was used to facilitate passage of the endoscope. However, this device was found to have insufficient length. Subsequently, commercially available 5/8" diameter clear plastic tubing, 70 cm to 80 cm in length, was adapted for use as an overtube. Standard endoscopic instruments included Boston Scientific biopsy forceps, needle-knife, papillotome, endoscopic clip applier, and Valley Lab electrosurgical unit. A Karl Storz laparoscope and tower were used for

  19. A Comparison of Training Experience, Training Satisfaction, and Job Search Experiences between Integrated Vascular Surgery Residency and Traditional Vascular Surgery Fellowship Graduates.

    Science.gov (United States)

    Colvard, Benjamin; Shames, Murray; Schanzer, Andres; Rectenwald, John; Chaer, Rabih; Lee, Jason T

    2015-10-01

    The first 2 integrated vascular residents in the United States graduated in 2012, and in 2013, 11 more entered the job market. The purpose of this study was to compare the job search experiences of the first cohort of integrated 0 + 5 graduates to their counterparts completing traditional 5 + 2 fellowship programs. An anonymous, Web-based, 15-question survey was sent to all 11 graduating integrated residents in 2013 and to the 25 corresponding 5 + 2 graduating fellows within the same institution. Questions focused on the following domains: training experience, job search timelines and outcomes, and overall satisfaction with each training paradigm. Survey response was nearly 81% for the 0 + 5 graduates and 64% for the 5 + 2 graduates. Overall, there was no significant difference between residents and fellows in the operative experience obtained as measured by the number of open and endovascular cases logged. Dedicated research time during the entire training period was similar between residents and fellows. Nearly all graduates were extremely satisfied with their training and had positive experiences during their job searches with respect to starting salaries, numbers of offers, and desired practice type. More 0 + 5 residents chose academic and mixed practices over private practices compared with 5 + 2 fellowship graduates. Although longer term data are needed to understand the impact of the addition of 0 + 5 graduating residents to the vascular surgery work force, preliminary survey results suggest that both training paradigms (0 + 5 and 5 + 2) provide positive training experiences that result in excellent job search experiences. Based on the current and future need for vascular surgeons in the work force, the continued growth and expansion of integrated 0 + 5 vascular surgery residency positions as an alternative to traditional fellowship training is thus far justified. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Objective assessment in residency-based training for transoral robotic surgery.

    Science.gov (United States)

    Curry, Martin; Malpani, Anand; Li, Ryan; Tantillo, Thomas; Jog, Amod; Blanco, Ray; Ha, Patrick K; Califano, Joseph; Kumar, Rajesh; Richmon, Jeremy

    2012-10-01

    To develop a robotic surgery training regimen integrating objective skill assessment for otolaryngology and head and neck surgery trainees consisting of training modules of increasing complexity leading up to procedure-specific training. In particular, we investigated applications of such a training approach for surgical extirpation of oropharyngeal tumors via a transoral approach using the da Vinci robotic system. Prospective blinded data collection and objective evaluation (Objective Structured Assessment of Technical Skills [OSATS]) of three distinct phases using the da Vinci robotic surgical system in an academic university medical engineering/computer science laboratory setting. Between September 2010 and July 2011, eight otolaryngology-head and neck surgery residents and four staff experts from an academic hospital participated in three distinct phases of robotic surgery training involving 1) robotic platform operational skills, 2) set up of the patient side system, and 3) a complete ex vivo surgical extirpation of an oropharyngeal tumor located in the base of tongue. Trainees performed multiple (four) approximately equally spaced training sessions in each stage of the training. In addition to trainees, baseline performance data were obtained for the experts. Each surgical stage was documented with motion and event data captured from the application programming interfaces of the da Vinci system, as well as separate video cameras as appropriate. All data were assessed using automated skill measures of task efficiency and correlated with structured assessment (OSATS and similar Likert scale) from three experts to assess expert and trainee differences and compute automated and expert assessed learning curves. Our data show that such training results in an improved didactic robotic knowledge base and improved clinical efficiency with respect to the set up and console manipulation. Experts (e.g., average OSATS, 25; standard deviation [SD], 3.1; module 1, suturing

  1. Can teenage novel users perform as well as General Surgery residents upon initial exposure to a robotic surgical system simulator?

    Science.gov (United States)

    Mehta, A; Patel, S; Robison, W; Senkowski, T; Allen, J; Shaw, E; Senkowski, C

    2017-06-05

    New techniques in minimally invasive and robotic surgical platforms require staged curricula to insure proficiency. Scant literature exists as to how much simulation should play a role in training those who have skills in advanced surgical technology. The abilities of novel users may help discriminate if surgically experienced users should start at a higher simulation level or if the tasks are too rudimentary. The study's purpose is to explore the ability of General Surgery residents to gain proficiency on the dVSS as compared to novel users. The hypothesis is that Surgery residents will have increased proficiency in skills acquisition as compared to naive users. Six General Surgery residents at a single institution were compared with six teenagers using metrics measured by the dVSS. Participants were given two 1-h sessions to achieve an MScoreTM in the 90th percentile on each of the five simulations. MScoreTM software compiles a variety of metrics including total time, number of attempts, and high score. Statistical analysis was run using Student's t test. Significance was set at p value Surgery residents took significantly less Total Time to complete Pegboard 1 (PB1) (p = 0.043). No significant difference was evident between the two groups in the other four simulations across the same MScoreTM metrics. A focused look at the energy dissection task revealed that overall score might not be discriminant enough. Our findings indicate that prior medical knowledge or surgical experience does not significantly impact one's ability to acquire new skills on the dVSS. It is recommended that residency-training programs begin to include exposure to robotic technology.

  2. Assessment of Surgery Residents' Interpersonal Communication Skills: Validation Evidence for the Communication Assessment Tool in a Simulation Environment.

    Science.gov (United States)

    Trickey, Amber W; Newcomb, Anna B; Porrey, Melissa; Wright, Jeffrey; Bayless, Jordan; Piscitani, Franco; Graling, Paula; Dort, Jonathan

    Although development of trainees' competency in interpersonal communication is essential to high-quality patient-centered surgical care, nontechnical skills present assessment challenges for residency program directors. The Communication Assessment Tool (CAT) demonstrated internal reliability and content validity for general surgery residents, though the tool has not yet been applied in simulation. The study provides validation evidence for using the CAT to assess surgical residents' interpersonal communication skills in simulation scenarios. Simulations of delivering bad news were completed by 21 general surgery residents during a mandatory communication curriculum. Upon completion of the 10-minute scenario, standardized participants (SPs) assessed performance using the 14-item CAT rating scale and individually provided feedback to residents. Discrete communication behaviors were recorded on video review by a trained blinded observer. The traits emotional intelligence questionnaire short form (TEIQue-SF) was completed by the residents 6 months later. SP-CAT ratings are evaluated with respect to learner characteristics, observed behaviors, and TEIQue results. Surgical simulation center in a 900-bed tertiary care hospital. General surgery residents were targeted learners. Trauma survivors network volunteers served as SPs, acting as a family member of a patient who developed an intracerebral hemorrhage following a small bowel procedure. Discrete communication behaviors were reliably assessed by the observer (interrater reliability with trainer: 89% agreement, κ = 0.77). SP-CAT ratings ranged from 34 to 61. Higher SP-CAT ratings were correlated with positive communication behaviors (Spearman ρ = 0.42, p = 0.056). Total TEIQue was positively related to SP-CAT ratings (ρ = 0.42, p = 0.061). The TEIQue emotionality factor was strongly correlated with SP-CAT ratings (ρ = 0.52, p = 0.016). The CAT demonstrates content validity in a simulation environment with former

  3. Using GoPro to Give Video-Assisted Operative Feedback for Surgery Residents: A Feasibility and Utility Assessment.

    Science.gov (United States)

    Moore, Maureen D; Abelson, Jonathan S; O'Mahoney, Paul; Bagautdinov, Iskander; Yeo, Heather; Watkins, Anthony C

    2017-08-21

    As an adjunct to simulation-based teaching, laparoscopic video-based surgical coaching has been an effective tool to augment surgical education. However, the wide use of video review in open surgery has been limited primarily due to technological and logistical challenges. The aims of our study were to (1) evaluate perceptions of general surgery (GS) residents on video-assisted operative instruction and (2) conduct a pilot study using a head-mounted GoPro in conjunction with the operative performance rating system to assess feasibility of providing video review to enhance operative feedback during open procedures. GS residents were anonymously surveyed to evaluate their perceptions of oral and written operative feedback and use of video-based operative resources. We then conducted a pilot study of 10 GS residents to assess the utility and feasibility of using a GoPro to record resident performance of an arteriovenous fistula creation with an attending surgeon. Categorical variables were analyzed using the chi-square test. Academic, tertiary medical center. GS residents and faculty. A total of 59 GS residents were anonymously surveyed (response rate = 65.5%). A total of 40% (n = 24) of residents reported that structured evaluations rarely or never provided meaningful feedback. When feedback was received, 55% (n = 32) residents reported that it was only rarely or sometimes in regard to their operative skills. There was no significant difference in surveyed responses among junior postgraduate year (PGY 1-2), senior (PGY 3-4), or chief residents (PGY-5). A total of 80% (n = 8) of residents found the use of GoPro video review very or extremely useful for education; they also deemed video review more useful for operative feedback than written or communicative feedback. An overwhelming majority (90%, n = 9) felt that video review would lead to improved technical skills, wanted to review the video with the attending surgeon for further feedback, and desired expansion of

  4. Emergency Endoscopy and the Importance of Endoscopy Training in General Surgery Residency: A Survey-Based Study.

    Science.gov (United States)

    Yıldız, İhsan; Koca, Yavuz Savaş; Bülbül, Mustafa Tevfik; Musri, Özgür Cem

    2017-10-31

    BACKGROUND Emergency endoscopy is a life-saving technique of great significance. The aim of our study was to draw attention to endoscopy training activities of general surgeons and their opinions on this issue. MATERIAL AND METHODS We asked general surgery specialists where they received their general surgery training, the institution where they currently worked, how many years they had been practicing, if they had endoscopy training during or after residency, if a gastroenterologist was available in their hospital, and whether they used endoscopy. We also asked some questions, including 'Should general surgeons perform emergency or elective endoscopy?', 'Is endoscopy training required in general surgery', and 'What is your opinion regarding this issue?', and we assessed the answers. RESULTS Of the 138 general surgeons undertaking surveys, 63% of participants received their general surgery training in university hospitals and 37% in training and research hospitals. The duration of practicing as a general surgeon was 5 years for 23.9%, 5-15 years for 38.4%, 15-20 years for 20.3%, and over 20 years for 17.4% of participants. The rate of receiving endoscopy training at residency was 51.4%, 25.4% did not have endoscopy training, and 23.2% had postgraduate training. All participants replied affirmatively to the question 'Should general surgeons perform emergency or elective endoscopy?'. CONCLUSIONS Although endoscopy has been widely used recently, gastroenterologists are not available in every hospital. Consequently, it is evident that endoscopy should be part of general surgery training.

  5. Cost of outpatient endoscopic sinus surgery from the perspective of the Canadian government: a time-driven activity-based costing approach.

    Science.gov (United States)

    Au, Jennifer; Rudmik, Luke

    2013-09-01

    The time-driven activity-based costing (TD-ABC) method is a novel approach to quantify the costs of a complex system. The aim of this study was to apply the TD-ABC technique to define the overall cost of a routine outpatient endoscopic sinus surgery (ESS) from the perspective of the Canadian government payer. Costing perspective was the Canadian government payer. All monetary values are in Canadian dollars as of December 2012. Costs were obtained by contacting staff unions, reviewing purchasing databases and provincial physician fee schedules. Practical capacity time values were collected from the College and Association of Registered Nurses of Alberta. Capacity cost rates ($/min) were calculated for all staff, capital equipment, and hospital space. The overall cost for routine outpatient ESS was $3510.31. The cost per ESS case for each clinical pathway encounter was as follows: preoperative holding ($49.19); intraoperative ($3296.60); sterilization ($90.20); postanesthesia care unit ($28.64); and postoperative day ward ($45.68). The 3 major cost drivers were physician fees, disposable equipment, and nursing costs. The intraoperative phase contributed to 94.5% of the overall cost. This study applied the TD-ABC method to evaluate the cost of outpatient ESS from the perspective of the Canadian government payer and defined the overall cost to be $3510.31 per case. © 2013 ARS-AAOA, LLC.

  6. Use of medical tourism for hip and knee surgery in osteoarthritis: a qualitative examination of distinctive attitudinal characteristics among Canadian patients

    Directory of Open Access Journals (Sweden)

    Crooks Valorie A

    2012-11-01

    Full Text Available Abstract Background Medical tourism is the term that describes patients’ international travel with the intention of seeking medical treatment. Some medical tourists go abroad for orthopaedic surgeries, including hip and knee resurfacing and replacement. In this article we examine the findings of interviews with Canadian medical tourists who went abroad for such surgeries to determine what is distinctive about their attitudes when compared to existing qualitative research findings about patients’ decision-making in and experiences of these same procedures in their home countries. Methods Fourteen Canadian medical tourists participated in semi-structured phone interviews, all of whom had gone abroad for hip or knee surgery to treat osteoarthritis. Transcripts were coded and thematically analysed, which involved comparing emerging findings to those in the existing qualitative literature on hip and knee surgery. Results Three distinctive attitudinal characteristics among participants were identified when interview themes were compared to findings in the existing qualitative research on hip and knee surgery in osteoarthritis. These attitudinal characteristics were that the medical tourists we spoke with were: (1 comfortable health-related decision-makers; (2 unwavering in their views about procedure necessity and urgency; and (3 firm in their desires to maintain active lives. Conclusions Compared to other patients reported on in the existing qualitative hip and knee surgery literature, medical tourists are less likely to question their need for surgery and are particularly active in their pursuit of surgical intervention. They are also comfortable with taking control of health-related decisions. Future research is needed to identify motivators behind patients’ pursuit of care abroad, determine if the attitudinal characteristics identified here hold true for other patient groups, and ascertain the impact of these attitudinal characteristics on

  7. Faculty and resident perspectives on ambulatory care education: A collective case study of family medicine, psychiatry, and surgery

    Science.gov (United States)

    Veinot, Paula; Lin, William; Woods, Nicole; Ng, Stella

    2017-01-01

    Background Ambulatory care (AC) experiences within medical education are garnering increasing attention. We sought to understand how faculty and residents’ describe their experiences of AC and ambulatory care education (ACEduc) within, between, and across disciplinary contexts. Methods We designed a Stakian collective case study, applying constructivist grounded theory analytic methods. Using purposive and snowball sampling, we interviewed 17 faculty and residents across three instrumental cases: family medicine, psychiatry, surgery. Through constant comparative analysis, we identified patterns within, between, and across cases. Results Family medicine and psychiatry saw AC as an inherent part of continuous, longitudinal care; surgery equated AC with episodic experiences in clinic, differentiating it from operating. Across cases, faculty and residents cautiously valued ACEduc, and in particular, considered it important to develop non-medical expert competencies (e.g., communication). However, surgery residents described AC and ACEduc as less interesting and a lower priority than operating. Educational structures mediated these views. Conclusion Differences between cases highlight a need for further study, as universal assumptions about ACEduc’s purposes and approaches may need to be tempered by situated, contextually-rich perspectives. How disciplinary culture, program structure, and systemic structure influence ACEduc warrant further consideration as does the educational potential for explicitly framing learners’ perspectives. PMID:29098047

  8. Surgery resident participation in short-term humanitarian international surgical missions can supplement exposure where program case volumes are low.

    Science.gov (United States)

    Bale, Asha G; Sifri, Ziad C

    2016-01-01

    General surgery training programs face declining case volume and diversity. We wanted to determine if resident participation in international surgical missions would increase exposure to cases underrepresented in our program case mix. Accreditation Council for Graduate Medical Education program data from 2008 to 2011 (University of Medicine and Dentistry-New Jersey Medical School, Newark, NJ) were analyzed to identify categories where volume was below national average. This was compared with case logs from 3 missions conducted by International Surgical Health Initiatives between 2011 and 2012. All chief residents completed more than minimum required index cases. Categories head and neck, alimentary tract, abdomen, and endocrine showed percentile below national average. Seven residents participated in 3 missions to Philippines and Sierra Leone. Sixty-five percent of the operations performed were in the 4 low-volume categories. International surgery missions expose residents to a high volume and variety of cases. Participation can be one way to increase case volume and diversity during training. Cases completed on missions with board certified surgeons should be considered for Accreditation Council for Graduate Medical Education credit. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Water systems, sanitation, and public health risks in remote communities: Inuit resident perspectives from the Canadian Arctic.

    Science.gov (United States)

    Daley, Kiley; Castleden, Heather; Jamieson, Rob; Furgal, Chris; Ell, Lorna

    2015-06-01

    Safe drinking water and wastewater sanitation are universally recognized as critical components of public health. It is well documented that a lack of access to these basic services results in millions of preventable deaths each year among vulnerable populations. Water and wastewater technologies and management practices are frequently tailored to local environmental conditions. Also important, but often overlooked in water management planning, are the social, cultural and economic contexts in which services are provided. The purpose of this qualitative case study was to identify and understand residents' perceptions of the functionality of current water and wastewater sanitation systems in one vulnerable context, that of a remote Arctic Aboriginal community (Coral Harbour, Nunavut), and to identify potential future water related health risks. Semi-structured interviews were conducted with 28 Inuit residents and 9 key informants in 2011 and 2012. Findings indicate that the population's rapid transition from a semi-nomadic hunting and gathering lifestyle to permanent settlements with municipally provided utilities is influencing present-day water usage patterns, public health perceptions, and the level of priority decision-makers place on water and wastewater management issues. Simultaneously environmental, social and cultural conditions conducive to increased human exposure to waterborne health risks were also found to exist and may be increasing in the settlements. While water and wastewater system design decisions are often based on best practices proven suitable in similar environmental conditions, this study reinforces the argument for inclusion of social, cultural, and economic variables in such decisions, particularly in remote and economically challenged contexts in Canada or elsewhere around the world. The results also indicate that the addition of qualitative data about water and wastewater systems users' behaviours to technical knowledge of systems and

  10. Orthopedic surgery fellowships: the effects of interviewing and how residents establish a rank list.

    Science.gov (United States)

    Niesen, Matthew C; Wong, Jeffrey; Ebramzadeh, Edward; Sangiorgio, Sophia; SooHoo, Nelson Fong; Luck, James V; Eckardt, Jeffrey

    2015-03-01

    The Orthopaedic Fellowship Match was established in 2008 to streamline and improve the process of matching residents and fellowships. The purpose of this study was to quantify the factors that affect the application process and to determine how residents establish a rank list. The Orthopaedic Fellowship Match has improved the ability of residents and programs to consider their options more carefully and to focus on finding the best match. However, this process introduces new factors for all parties involved to consider. The costs of the interview process and time away from service for residents may be larger than anticipated. Ultimately, residents value operative experience and staff members at a fellowship more than all other factors when selecting a fellowship. Copyright 2015, SLACK Incorporated.

  11. Senior general surgery residents can be trained to perform focused assessment with sonography for trauma patients accurately.

    Science.gov (United States)

    Hsu, Sheng-Der; Chen, Cheng-Jueng; Chan, De-Chuan; Yu, Jyh-Cherng

    2017-12-01

    Researchers studying trauma have found that physicians are able to perform a focused assessment with sonography for trauma (FAST) with minimal training and achieve ideal accuracy. However, there are currently no consensus or standard guidelines regarding the performance of this assessment. The aim of our study was to clarify the value of FAST performed by well-qualified senior general surgery residents in cases of suspected blunt abdominal trauma, which presents an important diagnostic problem in emergency departments. This was a retrospective study in the emergency department (ED) of our hospital performed from January 2011 to September 2013. Patients were included if they (1) had undergone a FAST examination performed by qualified residents and (2) had received subsequent formal radiographic or surgical evaluations. The results were compared against subsequent surgical findings or formal Department of Radiology reference standards. Among the 438 patients enrolled, false-negative results were obtained in 8 and false-positive results in 5. Only one patient was missed and required laparotomy to repair a small intestine perforation. The sensitivity and specificity were 87 and 99%, respectively; the accuracy was 97%. Senior general surgery residents can be trained to perform accurate FAST examinations on trauma patients.

  12. Cleft Lip Standardized Patient Examinations: The Role in Plastic Surgery Resident Education.

    Science.gov (United States)

    Wright, Eric J; Khosla, Rohit K; Howell, Lori; Luan, Anna; Lee, Gordon K

    2016-11-01

      Our institution has incorporated the use of objective structured clinical examinations (OSCE) in our residency curriculum. The OSCE provides trainee education and evaluation while addressing the six Accreditation Council for Graduate Medical Education (ACGME) core competencies required within training programs. We report our program's experience with the first cleft OSCE ever conducted.   A validated method for administration of OSCEs currently used at our medical school was utilized for residents in postgraduate years (PGYs) 3 through 6. The video-recorded patient encounter involved a 1-month-old newborn with a unilateral cleft lip and palate and used standardized patient actors as parents. A post-encounter written exam assessed medical knowledge. A questionnaire regarding the utility of the exercise was administered to residents after the OSCE. Results were evaluated using analysis of variance (P < .05).   There was a positive correlation with increasing level of training in terms of medical knowledge (P < .04). Residents in PGY-3 and PGY-4 demonstrated lower understanding of the surgical markings and details of the lip repair compared with those in PGY-5 and PGY-6 (P < .03). All residents performed similarly on evaluation of the remaining ACGME core competencies. All residents agreed that this was a realistic and useful encounter.   Results of our cleft OSCE demonstrate that medical knowledge regarding the evaluation, management, and surgical repair of patients is less in midlevel residents. All residents expressed an interest in earlier exposure to pediatric patients in the training period. Although a cleft OSCE does not replace clinical rotations, it is a valuable adjunct to training and evaluation of trainees, particularly for junior residents.

  13. "I've never asked one question." Understanding the barriers among orthopedic surgery residents to screening female patients for intimate partner violence.

    Science.gov (United States)

    Gotlib Conn, Lesley; Young, Aynsely; Rotstein, Ori D; Schemitsch, Emil

    2014-12-01

    Intimate partner violence (IPV) is a global public health problem. Orthopedic surgery residents may identify IPV among injured patients treated in fracture clinics. Yet, these residents face a number of barriers to recognizing and discussing IPV with patients. We sought to explore orthopedic surgery residents' knowledge of IPV and their preparedness to screen patients for IPV in academic fracture clinic settings with a view to developing targeted IPV education and training. We conducted focus groups with junior and intermediate residents. Discussions explored residents' knowledge of and experiences with IPV screening and preparedness for screening and responding to IPV among orthopedic patients. Data were analyzed iteratively using an inductive approach. Residents were aware of the issue of abuse generally, but had received no specific information or training on IPV in orthopedics. Residents did not see orthopedics faculty screen patients for IPV or advocate for screening. They did not view IPV screening or intervention as part of the orthopedic surgeon's role. Residents' clinical experiences emphasized time management and surgical intervention by effectively "getting through clinic" and "dealing with the surgical problem." Communication with patients about other health issues was minimal or nonexistent. Orthopedic surgery residents are entering a career path where IPV is well documented. They encounter cultural and structural barriers preventing the incorporation of IPV screening into their clinical and educational experiences. Hospitals and academic programs must collaborate in efforts to build capacity for sustainable IPV screening programs among these trainees.

  14. Letters of recommendation to an otolaryngology/head and neck surgery residency program: their function and the role of gender.

    Science.gov (United States)

    Messner, Anna H; Shimahara, Erika

    2008-08-01

    To ascertain common features and gender differences in letters of recommendation (LORs) for applicants to an otolaryngology/head and neck surgery (OHNS) residency program. Retrospective review. Seven hundred sixty-three LORs submitted to one OHNS residency program in 2006 were reviewed. All 763 letters "recommended" the applicant for OHNS residency. Ninety-one percent of letters were written by men, 68.4% by male otolaryngologists (OTOs), 4.2% by female OTOs, and 33% by OHNS department chairs or division chiefs (100% men). A comparison of female and male letter writers revealed five categories with significant differences: female letter writers were more likely to call an applicant a "team player" (P = .000), "compassionate," (P = .001) and use strings of adjectives (P = .024). In contrast, they were less likely when compared with male letter writers, to mention an applicant's personal life (P = .003), or write "letters of minimal assurance" (P = .035). Evaluation of the letters by applicant gender revealed two findings: letter writers were more likely to use a gender term in letters for male applicants (P = .004), and male letter writers were more likely to make reference to a female candidate's physical appearance (P = .040). LORs for OHNS residency universally advocate for the applicant. The letters are written predominately by the highest-ranking male OTOs in academic medicine. In the LORs, male and female applicants are described similarly. Male and female letter writers, however, often describe applicants in different ways regardless of applicant gender.

  15. Learning styles of medical students, general surgery residents, and general surgeons: implications for surgical education

    OpenAIRE

    de Gara Chris; Engels Paul T

    2010-01-01

    Abstract Background Surgical education is evolving under the dual pressures of an enlarging body of knowledge required during residency and mounting work-hour restrictions. Changes in surgical residency training need to be based on available educational models and research to ensure successful training of surgeons. Experiential learning theory, developed by David Kolb, demonstrates the importance of individual learning styles in improving learning. This study helps elucidate the way in which ...

  16. Psychometric characteristics of the 360° feedback scales in professionalism and interpersonal and communication skills assessment of surgery residents in China.

    Science.gov (United States)

    Zhao, Yuhong; Zhang, Xiangsu; Chang, Qing; Sun, Baozhi

    2013-01-01

    The aim of the study was to test the psychometric characteristics of the 360° evaluation instrument for assessing residents' competency in professionalism, interpersonal and communication skills, and develop a feasible, valid, and reliable multisource feedback (MSF) program for surgery residents to address this gap. We carried out an MSF assessment of 149 surgery residents at 19 hospitals all over China. MSF assessment includes 6 surveys with 21, 21, 21, 26, 14, and 15 items and these surveys were developed to assess surgery residents by attending doctor, resident self, peer, nurse, patient, and office staff, respectively, using a 5-point agreement scale with an "unable-to-evaluate" category. Reliability was assessed by Cronbach alpha. Exploratory factor analysis was used to assess validity and determine which items grouped together into scales. A total of 2384 questionnaires were analyzed in this study. The internal consistency reliability of the instruments was a Cronbach alpha of 0.932, 0.936, 0.914, 0.916, 0.939, and 0.903 for attending doctor, resident self, nurse, patient, resident peer, and office staff surveys, respectively. On the attending, resident self, resident peer, nurse, office staff, and patient surveys, the factor analysis identified 2 factors of professionalism and interpersonal and communication skills accounting for 75.62%, 74.81%, 72.65%, 73.38%, 76.11%, and 63.89% of the variance, respectively. Some items, such as Demonstrates respect for my "Sexual Orientation," "Religion," and "Disability," in different surveys had high unable-to-evaluate rates (more than 10%). The data suggest that these instruments developed to assess surgery residents are feasible to administer and provide valid and reliable evidence. Some items in survey need to be adjusted keeping in mind the Chinese culture. Copyright © 2013 Association of Program Directors in Surgery. All rights reserved.

  17. Emergency Endoscopy and the Importance of Endoscopy Training in General Surgery Residency: A Survey-Based Study

    Science.gov (United States)

    Yıldız, İhsan; Koca, Yavuz Savaş; Bülbül, Mustafa Tevfik; Musri, Özgür Cem

    2017-01-01

    Background Emergency endoscopy is a life-saving technique of great significance. The aim of our study was to draw attention to endoscopy training activities of general surgeons and their opinions on this issue. Material/Methods We asked general surgery specialists where they received their general surgery training, the institution where they currently worked, how many years they had been practicing, if they had endoscopy training during or after residency, if a gastroenterologist was available in their hospital, and whether they used endoscopy. We also asked some questions, including ‘Should general surgeons perform emergency or elective endoscopy?’, ‘Is endoscopy training required in general surgery’, and ‘What is your opinion regarding this issue?’, and we assessed the answers. Results Of the 138 general surgeons undertaking surveys, 63% of participants received their general surgery training in university hospitals and 37% in training and research hospitals. The duration of practicing as a general surgeon was 5 years for 23.9%, 5–15 years for 38.4%, 15–20 years for 20.3%, and over 20 years for 17.4% of participants. The rate of receiving endoscopy training at residency was 51.4%, 25.4% did not have endoscopy training, and 23.2% had postgraduate training. All participants replied affirmatively to the question ‘Should general surgeons perform emergency or elective endoscopy?’. Conclusions Although endoscopy has been widely used recently, gastroenterologists are not available in every hospital. Consequently, it is evident that endoscopy should be part of general surgery training. PMID:29084936

  18. Improving the quality of operative reports for transurethral resection of bladder tumor surgery in resident education.

    Science.gov (United States)

    Haddad, Joseph; Anderson, Christopher; Heinlen, Jonathan; Stratton, Kelly; Mellis, Adamantios; Herr, Harry; Cookson, Michael; Patel, Sanjay

    2017-10-01

    To assess the quality of resident dictations for transurethral resection of bladder tumor (TURBT). One indicator of surgical quality is the completeness of the operative report. Surprisingly, there is a paucity of standardized operative templates for TURBT and little formalized instruction for learners. The quality of TURBT dictations was assessed and areas of improvement were determined after implementation of a 10 item TURBT checklist. A retrospective review of the last 50 TURBT operative reports dictated by residents was performed. A 'TURBT checklist' was used assessing 10 key factors in documentation. A formal training session regarding TURBT dictations was given with TURBT checklists handed out to each trainee. Fifty TURBT dictations were subsequently analyzed. TURBT dictations improved across the board following checklist implementation. Total number of checklist items dictated increased to 7.0 from 2.6 prior (p improved across different resident years (p improved in every checklist item (p improved in almost every category but only two reached statistical significance. A regression model demonstrated checklist implantation to be a significant predictor of improvement in mean number of checklist items dictated independent of PGY level. Our study demonstrates that prior to implementation, TURBT operative dictations performed by residents lacked many of the critical components required for a quality TURBT. However, once properly instructed, a relatively simple 'checklist' can be easily implemented and serve as a teaching tool for residents in training to ensure critical procedural elements are documented.

  19. Predictive model for 5-year mortality after breast cancer surgery in Taiwan residents.

    Science.gov (United States)

    Huang, Su-Hsin; Loh, Joon-Khim; Tsai, Jinn-Tsong; Houg, Ming-Feng; Shi, Hon-Yi

    2017-02-27

    Few studies of breast cancer surgery outcomes have used longitudinal data for more than 2 years. This study aimed to validate the use of the artificial neural network (ANN) model to predict the 5-year mortality of breast cancer patients after surgery and compare predictive accuracy between the ANN model, multiple logistic regression (MLR) model, and Cox regression model. This study compared the MLR, Cox, and ANN models based on clinical data of 3632 breast cancer patients who underwent surgery between 1996 and 2010. An estimation dataset was used to train the model, and a validation dataset was used to evaluate model performance. The sensitivity analysis was also used to assess the relative significance of input variables in the prediction model. The ANN model significantly outperformed the MLR and Cox models in predicting 5-year mortality, with higher overall performance indices. The results indicated that the 5-year postoperative mortality of breast cancer patients was significantly associated with age, Charlson comorbidity index (CCI), chemotherapy, radiotherapy, hormone therapy, and breast cancer surgery volumes of hospital and surgeon (all P < 0.05). Breast cancer surgery volume of surgeon was the most influential (sensitive) variable affecting 5-year mortality, followed by breast cancer surgery volume of hospital, age, and CCI. Compared with the conventional MLR and Cox models, the ANN model was more accurate in predicting 5-year mortality of breast cancer patients who underwent surgery. The mortality predictors identified in this study can also be used to educate candidates for breast cancer surgery with respect to the course of recovery and health outcomes.

  20. Reoperations after first lumbar disc herniation surgery; a special interest on residives during a 5-year follow-up

    Directory of Open Access Journals (Sweden)

    Kautiainen Hannu

    2007-01-01

    Full Text Available Abstract Background The overall rate of operations after recurrent lumbar disc herniation has been shown to be 3–11%. However, little is known about the rate of residives. Thus the aim of this study was to explore the cumulative rates of re-operations and especially residive disc herniations at the same side and level as the primary disc herniation after first lumbar disc herniation surgery and the factors that influence the risk of re-operations over a five year follow-up study. Methods 166 virgin lumbar disc herniation patients (mean age 42 years, 57% males were studied. Data on patients' initial disc operations and type and timing of re-operations during the follow-up were collected from patient files. Back and leg pain on visual analog scale and employment status were collected by questionnaires. Results The cumulative rate of re-operations for lumbar disc herniation was 10.2% (95% Cl 6.0 to 15.1. The rate of residives at initial site was 7.4% (95% Cl 3.7 to 11.3 and rate of lumbar disc herniations at other sites was 3.1% (95% Cl 0.6 to 6.2. The occurrence of residive lumbar disc herniations was evenly distributed across the 5 years. Neither age, gender, preoperative symptoms, physical activity nor employment had effect on the probability of re-operation. Conclusion Seven percent of the lumbar disc patients had a residive lumbar disc operation within five years of their first operation. No specific factors influencing the risk for re-operation were found.

  1. Teaching the surgical craft: Surgery residents perception of the operating theater educational environment in a tertiary institution in Nigeria

    Directory of Open Access Journals (Sweden)

    Abdulrasheed Ibrahim

    2013-01-01

    Full Text Available Background: The transformation of a surgical trainee into a surgeon is strongly influenced by the quality of teaching in the operating theater. This study investigates the perceptions of residents about the educational environment of the operating theater and identifies variables that may improve the operating theater education of our trainees. Materials and Methods: Residents in the department of surgery anonymously evaluated teaching in the operating room using the operating theater education environment measure. The residents evaluated 33 variables that might have an impact on their surgical skills within the operating theater. The variables were grouped into four subscales; teaching and training, learning opportunities, operating theater atmosphere and workload/supervision/support. Differences between male and female residents and junior and senior registrars were assessed using Mann-Whitney test. Statistical analysis was completed with the statistics package for the social sciences version 17. Results: A total of 33 residents were participated in this study. Twenty nine (88% males and 4 (12% females. 30 (90% were junior registrars. The mean total score was 67.5%. Operating theater atmosphere subscale had the highest score of 79.2% while workload/supervision/support subscale had the least score of 48.3%. There were significant differences between male and female resident′s perception of workload/supervision/support P 0.05. Conclusion: This study has shown a satisfactory teaching environment based on the existing local realities of means, resources and tools and highlighted the need for improvement in workload/supervision/support in our institution. An acceptable learning environment in the operating theatre will produce surgeons that are technically competent to bridge the gap in the enormous unmet need for surgical care in Nigeria.

  2. Informed consent training improves surgery resident performance in simulated encounters with standardized patients.

    Science.gov (United States)

    Thompson, Britta M; Sparks, Rhonda A; Seavey, Jonathan; Wallace, Michelle D; Irvan, Jeremy; Raines, Alexander R; McClure, Heather; Nihira, Mikio A; Lees, Jason S

    2015-09-01

    Although informed consent is vital to patient-physician communication, little training is provided to surgical trainees. We hypothesized that highlighting critical aspects of informed consent would improve resident performance. Eighty (out of 88) surgical postgraduate year 1 surgical residents were randomly assigned to one of the 2 cases (laparoscopic cholecystectomy or ventral herniorrhaphy) and instructed to obtain and document informed consent with a standardized patient (SP) followed by a didactic training session. The residents then obtained and documented informed consent with the other case with the other SP. SPs graded encounters ("Checklist"); trained raters graded notes. Repeated measures multivariate analysis of variance (MANOVA) was used to determine differences between pre- and post-training and Checklist versus "Note" scores. Statistically significant pre- to post differences for Note (P informed consent. Despite this improvement, significant differences between discussion and documentation persisted. Documentation training is a future area for improvement. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. The effect of junior residents on surgical quality: a study of surgical outcomes in breast surgery.

    Science.gov (United States)

    Aguilar, Brenda; Sheikh, Fariha; Pockaj, Barbara; Wasif, Nabil; Gray, Richard

    2011-12-01

    Patients are often concerned about the participation of junior trainees in their operative treatment. Breast-conserving therapy (BCT) for nonpalpable breast lesions requires the use of localization devices and carries a significant risk for positive margins of excision. It was therefore hypothesized that the participation of junior residents in BCT operations for nonpalpable breast lesions could result in an increased rate of positive margins of excision. Retrospective analysis of a prospective database of all patients with nonpalpable tumors who underwent BCT from August 1999 to August 2009 was performed. Patient and tumor characteristics and factors involved in resection were analyzed. A ≥2-mm margin of normal breast tissue beyond tumor was considered an adequate margin. Chi-square analysis and Student's t test were performed to determine relationships between independent variables and margin status. Of 308 BCT procedures for nonpalpable tumors, 241 (78%) were performed by attending surgeons and junior residents (group 1) and 67 (22%) by attending surgeons without resident assistance (group 2). The operations for group 1 took significantly longer than the operations for group 2 (mean, 130 vs 116 min, P = .006). Intraoperative reexcision of margins was performed for 37% of group 1 patients and 31% of group 2 patients (P = .249), and reoperation for inadequate margins was performed in 11% of group 1 patients and 13% of group 2 patients (P = .361). Junior resident participation in BCT procedures was not associated with higher rates of inadequate margins of excision. Patients can be reassured that junior resident involvement in their BCT operations is safe and effective. Copyright © 2011 Elsevier Inc. All rights reserved.

  4. Association Between Flexible Duty Hour Policies and General Surgery Resident Examination Performance: A Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial Analysis.

    Science.gov (United States)

    Blay, Eddie; Hewitt, D Brock; Chung, Jeanette W; Biester, Thomas; Fiore, James F; Dahlke, Allison R; Quinn, Christopher M; Lewis, Frank R; Bilimoria, Karl Y

    2017-02-01

    Concerns persist about the effect of current duty hour reforms on resident educational outcomes. We investigated whether a flexible, less-restrictive duty hour policy (Flexible Policy) was associated with differential general surgery examination performance compared with current ACGME duty hour policy (Standard Policy). We obtained examination scores on the American Board of Surgery In-Training Examination, Qualifying Examination (written boards), and Certifying Examination (oral boards) for residents in 117 general surgery residency programs that participated in the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial. Using bivariate analyses and regression models, we compared resident examination performance across study arms (Flexible Policy vs Standard Policy) for 2015 and 2016, and 1 year of the Qualifying Examination and Certifying Examination. Adjusted analyses accounted for program-level factors, including the stratification variable for randomization. In 2016, FIRST trial participants were 4,363 general surgery residents. Mean American Board of Surgery In-Training Examination scores for residents were not significantly different between study groups (Flexible Policy vs Standard Policy) overall (Flexible Policy: mean [SD] 502.6 [100.9] vs Standard Policy: 502.7 [98.6]; p = 0.98) or for any individual postgraduate year level. There was no difference in pass rates between study arms for either the Qualifying Examination (Flexible Policy: 90.4% vs Standard Policy: 90.5%; p = 0.99) or Certifying Examination (Flexible Policy: 86.3% vs Standard Policy: 88.6%; p = 0.24). Results from adjusted analyses were consistent with these findings. Flexible, less-restrictive duty hour policies were not associated with differences in general surgery resident performance on examinations during the FIRST Trial. However, more years under flexible duty hour policies might be needed to observe an effect. Copyright © 2016 American College of Surgeons

  5. The cost-effectiveness of colonic stenting as a bridge to curative surgery in patients with acute left-sided malignant colonic obstruction: A Canadian perspective

    Science.gov (United States)

    Singh, Harminder; Latosinsky, Steven; Spiegel, Brennan MR; Targownik, Laura E

    2006-01-01

    BACKGROUND: Over the past several years, colonic stenting has been advocated as an alternative to the traditional surgical approach for relieving acute malignant left-sided colonic obstruction. The aim of the present study was to determine the most cost-effective strategy in a Canadian setting. PATIENTS AND METHODS: A decision analytical model was developed to compare three competing strategies: CS – emergent colonic stenting followed by elective resective surgery and reanastomosis; RS – emergent resective surgery followed by creation of either a diverting colostomy or primary reanastomosis; and DC – emergent diverting colostomy followed by elective resective surgery and reanastomosis. The costs were estimated from the perspective of the Manitoba provincial health plan. RESULTS: The use of CS resulted in fewer total operative procedures per patient (mean CS 1.03, RS 1.32, DC 1.9), lower mortality rate (CS 5%, RS 11%, DC 13%) and lower likelihood of requiring a permanent stoma (CS 7%, RS 14%, DC 14%). CS is slightly more expensive than DC, but less costly than RS (DC $11,851, CS $13,164, RS $13,820). The incremental cost-effectiveness ratio associated with the use of CS versus DC is $1,415 to prevent a temporary stoma, $1,516 to prevent an additional operation and $15,734 to prevent an additional death. CONCLUSIONS: Colonic stenting for patients with acute colonic obstruction secondary to a resectable colonic tumour is comparable in cost with surgical options, and reduces the likelihood of requiring both temporary and permanent stomas. Colonic stenting should be offered as the initial therapeutic modality for Canadian colorectal cancer patients presenting with acute obstruction as a bridge to definitive RS. PMID:17171197

  6. Resident Training in Bariatric Surgery-A National Survey in the Netherlands

    NARCIS (Netherlands)

    Ramshorst, Gabrielle H. van; Kaijser, Mirjam A.; Pierie, Jean-Pierre E. N.; van Wagensveld, Bart A.

    2017-01-01

    Purpose: Surgical procedures for morbid obesity, including laparoscopic Roux-en-Y gastric bypass (LRYGB), are considered standardized laparoscopic procedures. Our goal was to determine how bariatric surgery is trained in the Netherlands. Materials and Methods: Questionnaires were sent to lead

  7. How safe is it to train residents to perform off-pump coronary artery bypass surgery?

    Science.gov (United States)

    Smith, Tanya A; Asimakopoulos, George

    2015-05-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was, in [patients undergoing off-pump CABG] are [postoperative mortality and morbidity outcomes] acceptable when performed by [trainees]? Altogether more than 597 papers were found using the reported search, of which 8 represented the best evidence to answer the clinical question. Six retrospective cohort studies directly compared the performance of trainees and experienced surgeons in off-pump coronary artery bypass graft surgery. Of the remaining papers, one recorded the performance of trainees in on- and off-pump operations and finally one paper evaluated a single trainee's performance in off-pump coronary artery bypass graft surgery, both supervised and unsupervised, over a 1-year period. It is important to note that the two respective cohort studies included in our analysis compared similar cohorts of patients. However, both studies were included in our paper as they provide additional information regarding trainee performance. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Although a heterogeneous range of postoperative complications were recorded in the identified studies, we were able to determine that, overall, there was no significant difference in the 30-day mortality seen in operations performed by trainees or experienced surgeons. The incidence of myocardial infarction and stroke were also similar among cases performed by both groups. However, senior surgeons were more likely to operate on patients with more complex or severe disease, or those requiring more urgent operations. Therefore, it was not possible to directly compare outcomes between trainees and experienced surgeons in operations of similar complexity. However, we conclude that despite the absence of randomized controlled trials comparing the performance of trainees and

  8. Comparing resident cataract surgery outcomes under novice versus experienced attending supervision.

    Science.gov (United States)

    Puri, Sidharth; Kiely, Amanda E; Wang, Jiangxia; Woodfield, Alonzo S; Ramanathan, Saras; Sikder, Shameema

    2015-01-01

    To determine whether supervision by an attending who is new to surgical teaching, or an experienced attending measurably influences intraoperative complications rates or outcomes in phacoemulsification performed by ophthalmology residents. Single tertiary hospital. Retrospective cohort study. Resident-performed phacoemulsification cases supervised by one novice attending (N=189) and experienced attending (N=172) over 1 year were included. Data included: resident year, patient age, sex, preoperative risk factors (4+ on the four point scale for dense/white/brunescent cataracts, Flomax, zonular dialysis, pseudoexfoliation, glaucoma risk, post-vitrectomy), intraoperative risk factors (Trypan blue, iris hooks), and intraoperative complications (capsule tears, vitreous loss, zonular dialysis, zonular dehiscence, burns, nuclear fragment loss, Descemet's tear). Experienced attending data were compared against those of the novice attending. Regarding preoperative risks, experienced attending cases more likely involved 4+ cataract (P=0.005), Flomax (P<0.001), or glaucoma risk (P=0.001). For intraoperative risks, novice attending cases more likely involved Trypan blue (P<0.001). Regarding complications, novice attending cases were associated with vitreous loss (P=0.002) and anterior capsule tears (P<0.001). When comparing total complications, the novice attending was more likely to have both increased number of cases with complications and total complications than the experienced attending. The novice attending's overall complication rate trended downward (rate from 28% in first 25 cases to 6.67% in last 15). Early cases for the novice attending were accompanied by greater complications (vitreous loss and anterior capsule tear), likely due to a learning curve. Surgical judgment in the operating room likely develops with experience. Training programs may focus on these specific areas to aid new instructors.

  9. Improving surgical resident's performance in the American Board of Surgery in Training Examination (ABSITE)--do review courses help? The program directors' perspective.

    Science.gov (United States)

    Taggarshe, Deepa; Mittal, Vijay

    2011-01-01

    The implementation of the 80-hour week compounded by the need for the current trainee to be well versed technically with the newer developments in surgery has resulted in limited time for didactic education. Commercial American Board of Surgery in Training examination (ABSITE) review courses are flourishing and may seem to be filling the gap in didactic education. This study ascertained the opinion of the general surgery program directors across the country on the role of the review courses in the ABSITE performance of a surgical resident. A questionnaire was designed and sent out to all program directors using online survey. Sixty-five of 242 program directors completed the questionnaire. Fifty-seven percent belonged to university-based surgical residency programs. Seventy-two percent used ABSITE performance as a measure while evaluating the resident for promotion. Although 60% agreed that review courses help the performance of the residents, 80% did not have any institutional or regional review courses. Ninety percent allowed their residents to attend commercial review courses but 60% did not reimburse them. Program directors do feel that ABSITE by itself is important in evaluating the progression of surgical residents and has a correlation with the boards' pass percentile. Due to the limited hours available for didactics in current surgical residency, intensive review course over a 2- to 3-day period may help the surgical residents to perform better. In the current economy, review courses offered by a consortium of programs geared toward improving ABSITE performance and conducted by the surgical faculty may be of essence. Copyright © 2011 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  10. The importance of residency program size and location on American Osteopathic Board of Surgery In-Training Examination outcomes.

    Science.gov (United States)

    Falcone, John L; Rosen, Marc E

    2013-09-01

    The American Osteopathic Board of Surgery In-Training Examination (AOBSITE) is administered to general surgery residency training programs. Based on findings in allopathic training, we hypothesize that larger programs will outperform smaller programs and that Southern programs will perform lower than other geographic regions. In this retrospective study, the performance on the AOBSITE was obtained for all of the osteopathic general surgery programs from 2008 to 2012. To test if program size was related to AOBSITE performance, simple linear regression was performed. Geographic differences in median performance between states and US Census Bureau regions were evaluated using Kruskal-Wallis tests. Nonparametric statistics were performed using an α = 0.05. From 2008 to 2012, there were 49 general surgery residency training programs and 2278 examinees evaluated. The median raw performance by general surgery residency training program was 168.0 (IQR [161.8-177.7]). The weighted median standardized performance by general surgery residency training program was 487.8 (IQR [462.8-528.0]). Simple linear regression analyses showed that the slope of the least-square regression line was greater than zero for raw performance (P = 0.048) and standardized performance (P = 0.005). A Kruskal-Wallis test showed that there were no differences in raw performance or standardized performance by US Census Bureau Region or by state (all P > 0.05). Overall, larger general surgery residency training programs outperform smaller programs on the AOBSITE and that there are no geographical differences in performance by state or region. Copyright © 2013 Elsevier Inc. All rights reserved.

  11. Residents at the University of Maryland Medical System provide insight to learning infrapubic approach for IPP surgery: relative benefits but novel challenges exposed in first 15 cases.

    Science.gov (United States)

    Kramer, Andrew; Chason, Judd

    2010-03-01

    Emphasis should be placed on assessing resident education. At our institution, the trans-scrotal (TS) approach for inflatable penile prosthesis (IPP) surgery has been widely taught, with infrapubic (IP) approach recently introduced. Feedback and trends on learning a new implant technique is assessed. Aim. The aim is to understand the advantages and pitfalls of a surgical approach through residents in training. This will provide insight into resident education for teaching physicians and a framework for understanding how to teach the two approaches. The outcomes measured will be the residents' reflection on the ease of different steps of the infrapubic procedure upon finishing 15 sequential cases as well as feeling about the end result and time it took to complete the operation. Two senior residents with experience of over 100 TS implants recorded impressions on their first 15 infrapubic IPP cases via questionnaire. IPP was compared with TS with regard to reservoir, cylinder, pump placement, surgical exposure, and resident involvement. Scores of 1-5 were given, with 1 implying harder or more difficult, 3 the same, and 5 better or easier. Proximal dilatation and cylinder placement remained superior for the IP approach, but distal cylinder placement posed major challenges for the IP surgery. Pump placement was more difficult and remained so for the IP approach, yet reservoir placement was similar. Residents' sense of involvement was superior early on for the IP procedure. Operating room time improved steadily for the IP approach and ultimately was faster than implants placed trans-scrotally. The IP approach is quickly learned by residents. Resident placement with the IP approach offers no advantage for the experienced resident. Pump placement and distal dilatation began and remain challenging. Location of corporotomy is the most challenging component and dictates difficulty of dilatation. Residents gain early confidence with the IP approach.

  12. “I’ve never asked one question.” Understanding the barriers among orthopedic surgery residents to screening female patients for intimate partner violence

    Science.gov (United States)

    Conn, Lesley Gotlib; Young, Aynsely; Rotstein, Ori D.; Schemitsch, Emil

    2014-01-01

    Background Intimate partner violence (IPV) is a global public health problem. Orthopedic surgery residents may identify IPV among injured patients treated in fracture clinics. Yet, these residents face a number of barriers to recognizing and discussing IPV with patients. We sought to explore orthopedic surgery residents’ knowledge of IPV and their preparedness to screen patients for IPV in academic fracture clinic settings with a view to developing targeted IPV education and training. Methods We conducted focus groups with junior and intermediate residents. Discussions explored residents’ knowledge of and experiences with IPV screening and preparedness for screening and responding to IPV among orthopedic patients. Data were analyzed iteratively using an inductive approach. Results Residents were aware of the issue of abuse generally, but had received no specific information or training on IPV in orthopedics. Residents did not see orthopedics faculty screen patients for IPV or advocate for screening. They did not view IPV screening or intervention as part of the orthopedic surgeon’s role. Residents’ clinical experiences emphasized time management and surgical intervention by effectively “getting through clinic” and “dealing with the surgical problem.” Communication with patients about other health issues was minimal or nonexistent. Conclusion Orthopedic surgery residents are entering a career path where IPV is well documented. They encounter cultural and structural barriers preventing the incorporation of IPV screening into their clinical and educational experiences. Hospitals and academic programs must collaborate in efforts to build capacity for sustainable IPV screening programs among these trainees. PMID:25421078

  13. Urology residents experience comparable workload profiles when performing live porcine nephrectomies and robotic surgery virtual reality training modules.

    Science.gov (United States)

    Mouraviev, Vladimir; Klein, Martina; Schommer, Eric; Thiel, David D; Samavedi, Srinivas; Kumar, Anup; Leveillee, Raymond J; Thomas, Raju; Pow-Sang, Julio M; Su, Li-Ming; Mui, Engy; Smith, Roger; Patel, Vipul

    2016-03-01

    In pursuit of improving the quality of residents' education, the Southeastern Section of the American Urological Association (SES AUA) hosts an annual robotic training course for its residents. The workshop involves performing a robotic live porcine nephrectomy as well as virtual reality robotic training modules. The aim of this study was to evaluate workload levels of urology residents when performing a live porcine nephrectomy and the virtual reality robotic surgery training modules employed during this workshop. Twenty-one residents from 14 SES AUA programs participated in 2015. On the first-day residents were taught with didactic lectures by faculty. On the second day, trainees were divided into two groups. Half were asked to perform training modules of the Mimic da Vinci-Trainer (MdVT, Mimic Technologies, Inc., Seattle, WA, USA) for 4 h, while the other half performed nephrectomy procedures on a live porcine model using the da Vinci Si robot (Intuitive Surgical Inc., Sunnyvale, CA, USA). After the first 4 h the groups changed places for another 4-h session. All trainees were asked to complete the NASA-TLX 1-page questionnaire following both the MdVT simulation and live animal model sessions. A significant interface and TLX interaction was observed. The interface by TLX interaction was further analyzed to determine whether the scores of each of the six TLX scales varied across the two interfaces. The means of the TLX scores observed at the two interfaces were similar. The only significant difference was observed for frustration, which was significantly higher at the simulation than the animal model, t (20) = 4.12, p = 0.001. This could be due to trainees' familiarity with live anatomical structures over skill set simulations which remain a real challenge to novice surgeons. Another reason might be that the simulator provides performance metrics for specific performance traits as well as composite scores for entire exercises. Novice trainees experienced

  14. Graduating Students' and Surgery Program Directors' Views of the Association of American Medical Colleges Core Entrustable Professional Activities for Entering Residency: Where are the Gaps?

    Science.gov (United States)

    Lindeman, Brenessa M; Sacks, Bethany C; Lipsett, Pamela A

    2015-01-01

    Residency program directors have increasingly expressed concern about the preparedness of some medical school graduates for residency training. The Association of American Medical Colleges recently defined 13 core entrustable professional activities (EPAs) for entering residency that residents should be able to perform without direct supervision on the first day of training. It is not known how students' perception of their competency with these activities compares with that of surgery program directors'. Cross-sectional survey. All surgery training programs in the United States. All program directors (PDs) in the Association of Program Directors in Surgery (APDS) database (n = 222) were invited to participate in an electronic survey, and 119 complete responses were received (53.6%). Among the respondents, 83% were men and 35.2% represented community hospital programs. PDs' responses were compared with questions asking students to rate their confidence in performance of each EPA from the Association of American Medical Colleges Graduation Questionnaire (95% response). PDs rated their confidence in residents' performance without direct supervision for every EPA significantly lower when compared with the rating by graduating students. Although PDs' ratings continued to be lower than students' ratings, PDs from academic programs (those associated with a medical school) gave higher ratings than those from community programs. PDs generally ranked all 13 EPAs as important to being a trustworthy physician. PDs from programs without preliminary residents gave higher ratings for confidence with EPA performance as compared with PDs with preliminary residents. Among PDs with preliminary residents, there were equal numbers of those who agreed and those who disagreed that there are no identifiable differences between categorical and preliminary residents (42.7% and 41.8%, respectively). A large gap exists between confidence in performance of the 13 core EPAs for entering

  15. Multi-institutional study of self-reported attitudes and behaviors of general surgery residents about ethical academic practices in test taking.

    Science.gov (United States)

    Grignol, Valerie P; Grannan, Kevin; Sabra, John; Cromer, Robert M; Jarman, Benjamin; Dent, Daniel; Sticca, Robert P; Nelson, Timothy M; Kukora, John S; Daley, Brian J; Treat, Robert W; Termuhlen, Paula M

    2013-01-01

    Correlation exists between people who engage in academic dishonesty as students and unethical behavior once in practice. Previously, we assessed the attitudes of general surgery residents and ethical practices in test taking at a single institution. Most residents had not participated in activities they felt were unethical, yet what constituted unethical behavior was unclear. We sought to verify these results in a multi-institutional study. A scenario-based survey describing potentially unethical activities related to the American Board of Surgery In-training Examination (ABSITE) was administered. Participants were asked about their knowledge of or participation in the activities and whether the activity was unethical. Program directors were surveyed about the use of ABSITE results for resident evaluation and promotion. Ten programs participated in the study. The resident response rate was 67% (186/277). Of the respondents, 43% felt that memorizing questions to study for future examinations was unethical and 50% felt that using questions another resident memorized was unethical. Most felt that buying (86%) or selling (79%) questions was unethical. Significantly more senior than junior residents have memorized (30% vs 16%; p = 0.04) or used questions others memorized (33% vs 12%; p = 0.002) to study for future ABSITE examinations and know of other residents who have done so (42% vs 20%; p = 0.004). Most programs used results of the ABSITE in promotion (80%) and set minimum score expectations and consequences (70%). Similar to our single-institution study, residents had not participated in activities they felt to be unethical; however the definition of what constitutes cheating remains unclear. Differences were identified between senior and junior residents with regard to memorizing questions for study. Cheating and unethical behavior is not always clear to the learner and represents an area for further education. © 2013 Association of Program Directors in Surgery

  16. A six year head-to-head comparison of osteopathic and allopathic applicants to a university-based, allopathic general surgery residency.

    Science.gov (United States)

    Schlitzkus, Lisa L; Clark, Christopher J; Agle, Steven C; Schenarts, Paul J

    2012-01-01

    The number of osteopathic physicians is increasing as is the number applying to allopathic general surgery residency programs. A lack of knowledge of osteopathic schooling leads to a potential applicant bias in favor of allopathic applicants, but the 2 groups have not been compared head to head. Applications over a 6-year period to an allopathic general surgery residency program were reviewed. Demographics, examination scores, employment, education, and research experience were catalogued into a database. Allopathic applicants were compared with osteopathic applicants utilizing statistical analysis. A university teaching hospital. Allopathic and osteopathic applicants to an allopathic general surgery residency program. A total of 1290 applications were reviewed; 1155 allopathic and 135 osteopathic applications. Other than race, the 2 cohorts are similar in age, gender, and citizenship. The groups are not significantly different with regard to the number of letter of recommendations, volunteer activities, scholarly works, and advanced degrees. Graduates of both proceed directly to residency. A significantly higher percentage of allopathic graduates reported their United States medical licensing examination (USMLE) scores, yet when osteopaths released their USMLE transcript, they scored significantly higher on the USMLE Step 1 examination and required fewer attempts to pass. These differences do not apply to the USMLE Step 2 examination. No single screening tool exists for selecting a successful general surgery resident. We are seeing increased numbers of osteopathic applicants. Many criteria used to evaluate applicants do not apply to osteopathic applicants, but our comparison of common selection variables on the Electronic Residency Application Service (ERAS) application did not demonstrate an overall difference. While our analysis demonstrated a statistically higher USMLE Step 1 score by osteopathic applicants, they may only self-report favorable data. Copyright

  17. A Comparison of Surgery and Family Medicine Residents' Perceptions of Cross-Cultural Care Training of Cross-Cultural Care Training

    Science.gov (United States)

    Jackson, David S; Lin, Susan Y; Park, Elyse R

    2010-01-01

    The need for physicians formally trained to deliver care to diverse patient populations has been widely advocated. Utilizing a validated tool, Weissman and Betancourt's Cross-Cultural Care Survey, the aim of this current study was to compare surgery and family medicine residents' perceptions of their preparedness and skillfulness to provide high quality cross-cultural care. Past research has documented differences between the two groups' reported impressions of importance and level of instruction received in cross-cultural care. Twenty surgery and 15 family medicine residents participated in the study. Significant differences were found between surgery and family medicine residents on most ratings of the amount of training they received in cross-cultural skills. Specifically, family medicine residents reported having received more training on: 1) determining how patients want to be addressed, 2) taking a social history, 3) assessing their understanding of the cause of illness, 4) negotiating their treatment plan, 5) assessing whether they are mistrustful of the health care system and/or doctor, 6) identifying cultural customs, 7) identifying how patients make decisions within the family, and 8) delivering services through a medical interpreter. One unexpected finding was that surgery residents, who reported not receiving much formal cultural training, reported higher mean scores on perceived skillfulness (i.e. ability) than family medicine residents. The disconnect may be linked to the family medicine residents' training in cultural humility — more knowledge and understanding of cross-cultural care can paradoxically lead to perceptions of being less prepared or skillful in this area. PMID:21225585

  18. Can fatigue affect acquisition of new surgical skills? A prospective trial of pre- and post-call general surgery residents using the da Vinci surgical skills simulator.

    Science.gov (United States)

    Robison, Weston; Patel, Sonya K; Mehta, Akshat; Senkowski, Tristan; Allen, John; Shaw, Eric; Senkowski, Christopher K

    2017-08-24

    To study the effects of fatigue on general surgery residents' performance on the da Vinci Skills Simulator (dVSS). 15 General Surgery residents from various postgraduate training years (PGY2, PGY3, PGY4, and PGY5) performed 5 simulation tasks on the dVSS as recommended by the Robotic Training Network (RTN). The General Surgery residents had no prior experience with the dVSS. Participants were assigned to either the Pre-call group or Post-call group based on call schedule. As a measure of subjective fatigue, residents were given the Epworth Sleepiness Scale (ESS) prior to their dVSS testing. The dVSS MScore™ software recorded various metrics (Objective Structured Assessment of Technical Skills, OSATS) that were used to evaluate the performance of each resident to compare the robotic simulation proficiency between the Pre-call and Post-call groups. Six general surgery residents were stratified into the Pre-call group and nine into the Post-call group. These residents were also stratified into Fatigued (10) or Nonfatigued (5) groups, as determined by their reported ESS scores. A statistically significant difference was found between the Pre-call and Post-call reported sleep hours (p = 0.036). There was no statistically significant difference between the Pre-call and Post-call groups or between the Fatigued and Nonfatigued groups in time to complete exercise, number of attempts, and high MScore™ score. Despite variation in fatigue levels, there was no effect on the acquisition of robotic simulator skills.

  19. Can a laparoscopic Roux-en-Y gastric bypass be safely performed by surgical residents in a bariatric center-of-excellence? The learning curve of surgical residents in bariatric surgery.

    Science.gov (United States)

    van Rijswijk, Anne-Sophie; Moes, Daan E; Geubbels, Noëlle; Hutten, Barbara A; Acherman, Yair I Z; van de Laar, Arnold W; de Brauw, Maurits; Bruin, Sjoerd C

    2017-09-21

    A learning curve (LC) is a graphic display of the number of consecutive procedures performed necessary to reach competence and is defined by complications and duration of surgery (DOS). There is little evidence on the LC of surgical residents in bariatric surgery. Aim of the study is to evaluate whether the laparoscopic Roux-en-Y gastric bypass (LRYGB) can be safely performed by surgical residents, to evaluate the LC of surgical residents for LRYGB and to assess whether surgical residents fit in the LC of the bariatric center which has been established by their proctors. Records of all 3389 consecutive primary LRYGB patients, operated between December 2007 and January 2016 in a bariatric center-of-excellence in Amsterdam, were reviewed. Differences in DOS were assessed by means of a linear regression model. Differences in complications (classified as Clavien-Dindo ≥ 2) were evaluated with the χ 2 or the Fisher exact test. Cases were clustered in groups of 70 for comparison and reported for residents with ≥70 cases as primary surgeon. Four surgeons (S1-4) and three residents (R1-3) performed 2690 (88.2%) and 361 (11.8%) of 3051 LRYGBs, respectively. Median (IQR) DOS was 52.0 (42.0-65.0) min for S1-4 versus 53.0 (46.0-63.0) min for R1-3 (p = 0.52). The LC of R1-3 in their first 70 cases (n = 210) differs significantly from the individual (n = 70) LCs of surgeon 1, 2, and 3, with remarkably shorter DOS for the residents (adjusted p bariatric surgeons. Surgical residents benefit from the experience of their proctors and they fit faultlessly in the LC of the surgical team, as set out by their proctors in a large bariatric center-of-excellence.

  20. Teaching evidence based medicine to surgery residents-is journal club the best format? A systematic review of the literature.

    Science.gov (United States)

    Ahmadi, Negar; McKenzie, Margaret E; Maclean, Anthony; Brown, Carl J; Mastracci, Tara; McLeod, Robin S

    2012-01-01

    Systematic reviews were performed to assess methods of teaching the evidence-based medicine (EBM) process and determine which format or what components of journal club appear to be most effective in teaching critical appraisal skills to surgical residents and have the highest user satisfaction. MEDLINE, Embase, Web of Science, AMED, PsychINFO, PubMed, Cochrane Library, and Google scholar were searched to identify relevant articles. To be included, studies had to provide details about the format of their EBM curriculum or journal club and report on the effectiveness or participant satisfaction. Potentially relevant articles were independently reviewed by 2 authors and data were extracted on separate data forms. Seven studies met the inclusion criteria for assessment of teaching EBM and 8 studies (including 3 in the EBM systematic review) met criteria for assessment of journal club format. Overall, study quality was poor. Only 2 studies were randomized controlled trials. Five were before-after studies, which showed significant improvement in critical appraisal skills or statistical knowledge following an EBM course or journal club. The 2 randomized controlled trials (RCTs) compared teaching EBM or critical appraisal skills in lecture format or journal club to online learning. There was no significant difference in mean scores in 1 study whereas the other reported significantly better scores in the journal club format. Four studies reported high participant satisfaction with the EBM course or journal club format. There is some evidence that courses with or without the addition of journal clubs lead to improved knowledge of the EBM process although the impact on patient care is unknown. Journal clubs seem to be the preferred way of teaching critical appraisal skills but while some components of journal clubs are favored by participants, it remains unclear which elements are most important for resident learning. Copyright © 2012 Association of Program Directors in

  1. Validating the use of the Mimic dV-trainer for robotic surgery skill acquisition among urology residents.

    Science.gov (United States)

    Korets, Ruslan; Mues, Adam C; Graversen, Joseph A; Gupta, Mantu; Benson, Mitchell C; Cooper, Kimberly L; Landman, Jaime; Badani, Ketan K

    2011-12-01

    To compare robotic surgery skill acquisition of residents trained with Mimic dVTrainer (MdVT) and da Vinci Surgical System (dVSS) console. No standardized curriculum currently exists for robotic surgical education. The MdVT is a compact hardware platform that closely reproduces the experience of the dVSS. Sixteen urology trainees were randomized into 3 groups. A baseline evaluation using dVSS was performed and consisted of 2 exercises requiring endowrist manipulation (EM), camera movement and clutching (CC), needle control (NC), and knot-tying (KT). Groups 1 and 2 completed a standardized training curriculum on MdVT and dVSS, respectively. Group 3 received no additional training. After completion of the training phase, all trainees completed a secondary evaluation on dVSS consisting of the same exercises performed during baseline evaluation. There was no difference in baseline performance scores across the 3 groups. Although Group 3 showed no significant improvement in EM/CC domain (P = .15), Groups 1 and 2 had statistically significant improvement in EM/CC domain (P = .039 and P = .007, respectively). The difference in improvement between Groups 1 and group 2 was not statistically different (P = .21). Only Group 2 trainees showed significant improvement in the NC and KT domains during secondary evaluation (P = .02). Curriculum-based training with MdVT or dVSS significantly improves robotic surgery aptitude. Similar improvements are seen for exercise domains shared between MdVT and dVSS groups. Follow-up studies are necessary to assess the efficacy of MdVT over a wider spectrum of domains. Copyright © 2011 Elsevier Inc. All rights reserved.

  2. Surgical Training and Education in Promoting Professionalism: a comparative assessment of virtue-based leadership development in otolaryngology-head and neck surgery residents

    Science.gov (United States)

    Schulz, Kristine; Puscas, Liana; Tucci, Debara; Woodard, Charles; Witsell, David; Esclamado, Ramon M.; Lee, Walter T.

    2013-01-01

    Introduction Surgical Training and Education in Promoting Professionalism (STEPP) was developed in 2011 to train tomorrow's leaders during residency. It is based on virtue ethics and takes an approach similar to West Point military academy. The purpose of this research was: (i) to compare the virtue profiles of our residents with that of the military cohort using a standardized virtue assessment tool; and (ii) to assess the value of virtue education on residents. Methods As part of STEPP, otolaryngology residents participated in a virtue-based validated assessment tool called Virtue in Action (VIA) Inventory. This was completed at the initiation of STEPP in July 2011 as well as 1 year later in June 2012. Comparison of the VIA to a military cohort was performed. Leadership ‘Basic Training’ is a series of forums focused on virtues of initiative, integrity, responsibility, self-discipline, and accountability. A pre- and post-test was administered assessing resident perceptions of the value of this ‘Basic Training’. Results Virtues are shared between otolaryngology residents (n=9) and military personnel (n=2,433) as there were no significant differences in strength scores between two military comparison groups and otolaryngology-head and neck surgery (OHNS) residents. There was a significant improvement (p<0.001) in the understanding of components of the leadership vision and a significant improvement in the understanding of key leadership concepts based on ‘Basic Training’. All residents responded in the post-test that the STEPP program was valuable, up from 56%. Conclusions A virtue-based approach is valued by residents as a part of leadership training during residency. PMID:24172053

  3. Surgical Training and Education in Promoting Professionalism: a comparative assessment of virtue-based leadership development in otolaryngology-head and neck surgery residents

    Directory of Open Access Journals (Sweden)

    Kristine Schulz

    2013-10-01

    Full Text Available Introduction: Surgical Training and Education in Promoting Professionalism (STEPP was developed in 2011 to train tomorrow's leaders during residency. It is based on virtue ethics and takes an approach similar to West Point military academy. The purpose of this research was: (i to compare the virtue profiles of our residents with that of the military cohort using a standardized virtue assessment tool; and (ii to assess the value of virtue education on residents. Methods: As part of STEPP, otolaryngology residents participated in a virtue-based validated assessment tool called Virtue in Action (VIA Inventory. This was completed at the initiation of STEPP in July 2011 as well as 1 year later in June 2012. Comparison of the VIA to a military cohort was performed. Leadership ‘Basic Training’ is a series of forums focused on virtues of initiative, integrity, responsibility, self-discipline, and accountability. A pre- and post-test was administered assessing resident perceptions of the value of this ‘Basic Training’. Results: Virtues are shared between otolaryngology residents (n=9 and military personnel (n=2,433 as there were no significant differences in strength scores between two military comparison groups and otolaryngology-head and neck surgery (OHNS residents. There was a significant improvement (p<0.001 in the understanding of components of the leadership vision and a significant improvement in the understanding of key leadership concepts based on ‘Basic Training’. All residents responded in the post-test that the STEPP program was valuable, up from 56%. Conclusions: A virtue-based approach is valued by residents as a part of leadership training during residency.

  4. Surgical Training and Education in Promoting Professionalism: a comparative assessment of virtue-based leadership development in otolaryngology-head and neck surgery residents.

    Science.gov (United States)

    Schulz, Kristine; Puscas, Liana; Tucci, Debara; Woodard, Charles; Witsell, David; Esclamado, Ramon M; Lee, Walter T

    2013-01-01

    Introduction Surgical Training and Education in Promoting Professionalism (STEPP) was developed in 2011 to train tomorrow's leaders during residency. It is based on virtue ethics and takes an approach similar to West Point military academy. The purpose of this research was: (i) to compare the virtue profiles of our residents with that of the military cohort using a standardized virtue assessment tool; and (ii) to assess the value of virtue education on residents. Methods As part of STEPP, otolaryngology residents participated in a virtue-based validated assessment tool called Virtue in Action (VIA) Inventory. This was completed at the initiation of STEPP in July 2011 as well as 1 year later in June 2012. Comparison of the VIA to a military cohort was performed. Leadership 'Basic Training' is a series of forums focused on virtues of initiative, integrity, responsibility, self-discipline, and accountability. A pre- and post-test was administered assessing resident perceptions of the value of this 'Basic Training'. Results Virtues are shared between otolaryngology residents (n=9) and military personnel (n=2,433) as there were no significant differences in strength scores between two military comparison groups and otolaryngology-head and neck surgery (OHNS) residents. There was a significant improvement (pleadership vision and a significant improvement in the understanding of key leadership concepts based on 'Basic Training'. All residents responded in the post-test that the STEPP program was valuable, up from 56%. Conclusions A virtue-based approach is valued by residents as a part of leadership training during residency.

  5. Association of Otolaryngology Resident Duty Hour Restrictions With Procedure-Specific Outcomes in Head and Neck Endocrine Surgery.

    Science.gov (United States)

    Smith, Aaron; Braden, Lauren; Wan, Jim; Sebelik, Merry

    2017-06-01

    Graduate medical education has undergone a transformation from traditional long work hours to a restricted plan to allow adequate rest for residents. The initial goal of this restriction is to improve patient outcomes. To determine whether duty hour restrictions had any impact on surgery-specific outcomes by analyzing complications following thyroid and parathyroid procedures performed before and after duty hour reform. Retrospective cross-sectional analysis of the National Inpatient Sample (NIS).The NIS was queried for procedure codes associated with thyroid and parathyroid procedures for the years 2000 to 2002 and 2006 to 2008. Hospitals were divided based on teaching status into 3 groups: nonteaching hospitals (NTHs), teaching hospitals without otolaryngology programs (THs), and teaching hospitals with otolaryngology programs (THs-OTO). Procedure-specific complication rates, length of stay, and mortality rates were collected. SAS statistical software (version 9.4) was used for analysis with adjustment using Charlson comorbidity index. Total numbers of head and neck endocrine procedures were 34 685 and 39 770 (a 14.7% increase), for 2000 to 2002 and 2006 to 2008, respectively. THs-OTO contributed a greater share of procedures in 2006 to 2008 (from 18% to 25%). With the earlier period serving as the reference, length of stay remained constant (2.1 days); however, total hospital charges increased (from $12 978 to $23 708; P otolaryngology programs.

  6. Development of a new valid, reliable, and internationally applicable assessment tool of residents' competence in ophthalmic surgery (an American Ophthalmological Society thesis).

    Science.gov (United States)

    Golnik, C; Beaver, Hilary; Gauba, Vinod; Lee, Andrew G; Mayorga, Eduardo; Palis, Gabriela; Saleh, George M

    2013-09-01

    To test the validity and reliability of a new tool for assessing residents' competence in ophthalmic surgery. Changing paradigms of ophthalmic education in the United States have influenced worldwide ophthalmic education and necessitated new methods of assessing resident competence. Accordingly, a new tool for assessing residents' competence in ophthalmic surgery (phacoemulsification) that could be applicable internationally was developed. We hypothesize that this instrument is valid and reliable. A panel of six international content experts adapted a previously published tool for assessing phacoemulsification. The tool (called the International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric, or ICO-OSCAR:phaco) was reviewed by 12 international content experts for their constructive comments, which were incorporated to ensure content validity. Ten expert cataract surgery teachers then graded six recorded phacoemulsification surgeries with the ICO-OSCAR:phaco to investigate inter-rater reliability. The coefficient alpha statistic (a measure of reliability/internal consistency) for the ICO-OSCAR:phaco as a whole was 0.92, and 17 of its 20 dimensions had alpha coefficients greater than 0.70. The ICO-OSCAR:phaco is a valid and reliable assessment tool that could be applied internationally to satisfy the global need of new instruments to comply with emerging trends in ophthalmic education. A toolbox of similar surgical competency assessment tools is being developed.

  7. American Society for Radiation Oncology (ASTRO) survey of radiation biology educators in U.S. and Canadian radiation oncology residency programs.

    Science.gov (United States)

    Rosenstein, Barry S; Held, Kathryn D; Rockwell, Sara; Williams, Jacqueline P; Zeman, Elaine M

    2009-11-01

    To obtain, in a survey-based study, detailed information on the faculty currently responsible for teaching radiation biology courses to radiation oncology residents in the United States and Canada. In March-December 2007 a survey questionnaire was sent to faculty having primary responsibility for teaching radiation biology to residents in 93 radiation oncology residency programs in the United States and Canada. The responses to this survey document the aging of the faculty who have primary responsibility for teaching radiation biology to radiation oncology residents. The survey found a dramatic decline with time in the percentage of educators whose graduate training was in radiation biology. A significant number of the educators responsible for teaching radiation biology were not fully acquainted with the radiation sciences, either through training or practical application. In addition, many were unfamiliar with some of the organizations setting policies and requirements for resident education. Freely available tools, such as the American Society for Radiation Oncology (ASTRO) Radiation and Cancer Biology Practice Examination and Study Guides, were widely used by residents and educators. Consolidation of resident courses or use of a national radiation biology review course was viewed as unlikely by most programs. A high priority should be given to the development of comprehensive teaching tools to assist those individuals who have responsibility for teaching radiation biology courses but who do not have an extensive background in critical areas of radiobiology related to radiation oncology. These findings also suggest a need for new graduate programs in radiobiology.

  8. Error reporting from the da Vinci surgical system in robotic surgery: A Canadian multispecialty experience at a single academic centre

    Science.gov (United States)

    Rajih, Emad; Tholomier, Côme; Cormier, Beatrice; Samouëlian, Vanessa; Warkus, Thomas; Liberman, Moishe; Widmer, Hugues; Lattouf, Jean-Baptiste; Alenizi, Abdullah M.; Meskawi, Malek; Valdivieso, Roger; Hueber, Pierre-Alain; Karakewicz, Pierre I.; El-Hakim, Assaad; Zorn, Kevin C.

    2017-01-01

    Introduction The goal of the study is to evaluate and report on the third-generation da Vinci surgical (Si) system malfunctions. Methods A total of 1228 robotic surgeries were performed between January 2012 and December 2015 at our academic centre. All cases were performed by using a single, dual console, four-arm, da Vinci Si robot system. The three specialties included urology, gynecology, and thoracic surgery. Studied outcomes included the robotic surgical error types, immediate consequences, and operative side effects. Error rate trend with time was also examined. Results Overall robotic malfunctions were documented on the da Vinci Si systems event log in 4.97% (61/1228) of the cases. The most common error was related to pressure sensors in the robotic arms indicating out of limit output. This recoverable fault was noted in 2.04% (25/1228) of cases. Other errors included unrecoverable electronic communication-related in 1.06% (13/1228) of cases, failed encoder error in 0.57% (7/1228), illuminator-related in 0.33% (4/1228), faulty switch in 0.24% (3/1228), battery-related failures in 0.24% (3/1228), and software/hardware error in 0.08% (1/1228) of cases. Surgical delay was reported only in one patient. No conversion to either open or laparoscopic occurred secondary to robotic malfunctions. In 2015, the incidence of robotic error rose to 1.71% (21/1228) from 0.81% (10/1228) in 2014. Conclusions Robotic malfunction is not infrequent in the current era of robotic surgery in various surgical subspecialties, but rarely consequential. Their seldom occurrence does not seem to affect patient safety or surgical outcome. PMID:28503234

  9. Global Health Values of a Multidirectional Near Peer Training Program in Surgery, Pathology, Anatomy, Research Methodology, and Medical Education for Haitian, Rwandan, and Canadian Medical Students.

    Science.gov (United States)

    Elharram, Malik; Dinh, Trish; Lalande, Annie; Ge, Susan; Gao, Sophie; Noël, Geoffroy

    As health care delivery increasingly requires providers to cross international borders, medical students at McGill University, Canada, developed a multidirectional exchange program with Haiti and Rwanda. The program integrates surgery, pathology, anatomy, research methodology, and medical education. The aim of the present study was to explore the global health value of this international training program to improve medical education within the environment of developing countries, such as Haiti and Rwanda, while improving sociocultural learning of Canadian students. Students from the University of Kigali, Rwanda and Université Quisqueya, Haiti, participated in a 3-week program at McGill University. The students spanned from the first to sixth year of their respective medical training. The program consisted of anatomy dissections, surgical simulations, clinical pathology shadowing, and interactive sessions in research methodology and medical education. To evaluate the program, a survey was administered to students using a mixed methodology approach. Common benefits pointed out by the participants included personal and professional growth. The exchange improved career development, sense of responsibility toward one's own community, teaching skills, and sociocultural awareness. The participants all agreed that the anatomy dissections improved their knowledge of anatomy and would make them more comfortable teaching the material when the returned to their university. The clinical simulation activities and shadowing experiences allowed them to integrate the different disciplines. However, the students all felt the research component had too little time devoted to it and that the knowledge presented was beyond their educational level. The development of an integrated international program in surgery, pathology, anatomy, research methodology, and medical education provided medical students with an opportunity to learn about differences in health care and medical education

  10. Examination of Nondesignated Preliminary Surgery Residents Recruited Since the Inception of Supplementary Offer and Acceptance Program: Lessons Learned From a Large Academic Program.

    Science.gov (United States)

    Albuja-Cruz, Maria; Travis, Claire; Benge, Michael; Caufield, Barbara; Nehler, Mark

    2017-09-05

    The majority of surgery programs roster non-designated preliminary (NDP) residents. We and others have reported on the success of NDP resident mentoring with regard to categorical position placement. Lacking is a focus on the candidates themselves and differences based on initial career of choice. NDP residents' files since the institution of SOAP were reviewed for demographics, initial career choice, financial burden, region of medical school of origin, application and interview history, and pre-screen interview candidate score (high score of 22 - data includes USMLE scores, major clerkship grades, and AOA) used for categorical recruitment. From 2012-16 79 NDP residents have been recruited at UCDenver (82% via SOAP). Median age was 28 years, majority were single (73%), and male (82%). Thirty percent belonged to an under-represented minority group. Mean debt was $156,000 but 20% owe over $250,000. 90% attended US medical schools with 65% from the NRMP "South" region. 86% were recruited as fourth year students. NDPs were categorized as failing to match in general surgery (38%), surgical subspecialties (47%), or other (15%). NDPs applied to median of 68 programs (range 7-200) and granted a median of 8 interviews (range 0-24). NDPs had a mean pre-screening interview score of 13 out of 22 and only 9% would have met the standard threshold to obtain a categorical surgery interview. There were no differences in pre-screening scores in the three groups. 95% NDPs (excluding present year) successfully completed their R1 year (three resigned - one obtained a general surgery spot mid-year and two after matching in non-general surgery fields). 68% NDPs placed in categorical positions after the R1 year. The placement was better for the surgical subspecialty group compared to the other two. The bias is that due to a more competitive applicant pool recruiting NDPs from surgical subspecialties would be optimal. However, those unmatched surgical subspecialty candidates are no better

  11. The New Accreditation Council for Graduate Medical Education Next Accreditation System Milestones Evaluation System: What Is Expected and How Are Plastic Surgery Residency Programs Preparing?

    Science.gov (United States)

    Sillah, Nyama M; Ibrahim, Ahmed M S; Lau, Frank H; Shah, Jinesh; Medin, Caroline; Lee, Bernard T; Lin, Samuel J

    2015-07-01

    The Accreditation Council for Graduate Medical Education Next Accreditation System milestones were implemented for plastic surgery programs in July of 2014. Forward progress through the milestones is an indicator of trainee-appropriate development, whereas regression or stalling may indicate the need for concentrated, targeted training. Online software at www.surveymonkey.com was used to create a survey about the program's approaches to milestones and was distributed to program directors and administrators of 96 Accreditation Council for Graduate Medical Education-approved plastic surgery programs. The authors had a 63.5 percent response rate (61 of 96 plastic surgery programs). Most programs report some level of readiness, only 22 percent feel completely prepared for the Next Accreditation System milestones, and only 23 percent are completely satisfied with their planned approach for compliance. Seventy-five percent of programs claim to be using some form of electronic tracking system. Programs plan to use multiple tools to capture and report milestone data. Most programs (44.4 percent) plan to administer evaluations at the end of each rotation. Over 70 percent of respondents believe that the milestones approach would improve the quality of resident training. However, programs were less than confident that their current compliance systems would live up to their full potential. The Next Accreditation System has been implemented nationwide for plastic surgery training programs. Milestone-based resident training is a new paradigm for residency training evaluation; programs are in the process of making this transition to find ways to make milestone data meaningful for faculty and residents.

  12. A standardized resident training program in endoscopic surgery in general and in laparoscopic totally extraperitoneal (TEP) inguinal hernia repair in particular

    DEFF Research Database (Denmark)

    Miserez, Marc; Arregui, Maurice; Bisgaard, Thue

    2009-01-01

    The need for acquisition of specific laparoscopic skills has emphasized the role of a preclinical laboratory-training program. However, for laparoscopic inguinal hernia repair with a steep learning curve, especially for totally extraperitoneal repair, preclinical skill training remains a challenge....... A standardized preclinical resident training program in endoscopic surgery is described. Also, a standardized clinical training program is proposed with systematic dissection in 10 different consecutive steps for totally extraperitoneal inguinal hernia repair. Continuous mentoring by an expert is an absolute...

  13. Benzodiazepine administration during adult cardiac surgery: a survey of current practice among Canadian anesthesiologists working in academic centres.

    Science.gov (United States)

    Spence, Jessica; Belley-Côté, Emilie; Devereaux, P J; Whitlock, Richard; Um, Kevin; McClure, Graham; Lamy, Andre; LeManach, Yannick; Connolly, Stuart; Syed, Summer

    2018-03-01

    Benzodiazepines are commonly administered during cardiac surgery because of their limited effect on hemodynamics and presumed role in preventing intraoperative awareness. Recent concerns about an increased risk of delirium with benzodiazepines have resulted in decreased usage in the intensive care unit and in geriatric perioperative practice. Little is known, however, about current benzodiazepine usage in the setting of adult cardiac surgery. We contacted all academic anesthesia departments in Canada to identify practicing attending cardiac anesthesiologists; this group constituted our sampling frame. Information regarding participant demographics, benzodiazepine usage, type, dose, and other administration details were obtained by electronic survey. Responses were analyzed descriptively. The survey was completed by 243/346 (70%) of cardiac anesthesiologists. Eleven percent of respondents do not administer benzodiazepines. Midazolam was the most commonly used benzodiazepine, with a mean (standard deviation) dose of 4.9 (3.8) mg given to an average patient. When respondents were asked the proportion of patients that they gave benzodiazepines, the response was bimodal. The most common considerations that influenced benzodiazepine use were patient age (73%), patient anxiety (63%), history of alcohol/drug/benzodiazepine use (60%), and the presence of risk factors for intraoperative awareness (44%). Benzodiazepine use is common among academic cardiac anesthesiologists in Canada. Nonetheless, heterogeneity exists between individual practices, suggesting clinical equipoise between restrictive and liberal administration of benzodiazepines for cardiac anesthesia. L'administration de benzodiazépines pendant la chirurgie cardiaque chez l'adulte: évaluation de la pratique actuelle des anesthésiologistes canadiens exerçant en milieu universitaire.

  14. A novel approach to assessing technical competence of colorectal surgery residents: the development and evaluation of the Colorectal Objective Structured Assessment of Technical Skill (COSATS).

    Science.gov (United States)

    de Montbrun, Sandra L; Roberts, Patricia L; Lowry, Ann C; Ault, Glenn T; Burnstein, Marcus J; Cataldo, Peter A; Dozois, Eric J; Dunn, Gary D; Fleshman, James; Isenberg, Gerald A; Mahmoud, Najjia N; Reznick, Richard K; Satterthwaite, Lisa; Schoetz, David; Trudel, Judith L; Weiss, Eric G; Wexner, Steven D; MacRae, Helen

    2013-12-01

    To develop and evaluate an objective method of technical skills assessment for graduating subspecialists in colorectal (CR) surgery-the Colorectal Objective Structured Assessment of Technical Skill (COSATS). It may be reasonable for the public to assume that surgeons certified as competent have had their technical skills assessed. However, technical skill, despite being the hallmark of a surgeon, is not directly assessed at the time of certification by surgical boards. A procedure-based, multistation technical skills examination was developed to reflect a sample of the range of skills necessary for CR surgical practice. These consisted of bench, virtual reality, and cadaveric models. Reliability and construct validity were evaluated by comparing 10 graduating CR residents with 10 graduating general surgery (GS) residents from across North America. Expert CR surgeons, blinded to level of training, evaluated performance using a task-specific checklist and a global rating scale. The mean global rating score was used as the overall examination score and a passing score was set at "borderline competent for CR practice." The global rating scale demonstrated acceptable interstation reliability (0.69) for a homogeneous group of examinees. Both the overall checklist and global rating scores effectively discriminated between CR and GS residents (P Technical Skill effectively discriminated between CR and GS residents. With further validation, the Colorectal Objective Structured Assessment of Technical Skill could be incorporated into the colorectal board examination where it would be the first attempt of a surgical specialty to formally assess technical skill at the time of certification.

  15. Factors affecting orthopedic residency selection: a cross-sectional survey.

    Science.gov (United States)

    Strelzow, Jason; Petretta, Robert; Broekhuyse, Henry M

    2017-06-01

    Annually, orthopedic residency programs rank and recruit the best possible candidates. Little evidence exists identifying factors that potential candidates use to select their career paths. Recent literature from nonsurgical programs suggests hospital, social and program-based factors influence program selection. We sought to determine what factors influence the choice of an orthopedic career and a candidate's choice of orthopedic residency program. We surveyed medical student applicants to orthopedic programs and current Canadian orthopedic surgery residents (postgraduate year [PGY] 1-5). The confidential online survey focused on 3 broad categories of program selection: educational, program cohesion and noneducation factors. Questions were graded on a Likert Scale and tailed for mean scores. In total, 139 residents from 11 of 17 Canadian orthopedic programs (49% response rate) and 23 medical student applicants (88% response rate) completed our survey. Orthopedic electives and mandatory rotations were reported by 71% of participants as somewhat or very important to their career choice. Collegiality among residents (4.70 ± 0.6), program being the "right fit" (4.65 ± 0.53) and current resident satisfaction with their chosen program (4.63 ±0.66) were ranked with the highest mean scores on a 5-point Likert scale. There are several modifiable factors that residency programs may use to attract applicants, including early availability of clerkship rotations and a strong mentorship environment emphasizing both resident-resident and resident-staff cohesion. Desirable residency programs should develop early access to surgical and operative skills. These must be balanced with a continued emphasis on top-level orthopedic training.

  16. The differing perceptions of plastic surgery between potential applicants and current trainees: The importance of clinical exposure and electives for medical students.

    Science.gov (United States)

    Tahiri, Youssef; Lee, James; Kanevsky, Jonathan; Thibaudeau, Stephanie; Gilardino, Mirko

    2013-01-01

    Exposure to plastic surgery during medical school is limited. Most interested applicants form their perceptions of careers in this surgical specialty during elective rotations. To investigate the perceptions of Canadian medical students considering a career in plastic surgery. The results obtained were then compared with current Canadian plastic surgery residents' perceptions. The data were collected via two separate self-administered online surveys that were distributed to either Canadian plastic surgery residents or medical students. The questionnaires were similar and focused on three aspects: applicant details; driving force behind interest in the field; and essential character traits and competencies related to successful matching. Fifty-nine plastic surgery residents and 477 medical students participated in the online survey. The most commonly reported driving forces for interest in a plastic surgery career in both groups were variety of career choice, complexity of the field, future lifestyle and enjoyable rotations in plastic surgery. Despite these similarities, the proportion of medical students and residents who opted for future lifestyle and enjoyable rotations differed in a statistically significant manner (P=0.015 and P=0.029, respectively). In terms of the essential competencies to match into a plastic surgery training spot, the groups differed statistically in their opinions on the relevance of intellect (Pselection committees in identifying capable applicants.

  17. The American College of Surgeons/Association of Program Directors in Surgery National Skills Curriculum: adoption rate, challenges and strategies for effective implementation into surgical residency programs.

    Science.gov (United States)

    Korndorffer, James R; Arora, Sonal; Sevdalis, Nick; Paige, John; McClusky, David A; Stefanidis, Dimitris

    2013-07-01

    The American College of Surgeons/Association of Program Directors in Surgery (ACS/APDS) National Skills Curriculum is a 3-phase program targeting technical and nontechnical skills development. Few data exist regarding the adoption of this curriculum by surgical residencies. This study attempted to determine the rate of uptake and identify implementation enablers/barriers. A web-based survey was developed by an international expert panel of surgical educators (5 surgeons and 1 psychologist). After piloting, the survey was sent to all general surgery program directors via email link. Descriptive statistics were used to determine the residency program characteristics and perceptions of the curriculum. Implementation rates for each phase and module were calculated. Adoption barriers were identified quantitatively and qualitatively using free text responses. Standardized qualitative methodology of emergent theme analysis was used to identify strategies for success and details of support required for implementation. Of the 238 program directors approached, 117 (49%) responded to the survey. Twenty-one percent (25/117) were unaware of the ACS/APDS curriculum. Implementation rates for were 36% for phase I, 19% for phase II, and 16% for phase III. The most common modules adopted were the suturing, knot-tying, and chest tube modules of phase I. Over 50% of respondents identified lack of faculty protected time, limited personnel, significant costs, and resident work-hour restrictions as major obstacles to implementation. Strategies for effective uptake included faculty incentives, adequate funding, administrative support, and dedicated time and resources. Despite the availability of a comprehensive curriculum, its diffusion into general surgery residency programs remains low. Obstacles related to successful implementation include personnel, learner, and administrative issues. Addressing these issues may improve the adoption rate of the curriculum. Copyright © 2013 Mosby, Inc

  18. Superior subconjunctival anesthesia versus retrobulbar anesthesia for manual small-incision cataract surgery in a residency training program: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Kongsap P

    2012-11-01

    Full Text Available Pipat KongsapDepartment of Ophthalmology, Prapokklao Hospital, Chanthaburi, Thailand; Faculty of Medicine, Chulalongkorn University, Bangkok, ThailandPurpose: To evaluate the effectiveness of subconjunctival anesthesia as compared to retrobulbar anesthesia for pain control during manual small-incision cataract surgery (MSICS performed by third-year residents.Design: A randomized, controlled trial.Patients and methods: A total of 150 patients undergoing routine cataract surgery were randomly assigned to receive either subconjunctival anesthesia (group 1, n = 75 or retrobulbar anesthesia (group 2, n = 75. Third-year residents performed MSICS using the modified Blumenthal technique. Subconjunctival anesthesia was administered by injecting 2% xylocaine with adrenalin into the superior conjunctiva, and retrobulbar anesthesia by injecting 2 mL of 2% xylocaine with adrenalin into the retrobulbar space. We studied the following variables: intraoperative pain score rated on a 100-point visual analog scale (VAS, operative time, and injection and operative complications.Results: A mean age of 69 vs 70 years, an operative time of 47.1 (SD, 9.9 min vs 47.7 (10.9 min, and a median (interquartile range pain score of 40 (range, 20–70 vs 40 (range, 20–50 were observed in the subconjunctival and the retrobulbar groups, respectively. The injection complication of subconjunctival hemorrhage was significantly higher in the subconjunctival group (25.3% compared to the retrobulbar group (1.3%. The operative complication rate between groups was not different (P > 0.05.Conclusion: Both, superior subconjunctival anesthesia and retrobulbar anesthesia were effective during MSICS when used in a residency training program.Keywords: subconjunctival anesthesia, retrobulbar anesthesia, cataract surgery, small-incision cataract surgery, visual analog scale, pain score

  19. Surgery

    Science.gov (United States)

    ... Disease Lookup > COPD > Diagnosing and Treating COPD Surgery Chronic obstructive pulmonary disease (COPD) includes two separate lung problems, emphysema and chronic bronchitis. Some people with COPD have ...

  20. Evaluation of Oral and Maxillofacial Surgery Residents' Operative Skills: Feasibility and Engagement Study Using SIMPL Software for a Mobile Phone.

    Science.gov (United States)

    Kaban, Leonard B; Cappetta, Alyssa; George, Brian C; Lahey, Edward T; Bohnen, Jordan D; Troulis, Maria J

    2017-10-01

    There are no universally accepted tools to evaluate operative skills of surgical residents in a timely fashion. The purpose of this study was to determine the feasibility of using a smartphone application, SIMPL (System for Improving and Measuring Procedural Learning), developed by a multi-institutional research collaborative, to achieve a high rate of timely operative evaluations and resident communication and to collect performance data. The authors hypothesized that these goals would be achieved because the process is convenient and efficient. This was a prospective feasibility and engagement study using SIMPL to evaluate residents' operative skills. SIMPL requires the attending surgeon to answer 3 multiple-choice questions: 1) What level of help (Zwisch Scale) was required by the trainee? 2) What was the level of performance? 3) How complex was the case? The evaluator also can dictate a narrative. The sample was composed of 3 faculty members and 3 volunteer senior residents. Predictor variables were the surgeons, trainees, and procedures performed. Outcome variables included number and percentage of procedures performed by faculty-and-resident pairs assessed, time required to complete assessments, time lapsed to submission, percentage of assessments with narratives, and residents' response rates. From March through June 2016, 151 procedures were performed in the operating room by the faculty-and-resident teams. There were 107 assessments submitted (71%). Resident response (self-assessment) to faculty evaluations was 81%. Recorded time to complete assessments (n = 75 of 107) was shorter than 2 minutes. The time lapsed to submission was shorter than 72 hours (100%). Dictations were submitted for 35 evaluations (33%). Data for the type of help, performance, and complexity of cases were collected for each resident. SIMPL facilitates timely intraoperative evaluations of surgical skills, engagement by faculty and residents, and collection of detailed procedural

  1. The learning curve of laparoscopic holecystectomy in general surgery resident training: old age of the patient may be a risk factor?

    Science.gov (United States)

    Gentile, Valentina; Bindi, Marco; Rivelli, Matteo; Cumbo, Jacopo; Solej, Mario; Enrico, Stefano; Martino, Valter

    2016-01-01

    Abstract A well-designed learning curve is essential for the acquisition of laparoscopic skills: but, are there risk factors that can derail the surgical method? From a review of the current literature on the learning curve in laparoscopic surgery, we identified learning curve components in video laparoscopic cholecystectomy; we suggest a learning curve model that can be applied to assess the progress of general surgical residents as they learn and master the stages of video laparoscopic cholecystectomy regardless of type of patient. Electronic databases were interrogated to better define the terms “surgeon”, “specialized surgeon”, and “specialist surgeon”; we surveyed the literature on surgical residency programs outside Italy to identify learning curve components, influential factors, the importance of tutoring, and the role of reference centers in residency education in surgery. From the definition of acceptable error, self-efficacy, and error classification, we devised a learning curve model that may be applied to training surgical residents in video laparoscopic cholecystectomy. Based on the criteria culled from the literature, the three surgeon categories (general, specialized, and specialist) are distinguished by years of experience, case volume, and error rate; the patients were distinguished for years and characteristics. The training model was constructed as a series of key learning steps in video laparoscopic cholecystectomy. Potential errors were identified and the difficulty of each step was graded using operation-specific characteristics. On completion of each procedure, error checklist scores on procedure-specific performance are tallied to track the learning curve and obtain performance indices of measurement that chart the trainee’s progress. Conclusions. The concept of the learning curve in general surgery is disputed. The use of learning steps may enable the resident surgical trainee to acquire video laparoscopic cholecystectomy

  2. Human Emotion and Response in Surgery (HEARS): a simulation-based curriculum for communication skills, systems-based practice, and professionalism in surgical residency training.

    Science.gov (United States)

    Larkin, Anne C; Cahan, Mitchell A; Whalen, Giles; Hatem, David; Starr, Susan; Haley, Heather-Lyn; Litwin, Demetrius; Sullivan, Kate; Quirk, Mark

    2010-08-01

    This study examines the development and implementation of a pilot human factors curriculum during a 2-year period. It is one component of a comprehensive 5-year human factors curriculum spanning core competencies of interpersonal and communication skills, systems-based practice, and professionalism and using low-and high-fidelity simulation techniques. Members of the Department of Surgery and the Center for Clinical Communication and Performance Outcomes jointly constructed a curriculum for PGY1 and PGY2 residents on topics ranging from challenging communication to time and stress management. Video demonstrations, triggers, and simulated scenarios involving acting patients were created by surgeons and medical educators. Pre- and postintervention measures were obtained for communication skills, perceived stress level, and teamwork. Communication skills were evaluated using a series of video vignettes. The validated Perceived Stress Scale and Teamwork and Patient Safety Attitudes survey were used. Residents' perceptions of the program were also measured. Twenty-seven PGY1 residents and 15 PGY2 residents participated during 2 years. Analyses of video vignette tests indicated significant improvement in empathic communication for PGY1 (t = 3.62, p = 0.001) and PGY2 (t = 5.00, p = 0.004). There were no significant changes to teamwork attitudes. Perceived levels of stress became considerably higher. PGY1 residents reported trying 1 to 3 strategies taught in the time management session, with 60% to 75% reporting improvement post-training. This unique and comprehensive human factors curriculum is shown to be effective in building communication competency for junior-level residents in the human and emotional aspects of surgical training and practice. Continued refinement and ongoing data acquisition and analyses are underway. Copyright 2010 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  3. Surgery in the Horn of Africa: a 1-year experience of an American-sponsored surgical residency in Eritrea.

    Science.gov (United States)

    Khambaty, Fatima M; Ayas, Huda M; Mezghebe, Haile M

    2010-08-01

    To describe the 1-year experience of a unique postgraduate medical education program set in Eritrea, a recently war-torn country. The Partnership for Eritrea, a cooperative between The George Washington University Medical Center, Physicians for Peace, and the Eritrean Ministry of Health, formed a surgical residency program, launched January 2, 2008, in Asmara, Eritrea, to train native Eritrean surgeons. No prior residency program (to our knowledge) had existed in Eritrea. Eritrea, a country in the Horn of Africa. Five Eritrean physicians participated in the surgical residency. The number of operations performed, length of stay, antibiotic use, and intravenous fluid use. The number of operations increased and resource use decreased because of improved and standardized clinical management. The Partnership for Eritrea established a general surgical residency program that improved clinical care in a resource-poor country that previously had lacked postgraduate training. The program experience suggests a model that can be reproduced in other developing countries.

  4. Surgery

    Science.gov (United States)

    ... and impairs lung function. People need to stop smoking several weeks before surgery so that the defense mechanisms of the respiratory system can recover. Doctors' evaluations The surgeon does a ...

  5. Resident Exposure to Peripheral Nerve Surgical Procedures During Residency Training.

    Science.gov (United States)

    Gil, Joseph A; Daniels, Alan H; Akelman, Edward

    2016-05-01

    Background Variability in case exposures has been identified for orthopaedic surgery residents. It is not known if this variability exists for peripheral nerve procedures. Objective The objective of this study was to assess ACGME case log data for graduating orthopaedic surgery, plastic surgery, general surgery, and neurological surgery residents for peripheral nerve surgical procedures and to evaluate intraspecialty and interspecialty variability in case volume. Methods Surgical case logs from 2009 to 2014 for the 4 specialties were compared for peripheral nerve surgery experience. Peripheral nerve case volume between specialties was performed utilizing a paired t test, 95% confidence intervals were calculated, and linear regression was calculated to assess the trends. Results The average number of peripheral nerve procedures performed per graduating resident was 54.2 for orthopaedic surgery residents, 62.8 for independent plastic surgery residents, 84.6 for integrated plastic surgery residents, 22.4 for neurological surgery residents, and 0.4 for surgery residents. Intraspecialty comparison of the 10th and 90th percentile peripheral nerve case volume in 2012 revealed remarkable variability in training. There was a 3.9-fold difference within orthopaedic surgery, a 5.0-fold difference within independent plastic surgery residents, an 8.8-fold difference for residents from integrated plastic surgery programs, and a 7.0-fold difference within the neurological surgery group. Conclusions There is interspecialty and intraspecialty variability in peripheral nerve surgery volume for orthopaedic, plastic, neurological, and general surgery residents. Caseload is not the sole determinant of training quality as mentorship, didactics, case breadth, and complexity play an important role in training.

  6. Advanced care nurse practitioners can safely provide sole resident cover for level three patients: impact on outcomes, cost and work patterns in a cardiac surgery programme.

    Science.gov (United States)

    Skinner, Henry; Skoyles, Julian; Redfearn, Sue; Jutley, Raj; Mitchell, Ian; Richens, David

    2013-01-01

    There are significant pressures on resident medical rotas on intensive care. We have evaluated the safety and feasibility of nurse practitioners (NPs) delivering first-line care on an intensive care unit with all doctors becoming non-resident. Previously, resident doctors on a 1:8 full-shift rota supported by NPs delivered first-line care to patients after cardiac surgery. Subsequently, junior doctors changed to a 1:5 non-resident rota and NPs onto a 1:7 full-shift rota provided first-line care. A single centre before-and-after service evaluation on cardiac intensive care. mortality rates, surgical trainee attendance in theatre and cost before and after the change. After-hour calls by NPs to doctors and subsequent actions were also audited after the change. The overall mortality rates in the 12 months before the change were 2.8 and 2.2% in the 12 months after (P = 0.43). The median [range] logistic EuroSCORE was 5.3 [0.9-84] before and 5.0 [0.9-85] after the change (P = 0.16). After accounting for the risk profile, the odds ratio for death after the change relative to before was 0.83, 95% confidence interval 0.41-1.69. Before the change, a surgical trainee attended theatre 467 of 702 (68%) cases. This increased to 539 of 677 (80%) cases after the change (P cost of staffing the junior doctor and NP programme before the change was £933 344 and £764 691 after. In the year after the change, 192 after-hour calls were made to doctors. In 57% of cases telephone advice sufficed and doctors attended in 43%. With adequate training and appropriate support, resident NPs can provide a safe, sustainable alternative to traditional staffing models of cardiac intensive care. Training opportunities for junior surgeons increased and costs were reduced.

  7. Resident trainees do not affect patient satisfaction in an outpatient gastroenterology clinic: a prospective study conducted in a Canadian gastroenterology clinic.

    Science.gov (United States)

    Brahmania, Mayur; Young, Madison; Muthiah, Chetty; Ilnyckyj, Alexandra; Duerksen, Donald; Moffatt, Dana C

    2015-10-01

    There is little literature regarding how a gastroenterology trainee affects a patient's interpretation of care during outpatient clinic visits. Improving patient satisfaction is desirable and benefits may include enhanced patient compliance as well as providing trainees with areas for improvement. To evaluate patient satisfaction in an outpatient gastroenterology clinic when seen by a trainee and attending physician versus an attending physician alone. The secondary objective was to evaluate physician characteristics that play a role in creating a positive clinical experience. A randomized prospective survey study was conducted over an 11-month period (July 2012 to June 2013) at St Boniface Hospital (Winnipeg, Manitoba). Two gastroenterology fellows (postgraduate year 4 and 5) and nine internal medicine residents (postgraduate year 1 to 3) comprised the 'trainee' role, while three academic clinicians comprised the 'attending' role. Patients included individuals seen for an initial consultation and were >18 years of age. A total of 211 patients comprised the final study group, with 118 in the attending group and 93 in the trainee group. In univariate analysis, patients more often had a very good experience when seen by an attending physician alone versus a trainee and attending physician (73% versus 56%; P=0.016); however, on multivariate analysis, there was no significant difference in patient satisfaction (OR 0.89; P=0.931). Physician factors found to be associated with high patient satisfaction on multivariate analysis included: addressing all patient concerns (OR 27.56; P=0.021); giving the patient a preliminary diagnosis (OR 78.02; P=0.006); and feeling the physician was thorough (OR 72.53; P=0.029). The present study did not reveal a difference in patient satisfaction if a patient sees an attending physician alone or with a trainee. Moreover, to improve patient satisfaction in a gastroenterology clinic, physicians should address all patient concerns, provide a

  8. Selection bias: Examining the feasibility, utility, and participant receptivity to incorporating simulation into the general surgery residency selection process.

    Science.gov (United States)

    Gardner, Aimee K; Steffes, Christopher P; Nepomnayshy, Dmitry; Nicholas, Cate; Widmann, Warren D; Fitzgibbons, Shimae C; Dunkin, Brian J; Jones, Daniel B; Paige, John T

    2017-06-01

    Opportunities exist to revise the current residency selection process to capture desirable candidate competencies. We examined the extent to which components of the American College of Surgeons/Association for Surgical Education simulation-based medical student curriculum combined with a teamwork activity could be used as potential screening method. Students participated in a workshop consisting of training/evaluation of knot tying, suturing, airway management, gowning/gloving, and teamwork. Surveys were given to medical students (MS) and faculty/resident/staff (FRS) to examine their opinions about the residency screening process, the most critical competencies to assess, and the effectiveness of each station for candidate evaluation. Communication (FRS, 4.86 ± .35; MS, 4.93 ± .26), leadership (FRS, 4.41 ± .80; MS, 4.5 ± .76), judgment (FRS, 4.62 ± .74; MS, 4.67 ± .62), professionalism (FRS, 4.64 ± .73; MS, 5.00 ± .00), integrity (FRS, 4.71 ± .78; MS, 4.87 ± .35), and grit/resilience (FRS, 4.71 ± .78; MS, 4.53 ± .74) were considered most valuable for candidate screening. The simulation-based curriculum for evaluation of residency candidates was rated lowest by both groups. Open response comments indicated positive perceptions of this process. Employing simulation to assess candidates may be most beneficial for examining nontechnical attributes. Future work should continue to explore this area. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Trends in matching to urology residency in Canada: are we becoming noncompetitive?

    Science.gov (United States)

    Melnyk, Megan; Nelson, Hilary; Mickelson, Jennifer; Macneily, Andrew E

    2013-01-01

    Urology is perceived as a competitive specialty choice. Declining undergraduate exposure and the preference for "lifestyle specialties" may jeopardize urology's popularity. Our objective was to assess trends in application and matching rates to urology compared with other surgical specialties. We reviewed data collected by Canadian Residency Matching Service (CaRMS) and the Canadian Post-MD Education Registry since expansion in Canadian medical school enrollment began (2002-2011). The following were examined: applicant preference, number of positions, gender patterns, and match results. "Surgery" included general surgery, orthopedics, plastics, ENT, and urology. From 2002 to 2011 CaRMS applicants increased from 1117 to 2528 (126%). The number of applicants selecting surgery first increased from 178 to 338(90%). The number of surgery positions increased from 138 to 275 (100%). Urology positions increased from 15 to 31 (113%). Applicants to urology increased only 40% (30-42). The proportion of all CARMs applicants selecting urology as their first choice decreased from 2.7% (30) to 1.7% (42). The ratio of first choice urology applicants to positions decreased from 2 to 1.35. The probability of matching urology as first choice increased from 50% to 76%. Female medical graduates increased from 51% to 58%. The female applicants selecting surgery first increased from 21% (49) to 41% (173). In contrast, females selecting urology first rose from 13% (4) to 17% (7). Urology in Canada is becoming less competitive. Residency positions have doubled since 2002 whereas the number of applicants remains static. This trend was not reflected in other surgical specialities. Factors accounting for this may include poor undergraduate exposure, demand for specialties with controllable lifestyles, gender shifts in undergraduate medicine, and lack of role models. The need for undergraduate exposure to urology and vetting numbers of residency positions remains a matter of paramount

  10. Cirurgia do estapédio na residência: experiência do Hospital de Clínicas/UFPR Stapes surgery in residency: the ufpr clinical hospital experience

    Directory of Open Access Journals (Sweden)

    Adriano Ulisses Caldart

    2007-10-01

    Full Text Available A cirurgia do estapédio permanece como tratamento consagrado para a otosclerose. Recentes publicações têm demonstrado que o sucesso cirúrgico nas cirurgias realizadas por médicos residentes tem diminuído e que os resultados audiológicos tem sido piores que os obtidos por cirurgiões experientes. OBJETIVOS: Avaliar a experiência do serviço de otorrinolaringologia do Hospital de Clínicas/UFPR na realização de cirurgias do estapédio no programa de residência médica. MATERIAL E MÉTODO: Estudo retrospectivo de 114 cirurgias do estapédio realizadas nos últimos 9 anos, em 96 pacientes. Os resultados audiométricos foram analisados conforme orientação do Committee on Hearing and Equilibrium e através do Amsterdam Hearing Evaluation Plots, considerando a melhora do gap pós-operatório e de limiares da via aérea. RESULTADOS: Foram incluídos 96 pacientes, na maioria adultos, do sexo feminino (67,7% e caucasianos (93,7%. Em 50,9% dos casos foi realizada estapedectomia, sendo a grande maioria sob anestesia local e sedação (96,5% e utilizando principalmente a prótese de Teflon (37,7%. A taxa de sucesso cirúrgico foi de 50,88%, com 11,4% de complicações. CONCLUSÃO: Os ganhos de audição pós-operatórios considerados como sucesso cirúrgico foram inferiores aos publicados na literatura por cirurgiões experientes.Surgery of the stapedius remains the established treatment for otosclerosis. Recent publications have showed that success in surgeries done by residents have decreased and hearing results are worse than those obtained by experienced otologic surgeons. AIM: To evaluate the experience of the otorhinolaryngology unit, Parana University, relative to stapes surgery done in the residency training program. MATERIAL AND METHOD: A retrospective study of 114 stapes surgeries done in the past 9 years in 96 patients. Audiometric results were analysed according to the Commitee on Hearing and Equilibrium guidelines and the Amsterdam

  11. Residency training oversight(s) in surgery: the history and legacy of the accreditation council for graduate medical education reforms.

    Science.gov (United States)

    Nauta, Russell J

    2012-02-01

    Despite a quarter century of discourse since a sentinel event in New York City raised the question of appropriate oversight for graduate medical education, many questions remain unanswered. Even with the Accreditation Council for Graduate Medical Education rules in place, some opportunity remains to examine handoff methodology, the relationship of duty hours to education, and the impact of fatigue on resident performance. Neurophysiologic adjuncts applied concomitantly to evaluation of didactic performance offer promise for data-driven definition of the optimal shift. Concurrently, the merits of specialty-specific oversight of graduate medical education remain under active consideration. Copyright © 2012 Elsevier Inc. All rights reserved.

  12. Guidelines and enabling objectives for training primary healthcare providers, gynecologists and obstetric and gynecology residents in Female Pelvic Floor Medicine and Reconstructive Surgery.

    Science.gov (United States)

    Contreras Ortiz, Oscar; Rizk, Diaa Ee; Falconi, Gabriele; Schreiner, Lucas; Gorbea Chávez, Viridiana

    2017-02-01

    For four decades, the training for fellows in Urogynecology has been defined by taking into account the proposals of the relevant international societies. Primary health care providers and general OB/GYN practitioners could not find validated guidelines for the integration of knowledge in pelvic floor dysfunctions. The FIGO Working Group (FWG) in Pelvic Floor Medicine and Reconstructive Surgery has looked for the consensus of international opinion leaders in order to develop a set of minimal requirements of knowledge and skills in this area. This manuscript is divided into three categories of knowledge and skills, these are: to know, to understand, and to perform in order to offer the patients a more holistic health care in this area. The FWG reached consensus on the minimal requirements of knowledge and skills regarding each of the enabling objectives identified for postgraduate obstetrics and gynecology physicians and for residents in obstetrics and gynecology. Our goal is to propose and validate the basic objectives of minimal knowledge in pelvic floor medicine and reconstructive surgery. Neurourol. Urodynam. 36:514-517, 2017. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

  13. Improving resident performance on standardized assessments of medical knowledge: a retrospective analysis of interventions correlated to American Board of Surgery In-Service Training Examination performance.

    Science.gov (United States)

    Buckley, Elaine Jayne; Markwell, Stephen; Farr, Debb; Sanfey, Hilary; Mellinger, John

    2015-10-01

    American Board of Surgery In-Service Training Examination (ABSITE) scores are used to assess individual progress and predict board pass rates. We reviewed strategies to enhance ABSITE performance and their impact within a surgery residency. Several interventions were introduced from 2010 to 2014. A retrospective review was undertaken evaluating these and correlating them to ABSITE performance. Analyses of variance and linear trends were performed for ABSITE, United States Medical Licensing Examination (USMLEs), mock oral, and mock ABSITE scores followed by post hoc analyses if significant. Results were correlated with core curricular changes. ABSITE mean percentile increased 34% in 4 years with significant performance improvement and increasing linear trends in postgraduate year (PGY)1 and PGY4 ABSITE scores. Mock ABSITE introduction correlated to significant improvement in ABSITE scores for PGY4 and PGY5. Mock oral introduction correlated with significant improvement in PGY1 and PGY3. Our study demonstrates an improvement in mean program ABSITE percentiles correlating with multiple interventions. Similar strategies may be useful for other programs. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. I Am Canadian

    DEFF Research Database (Denmark)

    Goddard, Joe

    2011-01-01

    "I Am Canadian: Immigration and Multiculturalism in the True North" looks at Canadian immigration history from a contemporary point of view. The article scrutinizes recent discussions on dual nationality and what this may mean for Canadianness......."I Am Canadian: Immigration and Multiculturalism in the True North" looks at Canadian immigration history from a contemporary point of view. The article scrutinizes recent discussions on dual nationality and what this may mean for Canadianness....

  15. New Media for Educating Urology Residents: An Interview Study in Canada and Germany.

    Science.gov (United States)

    Salem, Johannes; Borgmann, Hendrik; MacNeily, Andrew; Boehm, Katharina; Schmid, Marianne; Groeben, Christer; Baunacke, Martin; Huber, Johannes

    To investigate the usage and perceived usefulness of new media for educating urology residents in Canada and Germany. We designed an 11-item online survey to assess the use and perceived usefulness of new media for education. We performed a comparative analysis. The survey was distributed via e-mail to 143 Canadian and 721 German urology residents. The survey included 58 urology residents from Canada and 170 from Germany. A total of 58 residents from Canada (41% response rate) and 170 from Germany (24% response rate) responded to this survey. Residents spent 45% of their education time on new media. The Internet was used by 91% (n = 208) of the residents for professional education purposes, with a median time of 270 minutes (interquartile range [IQR]: 114-540) per month. Apps were used by 54% (n = 118) of the residents, with a median time of 101 minutes (IQR: 45-293) per month. A total of 23% (n = 47) of the residents used social media (SoMe) for education, with a median time of 90 minutes (IQR: 53-80) per month. In all, 100% (n = 228) rated the Internet, 76% (n = 173) apps, and 43% (n = 97) SoMe as being useful for professional education purposes. A total of 90% (n = 205) watched medical videos for education, and 89% (n = 203) of these videos were on surgical procedures. Canadian urology residents used more new media sources for professional education than did the Germans (58% vs. 41%, p source for personal education in urology is the Internet. Future studies and technological developments should investigate and improve new media tools to optimize education during residency. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  16. Modeling the cardiac surgery workforce in Canada.

    Science.gov (United States)

    Vanderby, Sonia A; Carter, Michael W; Latham, Timothy; Ouzounian, Maral; Hassan, Ansar; Tang, Gilbert H; Teng, Carolyn J; Kingsbury, Kori; Feindel, Christopher M

    2010-08-01

    Limited employment opportunities for recently trained cardiac surgeons are deterring medical students from entering cardiac surgery residency programs. Given the lengthy training period and the aging of both the general population and currently practicing cardiac surgeons, this reduced enrollment raises concerns about the adequacy of the future cardiac surgery workforce. A workforce model was developed to explore the future need for cardiac surgeons in Canada. A novel system dynamics model was developed to simulate the supply and demand for cardiac surgery in Canada between 2008 and 2030 to identify whether an excess or shortage of surgeons would exist. Several different scenarios were examined, including varying surgeon productivity, revascularization rates, and residency enrollment rates. The simulation results of various scenarios are presented. In the base case, a surgeon shortage is expected to develop by 2025, although this depends on surgeons' response to demand-supply gap changes. An alternative scenario in which residency enrollment directly relates to the presence of unemployed surgeons also projects substantial shortages after 2021. The model results indicate that if residency enrollment rates remain at the 2009 level an alarming shortage may develop soon, possibly reaching almost 50% of the Canadian cardiac surgical workforce. These workforce model results project an eventual cardiac surgeon shortage in Canada. This study highlights the possibility of a crisis in cardiac surgery and emphasizes the urgency with which enrollment into cardiac surgery training programs and the employability of recently trained cardiac surgery graduates need to be addressed. Copyright 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  17. Effects of hospital procedure volume and resident training on clinical outcomes and resource use in radical retropubic prostatectomy surgery in the Department of Veterans Affairs.

    Science.gov (United States)

    Ku, Tse-Sun; Kane, Christopher J; Sen, Saunak; Henderson, William G; Dudley, R Adams; Cason, Brian A

    2008-01-01

    In this retrospective cohort study we used data from the National Surgical Quality Improvement Program of the Veterans Health Administration to examine the effect of case volume and resident participation on radical retropubic prostatectomy outcomes. The study population included 5,736 patients who underwent radical retropubic prostatectomy in Veterans Administration hospitals between October 1, 2001 and September 30, 2004. Resource related outcomes included operative times and length of stay. Clinical outcomes included blood transfusion, complications, readmissions and reoperations. Hierarchical multivariate regression models were developed to predict outcomes. Risk adjustment was performed using patient chronic health factors and results of preoperative laboratory testing. A total of 5,070 radical retropubic prostatectomy surgeries met inclusion criteria. After adjustment for case mix, academic training institutions had longer operative times (3.2 vs 2.4 hours, p <0.01) but shorter length of stay (3.4 vs 4.2 days, p <0.01). Surgery at academic institutions was not associated with greater risk of transfusion (p = 0.36), reoperation (p = 0.93), complications (p = 0.53) or readmissions (p = 0.97). However, among the academic institutions low vs high hospital radical retropubic prostatectomy volume was associated with longer length of stay (3.7 vs 3.1 days, p = 0.02) and higher transfusion rate (29.6% vs 18.2%, p = 0.02). Substantial clustering of outcomes at the hospital level was observed. Within the Veterans Administration system academic training institutions have longer operative times for radical retropubic prostatectomy, but shorter length of stay. Among the same institutions, high volume hospitals tend to have lower transfusion rates and shorter length of stay. Clustering of outcomes at the hospital level suggests that unmeasured institutional factors are key determinants of clinical and resource related outcomes.

  18. The Medical Mission and Modern Core Competency Training: A 10-Year Follow-Up of Resident Experiences in Global Plastic Surgery.

    Science.gov (United States)

    Yao, Caroline A; Swanson, Jordan; McCullough, Meghan; Taro, Trisa B; Gutierrez, Ricardo; Bradshaw, Allison; Campbell, Alex; Magee, William P; Magee, William P

    2016-09-01

    The emphasis on cultural competency for physicians and surgeons is increasingly important, as communication with both patients and other providers significantly affects individual and system-wide outcomes. International surgical training has been shown to improve leadership skills, cultural competency, and technical proficiency of participants in short-term follow-up. This study explores the long-term impact of international surgical mission experiences on developing participants' core competencies, professional outcomes, and commitment to global health. All 208 plastic and reconstructive surgeons who completed the Operation Smile Regan/Stryker fellowship programs between 2006 and 2015 were surveyed electronically. One hundred sixty-five surveys were returned, for an overall response rate of 79.3 percent. The majority of participants reported that the fellowship positively impacted all six Accreditation Council for Graduate Medical Education core competencies. Most participants who were attending physicians at the time of the survey were practicing general plastic surgery, with 42 percent in an academic/teaching environment, 32 percent in assistant/associate professor positions, and 6 percent in either a program director or department chairman position. The majority currently volunteer on local or international missions, and all respondents would consider volunteering again. Carefully structured and rigorously proctored programs such as the Regan/Stryker Fellowship offer plastic surgery residents the opportunity to gain valuable professional and personal experiences that benefit them long after their service experience. Programs of this nature can not only effectively improve cultural competency of physicians, but also positively influence their attitudes toward leadership and direct that potential to meet the growing need for surgical care in low- and middle-income countries.

  19. Femoral arterial cannulation performed by residents: a comparison between ultrasound-guided and palpation technique in infants and children undergoing cardiac surgery.

    Science.gov (United States)

    Siddik-Sayyid, Sahar M; Aouad, Marie T; Ibrahim, Muhammad H; Taha, Samar K; Nawfal, Maud F; Tfaili, Youssef J; Kaddoum, Roland N

    2016-08-01

    Percutaneous cannulation of the femoral artery in the pediatric age group can be technically challenging, especially when performed by residents in training. We examined whether the use of real-time ultrasound guidance is superior to a palpation landmark technique for femoral artery catheterization in children undergoing heart surgery. Patients were prospectively randomized into two groups. In the palpation group, the femoral artery was cannulated using the traditional landmark method of palpation of arterial pulse. In the ultrasound group, cannulation was guided by real-time scanning with an ultrasound probe. Ten minutes were set as time limit for the resident's trials during which the time taken for attempted cannulation (primary outcome), number of attempts, number of successful cannulations on first attempt, and success rate were compared between the two groups. Adverse events were monitored on postoperative days 1 and 3. A total of 106 patients were included in the study. The time taken for attempted femoral artery cannulation was shorter (301 ± 234 vs 420 ± 248 s; difference in mean: 119; 95% confidence interval (CI) of difference: 26-212; P = 0.012) and the number of attempts was lower [1 (1-10) vs 2 (1-5); difference in median: 1, 95% CI of difference: 0.28-1.72; P = 0.003] in the ultrasound group compared with the palpation group. The number of successful cannulations on first attempt was higher in the ultrasound group compared with palpation group [24/53 (45%) vs 13/53 (25%); odds ratio (OR): 2.54, 95% CI: 1.11-5.82; P = 0.025]. The number of patients who had successful cannulation was 31 of 55 (58%) in the palpation group and 40 of 53 (75%) in the ultrasound group (OR: 2.18, 95% CI: 0.95-5.01; P = 0.06). None of the patients had adverse events at days 1 and 3. Ultrasound-guided femoral arterial cannulation in children when performed by anesthesia residents is superior to the palpation technique based on the reduction of the time taken for attempted

  20. How do Perceptions of Autonomy Differ in General Surgery Training Between Faculty, Senior Residents, Hospital Administrators, and the General Public? A Multi-Institutional Study.

    Science.gov (United States)

    Kempenich, Jason W; Willis, Ross E; Rakosi, Robert; Wiersch, John; Schenarts, Paul Joseph

    2015-01-01

    Identify barriers to resident autonomy in today's educational environment as perceived through 4 selected groups: senior surgical residents, teaching faculty, hospital administration, and the general public. Anonymous surveys were created and distributed to senior residents, faculty, and hospital administrators working within 3 residency programs. The opinions of a convenience sample of the general public were also assessed using a similar survey. Keesler Medical Center, Keesler AFB, MS; the University of Texas Health Science of San Antonio, TX; and the University of Nebraska Medical Center, Omaha, NE. A total of 169 responses were collected: 32 residents, 50 faculty, 20 administrators, and 67 general public. Faculty and residents agree that when attending staff grant more autonomy, residents' self-confidence and sense of ownership improve. Faculty felt that residents should have less autonomy than residents did (p autonomy at their institution, 47% of residents felt that they had too little autonomy and 38% of faculty agreed. No resident or faculty felt that residents had too much autonomy at their institution. The general public were more welcoming of resident participation than faculty (p = 0.002) and administrators (p = 0.02) predicted they would be. When the general public were asked regarding their opinions about resident participation with complex procedures, they were less welcoming than faculty, administrators, and residents thought (p autonomy as important for resident development. The general public are more receptive to resident participation than anticipated. However, with increasing procedural complexity and resident independence, they were less inclined to have residents involved. The general public also had more concerns regarding quality of care provided by residents than the other groups had. Published by Elsevier Inc.

  1. Motivation, justification, normalization: talk strategies used by Canadian medical tourists regarding their choices to go abroad for hip and knee surgeries.

    Science.gov (United States)

    Cameron, Keri; Crooks, Valorie A; Chouinard, Vera; Snyder, Jeremy; Johnston, Rory; Casey, Victoria

    2014-04-01

    Contributing to health geography scholarship on the topic, the objective of this paper is to reveal Canadian medical tourists' perspectives regarding their choices to seek knee replacement or hip replacement or resurfacing (KRHRR) at medical tourism facilities abroad rather than domestically. We address this objective by examining the 'talk strategies' used by these patients in discussing their choices and the ways in which such talk is co-constructed by others. Fourteen interviews were conducted with Canadians aged 42-77 who had gone abroad for KRHRR. Three types of talk strategies emerged through thematic analysis of their narratives: motivation, justification, and normalization talk. Motivation talk referenced participants' desires to maintain or resume physical activity, employment, and participation in daily life. Justification talk emerged when participants described how limitations in the domestic system drove them abroad. Finally, being a medical tourist was talked about as being normal on several bases. Among other findings, the use of these three talk strategies in patients' narratives surrounding medical tourism for KRHRR offers new insight into the language-health-place interconnection. Specifically, they reveal the complex ways in which medical tourists use talk strategies to assert the soundness of their choice to shift the site of their own medical care on a global scale while also anticipating, if not even guarding against, criticism of what ultimately is their own patient mobility. These talk strategies provide valuable insight into why international patients are opting to engage in the spatially explicit practice of medical tourism and who and what are informing their choices. Copyright © 2014 Elsevier Ltd. All rights reserved.

  2. General surgery graduates may be ill prepared to enter rural or community surgical practice.

    Science.gov (United States)

    Gillman, Lawrence M; Vergis, Ashley

    2013-06-01

    Rural/community surgery presents unique challenges to general surgeons. Not only are they required to perform "classic" general surgery procedures, but they are also often expected to be competent in other surgical disciplines. Final-year Canadian-trained residents in general surgery were asked to complete the survey. The survey explored chief residents' career plans for the following year and whether or not they would independently perform various procedures, some general surgical, and others now considered within the domain of the subspecialties. Sixty-four residents (71%) completed the survey. Twenty percent planned to undertake a rural surgical practice, 17% an urban community practice, and 55% had confirmed fellowships. Most residents (>90%) expressed comfort with basic general surgical procedures. However, residents were less comfortable with subspecialty procedures that are still performed by general surgeons in many rural practices. More than half of graduating general surgery residents are choosing subspecialty fellowship training over proceeding directly to practice. Those choosing a rural or community practice are likely to feel ill prepared to replace existing surgeons. Copyright © 2013 Elsevier Inc. All rights reserved.

  3. Opportunity potential matrix for Atlantic Canadians

    Science.gov (United States)

    Greg Danchuk; Ed Thomson

    1992-01-01

    Opportunity for provision of Parks Service benefit to Atlantic Canadians was investigated by mapping travel behaviour into a matrix in terms of origin, season, purpose, distance, time, and destination. Findings identified potential for benefit in several activity areas, particularly within residents' own province.

  4. Upcoming female preponderance within surgery residents and the association of sex with the surgical career choice in the new millennium: results from a national survey in France.

    Science.gov (United States)

    Rouprêt, Morgan; Maggiori, Léon; Lefevre, Jérémie H

    2011-08-01

    Women are increasingly entering the medical studies. We aim to investigate surgical residents' career decision making among surgical residents and to assess the presence of women. An "electronic questionnaire" of self-assessment was distributed to the 2,500 current French surgical residents. Items analyzed included population characteristics, demographics, educational experiences, and choice of career. There was a response rate of 31.2% (n = 779). The male/female ratio was 1.1 with 370 women (47.5%). The mean age was 28 ± 2 years. All surgical specialties were represented. Sex was significantly associated with the choice of surgical specialty (P < .05). Female residents had a shorter working time per week than male residents (P < .001). Sex was significantly linked with future career plans as female residents expected to work in a public hospital (P = .005) and as male residents expected to work in private practice (P = .001). Female surgical residents are more populous than ever among surgical residents. Sex appears to be linked with where and how the residents expect to work in the future. Copyright © 2011 Elsevier Inc. All rights reserved.

  5. Exposure to plastic surgery during undergraduate medical training: A single-institution review

    Science.gov (United States)

    Austin, Ryan E; Wanzel, Kyle R

    2015-01-01

    BACKGROUND: Applications to surgical residency programs have declined over the past decade. Even highly competitive programs, such as plastic surgery, have begun to witness these effects. Studies have shown that early surgical exposure has a positive influence on career selection. OBJECTIVE: To review plastic surgery application trends across Canada, and to further investigate medical student exposure to plastic surgery. METHODS: To examine plastic surgery application trends, national data from the Canadian Resident Matching Service database were analyzed, comparing 2002 to 2007 with 2008 to 2013. To evaluate plastic surgery exposure, a survey of all undergraduate medical students at the University of Toronto (Toronto, Ontario) during the 2012/2013 academic year was conducted. RESULTS: Comparing 2002 to 2007 and 2008 to 2013, the average number of national plastic surgery training positions nearly doubled, while first-choice applicants decreased by 15.3%. The majority of Canadian academic institutions experienced a decrease in first-choice applicants; 84.7% of survey respondents indicated they had no exposure to plastic surgery during their medical education. Furthermore, 89.7% believed their education had not provided a basic understanding of issues commonly managed by plastic surgeons. The majority of students indicated they receive significantly less plastic surgery teaching than all other surgical subspecialties. More than 44% of students not considering plastic surgery as a career indicated they may be more likely to with increased exposure. CONCLUSION: If there is a desire to grow the specialty through future generations, recruiting tactics to foster greater interest in plastic surgery must be altered. The present study suggests increased and earlier exposure for medical students is a potential solution. PMID:25821773

  6. Dictionaries of Canadian English

    African Journals Online (AJOL)

    Information Technology

    ... Globe and Mail said, an enterprising publication. Despite the existence of the Winston dictionary, some Canadians were still, at the end of the 1950s, prepared to dismiss Canadian lexicography as pointless. When the idea of a Canadian dictionary was introduced to the Dean of Arts and Science at Dalhousie University in ...

  7. Leadership in Canadian urology: what is the right stuff?

    Science.gov (United States)

    Robinson, Michael; Macneily, Andrew; Afshar, Kourosh; McInnes, Colin; Lennox, Peter; Carr, Nicholas; Skarlicki, Daniel; Masterson, John; Arneja, Jugpal

    2013-01-01

    There are little data characterizing leadership roles within Canadian Urology. The importance of these positions in urology underscores the need for further investigation to provide insight for recruitment, development, and success. All Canadian Urology Program Directors and Division/Department Heads were invited to complete an online leadership survey as part of a larger national cohort from 11 other surgical specialties. Response rate was 62% (13/21), the majority of whom were Caucasian (77%) and male (92%). Only 8% of respondents in urology hold an advanced degree compared with 45% in other specialties. Additional leadership training was done by 54% of the respondents. Residency was completed in Canada by 92%, but 62% completed fellowships abroad. A majority reported no well-defined job description for their role (54%). The top responsibility reported by leaders was mentoring residents (67%), followed by advising staff (62%). Excellence in patient care and teaching were seen as the most important professional characteristics, whereas integrity was the personal quality felt most important. Leaders reported 17% of their income came from their leadership role, equivalent to the time required for position duties (19%). "Time management" was listed as the greatest challenge faced (54%). Leadership style was reported as "democratic" by 92%. Leaders in urology most often self-rated their leadership skills lower than leaders from other surgical specialties (7 vs 8/10). Positions of leadership in urology are disproportionately represented by Caucasian males and comparatively few hold relevant advanced degrees. Excellence in the areas of teaching and patient care, and high personal integrity are felt to be the most important characteristics for success. Time management issues are viewed as the greatest challenge. These preliminary data may prove useful for the mentoring, recruitment, and success of future leaders in our specialty. Copyright © 2013 Association of Program

  8. Resident fatigue in otolaryngology residents: a Web based survey.

    Science.gov (United States)

    Nida, Andrew M; Googe, Benjamin J; Lewis, Andrea F; May, Warren L

    2016-01-01

    Resident fatigue has become a point of emphasis in medical education and its effects on otolaryngology residents and their patients require further study. The purpose of our study was to evaluate the prevalence and nature of fatigue in otolaryngology residents, evaluate various quality of life measures, and investigate associations of increased fatigue with resident safety. Anonymous survey. Internet based. United States allopathic otolaryngology residents. None. The survey topics included demographics, residency structure, sleep habits and perceived stress. Responses were correlated with a concurrent Epworth Sleep Scale questionnaire to evaluate effects of fatigue on resident training and quality of life. 190 residents responded to the survey with 178 completing the Epworth Sleep Scale questionnaire. Results revealed a mean Epworth Sleep Scale score of 9.9±5.1 with a median of 10.0 indicating a significant number of otolaryngology residents are excessively sleepy. Statistically significant correlations between Epworth Sleep Scale and sex, region, hours of sleep, and work hours were found. Residents taking in-house call had significantly fewer hours of sleep compared to home call (p=0.01). Residents on "head and neck" (typically consisting of a large proportion of head and neck oncologic surgery) rotations tended to have higher Epworth Sleep Scale and had significantly fewer hours of sleep (p=.003) and greater work hours (potolaryngology residents are excessively sleepy. Our data suggest that the effects of fatigue play a role in resident well-being and resident safety. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. The Future of General Surgery: Evolving to Meet a Changing Practice.

    Science.gov (United States)

    Webber, Eric M; Ronson, Ashley R; Gorman, Lisa J; Taber, Sarah A; Harris, Kenneth A

    2016-01-01

    Similar to other countries, the practice of General Surgery in Canada has undergone significant evolution over the past 30 years without major changes to the training model. There is growing concern that current General Surgery residency training does not provide the skills required to practice the breadth of General Surgery in all Canadian communities and practice settings. Led by a national Task Force on the Future of General Surgery, this project aimed to develop recommendations on the optimal configuration of General Surgery training in Canada. A series of 4 evidence-based sub-studies and a national survey were launched to inform these recommendations. Generalized findings from the multiple methods of the project speak to the complexity of the current practice of General Surgery: (1) General surgeons have very different practice patterns depending on the location of practice; (2) General Surgery training offers strong preparation for overall clinical competence; (3) Subspecialized training is a new reality for today's general surgeons; and (4) Generation of the report and recommendations for the future of General Surgery. A total of 4 key recommendations were developed to optimize General Surgery for the 21st century. This project demonstrated that a high variability of practice dependent on location contrasts with the principles of implementing the same objectives of training for all General Surgery graduates. The overall results of the project have prompted the Royal College to review the training requirements and consider a more "fit for purpose" training scheme, thus ensuring that General Surgery residency training programs would optimally prepare residents for a broad range of practice settings and locations across Canada. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  10. Needs Assessment for Incoming PGY-1 Residents in Neurosurgical Residency.

    Science.gov (United States)

    Brandman, David M; Haji, Faizal A; Matte, Marie C; Clarke, David B

    2015-01-01

    Residents must develop a diverse range of skills in order to practice neurosurgery safely and effectively. The purpose of this study was to identify the foundational skills required for neurosurgical trainees as they transition from medical school to residency. Based on the CanMEDS competency framework, a web-based survey was distributed to all Canadian academic neurosurgical centers, targeting incoming and current PGY-1 neurosurgical residents as well as program directors. Using Likert scale and free-text responses, respondents rated the importance of various cognitive (e.g. management of raised intracranial pressure), technical (e.g. performing a lumbar puncture) and behavioral skills (e.g. obtaining informed consent) required for a PGY-1 neurosurgical resident. Of 52 individuals contacted, 38 responses were received. Of these, 10 were from program directors (71%), 11 from current PGY-1 residents (58%) and 17 from incoming PGY-1 residents (89%). Respondents emphasized operative skills such as proper sterile technique and patient positioning; clinical skills such as lesion localization and interpreting neuro-imaging; management skills for common scenarios such as raised intracranial pressure and status epilepticus; and technical skills such as lumbar puncture and external ventricular drain placement. Free text answers were concordant with the Likert scale results. We surveyed Canadian neurosurgical program directors and PGY-1 residents to identify areas perceived as foundational to neurosurgical residency education and training. This information is valuable for evaluating the appropriateness of a training program's goals and objectives, as well as for generating a national educational curriculum for incoming PGY-1 residents.

  11. Resultados da cirurgia para otospongiose com dois tipos de prótese em procedimentos realizados por residentes Results of stapes surgery for otosclerosis with two kinds of prothesis in residency training

    Directory of Open Access Journals (Sweden)

    Celso Dall'Igna

    2008-12-01

    Full Text Available A cirurgia do estapédio é um dos tratamentos indicados para a melhora da surdez condutiva secundária à otospongiose. O procedimento requer habilidade e experiência do cirurgião e faz parte do treinamento durante a residência médica. OBJETIVOS: Avaliar qual tipo de prótese (teflon ou mista de metal e aço apresenta melhores os resultados auditivos em cirurgias realizadas por residentes e a incidência de complicações. MATERIAL E MÉTODOS: Foram avaliadas retrospectivamente 189 intervenções cirúrgicas que tiveram participação ativa de residentes, comparando-se os dois tipos de prótese utilizados. Os resultados audiométricos foram analisados conforme orientação do Committee on Hearing and Equilibrium e segundo o Amsterdam Hearing Evaluation Plots. RESULTADOS: O gap aéreo-ósseo diminuiu em média 21,90 dB (pStapes surgery is one of the approaches indicated to treat conductive hearing loss secondary to otosclerosis. The procedures requires skill and experience from the surgeon and is part of medical residency training. AIMS: To assess which type of prosthesis (Teflon or metal/steel presents the best results in surgeries performed by residents and the incidence of complications. MATERIALS AND METHODS: we retrospectively assessed 189 interventions that counted on the active participation of resident physicians, and we compared the two types of prosthesis used. Audiometric results were analyzed following the guidelines from the Committee on Hearing and Equilibrium and also according to the Amsterdam Hearing Evaluation Plots. RESULTS: Bone-air gap reduced in an average value of 21.90 dB (p<0.05 after the surgery in the group that received the Teflon prosthesis and 21.37 dB (p<0.05 in the group that received the mixed prosthesis, and gain in SRI was of 22.33 and 26.10 dB (p<0.05, and the air-bone gap was below 20 dB in 80.6% and 85.04%, respectively. CONCLUSIONS: We did not see differences in the audiometry and in the incidence of

  12. Residents' perceived physician-manager educational needs: a national survey of psychiatry residents.

    Science.gov (United States)

    Sockalingam, Sanjeev; Stergiopoulos, Vicky; Maggi, Julie

    2008-11-01

    To determine Canadian psychiatry residents' perceived gaps in physician-manager competencies during their residency training. Residents at 16 Canadian psychiatry residency programs were mailed an 11-item questionnaire (a copy is available from the authors) assessing their perceived deficiencies in selected managerial knowledge (GSk) and skill (GSs) areas as determined by gap scores (GS). GSs are defined as the difference between residents' perceived current and desired level of knowledge or skill in selected physician-manager domains. Residents' educational preferences were also elicited in the questionnaire. Among the 494 psychiatry residents who were sent the survey, 237 residents (48%) responded. Residents reported the greatest GSk in Program Planning and the greatest GSs in Personal and Professional Self-Care. Predictors of greater total GSks included a lack of previous administrative education during medical school, higher training level, and female sex. Only sex was a significant predictor of total GSss. More than 50% of residents preferred workshops, small groups, mentoring, and didactic learning methods for furthering their knowledge and skills. Residents report significant gaps in specific physician-manager training areas, specifically Program Planning, and Personal and Professional Self-Care. The results of this national survey can inform the development of formal physician-manager curricula. To appeal to residents, such curricula should incorporate more interactive pedagogical methods combined with mentoring opportunities.

  13. Impact of Three-Dimensional Printed Pelvicaliceal System Models on Residents' Understanding of Pelvicaliceal System Anatomy Before Percutaneous Nephrolithotripsy Surgery: A Pilot Study.

    Science.gov (United States)

    Atalay, Hasan Anıl; Ülker, Volkan; Alkan, İlter; Canat, Halil Lütfi; Özkuvancı, Ünsal; Altunrende, Fatih

    2016-10-01

    To investigate the impact of three-dimensional (3D) printed pelvicaliceal system models on residents' understanding of pelvicaliceal system anatomy before percutaneous nephrolithotripsy (PCNL). Patients with unilateral complex renal stones indicating PCNL were selected. Usable data of patients were obtained from CT-scans in Digital Imaging and Communications in Medicine (DICOM) format. Mimics software version 16.0 (Materialise, Belgium) was used for segmentation and extraction of pelvicaliceal systems (PCSs). All DICOM-formatted files were converted to the stereolithography file format. Finally, fused deposition modeling was used to create plasticine 3D models of PCSs. A questionnaire was designed so that residents could assess the 3D models' effects on their understanding of the anatomy of the pelvicaliceal system before PCNL (Fig. 3). Five patients' anatomically accurate models of the human renal collecting system were effectively generated (Figs. 1 and 2). After presentation of the 3D models, residents were 86% and 88% better at determining the number of anterior and posterior calices, respectively, 60% better at understanding stone location, and 64% better at determining optimal entry calix into the collecting system (Fig. 5). Generating kidney models of PCSs using 3D printing technology is feasible, and the models were accepted by residents as aids in surgical planning and understanding of pelvicaliceal system anatomy before PCNL.

  14. Canadian guidelines for acute bacterial rhinosinusitis

    Science.gov (United States)

    Kaplan, Alan

    2014-01-01

    Objective To provide a clinical summary of the Canadian clinical practice guidelines for acute bacterial rhinosinusitis (ABRS) that includes relevant considerations for family physicians. Quality of evidence Guideline authors performed a systematic literature search and drafted recommendations. Recommendations received both strength of evidence and strength of recommendation ratings. Input from external content experts was sought, as was endorsement from Canadian medical societies (Association of Medical Microbiology and Infectious Disease Canada, Canadian Society of Allergy and Clinical Immunology, Canadian Society of Otolaryngology—Head and Neck Surgery, Canadian Association of Emergency Physicians, and the Family Physicians Airways Group of Canada). Main message Diagnosis of ABRS is based on the presence of specific symptoms and their duration; imaging or culture are not needed in uncomplicated cases. Treatment is dependent on symptom severity, with intranasal corticosteroids (INCSs) recommended as monotherapy for mild and moderate cases, although the benefit might be modest. Use of INCSs plus antibiotics is reserved for patients who fail to respond to INCSs after 72 hours, and for initial treatment of patients with severe symptoms. Antibiotic selection must account for the suspected pathogen, the risk of resistance, comorbid conditions, and local antimicrobial resistance trends. Adjunct therapies such as nasal saline irrigation are recommended. Failure to respond to treatment, recurrent episodes, and signs of complications should prompt referral to an otolaryngologist. The guidelines address situations unique to the Canadian health care environment, including actions to take during prolonged wait periods for specialist referral or imaging. Conclusion The Canadian guidelines provide up-to-date recommendations for diagnosis and treatment of ABRS that reflect an evolving understanding of the disease. In addition, the guidelines offer useful tools to help

  15. A National Survey on Teaching and Assessing Technical Proficiency in Vascular Surgery in Canada.

    Science.gov (United States)

    Drudi, Laura; Hossain, Sajjid; Mackenzie, Kent S; Corriveau, Marc-Michel; Abraham, Cherrie Z; Obrand, Daniel I; Vassiliou, Melina; Gill, Heather; Steinmetz, Oren K

    2016-05-01

    This survey aims to explore trainees' perspectives on how Canadian vascular surgery training programs are using simulation in teaching and assessing technical skills through a cross-sectional national survey. A 10-min online questionnaire was sent to Program Directors of Canada's Royal College of Physicians and Surgeons' of Canada approved training programs in vascular surgery. This survey was distributed among residents and fellows who were studying in the 2013-2014 academic year. Twenty-eight (58%) of the 48 Canadian vascular surgery trainees completed the survey. A total of 68% of the respondents were part of the 0 + 5 integrated vascular surgery training program. The use of simulation in the assessment of technical skills at the beginning of training was reported by only 3 (11%) respondents, whereas 43% reported that simulation was used in their programs in the assessment of technical skills at some time during their training. Training programs most often provided simulation as a method of teaching and learning endovascular abdominal aortic or thoracic aneurysm repair (64%). Furthermore, 96% of trainees reported the most common resource to learn and enhance technical skills was dialog with vascular surgery staff. Surveyed vascular surgery trainees in Canada report that simulation is rarely used as a tool to assess baseline technical skills at the beginning of training. Less than half of surveyed trainees in vascular surgery programs in Canada report that simulation is being used for skills acquisition. Currently, in Canadian training programs, simulation is most commonly used to teach endovascular skills. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Social media in otolaryngology-head and neck surgery.

    Science.gov (United States)

    Oyewumi, Modupe; Lee, John; Vescan, Allan

    2017-09-01

    The objective of this study was to assess the current use of social media tools within Canadian otolaryngology-head and neck surgery (OHNS) programs and to assess the interest within these programs to integrate social media for networking, social, and educational programs. A prospective study from September 2013 to February 2014 was performed involving residents and faculty in Canadian OHNS programs. A 26-item questionnaire was created and sent to staff and resident physicians who met the study inclusion criteria using an online survey tool (http://surveymonkey.com). There were 101 respondents for a 10% response rate. More than half (58.4%) of respondents reported use of social media for personal and/or professional matters. Residents and junior faculty physicians 39 years and younger were more likely to have social media accounts and used them more frequently than their older counterparts. Among staff physicians, pediatric otolaryngologists had the highest rate of use, and otologists exhibited the lowest rate. Cellular phones were the most commonly used devices to access social media sites. Fewer than 35% of social media users failed to separate their personal and professional accounts. Although OHNS trainees and practicing physicians identified the potential benefits of social media tools in their specialty, most were unsure how to apply these tools to their practice. Ours is the first study to assess social media use in OHNS. Otolaryngologists are currently using social media; however, their application as a communication and educational tool in otolaryngology remains to be defined.

  17. What Is the Current Role and Factors for Success of the Journal Club in Podiatric Foot and Ankle Surgery Residency Training Programs?

    Science.gov (United States)

    So, Eric; Hyer, Christopher F; Richardson, Marcus P; Thomas, Randall C

    The journal club (JC) is a traditional part of postgraduate medical education, although little has been written on its current role in podiatric surgical training programs. The goal of the present study was to determine how JCs are conducted and the factors associated with their success. Anonymous electronic surveys were distributed to all podiatric foot and ankle surgical training program directors in the United States with a valid e-mail address. A total of 202 surveys were initially e-mailed to training program directors, with a second and third round sent to those who did not respond. The eventual response rate was 47.5%. The variables associated with success included high faculty attendance, dissemination of articles in advance, and regularly scheduled meetings. Of the residency programs that responded, 39.0% provided some type of handout or supplemental session and 39.8% provided supplemental session or handouts regarding the process of critical review, epidemiology, or biostatistics. A structured review instrument or checklist was used to guide critical appraisal in 21.5% of the JCs, and 11.8% of the programs provided feedback to residents. The JC was perceived by residency directors to be valuable and worthy of maintaining. Residency directors perceived the following factors to be associated with a successful JC: faculty participation, a designated leader, mandatory attendance, dissemination of materials in advance, and regularly scheduled meetings. Areas cited for improvement included implementation of a structured review instrument, delineation of clear goals, and periodic evaluation. We believe these findings could aid residency directors interested in maximizing the educational benefits of their JC. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  18. Framing Canadian federalism

    National Research Council Canada - National Science Library

    Saywell, John; Anastakis, Dimitry; Bryden, Penny E

    2009-01-01

    ... the pervasive effects that federalism has on Canadian politics, economics, culture, and history, and provide a detailed framework in which to understand contemporary federalism. Written in honour of John T. Saywell's half-century of accomplished and influential scholarly work and teaching, Framing Canadian Federalism is a timely and fitting t...

  19. The Canadian elder standard - pricing the cost of basic needs for the Canadian elderly.

    Science.gov (United States)

    MacDonald, Bonnie-Jeanne; Andrews, Doug; Brown, Robert L

    2010-03-01

    We determined the after-tax income required to finance basic needs for Canadian elders living with different circumstances in terms of age, gender, city of residence, household size, homeowner or renter status, means of transportation, and health status. Using 2001 as our base year, we priced the typical expenses for food, shelter, medical, transportation, miscellaneous basic living items and home-based long-term care for elders living in five Canadian cities. This is the first Canadian study of basic living expenses tailored to elders instead of adults in general, prepared on an absolute rather than a relative basis. We also accounted for an individual's unique life circumstances and established the varying effect that they have on the cost of basic expenses, particularly for home care. We found that the maximum Guaranteed Income Supplement and Old Age Security benefit did not meet the cost of basic needs for an elder living in poor circumstances.

  20. Developing the Blueprint for a General Surgery Technical Skills Certification Examination: A Validation Study.

    Science.gov (United States)

    de Montbrun, Sandra; Louridas, Marisa; Szasz, Peter; Harris, Kenneth A; Grantcharov, Teodor P

    2017-08-29

    There is a recognized need to develop high-stakes technical skills assessments for decisions of certification and resident promotion. High-stakes examinations requires a rigorous approach in accruing validity evidence throughout the developmental process. One of the first steps in development is the creation of a blueprint which outlines the potential content of examination. The purpose of this validation study was to develop an examination blueprint for a Canadian General Surgery assessment of technical skill certifying examination. A Delphi methodology was used to gain consensus amongst Canadian General Surgery program directors as to the content (tasks or procedures) that could be included in a certifying Canadian General Surgery examination. Consensus was defined a priori as a Cronbach's α ≥ 0.70. All procedures or tasks reaching a positive consensus (defined as ≥80% of program directors rated items as ≥4 on the 5-point Likert scale) were then included in the final examination blueprint. Two Delphi rounds were needed to reach consensus. Of the 17 General Surgery Program directors across the country, 14 (82.4%) and 10 (58.8%) program directors responded to the first and second round, respectively. A total of 59 items and procedures reached positive consensus and were included in the final examination blueprint. The present study has outlined the development of an examination blueprint for a General Surgery certifying examination using a consensus-based methodology. This validation study will serve as the foundational work from which simulated model will be developed, pilot tested and evaluated. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  1. Perception and Awareness of Bariatric Surgery in Canada: a National Survey of General Surgeons.

    Science.gov (United States)

    Hirpara, Dhruvin H; Cleghorn, Michelle C; Kwong, Josephine; Saleh, Fady; Sockalingam, Sanjeev; Quereshy, Fayez A; Okrainec, Allan; Jackson, Timothy D

    2016-08-01

    The objective of this study was to assess Canadian general surgeons' knowledge of bariatric surgery and perceived availability of resources to manage bariatric surgery patients. A self-administered questionnaire was developed using a focus group of general surgeons. The questionnaire was distributed at two large general surgery conferences in September and November 2012. The survey was also disseminated via membership association electronic newsletters in November and December 2012. One hundred sixty-seven questionnaires were completed (104 practicing surgeons, 63 general surgery trainees). Twenty respondents were bariatric surgeons. Among 84 non-bariatric surgeons, 68.3 % referred a patient in the last year for bariatric surgery, 79 % agreed that bariatric surgery resulted in sustained weight loss, and 81.7 % would consider referring a family member. Knowledge gaps were identified in estimates of mortality and morbidity associated with bariatric procedures. The majority of surgeons surveyed have encountered patients with complications from bariatric surgery in the last year. Over 50 % of surgeons who do not perform bariatric procedures reported not feeling confident to manage complications, 35.4 % reported having adequate resources and equipment to manage morbidly obese patients, and few are able to transfer patients to a bariatric center. Of the respondents, 73.3 % reported residency training provided inadequate exposure to bariatric surgery, and 85.3 % felt that additional continuing medical education resources would be useful. There appears to be support for bariatric surgery among Canadian general surgeons participating in this survey. Knowledge gaps identified indicate the need for more education and resources to support general surgeons managing bariatric surgical patients.

  2. Canadians' eating habits

    National Research Council Canada - National Science Library

    Garriguet, Didier

    2007-01-01

    This report is an overview of Canadians' eating habits: total calories consumed and the number of servings from the various food groups, as well as the percentage of total calories from fat, protein and carbohydrates...

  3. Transition to surgical residency: a multi-institutional study of perceived intern preparedness and the effect of a formal residency preparatory course in the fourth year of medical school.

    Science.gov (United States)

    Minter, Rebecca M; Amos, Keith D; Bentz, Michael L; Blair, Patrice Gabler; Brandt, Christopher; D'Cunha, Jonathan; Davis, Elisabeth; Delman, Keith A; Deutsch, Ellen S; Divino, Celia; Kingsley, Darra; Klingensmith, Mary; Meterissian, Sarkis; Sachdeva, Ajit K; Terhune, Kyla; Termuhlen, Paula M; Mullan, Patricia B

    2015-08-01

    To evaluate interns' perceived preparedness for defined surgical residency responsibilities and to determine whether fourth-year medical school (M4) preparatory courses ("bootcamps") facilitate transition to internship. The authors conducted a multi-institutional, mixed-methods study (June 2009) evaluating interns from 11 U.S. and Canadian surgery residency programs. Interns completed structured surveys and answered open-ended reflective questions about their preparedness for their surgery internship. Analyses include t tests comparing ratings of interns who had and had not participated in formal internship preparation programs. The authors calculated Cohen d for effect size and used grounded theory to identify themes in the interns' reflections. Of 221 eligible interns, 158 (71.5%) participated. Interns self-reported only moderate preparation for most defined care responsibilities in the medical knowledge and patient care domains but, overall, felt well prepared in the professionalism, interpersonal communication, practice-based learning, and systems-based practice domains. Interns who participated in M4 preparatory curricula had higher self-assessed ratings of surgical technical skills, professionalism, interpersonal communication skills, and overall preparation, at statistically significant levels (P technical skills or procedures, managing simultaneous demands, being first responders for critically ill patients, clinical management of predictable postoperative conditions, and difficult communications. Entering surgical residency, interns report not feeling prepared to fulfill common clinical and professional responsibilities. As M4 curricula may enhance preparation, programs facilitating transition to residency should be developed and evaluated.

  4. Effects of implementation of an urgent surgical care service on subspecialty general surgery training

    Science.gov (United States)

    Wood, Leanne; Buczkowski, Andrzej; Panton, Ormond M.N.; Sidhu, Ravi S.; Hameed, S. Morad

    2010-01-01

    Background In July 2007, a large Canadian teaching hospital realigned its general surgery services into elective general surgery subspecialty-based services (SUBS) and a new urgent surgical care (USC) service (also know in the literature as an acute care surgery service). The residents on SUBS had their number of on-call days reduced to enable them to focus on activities related to SUBS. Our aim was to examine the effect of the creation of the USC service on the educational experiences of SUBS residents. Methods We enrolled residents who were on SUBS for the 6 months before and after the introduction of the USC service. We collected data by use of a survey, WEB eVAL and recorded attendance at academic half days. Our 2 primary outcomes were residents’ attendance at ambulatory clinics and compliance with the reduction in the number of on-call days. Our secondary outcomes included residents’ time for independent study, attendance at academic half days, operative experience, attendance at multidisciplinary rounds and overall satisfaction with SUBS. Results Residents on SUBS had a decrease in the mean number of on-call days per resident per month from 6.28 to 1.84 (p = 0.006), an increase in mean attendance at academic half days from 65% to 87% (p = 0.028), at multidisciplinary rounds (p = 0.002) and at ambulatory clinics and an increase in independent reading time (p = 0.015), and they reported an improvement in their work environment. There was no change in the amount of time residents spent in the operating room or in their overall satisfaction with SUBS. Conclusion Residents’ education in the SUBS structure was positively affected by the creation of a USC service. Compliance with the readjustment of on-call duties was high and was identified as the single most significant factor in enabling residents to take full advantage of the unique educational opportunities available only while on SUBS. PMID:20334744

  5. Permanent resident

    Directory of Open Access Journals (Sweden)

    John F. Fisher

    2016-05-01

    Full Text Available The training of physicians in the past century was based primarily on responsibility and the chain-of-command. Those with the bulk of that responsibility in the fields of pediatrics and internal medicine were residents. Residents trained the medical students and supervised them carefully in caring for patients. Most attending physicians supervised their teams at arm's length, primarily serving as teachers of the finer points of diagnosis and treatment during set periods of the day or week with a perfunctory signature on write-ups or progress notes. Residents endeavored to protect the attending physician from being heavily involved unless they were unsure about a clinical problem. Before contacting the attending physician, a more senior resident would be called. Responsibility was the ultimate teacher. The introduction of diagnosis-related groups by the federal government dramatically changed the health care delivery system, placing greater emphasis on attending physician visibility in the medical record, ultimately resulting in more attending physician involvement in day-to-day care of patients in academic institutions. Without specified content in attending notes, hospital revenues would decline. Although always in charge technically, attending physicians increasingly have assumed the role once dominated by the resident. Using biographical experiences of more than 40 years, the author acknowledges and praises the educational role of responsibility in his own training and laments its declining role in today's students and house staff.

  6. [How are resident physicians evaluated? The residents' computerized activity record].

    Science.gov (United States)

    Serra Aracil, Xavier; Navarro Soto, Salvador; Artigau Nieto, Eva; Rebasa Cladera, Pere; Hernando Tavira, Rubén; Moreno Matías, Juan; Aparicio Rodríguez, Oscar; Hermoso Bosch, Judit; Montmany Vioque, Sandra

    2006-09-01

    Because of the developments that have occurred in surgery in the last few years, updates are required not only in the content of resident physicians' training but also in evaluation of the knowledge acquired. The present article aims to present our experience of an integral evaluation model. This model is based on evaluation of theoretical knowledge and surgical skills. The training program for resident physicians (medico interno residente [MIR]) has four main branches: clinical work, continuing training, research (doctorate) and evaluation of the activity performed (computerized activity record). This record allows the theoretical knowledge and skills acquired to be evaluated at the end of each rotation. Through 6-monthly evaluations, each resident's activity can be quantified over time and compared with that of other residents. The system was introduced in July 2004. Each resident was given his or her own database. All the activities performed were then introduced into the database. The results of overall activity and that of each resident are presented. The method used allows residents' integral progress to be followed-up and a completely objective evaluation to be made at the end of each year and at the end of the residency period. Widespread use of this system, or a similar system, would enable comparisons with other centers to be made under similar premises. This system could also help to unify criteria and identify deviations in training.

  7. Doctors of osteopathic medicine (DO): a Canadian perspective.

    Science.gov (United States)

    Evren, Sevan; Bi, Andrew Yuzhong; Talwar, Shuchi; Yeh, Andrew; Teitelbaum, Howard

    2014-01-01

    Doctors of osteopathic medicine (DO) are one of the fastest growing segments of health care professionals in the United States. Although Canada has taken significant leaps in the acknowledgment of US trained DOs, there continues to be a lack of understanding of the profession by Canadian trained physicians. In this article, we provide a brief overview of osteopathic medical education and training in the United States. Current information of osteopathic training by American Association of Colleges of Osteopathic Medicine (AACOM) and American Osteopathic Association (AOA) was presented. Data pertaining to Canadians enrolled in osteopathic colleges was compared with allopathic (MD) and international medical graduates (IMGs). Doctors of osteopathic medicine programs provide an additional pathway for students interested in pursuing a medical education. Canadian applications to osteopathic colleges are expected to grow due to successful post-graduate US residency matching, increased difficulty of matriculating at Canadian medical schools, and a greater awareness of the profession in Canada. Given the increasing enrollment of Canadian students in US osteopathic medical schools, we expect that Canadian DOs will play a significant role in shaping health care in both the US and Canada.

  8. Twitter and Canadian Educators

    Science.gov (United States)

    Cooke, Max

    2012-01-01

    An emerging group of leaders in Canadian education has attracted thousands of followers. They've made Twitter an extension of their lives, delivering twenty or more tweets a day that can include, for example, links to media articles, research, new ideas from education bloggers, or to their own, or simply a personal thought. At their best,…

  9. Canadian Mathematical Congress

    CERN Document Server

    1977-01-01

    For two weeks in August, 1975 more than 140 mathematicians and other scientists gathered at the Universite de Sherbrooke. The occasion was the 15th Biennial Seminar of the Canadian Mathematical Congress, entitled Mathematics and the Life Sciences. Participants in this inter­ disciplinary gathering included researchers and graduate students in mathematics, seven different areas of biological science, physics, chemistry and medical science. Geographically, those present came from the United States and the United Kingdom as well as from academic departments and government agencies scattered across Canada. In choosing this particular interdisciplinary topic the programme committee had two chief objectives. These were to promote Canadian research in mathematical problems of the life sciences, and to encourage co-operation and exchanges between mathematical scientists" biologists and medical re­ searchers. To accomplish these objective the committee assembled a stim­ ulating programme of lectures and talks. Six ...

  10. Beyond "medical tourism": Canadian companies marketing medical travel.

    Science.gov (United States)

    Turner, Leigh

    2012-06-15

    Despite having access to medically necessary care available through publicly funded provincial health care systems, some Canadians travel for treatment provided at international medical facilities as well as for-profit clinics found in several Canadian provinces. Canadians travel abroad for orthopaedic surgery, bariatric surgery, ophthalmologic surgery, stem cell injections, "Liberation therapy" for multiple sclerosis, and additional interventions. Both responding to public interest in medical travel and playing an important part in promoting the notion of a global marketplace for health services, many Canadian companies market medical travel. Research began with the goal of locating all medical tourism companies based in Canada. Various strategies were used to find such businesses. During the search process it became apparent that many Canadian business promoting medical travel are not medical tourism companies. To the contrary, numerous types of businesses promote medical travel. Once businesses promoting medical travel were identified, content analysis was used to extract information from company websites. Company websites were analyzed to establish: 1) where in Canada these businesses are located; 2) the destination countries and health care facilities that they market; 3) the medical procedures they promote; 4) core marketing messages; and 5) whether businesses market air travel, hotel accommodations, and holiday tours in addition to medical procedures. Searches conducted from 2006 to 2011 resulted in identification of thirty-five Canadian businesses currently marketing various kinds of medical travel. The research project began with what seemed to be the straightforward goal of establishing how many medical tourism companies are based in Canada. Refinement of categories resulted in the identification of eighteen businesses fitting the category of what most researchers would identify as medical tourism companies. Seven other businesses market regional, cross

  11. Beyond "medical tourism": Canadian companies marketing medical travel

    Directory of Open Access Journals (Sweden)

    Turner Leigh

    2012-06-01

    Full Text Available Abstract Background Despite having access to medically necessary care available through publicly funded provincial health care systems, some Canadians travel for treatment provided at international medical facilities as well as for-profit clinics found in several Canadian provinces. Canadians travel abroad for orthopaedic surgery, bariatric surgery, ophthalmologic surgery, stem cell injections, “Liberation therapy” for multiple sclerosis, and additional interventions. Both responding to public interest in medical travel and playing an important part in promoting the notion of a global marketplace for health services, many Canadian companies market medical travel. Methods Research began with the goal of locating all medical tourism companies based in Canada. Various strategies were used to find such businesses. During the search process it became apparent that many Canadian business promoting medical travel are not medical tourism companies. To the contrary, numerous types of businesses promote medical travel. Once businesses promoting medical travel were identified, content analysis was used to extract information from company websites. Company websites were analyzed to establish: 1 where in Canada these businesses are located; 2 the destination countries and health care facilities that they market; 3 the medical procedures they promote; 4 core marketing messages; and 5 whether businesses market air travel, hotel accommodations, and holiday tours in addition to medical procedures. Results Searches conducted from 2006 to 2011 resulted in identification of thirty-five Canadian businesses currently marketing various kinds of medical travel. The research project began with what seemed to be the straightforward goal of establishing how many medical tourism companies are based in Canada. Refinement of categories resulted in the identification of eighteen businesses fitting the category of what most researchers would identify as medical tourism

  12. Beyond "medical tourism": Canadian companies marketing medical travel

    Science.gov (United States)

    2012-01-01

    Background Despite having access to medically necessary care available through publicly funded provincial health care systems, some Canadians travel for treatment provided at international medical facilities as well as for-profit clinics found in several Canadian provinces. Canadians travel abroad for orthopaedic surgery, bariatric surgery, ophthalmologic surgery, stem cell injections, “Liberation therapy” for multiple sclerosis, and additional interventions. Both responding to public interest in medical travel and playing an important part in promoting the notion of a global marketplace for health services, many Canadian companies market medical travel. Methods Research began with the goal of locating all medical tourism companies based in Canada. Various strategies were used to find such businesses. During the search process it became apparent that many Canadian business promoting medical travel are not medical tourism companies. To the contrary, numerous types of businesses promote medical travel. Once businesses promoting medical travel were identified, content analysis was used to extract information from company websites. Company websites were analyzed to establish: 1) where in Canada these businesses are located; 2) the destination countries and health care facilities that they market; 3) the medical procedures they promote; 4) core marketing messages; and 5) whether businesses market air travel, hotel accommodations, and holiday tours in addition to medical procedures. Results Searches conducted from 2006 to 2011 resulted in identification of thirty-five Canadian businesses currently marketing various kinds of medical travel. The research project began with what seemed to be the straightforward goal of establishing how many medical tourism companies are based in Canada. Refinement of categories resulted in the identification of eighteen businesses fitting the category of what most researchers would identify as medical tourism companies. Seven other

  13. Canadian petroleum history bibliography

    Energy Technology Data Exchange (ETDEWEB)

    Cass, D.

    2003-09-27

    The Petroleum History Bibliography includes a list of more than 2,000 publications that record the history of the Canadian petroleum industry. The list includes books, theses, films, audio tapes, published articles, company histories, biographies, autobiographies, fiction, poetry, humour, and an author index. It was created over a period of several years to help with projects at the Petroleum History Society. It is an ongoing piece of work, and as such, invites comments and additions.

  14. Tuberculosis in Aboriginal Canadians

    Directory of Open Access Journals (Sweden)

    Vernon H Hoeppner

    2000-01-01

    Full Text Available Endemic tuberculosis (TB was almost certainly present in Canadian aboriginal people (aboriginal Canadians denotes status Indians, Inuit, nonstatus Indians and metis as reported by Statistics Canada before the Old World traders arrived. However, the social changes that resulted from contact with these traders created the conditions that converted endemic TB into epidemic TB. The incidence of TB varied inversely with the time interval from this cultural collision, which began on the east coast in the 16th century and ended in the Northern Territories in the 20th century. This relatively recent epidemic explains why the disease is more frequent in aboriginal children than in Canadian-born nonaboriginal people. Treatment plans must account for the socioeconomic conditions and cultural characteristics of the aboriginal people, especially healing models and language. Prevention includes bacillus Calmette-Guerin vaccination and chemoprophylaxis, and must account for community conditions, such as rates of suicide, which have exceeded the rate of TB. The control of TB requires a centralized program with specifically directed funding. It must include a program that works in partnership with aboriginal communities.

  15. Applying Expectancy Theory to residency training: proposing opportunities to understand resident motivation and enhance residency training

    Directory of Open Access Journals (Sweden)

    Shweiki E

    2015-04-01

    Full Text Available Ehyal Shweiki,1 Niels D Martin,2 Alec C Beekley,1 Jay S Jenoff,1 George J Koenig,1 Kris R Kaulback,1 Gary A Lindenbaum,1 Pankaj H Patel,1 Matthew M Rosen,1 Michael S Weinstein,1 Muhammad H Zubair,2 Murray J Cohen1 1Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA; 2Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA Abstract: Medical resident education in the United States has been a matter of national priority for decades, exemplified initially through the Liaison Committee for Graduate Medical Education and then superseded by the Accreditation Council for Graduate Medical Education. A recent Special Report in the New England Journal of Medicine, however, has described resident educational programs to date as prescriptive, noting an absence of innovation in education. Current aims of contemporary medical resident education are thus being directed at ensuring quality in learning as well as in patient care. Achievement and work-motivation theories attempt to explain people's choice, performance, and persistence in tasks. Expectancy Theory as one such theory was reviewed in detail, appearing particularly applicable to surgical residency training. Correlations between Expectancy Theory as a work-motivation theory and residency education were explored. Understanding achievement and work-motivation theories affords an opportunity to gain insight into resident motivation in training. The application of Expectancy Theory in particular provides an innovative perspective into residency education. Afforded are opportunities to promote the development of programmatic methods facilitating surgical resident motivation in education. Keywords: learning, education, achievement

  16. Canadian identity: Implications for international social work by Canadians

    DEFF Research Database (Denmark)

    Hiranandani, Vanmala Sunder

    2011-01-01

    This paper is in response to recent calls to conceptualize and articulate Canadian perspectives and experiences in international social work, given that the Canadian standpoint has been lacking in international social work literature. This paper contends that it is imperative, first of all......, to critically examine and unpack our ‘Canadian’ identity in order to practice international work that is socially just and anti-imperialist. Drawing on the work of post-colonial authors, critical race theorists, and those who study national myth-making, this essay revisits Canadian identity because...... it is this identity that Canadian social workers often carry into their international work....

  17. Simulation in Canadian postgraduate emergency medicine training - a national survey.

    Science.gov (United States)

    Russell, Evan; Hall, Andrew Koch; Hagel, Carly; Petrosoniak, Andrew; Dagnone, Jeffrey Damon; Howes, Daniel

    2018-01-01

    Simulation-based education (SBE) is an important training strategy in emergency medicine (EM) postgraduate programs. This study sought to characterize the use of simulation in FRCPC-EM residency programs across Canada. A national survey was administered to residents and knowledgeable program representatives (PRs) at all Canadian FRCPC-EM programs. Survey question themes included simulation program characteristics, the frequency of resident participation, the location and administration of SBE, institutional barriers, interprofessional involvement, content, assessment strategies, and attitudes about SBE. Resident and PR response rates were 63% (203/321) and 100% (16/16), respectively. Residents reported a median of 20 (range 0-150) hours of annual simulation training, with 52% of residents indicating that the time dedicated to simulation training met their needs. PRs reported the frequency of SBE sessions ranging from weekly to every 6 months, with 15 (94%) programs having an established simulation curriculum. Two (13%) of the programs used simulation for resident assessment, although 15 (94%) of PRs indicated that they would be comfortable with simulation-based assessment. The most common PR-identified barriers to administering simulation were a lack of protected faculty time (75%) and a lack of faculty experience with simulation (56%). Interprofessional involvement in simulation was strongly valued by both residents and PRs. SBE is frequently used by Canadian FRCPC-EM residency programs. However, there exists considerable variability in the structure, frequency, and timing of simulation-based activities. As programs transition to competency-based medical education, national organizations and collaborations should consider the variability in how SBE is administered.

  18. Iron sufficiency of Canadians.

    Science.gov (United States)

    Cooper, Marcia; Greene-Finestone, Linda; Lowell, Hélène; Levesque, Johanne; Robinson, Stacey

    2012-12-01

    Iron deficiency is the most common nutritional deficiency in the world, but little is known about the iron status of people in Canada, where the last estimates are from 1970-1972. The data are from cycle 2 (2009 to 2011) of the Canadian Health Measures Survey, which collected blood samples from a nationally representative sample of Canadians aged 3 to 79. Descriptive statistics (percentages, arithmetic means, geometric means) were used to estimate hemoglobin and serum ferritin concentrations, and other markers of iron status. Analyses were performed by age/sex group, household income, self-perceived health, diet, and use of iron supplements. World Health Organization reference values (2001) were used to estimate the prevalence of iron sufficiency and anemia. The overall prevalence of anemia was low in the 2009-to-2011 period--97% of Canadians had sufficient hemoglobin levels. Generally, hemoglobin concentration increased compared with 1970-1972; however, at ages 65 to 79, rates of anemia were higher than in 1970-1972. Depleted iron stores were found in 13% of females aged 12 to 19 and 9% of females aged 20 to 49. Lower household income was associated with a lower prevalence of hemoglobin sufficiency, but was not related to lower serum ferritin sufficiency. Self-perceived health and diet were not significantly associated with hemoglobin and serum ferritin levels. The lack of a relationship between iron status and diet may be attributable to the use of questions about food consumption frequency that were not specifically designed to estimate dietary iron intake. Factors other than iron intake might have contributed to the increase in the prevalence of anemia among seniors.

  19. Canadian space robotic activities

    Science.gov (United States)

    Sallaberger, Christian; Space Plan Task Force, Canadian Space Agency

    The Canadian Space Agency has chosen space robotics as one of its key niche areas, and is currently preparing to deliver the first flight elements for the main robotic system of the international space station. The Mobile Servicing System (MSS) is the Canadian contribution to the international space station. It consists of three main elements. The Space Station Remote Manipulator System (SSRMS) is a 7-metre, 7-dof, robotic arm. The Special Purpose Dextrous Manipulator (SPDM), a smaller 2-metre, 7-dof, robotic arm can be used independently, or attached to the end of the SSRMS. The Mobile Base System (MBS) will be used as a support platform and will also provide power and data links for both the SSRMS and the SPDM. A Space Vision System (SVS) has been tested on Shuttle flights, and is being further developed to enhance the autonomous capabilities of the MSS. The CSA also has a Strategic Technologies in Automation and Robotics Program which is developing new technologies to fulfill future robotic space mission needs. This program is currently developing in industry technological capabilities in the areas of automation of operations, autonomous robotics, vision systems, trajectory planning and object avoidance, tactile and proximity sensors, and ground control of space robots. Within the CSA, a robotic testbed and several research programs are also advancing technologies such as haptic devices, control via head-mounted displays, predictive and preview displays, and the dynamic characterization of robotic arms. Canada is also now developing its next Long Term Space Plan. In this context, a planetary exploration program is being considered, which would utilize Canadian space robotic technologies in this new arena.

  20. Research Experience in Psychiatry Residency Programs Across Canada: Current Status

    Science.gov (United States)

    Shanmugalingam, Arany; Ferreria, Sharon G; Norman, Ross M G; Vasudev, Kamini

    2014-01-01

    Objective: To determine the current status of research experience in psychiatry residency programs across Canada. Method: Coordinators of Psychiatric Education (COPE) resident representatives from all 17 psychiatry residency programs in Canada were asked to complete a survey regarding research training requirements in their programs. Results: Among the 17 COPE representatives, 15 completed the survey, representing 88% of the Canadian medical schools that have a psychiatry residency program. Among the 15 programs, 11 (73%) require residents to conduct a scholarly activity to complete residency. Some of these programs incorporated such a requirement in the past 5 years. Ten respondents (67%) reported availability of official policy and (or) guidelines on resident research requirements. Among the 11 programs that have a research requirement, 10 (91%) require residents to complete 1 scholarly activity; 1 requires completion of 2 scholarly activities. Eight (53%) residency programs reported having a separate research track. All of the programs have a research coordinator and 14 (93%) programs provide protected time to residents for conducting research. The 3 most common types of scholarly activities that qualify for the mandatory research requirement are a full independent project (10 programs), a quality improvement project (8 programs), and assisting in a faculty project (8 programs). Six programs expect their residents to present their final work in a departmental forum. None of the residency programs require publication of residents’ final work. Conclusions: The current status of the research experience during psychiatry residency in Canada is encouraging but there is heterogeneity across the programs. PMID:25565474

  1. Advanced laparoscopic bariatric surgery Is safe in general surgery training.

    Science.gov (United States)

    Kuckelman, John; Bingham, Jason; Barron, Morgan; Lallemand, Michael; Martin, Matthew; Sohn, Vance

    2017-05-01

    Bariatric surgery makes up an increasing percentage of general surgery training. The safety of resident involvement in these complex cases has been questioned. We evaluated patient outcomes in resident performed laparoscopic bariatric procedures. Retrospective review of patients undergoing a laparoscopic bariatric procedure over seven years at a tertiary care single center. Procedures were primarily performed by a general surgery resident and proctored by an attending surgeon. Primary outcomes included operative volume, operative time and leak rate with perioperative outcomes evaluated as secondary outcomes. A total of 1649 bariatric procedures were evaluated. Operations included laparoscopic bypass (690) and laparoscopic sleeve gastrectomy (959). Average operating time was 136 min. Eighteen leaks (0.67%) were identified. Graduating residents performed an average of 89 laparoscopic bariatric cases during their training. There were no significant differences between resident levels with concern to operative time or leak rate (p 0.97 and p = 0.54). General surgery residents can safely perform laparoscopic bariatric surgery. When proctored by a staff surgeon, a resident's level of training does not significantly impact leak rate. Published by Elsevier Inc.

  2. Unique Factors Affecting Canadian Education.

    Science.gov (United States)

    Farquhar, Robin H.

    In a background statement identifying what is unique about Canada and the issues it currently faces, this paper begins by discussing the concurrent movements toward Canadian nationalism and Quebec nationalism as an illustration of the problems caused by large size and great diversity. It then focuses on unique aspects of Canadian education,…

  3. Well-being in residency training: a survey examining resident physician satisfaction both within and outside of residency training and mental health in Alberta

    Directory of Open Access Journals (Sweden)

    Patten Scott

    2005-06-01

    Full Text Available Abstract Background Despite the critical importance of well-being during residency training, only a few Canadian studies have examined stress in residency and none have examined well-being resources. No recent studies have reported any significant concerns with respect to perceived stress levels in residency. We investigated the level of perceived stress, mental health and understanding and need for well-being resources among resident physicians in training programs in Alberta, Canada. Methods A mail questionnaire was distributed to the entire resident membership of PARA during 2003 academic year. PARA represents each of the two medical schools in the province of Alberta. Results In total 415 (51 % residents participated in the study. Thirty-four percent of residents who responded to the survey reported their life as being stressful. Females reported stress more frequently than males (40% vs. 27%, p Residents highly valued their colleagues (67%, program directors (60% and external psychiatrist/psychologist (49% as well-being resources. Over one third of residents wished to have a career counselor (39% and financial counselor (38%. Conclusion Many Albertan residents experience significant stressors and emotional and mental health problems. Some of which differ among genders. This study can serve as a basis for future resource application, research and advocacy for overall improvements to well-being during residency training.

  4. Daily smoking and lower back pain in adult Canadians: the Canadian Community Health Survey

    Directory of Open Access Journals (Sweden)

    Fahad Alkherayf

    2010-08-01

    Full Text Available Fahad Alkherayf1,2,3, Eugene K Wai4,5,6, Eve C Tsai1,3,4,6, Charles Agbi1,3,41University of Ottawa, Division of Neurosurgery, Ottawa, Ontario; 2University of Ottawa, Department of Clinical Epidemiology, Ottawa, Ontario; 3The Ottawa Hospital, Civic campus, Division of Neurosurgery, Ottawa, Ontario; 4The Ottawa Hospital, Civic Campus, Spine Unit Ottawa, Ontario; 5The Ottawa Hospital, Civic Campus, Division of Orthopedic Surgery, Ottawa, Ontario; 6The Ottawa Hospital Research Institute, Ottawa, Ontario, CanadaBackground: Lower back pain (LBP is one of the primary causes of disability in the Canadian community. However, only a limited number of studies have addressed the association between daily smoking and LBP in Canada. Of the studies that have explored this association, many had small sample sizes and failed to control for confounders.Objective: The primary objective of the study was to determine if daily smoking is associated with an increased risk of having LBP. The secondary objectives were to assess the risk for LBP among occasional smokers and to determine the prevalence of LBP in relation to different covariates.Data and study design: Using the Canadian Community Health Survey (cycle 3.1 data, 73,507 Canadians between the ages of 20 and 59 years were identified. LBP status, smoking level, sex, age, body mass index (BMI, level of activity and level of education were assessed in these subjects.Methods: Stratified analysis and logistic regression analysis were used to detect effect modifications and to adjust for covariates. Population weight and design were taken into consideration.Results: The prevalence of LBP was 23.3% among daily smokers and 15.7% among non-smokers. Age and sex were found to be effect modifiers. The association between LBP and daily smoking was statistically significant in all ages and genders; this association was stronger for younger age groups. The adjusted odds ratio for male daily smokers aged 20 to 29 was 1.87 (95

  5. “We have been forced to move away from home”: print news coverage of Canadians studying abroad at Caribbean offshore medical schools

    Directory of Open Access Journals (Sweden)

    Jeffrey Morgan

    2017-11-01

    Full Text Available Abstract Background Canadian international medical graduates are Canadian-citizens who have graduated from a medical school outside of Canada or the United States. A growing number of Canadians enroll in medical school abroad, including at Caribbean offshore medical schools. Often, Canadians studying medicine abroad attempt to return to Canada for postgraduate residency training and ultimately to practice. Methods The authors conducted a qualitative media analysis to discern the dominant themes and ideologies that frame discussion of offshore medical schools, and the Canadian medical students they graduate, in the Canadian print news. We carried out structured searches on Canadian Newsstand Database for print media related to offshore medical schools. Results Canadian news articles used two frames to characterize offshore medical schools and the Canadian international medical graduates they train: (1 increased opportunity for medical education for Canadians; and (2 frustration returning to Canada to practice despite domestic physician shortages. Conclusion Frames deployed by the Canadian print media to discuss Caribbean offshore medical schools and Canadians studying abroad define two problems: (1 highly qualified Canadians are unable to access medical school in Canada; and (2 some Canadian international medical graduates are unable to return to Canada to practice medicine. Caribbean offshore medical schools are identified as a solution to the first problem while playing a central role in creating the second problem. These frames do not acknowledge that medical school admissions are a primary means to control the make-up of the Canadian physician workforce and they do not address the nature of Canadian physician shortages.

  6. Recent Canadian ophthalmology graduates: experiences in finding jobs and assessment of their training.

    Science.gov (United States)

    Bellan, Lorne

    2012-06-01

    To examine the ability of recent Canadian ophthalmology graduates to commence clinical practice and obtain surgical privileges. A secondary objective was to assess their perception of the adequacy of their residency training. An Internet questionnaire survey. Canadian graduates of Canadian ophthalmology residency programs between 2005 and 2009, inclusive. Email addresses for the participants were obtained from the Canadian Ophthalmological Society and invitations to participate were sent, followed by 2 reminder emails. A 44% response rate was obtained (65 out of 154 emails sent). Of the respondents, 91% were working full time, and 89% had operating-room time. Training was adequate for all CanMEDs competencies except working as a manager. Assessment that one's practice did not live up to expectations correlated with male gender, dissatisfaction with location, inability to get operating-room time, inability to get other hospital resources, feelings about fairness of distribution of resources, and net income below expectations. For the most part, recent graduates are successful in establishing practices that meet their expectations. Training in management skills should be improved in residency programs. Copyright © 2012 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

  7. Residency Allocation Database

    Data.gov (United States)

    Department of Veterans Affairs — The Residency Allocation Database is used to determine allocation of funds for residency programs offered by Veterans Affairs Medical Centers (VAMCs). Information...

  8. Elucidating Reasons for Resident Underutilization of Electronic Adverse Event Reporting.

    Science.gov (United States)

    Hatoun, Jonathan; Suen, Winnie; Liu, Constance; Shea, Sandy; Patts, Gregory; Weinberg, Janice; Eng, Jessica

    2016-07-01

    Reasons for resident underutilization of adverse event (AE) reporting systems are unclear, particularly given frequent resident exposure to AEs and near misses (NMs). Residents at an academic medical center were surveyed about AEs/NMs, barriers to reporting, patient safety climate, and educational interventions. A total of 350 of 527 eligible residents (66%) completed the survey; 77% of respondents reported involvement in an AE/NM, though only 43% had used the reporting system. Top barriers to reporting were not knowing what or how to report. Surgeons reported more than other residents (surgery, 61%; medical, 38%; hospital-based, 15%; P reporting (surgery, 49%; medical, 28%; hospital-based. 18%; P reporting. Efforts to increase resident reporting should address common barriers to reporting as well as department-specific differences in resident knowledge, perceptions of system effectiveness, and educational preferences. © The Author(s) 2015.

  9. Canadian National Vegetation Classification (CNVC)

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — The mandate of the CNVC is to comprehensively classify and describe natural and semi-natural Canadian vegetation in an ecologically meaningful manner. The...

  10. Engendering migrant health: Canadian perspectives

    National Research Council Canada - National Science Library

    Spitzer, Denise L

    2011-01-01

    .... What contributes to this deterioration, and how can its effects be mitigated? Engendering Migrant Health brings together researchers from across Canada to address the intersections of gender, immigration, and health in the lives of new Canadians...

  11. Natural history of Canadian mammals

    National Research Council Canada - National Science Library

    Naughton, Donna; Banfield, A. W. F

    2012-01-01

    .... A complete revision of A.W.F. Banfield's classic text Mammals of Canada, it features brand-new, full-colour images of each species, as well as stunning photographs from Canadian Geographic magazine's national photography...

  12. Engendering migrant health: Canadian perspectives

    National Research Council Canada - National Science Library

    Spitzer, Denise L

    2011-01-01

    "Voluntary migrants to Canada are generally healthier than the average Canadian, but after ten years in the country they report poorer health and higher rates of chronic disease than those born here...

  13. Dermatoethics: a curriculum in bioethics and professionalism for dermatology residents at Brown Medical School.

    Science.gov (United States)

    Bercovitch, Lionel; Long, Thomas P

    2007-04-01

    Both American and Canadian residency accreditation bodies have formal requirements in core competencies that include training in ethics and professionalism without prescribing content. A structured seminar series in medical ethics and professionalism relating to dermatology practice was started at Brown Medical School's dermatology residency in 2001. Methods of instruction include discussion groups, review of medical and lay literature, book review, didactic teaching, case presentation, and informal e-mail exchange. Some of the topics that have been covered include basic medical ethics, research ethics, physician-industry relationships, truth telling, privacy and confidentiality, duty to treat, and ethical and legal issues in cosmetic dermatology, dermatologic surgery, dermatologic genetics, occupational dermatology, and pediatric dermatology. The main goals of the curriculum are to fulfill the core competency requirement in professionalism of the specialty certifying boards, introduce trainees to the cross-disciplinary literature of biomedical ethics and current ethical controversies, and encourage dialogue on ethics and professionalism among faculty, colleagues in other specialties, and dermatology trainees.

  14. Cosmetic dermatology training in residency: results of a survey from the residents' perspective.

    Science.gov (United States)

    Group, Ashley; Philips, Rebecca; Kelly, Erica

    2012-12-01

    Dermatologists are expected to be experts in the evaluation and treatment of their patient's cosmetic concerns. It has been reported that some dermatology residents do not feel adequately trained in this field. To assess how dermatology residents are being trained in cosmetic dermatology. A survey was e-mailed to 473 third-year dermatology residents. One hundred eighteen surveys were returned (24.9%), representing 45% of programs. Most residents have assigned reading (70.7%) and lectures (81.4%) in cosmetic dermatology. To learn technical skills, 79.7% participate in formal training sessions, and 73% have an apprenticeship model. Most residents have the opportunity to perform botulinum toxin injections, laser surgery, fillers, chemical peels, and sclerotherapy. More than 58% of programs have an encouraging or somewhat encouraging attitude toward teaching cosmetics, whereas 22% were somewhat discouraging or discouraging. Most residents (75.4%) plan to incorporate cosmetics into their practice. Residents do not feel less prepared (94.9%) or less interested (97.4%) in medical dermatology as a result of their cosmetic training. Residents are being trained in cosmetic dermatology through a variety of methods. Residency programs should periodically assess and adapt their curricula to ensure adequate training in this field. © 2012 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.

  15. Bariatric Surgery

    Science.gov (United States)

    ... Loss Featured Resource Find an Endocrinologist Search Bariatric Surgery September 2017 Download PDFs English Espanol Editors Durga ... Metabolic and Bariatric Surgery MedlinePlus What is bariatric surgery? Bariatric surgery helps people who are very obese ...

  16. Bariatric Surgery

    Science.gov (United States)

    ... Weight Loss Featured Resource Find an Endocrinologist Search Bariatric Surgery September 2017 Download PDFs English Espanol Editors Durga ... for Metabolic and Bariatric Surgery MedlinePlus What is bariatric surgery? Bariatric surgery helps people who are very obese ...

  17. Making a difference: using the safe surgery checklist to initiate continuing education for perioperative nurses in low-income settings.

    Science.gov (United States)

    Leifso, Genelle

    2014-03-01

    The WHO Safe Surgery Checklist (2008) patient safety focus and communication prompts are widely accepted. In many low-income regions (as defined by the World Bank and accepted by the World Health Organization) perioperative nurses have little or no formal training; continuing and in-service education are virtually unknown; nor does an articulated "culture of safety" exist. In 2009 the Canadian Network for International Surgery (CNIS) piloted a two-day perioperative nursing course, in Addis Ababa, Ethiopia, using lectures, case studies, skills sessions, and role-play exercises based on the SSSL Checklist outline and protocols. Canadian instructors (who are certified after taking the Canadian Network for International Surgery-sponsored Instructor's Course) have since returned and taught at additional sites in Ethiopia and Uganda. Course participants now include perioperative nurses, anaesthetists, and junior surgical residents--mirroring the interdisciplinary teamwork that is crucial to safe perioperative patient care. The course's facilitated discussions focus on workplace and practice issues in order to allow for appropriate evaluation and planning of future educational initiatives. Participants complete pre- and post-course questionnaires, which evaluate baseline and post-course knowledge, and further follow-up is completed four months after course completion. This article explains the need for aiding in the expansion of perioperative nursing knowledge and skill in low-income settings and provides the author's personal perspective and experience in responding to this need. Her experience as facilitator in a pilot project and subsequent course development described. The objective is to discuss ways that other perioperative nurses can work to make a positive difference on professional practice and patient care in low-income regions.

  18. The Canadian International Medical Graduate Bottleneck: A New Problem for New Doctors

    Directory of Open Access Journals (Sweden)

    Evan Watts

    2011-11-01

    Full Text Available Background: A growing population of Canadian students are travelling outside of Canada for medical training. The purpose of this study is to assess the opportunity for Canadians studying medicine abroad (CSAs to secure post-graduate medical residency positions as International medical graduates (IMGs in Canada. Methods: Current statistics on IMG applicants into the Canadian Residency Matching Service (CaRMS will be compared to the number of CSAs applying to return to Canada. Results: In 2010, 75% (1232 of IMG applicants were unmatched following application to CaRMS, despite a doubling in positions reserved for IMGs from 2003. An estimated 3750 CSAs are currently attending over 55 medical schools globally; a six-fold increase since first reports in 2006. Between 2012 and 2014, it is estimated that 72.8% of CSAs will graduate, with 90.4% hoping to return to Canada for post-graduate residency training.   Discussion: The increasing population of CSAs poses a significant risk for future IMGs attempting to secure postgraduate training positions in Canada. From this perspective, we have coined the term ‘Canadian IMG Bottleneck’ – which describes the funnelling effect that has been created by the growing number of CSAs and the limited number of IMG residency positions available in Canada.

  19. Family Language Policy and School Language Choice: Pathways to Bilingualism and Multilingualism in a Canadian Context

    Science.gov (United States)

    Slavkov, Nikolay

    2017-01-01

    This article reports on a survey with 170 school-age children growing up with two or more languages in the Canadian province of Ontario where English is the majority language, French is a minority language, and numerous other minority languages may be spoken by immigrant or Indigenous residents. Within this context the study focuses on minority…

  20. Unmet Healthcare and Social Services Needs of Older Canadian Adults with Developmental Disabilities

    Science.gov (United States)

    Shooshtari, Shahin; Naghipur, Saba; Zhang, Jin

    2012-01-01

    The authors sought to create a demographic, socioeconomic, and health-related profile of older (40+) Canadian adults with developmental disabilities (DD) residing in their communities, and to enhance current knowledge of their unmet health and social support services needs. They provide a secondary analysis of cross-sectional data from the 2001…

  1. Impact of integrated programs on general surgery operative volume.

    Science.gov (United States)

    Jensen, Amanda R; Nickel, Brianne L; Dolejs, Scott C; Canal, David F; Torbeck, Laura; Choi, Jennifer N

    2017-03-01

    Integrated residencies are now commonplace, co-existing with categorical general surgery residencies. The purpose of this study was to define the impact of integrated programs on categorical general surgery operative volume. Case logs from categorical general, integrated plastics, vascular, and thoracic surgery residents from a single institution from 2008 to 2016 were collected and analyzed. Integrated residents have increased the number of cases they perform that would have previously been general surgery resident cases from 11 in 2009-2010 to 1392 in 2015-2016. Despite this, there was no detrimental effect on total major cases of graduating chief residents. Multiple integrated programs can co-exist with a general surgery program through careful collaboration and thoughtful consideration to longitudinal needs of individual trainees. As additional programs continue to be created, both integrated and categorical program directors must continue to collaborate to insure the integrity of training for all residents. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Canadian leadership in energy

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2010-09-15

    Canada's energy is complex and an important resource as it fuels and funds the economy. The unique character of Canada's energy production and consumption provides strength to the country. The purpose of this booklet was to highlight Canada's energy production and consumption and to demonstrate Canada's rank globally with other major global energy players. The document also presented information on the value of Canada's energy exports, Canada's relationship with the United States, and Canada's energy-related carbon dioxide emissions. Specifically, the document discussed Canada's energy in a global context; the value of Canada's energy exports; domestic value of energy; Canada's unique energy mix; Canada's electricity mix; Canada's carbon dioxide emissions; energy strategies; and the importance of energy to Canadians. It was concluded that there are 14 federal, provincial and territorial jurisdictions managing their respective energy resources. All of these regions, with the exception of Saskatchewan have produced an energy strategy document or a climate change action plan focusing on 8 areas of action, notably awareness; benefit; efficiency; development; diversification; electricity; and emissions. refs., tabs., figs.

  3. Simulation Activity in Otolaryngology Residencies.

    Science.gov (United States)

    Deutsch, Ellen S; Wiet, Gregory J; Seidman, Michael; Hussey, Heather M; Malekzadeh, Sonya; Fried, Marvin P

    2015-08-01

    Simulation has become a valuable tool in medical education, and several specialties accept or require simulation as a resource for resident training or assessment as well as for board certification or maintenance of certification. This study investigates current simulation resources and activities in US otolaryngology residency programs and examines interest in advancing simulation training and assessment within the specialty. Web-based survey. US otolaryngology residency training programs. An electronic web-based survey was disseminated to all US otolaryngology program directors to determine their respective institutional and departmental simulation resources, existing simulation activities, and interest in further simulation initiatives. Descriptive results are reported. Responses were received from 43 of 104 (43%) residency programs. Simulation capabilities and resources are available in most respondents' institutions (78.6% report onsite resources; 73.8% report availability of models, manikins, and devices). Most respondents (61%) report limited simulation activity within otolaryngology. Areas of simulation are broad, addressing technical and nontechnical skills related to clinical training (94%). Simulation is infrequently used for research, credentialing, or systems improvement. The majority of respondents (83.8%) expressed interest in participating in multicenter trials of simulation initiatives. Most respondents from otolaryngology residency programs have incorporated some simulation into their curriculum. Interest among program directors to participate in future multicenter trials appears high. Future research efforts in this area should aim to determine optimal simulators and simulation activities for training and assessment as well as how to best incorporate simulation into otolaryngology residency training programs. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

  4. From Residency to Lifelong Learning.

    Science.gov (United States)

    Brandt, Keith

    2015-11-01

    The residency training experience is the perfect environment for learning. The university/institution patient population provides a never-ending supply of patients with unique management challenges. Resources abound that allow the discovery of knowledge about similar situations. Senior teachers provide counseling and help direct appropriate care. Periodic testing and evaluations identify deficiencies, which can be corrected with future study. What happens, however, when the resident graduates? Do they possess all the knowledge they'll need for the rest of their career? Will medical discovery stand still limiting the need for future study? If initial certification establishes that the physician has the skills and knowledge to function as an independent physician and surgeon, how do we assure the public that plastic surgeons will practice lifelong learning and remain safe throughout their career? Enter Maintenance of Certification (MOC). In an ideal world, MOC would provide many of the same tools as residency training: identification of gaps in knowledge, resources to correct those deficiencies, overall assessment of knowledge, feedback about communication skills and professionalism, and methods to evaluate and improve one's practice. This article discusses the need; for education and self-assessment that extends beyond residency training and a commitment to lifelong learning. The American Board of Plastic Surgery MOC program is described to demonstrate how it helps the diplomate reach the goal of continuous practice improvement.

  5. Female genital cosmetic surgery.

    Science.gov (United States)

    Shaw, Dorothy; Lefebvre, Guylaine; Bouchard, Celine; Shapiro, Jodi; Blake, Jennifer; Allen, Lisa; Cassell, Krista

    2013-12-01

    To provide Canadian gynaecologists with evidence-based direction for female genital cosmetic surgery in response to increasing requests for, and availability of, vaginal and vulvar surgeries that fall well outside the traditional realm of medically-indicated reconstructions. Published literature was retrieved through searches of PubMed or MEDLINE, CINAHL, and The Cochrane Library in 2011 and 2012 using appropriate controlled vocabulary and key words (female genital cosmetic surgery). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to May 2012. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table). Recommendations 1. The obstetrician and gynaecologist should play an important role in helping women to understand their anatomy and to respect individual variations. (III-A) 2. For women who present with requests for vaginal cosmetic procedures, a complete medical, sexual, and gynaecologic history should be obtained and the absence of any major sexual or psychological dysfunction should be ascertained. Any possibility of coercion or exploitation should be ruled out. (III-B) 3. Counselling should be a priority for women requesting female genital cosmetic surgery. Topics should include normal variation and physiological changes over the lifespan, as well as the possibility of unintended consequences of cosmetic surgery to the genital area. The lack of evidence regarding outcomes and the lack of data on the

  6. National Survey Among Radiation Oncology Residents Related to Their Needs in Geriatric Oncology.

    Science.gov (United States)

    Leifer, Rachel; Bristow, Bonnie; Puts, Martine; Alibhai, Shabbir; Cao, Xingshan; Millar, Barbara-Ann; Giuliani, Meredith; Hsu, Tina; Trudeau, Maureen; Mehta, Rajin; Menjak, Ines; Norris, Mireille; Liu, Barbara; Gallant, Francois; Szumacher, Ewa

    2017-06-24

    Currently, there is no formal curriculum addressing geriatric oncology within Canadian radiation oncology (RO) residency programs. Knowledge related to geriatric medicine may help radiation oncologists modify RT based on frailty status and geriatric considerations. Understanding specific learning needs allow program coordinators to align the current curriculum with residents' geriatric oncology learning needs. The purpose of this study is to determine the geriatric oncology educational needs of the Canadian RO residents and to inform Canadian RO residency training. A cross-sectional survey, with Likert, multiple choice, and open-ended questions, was pretested and distributed electronically by program directors to Canadian RO residents over 6 weeks. Responses were analyzed with descriptive statistics and common themes. One-hundred and thirty-five Canadian RO residents were contacted and 63 responded (47%). Half (49%) lacked confidence managing the elderly with multiple comorbidities, polypharmacy, functional and cognitive impairment, and challenging social circumstances;73% agreed additional training would be helpful. Forty-four percent lacked confidence regarding psychogeriatric referrals, fall prevention, palliative and hospice care, and community resources preventing re-hospitalization; 63% agreed additional training would be helpful. Seventy-six percent believed discussion groups, continuing education, geriatric oncology electives, and journal clubs would provide learning opportunities. Seventy-one percent agreed integrating geriatric assessment into RO curricula would improve care. Seventy-nine percent believed geriatric oncology principles have not been adequately integrated into radiation oncology curricula. There are significant gaps specific to geriatric assessment and management of older cancer patients in the current Canadian RO curricula. Most residents agreed that it is important to integrate geriatric oncology training to improve and personalize the

  7. Telepathy: maximizing resident exposure to surgical pathology decision making.

    Science.gov (United States)

    McLemore, Elisabeth C; Schlinkert, Richard T; Schlinkert, Denise K; Williams, James W; Bailey, David P

    2006-04-01

    General surgery residents are often not present for the critical intraoperative discussion between surgeon and pathologist regarding surgical pathology findings. A prospective pilot study analyzed general surgery resident exposure to surgical pathology. Thereafter, an operating room was equipped to view frozen section images in real time and verbally communicate with the pathologist (TelePATHy). Total operative cases, cases using frozen sections, and use of TelePATHy were recorded. Most residents (78%) reported they were exposed to frozen-section surgical pathology TelePATHy was successfully used in 32 cases (80%). General surgery resident exposure to intraoperative pathology findings increased from a reported TelePATHy is a novel intraoperative tool capable of maximizing the intraoperative experience of the surgical resident.

  8. Surgical resident learning styles: faculty and resident accuracy at identification of preferences and impact on ABSITE scores.

    Science.gov (United States)

    Kim, Roger H; Gilbert, Timothy; Ristig, Kyle; Chu, Quyen D

    2013-09-01

    As a consequence of surgical resident duty hour restrictions, there is a need for faculty to utilize novel teaching methods to convey information in a more efficient manner. The current paradigm of surgical training, which has not changed significantly since the time of Halsted, assumes that all residents assimilate information in a similar fashion. However, recent data has shown that learners have preferences for the ways in which they receive and process information. The VARK model categorizes learners as visual (V), aural (A), read/write (R), and kinesthetic (K). The VARK learning style preferences of surgical residents have not been previously evaluated. In this study, the preferred learning styles of general surgery residents were determined, along with faculty and resident perception of resident learning styles. In addition, we hypothesized that American Board of Surgery In-Training Exam (ABSITE) scores are associated with preference for a read/write (R) learning style. The Fleming VARK learning styles inventory was administered to all general surgery residents at a university hospital-based program. Responses on the inventory were scored to determine the preferred learning style for each resident. Faculty members were surveyed to determine their accuracy in identifying the preferred learning style of each resident. All residents were also surveyed to determine their accuracy in identifying their peers' VARK preferences. Resident ABSITE scores were examined for association with preferred learning styles. Twenty-nine residents completed the inventory. Most (18 of 29, 62%) had a multimodal preference, although more than a third (11 of 29, 38%) demonstrated a single-modality preference. Seventy-six percent of all residents (22 of 29) had some degree of kinesthetic (K) learning, while under 50% (14 of 29) were aural (A) learners. Although not significant, dominant (R) learners had the highest mean ABSITE scores. Faculty identified residents' learning styles

  9. Canadian synthetic resins industry

    Energy Technology Data Exchange (ETDEWEB)

    Margeson, J. [Industry Canada, Ottawa, ON (Canada)

    2000-06-01

    The growth of the synthetic resin industry in Canada is described. In 1999 the industry had shipments totalling $6.3 billion and employed about 9,000 people in 105 establishments. The industry is concentrated in Alberta, Ontario and Quebec. Plants in Alberta produce commodity-grade thermoplastic resins from raw materials derived mainly from natural gas, whereas plants in Ontario and Quebec produce both thermoplastic and thermoset resins using raw materials derived from both crude oil and natural gas. Sixty-four per cent of the synthetic reins produced in Canada, worth about $4.1 billion, are exported. This is offset by imports of 68 per cent of domestic consumption, (valued at $5.0 billion) reflecting rationalization and specialization of the resin industry on a continental basis. Process and product technologies used in Canada are up-to-date and licensed from parent or other foreign chemical companies. Capital investment in the Canadian resin industry is lagging behind investment in the United States, however, this is expected to change once the impact of recent investments in the industry in Alberta is reflected in the statistics. A five to seven per cent real average annual growth in world-wide consumption is predicted over the next five years. Growth in North America is projected to be in the three to four per cent range. The Alberta-based component of the industry, being relatively new, is expected to improve its ability to compete globally in commodity thermoplastics. In contrast, the plants in Ontario and Quebec suffer from the fact that they were built prior to the Free Trade Agreement and were designed to satisfy domestic requirements. They are attempting to compensate for their lack of economics of scale by developing strategies to supply niche products. 8 figs.

  10. Expansion of the Coordinator Role in Orthopaedic Residency Program Management

    OpenAIRE

    Grant, Richard E.; Murphy, Laurie A.; Murphy, James E.

    2008-01-01

    The Accreditation Council of Graduate Medical Education’s (ACGME) Data Accreditation System indicates 124 of 152 orthopaedic surgery residency program directors have 5 or fewer years of tenure. The qualifications and responsibilities of the position based on the requirements of orthopaedic surgery residency programs, the institutions that support them, and the ACGME Outcome Project have evolved the role of the program coordinator from clerical to managerial. To fill the void of information on...

  11. Pyloric trichobezoar in a Canadian lynx (Lynx canadensis).

    Science.gov (United States)

    Kottwitz, Jack; Munsterman, Amelia S

    2013-12-01

    An adult female Canadian lynx (Lynx canadensis) was presented with a 3-wk history of anorexia and lethargy. Initial examination and diagnostics did not provide a diagnosis. The lynx continued to demonstrate vague clinical signs, including anorexia and an abnormal gait. During follow-up immobilizations 2 wk later, a barium gastrointestinal study revealed a pyloric obstruction. Abdominal exploratory surgery was elected, and a gastrotomy and an enterotomy of the proximal duodenum were performed to remove the pyloric obstruction. The obstruction was determined to be a trichobezoar. Fleas, a likely cause of hair ingestion through grooming, were noted during surgical preparation. The lynx made a full recovery from surgery. Reoccurrence of the trichobezoar was prevented after surgery with the use of monthly flea control and three times a week hairball laxative.

  12. The Best of Both Worlds: Resident Experiences of Urban and Regional Contexts in a Hybrid Pediatrics Residency Program.

    Science.gov (United States)

    Topps, Maureen; Ellaway, Rachel H; Baron, Tara; Peek, Alison

    2015-12-01

    The context for specialty residency training in pediatrics has broadened in recent decades to include distributed community sites as well as academic health science centers. Rather than creating parallel, community-only programs, most programs have expanded to include both community and large urban tertiary health center experiences. Despite these changes, there has been relatively little research looking at residents' experiences in these distributed graduate medical education programs. A longitudinal case study was undertaken to explore the experiences of residents in a Canadian pediatrics residency program that involved a combination of clinical placements in a large urban tertiary health center and in regional hospitals. The study drew on 2 streams of primary data: 1-on-1 interviews with residents at the end of each block rotation and annual focus groups with residents. A thematic analysis (using grounded theory techniques) of transcripts of the interviews and focus groups identified 6 high-level themes: access to training, quality of learning, patient mix, continuity of care, learner roles, and residents as teachers. Rather than finding that certain training contexts were "better" than others when comparing residents' experiences of the various training contexts in this pediatrics residency, what emerged was an understanding that the different settings complemented each other. Residents were adamant that this was not a matter of superiority of one context over any other; their experiences in different contexts each made a valuable contribution to the quality of their training.

  13. Morbidity and mortality of complex spine surgery

    DEFF Research Database (Denmark)

    Karstensen, Sven; Bari, Tanvir; Gehrchen, Martin

    2016-01-01

    BACKGROUND CONTEXT: Most literature on complications in spine surgery has been retrospective or based on national databases with few variables. The Spine AdVerse Events Severity (SAVES) system has been found reliable and valid in two Canadian centers, providing precise information regarding all...

  14. Cultural transition of international medical graduate residents into family practice in Canada.

    Science.gov (United States)

    Triscott, Jean A C; Szafran, Olga; Waugh, Earle H; Torti, Jacqueline M I; Barton, Martina

    2016-05-04

    To identify the perceived strengths that international medical graduate (IMG) family medicine residents possess and the challenges they are perceived to encounter in integrating into Canadian family practice. This was a qualitative, exploratory study employing focus groups and interviews with 27 participants - 10 family physicians, 13 health care professionals, and 4 family medicine residents. Focus group/interview questions addressed the strengths that IMGs possess and the challenges they face in becoming culturally competent within the Canadian medico-cultural context. Qualitative data were audiotaped, transcribed, and analyzed thematically. Participants identified that IMG residents brought multiple strengths to Canadian practice including strong clinical knowledge and experience, high education level, the richness of varied cultural perspectives, and positive personal strengths. At the same time, IMG residents appeared to experience challenges in the areas of: (1) communication skills (language nuances, unfamiliar accents, speech volume/tone, eye contact, directness of communication); (2) clinical practice (uncommon diagnoses, lack of familiarity with care of the opposite sex and mental health conditions); (3) learning challenges (limited knowledge of Canada's health care system, patient-centered care and ethical principles, unfamiliarity with self-directed learning, unease with receiving feedback); (4) cultural differences (gender roles, gender equality, personal space, boundary issues; and (5) personal struggles. Residency programs must recognize the challenges that can occur during the cultural transition to Canadian family practice and incorporate medico-cultural education into the curriculum. IMG residents also need to be aware of cultural differences and be open to different perspectives and new learning.

  15. Thyroid Surgery

    Science.gov (United States)

    ... has had a previous neck operation (thyroid surgery, parathyroid surgery, spine surgery, carotid artery surgery, etc.) and/or who has had a suspected invasive thyroid cancer should have their vocal cord function evaluated routinely before surgery. This is necessary to ...

  16. Responsible Canadian energy progress report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2010-07-01

    The Canadian Association of Petroleum Producers (CAPP) represents oil and gas companies throughout Canada; its members produce over 90% of Canada's natural gas and crude oil output. The aim of the Association is to improve the economics of the Canadian upstream petroleum sector in an environmentally and socially responsible way. The aim of this Responsible Canadian Energy report is to present the performance data of CAPP's members for the year 2009. Data, trends, and performance analyses are provided throughout the document. This analysis makes it possible to determine where progress has been made and where performance improvement is necessary. It also presents success stories and best practices so that other companies can learn from them how to improve their own performance. This paper provides useful information on the performance of the upstream petroleum industry in Canada and highlights where the focus should be for further improvement in its performance.

  17. The Urology Residency Program in Israel—Results of a Residents Survey and Insights for the Future

    Directory of Open Access Journals (Sweden)

    Arnon Lavi

    2017-10-01

    Full Text Available Objective Urology practice has undergone several changes in recent years mainly related to novel technologies introduced. We aimed to get the residents’ perspective on the current residency program in Israel and propose changes in it. Methods A web-based survey was distributed among urology residents. Results 61 residents completed the survey out of 95 to whom it was sent (64% compliance. A total of 30% replied that the 9 months of mandatory general surgery rotation contributed to their training, 48% replied it should be shortened/canceled, and 43% replied that the Step A exam (a mandatory written certifying exam in general surgery was relevant to their training. A total of 37% thought that surgical exposure during the residency was adequate, and 28% considered their training “hands-on.” Most non-junior