Factors affecting interest in cardiothoracic surgery: Survey of North American general surgery residents.

Science.gov (United States)

Vaporciyan, Ara A; Reed, Carolyn E; Erikson, Clese; Dill, Michael J; Carpenter, Andrea J; Guleserian, Kristine J; Merrill, Walter

2009-05-01

Applications to cardiothoracic surgery (CTS) training programs have declined precipitously. The viewpoints of potential applicants, general surgery residents, have not yet been assessed. Their perceptions are crucial to understanding the cause and formulating appropriate changes in our educational system. An initial survey instrument was content-validated, and the final instrument was distributed electronically between March 24 and May 2, 2008 through 251 general surgery program directors to all Accreditation Council for Graduate Medical Education-accredited general surgery residents (7508). The response rate was 29% (2153 residents; 89% programs). Respondent's demographics matched existing data; 6% were committed to CTS, and 26% reported prior or current interest in CTS. Interest waned after postgraduate year 3. Interest correlated with CTS rotation duration. Of the respondents committed to CTS, 76% had mentors (71% were cardiothoracic surgeons). CTS had the most shortcomings among 9 subspecialties. Job security and availability accounted for 46% of reported shortcomings (3 to 14 times higher than other subspecialties). Work schedule accounted for 25%. Length of training was not a very important factor, although it was identified as an option to increase interest in CTS. Residents who were undecided or uninterested in CTS were twice as likely to cite the ability to balance work and personal life as important than residents who chose CTS. The dominant concern documented in the survey is job security and availability. The importance of mentorship and exposure to CTS faculty in promoting interest was also evident. Decision makers should consider these findings when planning changes in education and the specialty.

Exposure in emergency general surgery in a time-based residency ...

African Journals Online (AJOL)

Objective: This paper aimed to characterize the resident exposure to acute general surgical conditions during a three-months rotation in a general surgical unit. Setting: The Department of Surgery, University of Nairobi and Kenyatta National Referral and Teaching Hospital in Nairobi. MethodS: Four residents (in their first to ...

Early tracking would improve the operative experience of general surgery residents.

Science.gov (United States)

Stain, Steven C; Biester, Thomas W; Hanks, John B; Ashley, Stanley W; Valentine, R James; Bass, Barbara L; Buyske, Jo

2010-09-01

High surgical complexity and individual career goals has led most general surgery (GS) residents to pursue fellowship training, resulting in a shortage of surgeons who practice broad-based general surgery. We hypothesize that early tracking of residents would improve operative experience of residents planning to be general surgeons, and could foster greater interest and confidence in this career path. Surgical Operative Log data from GS and fellowship bound residents (FB) applying for the 2008 American Board of Surgery Qualifying Examination (QE) were used to construct a hypothetical training model with 6 months of early specialization (ESP) for FB residents in 4 specialties (cardiac, vascular, colorectal, pediatric); and presumed these cases would be available to GS residents within the same program. A total of 142 training programs had both FB residents (n = 237) and GS residents (n = 402), and represented 70% of all 2008 QE applicants. The mean numbers of operations by FB and GS residents were 1131 and 1091, respectively. There were a mean of 252 cases by FB residents in the chief year, theoretically making 126 cases available for each GS resident. In 9 defined categories, the hypothetical model would result in an increase in the 5-year operative experience of GS residents (mastectomy 6.5%; colectomy 22.8%; gastrectomy 23.4%; antireflux procedures 23.4%; pancreatic resection 37.4%; liver resection 29.3%; endocrine procedures 19.6%; trauma operations 13.3%; GI endoscopy 6.5%). The ESP model improves operative experience of GS residents, particularly for complex gastrointestinal procedures. The expansion of subspecialty ESP should be considered.

General surgery residents improve efficiency but not outcome of trauma care.

Science.gov (United States)

Offner, Patrick J; Hawkes, Allison; Madayag, Robert; Seale, Fred; Maines, Charles

2003-07-01

Current American College of Surgeons Level I trauma center verification requires the presence of a residency program in which trauma care is an integral part of the training. The rationale for this requirement remains unclear, with no scientific evidence that resident participation improves the quality of trauma care. The purpose of this study was to determine whether quality or efficiency of trauma care is influenced by general surgery residents. Our urban Level I trauma center has traditionally used 24-hour in-house postgraduate year-4 general surgery residents in conjunction with at-home trauma attending backup to provide trauma care. As of July 1, 2000, general surgery residents no longer participated in trauma patient care, leaving sole responsibility to an in-house trauma attending. Data regarding patient outcome and resource use with and without surgery resident participation were tabulated and analyzed. Continuous data were compared using Student's t test if normally distributed and the Mann-Whitney U test if nonparametric. Categorical data were compared using chi2 analysis or Fisher's exact test as appropriate. During the 5-month period with resident participation, 555 trauma patients were admitted. In the identical time period without residents, 516 trauma patients were admitted. During the period without housestaff, patients were older and more severely injured. Mechanism was not different during the two time periods. Mortality was not affected; however, time in the emergency department and hospital lengths of stay were significantly shorter with residents. Multiple regression confirmed these findings while controlling for age, mechanism, and Injury Severity Score. Although resident participation in trauma care at a Level I trauma center does not affect outcome, it does significantly improve the efficiency of trauma care delivery.

Pregnancy among residents enrolled in general surgery: a nationwide survey of attitudes and experiences.

Science.gov (United States)

Merchant, Shaila J; Hameed, S Morad; Melck, Adrienne L

2013-10-01

Medical student interest in general surgery has declined, and the lack of adequate accommodation for pregnancy and parenting during residency training may be a deterrent. We explored resident and program director experiences with these issues in general surgery programs across Canada. Using a web-based tool, residents and program directors from 16 Canadian general surgery programs were surveyed regarding their attitudes toward and experiences with pregnancy during residency. One hundred seventy-six of 600 residents and 8 of 16 program directors completed the survey (30% and 50% response rate, respectively). Multiple issues pertaining to pregnancy during surgical residency were reported including the lack of adequate policies for maternity/parenting, the major obstacles to breast-feeding, and the increased workload for fellow resident colleagues. All program directors reported the lack of a program-specific maternity/parenting policy. General surgery programs lack program-specific maternity/parenting policies. Several issues have been highlighted in this study emphasizing the importance of creating and implementing such a policy. Copyright © 2013 Elsevier Inc. All rights reserved.

Pregnancy among residents enrolled in general surgery (PREGS): a survey of residents in a single Canadian training program.

Science.gov (United States)

Merchant, Shaila; Hameed, Morad; Melck, Adrienne

2011-12-01

Interest in general surgery has declined, and lack of adequate accommodation for pregnancy and parenting may be a deterrent. We explored resident experiences with these issues within a single general surgery program. We surveyed residents enrolled in the University of British Columbia general surgery program from 1997 to 2009 using a Web-based survey tool. Information regarding demographics, pregnancy, postpartum issues and issues pertaining to maternity/parenting policies was obtained. We used the Student t test, Z test and Fisher exact test for statistical comparisons. Of the 81 residents surveyed, 53 responded (65% response rate). There were fewer pregnancies during residency among female residents than among partners of male residents (PMRs; 9 pregnancies for 6 of 25 residents v. 23 pregnancies for 15 of 28 PMRs, p = 0.002). One of 9 pregnancies among female residents and 5 of 23 among PMRs ended in miscarriage (p > 0.99). Female residents and PMRs reported pregnancy-related complications with equal frequency. All female residents breastfed for at least 6 months; however, 67% (4 of 6) felt their resident role prevented them from breastfeeding as long as they would have liked. Most (5 of 6, 83%) pursued a graduate degree or research during their "maternity leave." More than 50% of residents reported that their own workload increased because of a colleague's pregnancy. Many (36 of 53, 68%) were unaware of the existence of any maternity/parenting policy, and most were in favour of instituting such a policy. Resident mothers do not breastfeed for the desired duration, and precluding factors must be explored. Contingency plans are needed so colleagues are not overburdened when pregnant residents cannot perform clinical duties. General surgery programs must have a formal policy addressing these issues.

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.

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

Career outcomes of nondesignated preliminary general surgery residents at an academic surgical program.

Science.gov (United States)

Ahmad, Rima; Mullen, John T

2013-01-01

There remains a debate as to whether nondesignated preliminary (NDP) positions in surgery ultimately translate into successful surgical careers for those who pursue them. We sought to identify the success with which our NDP residents were able to transition to their desired career and what, if any, factors contributed to their success. The records of all NDP residents accepted into the Massachusetts General Hospital General Surgery Residency Program from 1995 to 2010 were examined and long-term follow-up was completed. Thirty-four NDP residents were identified, including 26.5% US graduates and 73.5% international medical graduates. At the end of the initial preliminary year, 30 (88%) got placed in a postgraduate residency program, whereas 4 (12%) pursued other career paths. Of those who got placed, 25 (83%) attained surgical residency positions, including 17 (57%) who continued as preliminary residents at our institution and 8 (27%) who got placed in categorical surgical positions at other programs. After multiple preliminary years, 15 of 17 achieved a categorical position, of which, 93% were in surgical fields. Overall, 64.7% of all entering NDP residents eventually went on to have careers in general surgery (50%) or surgical subspecialties (14.7%), and 24 of 34 (71%) fulfilled their desired career goals. No factor predicted success. From 1995 to 2012 there have been 15 midlevel (11 postgraduate year 4) vacancies in our program, 4 of which were filled by preliminary residents, 2 from our program and 2 from elsewhere. All have gone on to board certifications and careers in surgery. More than 70% of NDP residents in our program successfully transitioned to their desired career paths, many achieving categorical surgical positions and academic surgical careers, thus demonstrating the benefit of this track to both residency programs and trainees. © 2013 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Current integrated cardiothoracic surgery residents: a Thoracic Surgery Residents Association survey.

Science.gov (United States)

Tchantchaleishvili, Vakhtang; LaPar, Damien J; Stephens, Elizabeth H; Berfield, Kathleen S; Odell, David D; DeNino, Walter F

2015-03-01

After approval by the Thoracic Surgery Residency Review Committee in 2007, 6-year integrated cardiothoracic surgery (I-6) residency programs have gained in popularity. We sought to assess and objectively quantify the level of satisfaction I-6 residents have with their training and to identify areas of improvement for future curriculum development. A completely anonymous, electronic survey was created by the Thoracic Surgery Residents Association that asked the responders to provide demographic information, specialty interest, and lifestyle priorities, and to rate their experience and satisfaction with I-6 residency. The survey was distributed nationwide to all residents in I-6 programs approved by the Accreditation Council for Graduate Medical Education. Of a total of 88 eligible I-6 residents, 49 completed the survey (55.7%). Career choice satisfaction was high (75.5%), as was overall satisfaction with integrated training (83.7%). The majority (77.6%) were interested in cardiac surgery. Overall, the responders reported sufficient time for life outside of the hospital (57.1%), but experienced conflicts between work obligations and personal life at least sometimes (75.5%). Early exposure to cardiothoracic surgery was reported as the dominant advantage of the I-6 model, whereas variable curriculum structure and unclear expectations along with poor integration with general surgery training ranked highest among perceived disadvantages. Current I-6 residents are largely satisfied with the integrated training model and report a reasonable work/life balance. The focused nature of training is the primary perceived advantage of the integrated pathway. Curriculum variability and poor integration with general surgery training are identified by residents as primary areas of concern. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Employment and satisfaction trends among general surgery residents from a community hospital.

Science.gov (United States)

Cyr-Taro, Amy E; Kotwall, Cyrus A; Menon, Rema P; Hamann, M Sue; Nakayama, Don K

2008-01-01

Physician satisfaction is an important and timely issue in health care. A paucity of literature addresses this question among general surgeons. To review employment patterns and job satisfaction among general surgery residents from a single university-affiliated institution. All general surgery residents graduating from 1986 to 2006, inclusive, were mailed an Institutional Review Board-approved survey, which was then returned anonymously. Information on demographics, fellowship training, practice characteristics, job satisfaction and change, and perceived shortcomings in residency training was collected. A total of 31 of 34 surveys were returned (91%). Most of those surveyed were male (94%) and Caucasian (87%). Sixty-one percent of residents applied for a fellowship, and all but 1 were successful in obtaining their chosen fellowship. The most frequent fellowship chosen was plastic surgery, followed by minimally invasive surgery. Seventy-one percent of residents who applied for fellowship felt that the program improved their competitiveness for a fellowship. Most of the sample is in private practice, and of those, 44% are in groups with more than 4 partners. Ninety percent work less than 80 hours per week. Only 27% practice in small towns (population job. Twenty-three percent agreed that they had difficulty finding their first job, and 30% had fewer job offers than expected. Thirty-five percent of the graduates have changed jobs: 29% of the residents have changed jobs once, and 6% have changed jobs at least twice since completing training. Reasons for leaving a job included colleague issues (82%), financial issues (82%), inadequate referrals (64%), excessive trauma (64%), and marriage or family reasons (55% and 55%, respectively). One half to three fourths of the graduates wished they had more teaching on postresidency business and financial issues, review of contracts, and suggestions for a timeline for finding a job. Although general surgical residencies prepare

Textual Analysis of General Surgery Residency Personal Statements: Topics and Gender Differences.

Science.gov (United States)

Ostapenko, Laura; Schonhardt-Bailey, Cheryl; Sublette, Jessica Walling; Smink, Douglas S; Osman, Nora Y

2017-10-25

Applicants to US general surgery residency training programs submit standardized applications. Applicants use the personal statement to express their individual rationale for a career in surgery. Our research explores common topics and gender differences within the personal statements of general surgery applicants. We analyzed the electronic residency application service personal statements of 578 applicants (containing 3,82,405 words) from Liaison Committee on Medical Education-accredited medical schools to a single ACGME-accredited general surgery program using an automated textual analysis program to identify common topics and gender differences. Using a recursive algorithm, the program identified common words and clusters, grouping them into topic classes, which are internally validated. We identified and labeled 8 statistically significant topic classes through independent review: "my story," "the art of surgery," "clinical vignettes," "why I love surgery," "residency program characteristics," "working as a team," "academics and research," and "global health and policy." Although some classes were common to all applications, we also identified gender-specific differences. Notably, women were significantly more likely than men to be represented within the class of "working as a team." (p differences between the statements of men and women. Women were more likely to discuss surgery as a team endeavor while men were more likely to focus on the details of their surgical experiences. Our work mirrors what has been found in social psychology research on gender-based differences in how men and women communicate their career goals and aspirations in other competitive professional situations. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

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

Creation of an emergency surgery service concentrates resident training in general surgical procedures.

Science.gov (United States)

Ahmed, Hesham M; Gale, Stephen C; Tinti, Meredith S; Shiroff, Adam M; Macias, Aitor C; Rhodes, Stancie C; Defreese, Marissa A; Gracias, Vicente H

2012-09-01

Emergency general surgery (EGS) is increasingly being provided by academic trauma surgeons in an acute care surgery model. Our tertiary care hospital recently changed from a model where all staff surgeons (private, subspecialty academic, and trauma academic) were assigned EGS call to one in which an emergency surgery service (ESS), staffed by academic trauma faculty, cares for all EGS patients. In the previous model, many surgeries were "not covered" by residents because of work-hour restrictions, conflicting needs, or private surgeon preference. The ESS was separate from the trauma service. We hypothesize that by creating a separate ESS, residents can accumulate needed and concentrated operative experience in a well-supervised academic environment. A prospectively accrued EGS database was retrospectively queried for the 18-month period: July 2010 to June 2011. The Accreditation Council for Graduate Medical Education (ACGME) databases were queried for operative numbers for our residency program and for national resident data for 2 years before and after creating the ESS. The ACGME operative requirements were tabulated from online sources. ACGME requirements were compared with surgical cases performed. During the 18-month period, 816 ESS operations were performed. Of these, 307 (38%) were laparoscopy. Laparoscopic cholecystectomy and appendectomy were most common (138 and 145, respectively) plus 24 additional laparoscopic surgeries. Each resident performed, on average, 34 basic laparoscopic cases during their 2-month rotation, which is 56% of their ACGME basic laparoscopic requirement. A diverse mixture of 70 other general surgical operations was recorded for the remaining 509 surgical cases, including reoperative surgery, complex laparoscopy, multispecialty procedures, and seldom-performed operations such as surgery for perforated ulcer disease. Before the ESS, the classes of 2008 and 2009 reported that only 48% and 50% of cases were performed at the main academic

Are general surgery residents adequately prepared for hepatopancreatobiliary fellowships? A questionnaire-based study

Science.gov (United States)

Osman, Houssam; Parikh, Janak; Patel, Shirali; Jeyarajah, D Rohan

2015-01-01

Background The present study was conducted to assess the preparedness of hepatopancreatobiliary (HPB) fellows upon entering fellowship, identify challenges encountered by HPB fellows during the initial part of their HPB training, and identify potential solutions to these challenges that can be applied during residency training. Methods A questionnaire was distributed to all HPB fellows in accredited HPB fellowship programmes in two consecutive academic years (n = 42). Reponses were then analysed. Results A total of 19 (45%) fellows responded. Prior to their fellowship, 10 (53%) were in surgical residency and the rest were in other surgical fellowships or surgical practice. Thirteen (68%) were graduates of university-based residency programmes. All fellows felt comfortable in performing basic laparoscopic procedures independently at the completion of residency and less comfortable in performing advanced laparoscopy. Eight (42%) fellows cited a combination of inadequate case volume and lack of autonomy during residency as the reasons for this lack of comfort. Thirteen (68%) identified inadequate preoperative workup and management as their biggest fear upon entering practice after general surgery training. A total of 17 (89%) fellows felt they were adequately prepared to enter HPB fellowship. Extra rotations in transplant, vascular or minimally invasive surgery were believed to be most helpful in preparing general surgery residents pursing HPB fellowships. Conclusions Overall, HPB fellows felt themselves to be adequately prepared for fellowship. Advanced laparoscopic procedures and the perioperative management of complex patients are two of the challenges facing HPB fellows. General surgery residents who plan to pursue an HPB fellowship may benefit from spending extra rotations on certain subspecialties. Focus on perioperative workup and management should be an integral part of residency and fellowship training. PMID:25387852

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 adverse outcome. Mean (SD) in-training examination scores did not significantly change from 2010 to 2013 for first-year residents (499.7 [ 85.2] to 500.5 [84.2], P = .99), for residents from other postgraduate years, or for first-time examinees taking the written or oral board

A strategic approach to quality improvement and patient safety education and resident integration in a general surgery residency.

Science.gov (United States)

O'Heron, Colette T; Jarman, Benjamin T

2014-01-01

To outline a structured approach for general surgery resident integration into institutional quality improvement and patient safety education and development. A strategic plan to address Accreditation Council for Graduate Medical Education (ACGME) Clinical Learning Environment Review assessments for resident integration into Quality Improvement and Patient Safety initiatives is described. Gundersen Lutheran Medical Foundation is an independent academic medical center graduating three categorical residents per year within an integrated multi-specialty health system serving 19 counties over 3 states. The quality improvement and patient safety education program includes a formal lecture series, online didactic sessions, mandatory quality improvement or patient safety projects, institutional committee membership, an opportunity to serve as a designated American College of Surgeons National Surgical Quality Improvement Project and Quality in Training representative, mandatory morbidity and mortality conference attendance and clinical electives in rural surgery and international settings. Structured education regarding and participation in quality improvement and patient safety programs are able to be accomplished during general surgery residency. The long-term outcomes and benefits of these strategies are unknown at this time and will be difficult to measure with objective data. © 2013 Published by Association of Program Directors in Surgery on behalf of Association of Program Directors in Surgery.

Graduating general surgery resident operative confidence: perspective from a national survey.

Science.gov (United States)

Fonseca, Annabelle L; Reddy, Vikram; Longo, Walter E; Gusberg, Richard J

2014-08-01

General surgical training has changed significantly over the last decade with work hour restrictions, increasing subspecialization, the expanding use of minimally invasive techniques, and nonoperative management for solid organ trauma. Given these changes, this study was undertaken to assess the confidence of graduating general surgery residents in performing open surgical operations and to determine factors associated with increased confidence. A survey was developed and sent to general surgery residents nationally. We queried them regarding demographics and program characteristics, asked them to rate their confidence (rated 1-5 on a Likert scale) in performing open surgical procedures and compared those who indicated confidence with those who did not. We received 653 responses from the fifth year (postgraduate year 5) surgical residents: 69% male, 68% from university programs, and 51% from programs affiliated with a Veterans Affairs hospital; 22% from small programs, 34% from medium programs, and 44% from large programs. Anticipated postresidency operative confidence was 72%. More than 25% of residents reported a lack of confidence in performing eight of the 13 operations they were queried about. Training at a university program, a large program, dedicated research years, future fellowship plans, and training at a program that performed a large percentage of operations laparoscopically was associated with decreased confidence in performing a number of open surgical procedures. Increased surgical volume was associated with increased operative confidence. Confidence in performing open surgery also varied regionally. Graduating surgical residents indicated a significant lack of confidence in performing a variety of open surgical procedures. This decreased confidence was associated with age, operative volume as well as type, and location of training program. Analyzing and addressing this confidence deficit merits further study. Copyright © 2014 Elsevier Inc. All

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

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

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.

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

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

Work-Related Quality of Life of US General Surgery Residents: Is It Really so Bad?

Science.gov (United States)

Zubair, Muhammad H; Hussain, Lala R; Williams, Kristen N; Grannan, Kevin J

The quality of working life of US surgical residents has not been studied, and given the complexity of interaction between work and personal life there is a need to assess this interaction. We utilized a validated Work Related Quality of Life (WRQoL) questionnaire to evaluate the perceived work-related quality of life of general surgery residents, using a large, nationally representative sample in the United States. Between January 2016 and March 2016, all US general surgery residents enrolled in an ACGME general surgery training program were invited to participate. The WRQoL scale measures perceived quality of life covering six domains: General Well-Being (GWB), Home-Work Interface (HWI), Job and Career Satisfaction (JCS), Control at Work (CAW), Working Conditions (WCS) and Stress at Work (SAW). After excluding for missing data, the final analysis included 738 residents. The average age was 30 (±3) years, of whom 287 (38.9%) were female, 272 (36.9%) were from a community hospital, and 477 (64.6%) were juniors (postgraduate year ≤ 3). Demographically, the respondents matched expected percentages. When male and female residents were compared, males had statistically better HWI (pseniors. There were no differences between university and community residents in any of the domains of WRQoL. Although residents were more stressed than other professions but the overall WRQoL was comparable. The nature of surgical residency and a surgical career may in fact be more "stressful" than other professions, yet may not translate into a worsened Quality of Life. Our findings suggest further study is needed to elucidate why female residents have or experience a lower perceived WRQoL than their male colleagues. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

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 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 residency have a different pattern of VARK preferences than that of the general population. Interviewees with preferences for read/write learning modalities have higher scores

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.

"iBIM"--internet-based interactive modules: an easy and interesting learning tool for general surgery residents.

Science.gov (United States)

Azer, Nader; Shi, Xinzhe; de Gara, Chris; Karmali, Shahzeer; Birch, Daniel W

2014-04-01

The increased use of information technology supports a resident- centred educational approach that promotes autonomy, flexibility and time management and helps residents to assess their competence, promoting self-awareness. We established a web-based e-learning tool to introduce general surgery residents to bariatric surgery and evaluate them to determine the most appropriate implementation strategy for Internet-based interactive modules (iBIM) in surgical teaching. Usernames and passwords were assigned to general surgery residents at the University of Alberta. They were directed to the Obesity101 website and prompted to complete a multiple-choice precourse test. Afterwards, they were able to access the interactive modules. Residents could review the course material as often as they wanted before completing a multiple-choice postcourse test and exit survey. We used paired t tests to assess the difference between pre- and postcourse scores. Out of 34 residents who agreed to participate in the project, 12 completed the project (35.3%). For these 12 residents, the precourse mean score was 50 ± 17.3 and the postcourse mean score was 67 ± 14 (p = 0.020). Most residents who participated in this study recommended using the iBIMs as a study tool for bariatric surgery. Course evaluation scores suggest this novel approach was successful in transferring knowledge to surgical trainees. Further development of this tool and assessment of implementation strategies will determine how iBIM in bariatric surgery may be integrated into the curriculum.

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.

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

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.

Are Canadian general surgery residents ready for the 80-hour work week? A nationwide survey.

Science.gov (United States)

Sudarshan, Monisha; Hanna, Wael C; Jamal, Mohammed H; Nguyen, Lily H P; Fraser, Shannon A

2012-02-01

The purpose of this study was to describe Canadian general surgery residents' perceptions regarding potential implementation of work-hour restrictions. An ethics review board-approved, Web-based survey was submitted to all Canadian general surgery residency programs between April and July 2009. Questions evaluated the perceived effects of an 80-hour work week on length of training, operative exposure, learning and lifestyle. We used the Fisher exact test to compare senior and junior residents' responses. Of 360 residents, 158 responded (70 seniors and 88 juniors). Among them, 79% reported working 75-100 hours per week. About 74% of seniors believed that limiting their work hours would decrease their operative exposure; 43% of juniors agreed (p seniors and juniors thought limiting their work hours would improve their lifestyle (86% v. 96%, p = 0.12). Overall, 60% of residents did not believe limiting work hours would extend the length of their training. Regarding 24-hour call, 60% of juniors thought it was hazardous to their health; 30% of seniors agreed (p = 0.001). Both senior and junior residents thought abolishing 24-hour call would decrease their operative exposure (84% v. 70%, p = 0.21). Overall, 31% of residents supported abolishing 24-hour call. About 47% of residents (41% seniors, 51%juniors, p = 0.26) agreed with the adoption of the 80-hour work week. There is a training-level based dichotomy of opinion among general surgery residents in Canada regarding the perceived effects of work hour restrictions. Both groups have voted against abolishing 24-hour call, and neither group strongly supports the implementation of the 80-hour work week.

Prevalence and cost of full-time research fellowships during general surgery residency: a national survey.

Science.gov (United States)

Robertson, Charles M; Klingensmith, Mary E; Coopersmith, Craig M

2009-01-01

To quantify the prevalence, outcomes, and cost of surgical resident research. General surgery is unique among graduate medical education programs because a large percentage of residents interrupt their clinical training to spend 1 to 3 years performing full-time research. No comprehensive data exists on the scope of this practice. Survey sent to all 239 program directors of general surgery residencies participating in the National Resident Matching Program. Response rate was 200 of 239 (84%). A total of 381 of 1052 trainees (36%) interrupt residency to pursue full-time research. The mean research fellowship length is 1.7 years, with 72% of trainees performing basic science research. A significant association was found between fellowship length and postresidency activity, with a 14.7% increase in clinical fellowship training and a 15.2% decrease in private practice positions for each year of full-time research (P < 0.0001). Program directors at 31% of programs reported increased clinical duties for research fellows as a result of Accreditation Council for Graduate Medical Education work hour regulations for clinical residents, whereas a further 10% of programs are currently considering such changes. It costs $41.5 million to pay the 634 trainees who perform research fellowships each year, the majority of which is paid for by departmental funds (40%) and institutional training grants (24%). Interrupting residency to perform a research fellowship is a common and costly practice among general surgery residents. Although performing a research fellowship is associated with clinical fellowship training after residency, it is unclear to what extent this practice leads to the development of surgical investigators after postgraduate training.

Long-term outcomes of performing a postdoctoral research fellowship during general surgery residency.

Science.gov (United States)

Robertson, Charles M; Klingensmith, Mary E; Coopersmith, Craig M

2007-04-01

To determine whether dedicated research time during surgical residency leads to funding following postgraduate training. Unlike other medical specialties, a significant number of general surgery residents spend 1 to 3 years in dedicated laboratory research during their training. The impact this has on obtaining peer reviewed research funding after residency is unknown. Survey of all graduates of an academic general surgery resident program from 1990 to 2005 (n = 105). Seventy-five (71%) of survey recipients responded, of which 66 performed protected research during residency. Fifty-one currently perform research (mean effort, 26%; range, 2%-75%). Twenty-three respondents who performed research during residency (35%) subsequently received independent faculty funding. Thirteen respondents (20%) obtained NIH grants following residency training. The number of papers authored during resident research was associated with obtaining subsequent faculty grant support (9.3 vs. 5.2, P = 0.02). Faculty funding was associated with obtaining independent research support during residency (42% vs. 17%, P = 0.04). NIH-funded respondents spent more combined years in research before and during residency (3.7 vs. 2.8, P = 0.02). Academic surgeons rated research fellowships more relevant to their current job than private practitioners (4.3 vs. 3.4 by Likert scale, P < 0.05). Both groups considered research a worthwhile use of their time during residency (4.5 vs. 4.1, P = not significant). A large number of surgical trainees who perform a research fellowship in the middle of residency subsequently become funded investigators in this single-center survey. The likelihood of obtaining funding after residency is related to productivity and obtaining grant support during residency as well as cumulative years of research prior to obtaining a faculty position.

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 remediation. Despite difficulties with training logistics and busy resident schedules, it is feasible to objectively assess most GS trainees and

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.

Prevalence and Cost of Full-Time Research Fellowships During General Surgery Residency – A National Survey

Science.gov (United States)

Robertson, Charles M.; Klingensmith, Mary E.; Coopersmith, Craig M.

2009-01-01

Structured Abstract Objective To quantify the prevalence, outcomes, and cost of surgical resident research. Summary Background Data General surgery is unique among graduate medical education programs because a large percentage of residents interrupt their clinical training to spend 1-3 years performing full-time research. No comprehensive data exists on the scope of this practice. Methods Survey sent to all 239 program directors of general surgery residencies participating in the National Resident Matching Program. Results Response rate was 200/239 (84%). A total of 381 out of 1052 trainees (36%) interrupt residency to pursue full-time research. The mean research fellowship length is 1.7 years, with 72% of trainees performing basic science research. A significant association was found between fellowship length and post-residency activity, with a 14.7% increase in clinical fellowship training and a 15.2% decrease in private practice positions for each year of full-time research (p<0.0001). Program directors at 31% of programs reported increased clinical duties for research fellows as a result of ACGME work hour regulations for clinical residents, while a further 10% of programs are currently considering such changes. It costs $41.5 million to pay the 634 trainees who perform research fellowships each year, the majority of which is paid for by departmental funds (40%) and institutional training grants (24%). Conclusions Interrupting residency to perform a research fellowship is a common and costly practice among general surgery residents. While performing a research fellowship is associated with clinical fellowship training after residency, it is unclear to what extent this practice leads to the development of surgical investigators after post-graduate training. PMID:19106692

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

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.

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.

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

2018-02-01

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.

The effects of the addition of a pediatric surgery fellow on the operative experience of the general surgery resident.

Science.gov (United States)

Raines, Alexander; Garwe, Tabitha; Adeseye, Ademola; Ruiz-Elizalde, Alejandro; Churchill, Warren; Tuggle, David; Mantor, Cameron; Lees, Jason

2015-06-01

Adding fellows to surgical departments with residency programs can affect resident education. Our specific aim was to evaluate the effect of adding a pediatric surgery (PS) fellow on the number of index PS cases logged by the general surgery (GS) residents. At a single institution with both PS and GS programs, we examined the number of logged cases for the fellows and residents over 10 years [5 years before (Time 1) and 5 years after (Time 2) the addition of a PS fellow]. Additionally, the procedure related relative value units (RVUs) recorded by the faculty were evaluated. The fellows averaged 752 and 703 cases during Times 1 and 2, respectively, decreasing by 49 (P = 0.2303). The residents averaged 172 and 161 cases annually during Time 1 and Time 2, respectively, decreasing by 11 (P = 0.7340). The total number of procedure related RVUs was 4627 and 6000 during Times 1 and 2, respectively. The number of cases logged by the PS fellows and GS residents decreased after the addition of a PS fellow; however, the decrease was not significant. Programs can reasonably add an additional PS fellow, but care should be taken especially in programs that are otherwise static in size.

Striving for work-life balance: effect of marriage and children on the experience of 4402 US general surgery residents.

Science.gov (United States)

Sullivan, Michael C; Yeo, Heather; Roman, Sanziana A; Bell, Richard H; Sosa, Julie A

2013-03-01

To determine how marital status and having children impact US general surgical residents' attitudes toward training and personal life. There is a paucity of research describing how family and children affect the experience of general surgery residents. Cross-sectional survey involving all US categorical general surgery residents. Responses were evaluated by resident/program characteristics. Statistical analysis included the χ test and hierarchical logistic regression modeling. A total of 4402 residents were included (82.4% response rate) and categorized as married, single, or other (separated/divorced/widowed). Men were more likely to be married (57.8% vs 37.9%, P work (P work (P work hours caused strain on family life (P work (P = 0.001), were happy at work (P = 0.001), and reported a good program fit (P = 0.034), but had strain on family life (P work [odds ratio (OR): 1.22, P = 0.035], yet feeling that work caused family strain (OR: 1.66, P work (OR: 0.81, P = 0.007). Residents who were married or parents reported greater satisfaction and work-life conflict. The complex effects of family on surgical residents should inform programs to target support mechanisms for their trainees.

Variable Operative Experience in Hand Surgery for Plastic Surgery Residents.

Science.gov (United States)

Silvestre, Jason; Lin, Ines C; Levin, Lawrence Scott; Chang, Benjamin

Efforts to standardize hand surgery training during plastic surgery residency remain challenging. We analyze the variability of operative hand experience at U.S. plastic surgery residency programs. Operative case logs of chief residents in accredited U.S. plastic surgery residency programs were analyzed (2011-2015). Trends in fold differences of hand surgery case volume between the 10th and 90th percentiles of residents were assessed graphically. Percentile data were used to calculate the number of residents achieving case minimums in hand surgery for 2015. Case logs from 818 plastic surgery residents were analyzed of which a minority were from integrated (35.7%) versus independent/combined (64.3%) residents. Trend analysis of fold differences in case volume demonstrated decreasing variability among procedure categories over time. By 2015, fold differences for hand reconstruction, tendon cases, nerve cases, arthroplasty/arthrodesis, amputation, arterial repair, Dupuytren release, and neoplasm cases were below 10-fold. Congenital deformity cases among independent/combined residents was the sole category that exceeded 10-fold by 2015. Percentile data suggested that approximately 10% of independent/combined residents did not meet case minimums for arterial repair and congenital deformity in 2015. Variable operative experience during plastic surgery residency may limit adequate exposure to hand surgery for certain residents. Future studies should establish empiric case minimums for plastic surgery residents to ensure hand surgery competency upon graduation. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

The Resident-Run Minor Surgery Clinic: A Pilot Study to Safely Increase Operative Autonomy.

Science.gov (United States)

Wojcik, Brandon M; Fong, Zhi Ven; Patel, Madhukar S; Chang, David C; Petrusa, Emil; Mullen, John T; Phitayakorn, Roy

General surgery training has evolved to align with changes in work hour restrictions, supervision regulations, and reimbursement practices. This has culminated in a lack of operative autonomy, leaving residents feeling inadequately prepared to perform surgery independently when beginning fellowship or practice. A resident-run minor surgery clinic increases junior resident autonomy, but its effects on patient outcomes have not been formally established. This pilot study evaluated the safety of implementing a resident-run minor surgery clinic within a university-based general surgery training program. Single institution case-control pilot study of a resident-run minor surgery clinic from 9/2014 to 6/2015. Rotating third-year residents staffed the clinic once weekly. Residents performed operations independently in their own procedure room. A supervising attending surgeon staffed each case prior to residents performing the procedure and viewed the surgical site before wound closure. Postprocedure patient complications and admissions to the hospital because of a complication were analyzed and compared with an attending control cohort. Massachusetts General Hospital General in Boston, MA; an academic tertiary care general surgery residency program. Ten third-year general surgery residents. Overall, 341 patients underwent a total of 399 procedures (110 in the resident clinic vs. 289 in the attending clinic). Minor surgeries included soft tissue mass excision (n = 275), abscess incision and drainage (n = 66), skin lesion excision (n = 37), skin tag removal (n = 15), and lymph node excision (n = 6). There was no significant difference in the overall rate of patients developing a postprocedure complication within 30 days (3.6% resident vs. 2.8% attending; p = 0.65); which persisted on multivariate analysis. Similar findings were observed for the rate of hospital admission resulting from a complication. Resident evaluations overwhelmingly supported the rotation, citing

Text messaging among residents and faculty in a university general surgery residency program: prevalence, purpose, and patient care.

Science.gov (United States)

Shah, Dhruvil R; Galante, Joseph M; Bold, Richard J; Canter, Robert J; Martinez, Steve R

2013-01-01

There is little information about the use of text messaging (texting) devices among resident and faculty physicians for patient-related care (PRC). To determine the prevalence, frequency, purpose, and concerns regarding texting among resident and attending surgeons and to identify factors associated with PRC texting. E-mail survey. University medical center and its affiliated hospitals. Surgery resident and attending staff. Prevalence, frequency, purpose, and concerns regarding patient-related care text messaging. Overall, 73 (65%) surveyed physicians responded, including 45 resident (66%) and 28 attending surgeons (62%). All respondents owned a texting device. Majority of surgery residents (88%) and attendings (71%) texted residents, whereas only 59% of residents and 65% of attendings texted other faculty. Most resident to resident text occurred at a frequency of 3-5 times/d (43%) compared with most attending to resident texts, which occurred 1-2 times/d (33%). Most resident to attending (25%) and attending to attending (30%) texts occurred 1-2 times/d. Among those that texted, PRC was the most frequently reported purpose for resident to resident (46%), resident to attending (64%), attending to resident (82%), and attending to other attending staff (60%) texting. Texting was the most preferred method to communicate about routine PRC (47% of residents vs 44% of attendings). Age (OR: 0.86, 95% CI: 0.79-0.95; p = 0.003), but not sex, specialty/clinical rotation, academic rank, or postgraduate year (PGY) level predicted PRC texting. Most resident and attending staff surveyed utilize texting, mostly for PRC. Texting was preferred for communicating routine PRC information. Our data may facilitate the development of guidelines for the appropriate use of PRC texting. Copyright © 2013 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

A Comparison Study of Communication Skills between General Surgery and General Practice Residents on First-time Patient Visits

Directory of Open Access Journals (Sweden)

Ahmed Al Ansari

2012-04-01

Full Text Available Background: There is little published research about differences in doctor-patient communication of different specialties. Accordingly, we compared doctor-patient communication skills in two different specialties, general surgery (GS and general practice (GP. Methods: Twenty residents training at the Bahrain Defence Force Hospital (10 men and 10 women; mean age 28 years; 10 GS and 10 GP participated in 200 patient first visit consultations. The consultations were video-recorded and analysed by four trained observers using the MAAS Global scale. Results: 1 Internal consistency reliability of the MAAS Global (> 0.91 and Ep2 = 0.84 for raters was high, 2 GP residents spent more time (12 minutes than GS residents (7 minutes, in the visits, 3 There were several differences on the MAAS Global items between GP and GS residents (GS > GP, p GS, p < 0.05 on information giving, and 4 The present participants performed well compared to normative samples as well as to criterion-referenced cut-off scores. The general level of communication skills in both specialties, however, was ‘unsatisfactory’ and ‘doubtful’, as it is for normative samples. Conclusion: Excellent doctor-patient communication is essential but does not appear to receive the amount of attention that it deserves in practice settings. There are some differences between specialties as well as unsatisfactory communication skills for both specialties, since residents from both programs spent less time than recommended on each consultation. Our findings emphasize the need to improve the communication skills of physicians in general and for surgeons in particular.

Surgical resident perceptions of trauma surgery as a specialty.

Science.gov (United States)

Hadzikadic, Lejla; Burke, Peter A; Esposito, Thomas J; Agarwal, Suresh

2010-05-01

Presenting the opinions of surgical residents about the appeal of trauma surgery as a specialty may influence current reform. Survey study. Academic research. General surgery residents (postgraduate years 1-5 and recent graduates) registered with the American College of Surgeons. A 22-item survey. Career plans and perceptions about trauma surgery as a specialty. Of 6006 mailed surveys, we had a 20.1% response rate. Midlevel residents comprised most of the respondents, and most were undecided about their career choice or planned to enter general surgical private practice. The typical residency programs represented were academic (81.7%), urban (90.6%), and level I trauma centers (78.7%), and included more than 6 months of trauma experience (77.6%). Most respondents (70.6%) thought that trauma surgery was unappealing. The most important deterrents to entering the field were lifestyle, poor reimbursement, and limited operating room exposure, while increased surgical critical care was not seen as a restriction. When questioned about the future of trauma surgery, they believed that trauma surgeons should perform elective (86.8%) and nontrauma emergency (91.5%) cases and would benefit from active association with an outpatient clinic (76.0%). Intellectual challenge and exciting nature of the field were listed as the most appealing aspects, and ideal practice characteristics included guaranteed salary and time away from work. As demand for trauma surgeons increases, resident interest has dwindled. As a specialty, trauma surgery must undergo changes that reflect the needs of the incoming generation. We present a sampling of current surgical resident opinion and offer these data to assist the changing discipline and the evolving field of acute care surgery.

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

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.

Pregnancy and the Plastic Surgery Resident.

Science.gov (United States)

Garza, Rebecca M; Weston, Jane S; Furnas, Heather J

2017-01-01

Combining pregnancy with plastic surgery residency has historically been difficult. Two decades ago, 36 percent of plastic surgery program directors surveyed actively discouraged pregnancy among residents, and 33 percent of women plastic surgeons suffered from infertility. Most alarmingly, 26 percent of plastic surgery trainees had had an elective abortion during residency. With increasing numbers of women training in plastic surgery, this historical lack of support for pregnancy deserves further attention. To explore the current accommodations made for the pregnant plastic surgery resident, an electronic survey was sent to 88 plastic surgery program directors in the United States. Fifty-four responded, for a response rate of 61.36 percent. On average, a director trained a total of 7.91 women among 17.28 residents trained over 8.19 years. Of the women residents, 1.43 were pregnant during a director's tenure, with 1.35 of those residents taking maternity leave. An average 1.75 male residents took paternity leave. Approximately one-third of programs had a formal maternity/paternity leave policy (36.54 percent) which, in most cases, was limited to defining allowed weeks of leave, time required to fulfill program requirements, and remuneration during leave. This survey of plastic surgery directors is a first step in defining the challenges training programs face in supporting the pregnant resident. Directors provided comments describing their challenges accommodating an absent resident in a small program and complying with the American Board of Plastic Surgery's required weeks of training per year. A discussion of these challenges is followed by suggested solutions.

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.

Cosmetic Surgery Training in Plastic Surgery Residency Programs

Directory of Open Access Journals (Sweden)

Colton H. L. McNichols, MD

2017-09-01

Conclusions:. 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.

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 Marital status, children, and gender appear to have a powerful effect on general surgery residents' career planning.

Identifying areas of weakness in thoracic surgery residency training: a comparison of the perceptions of residents and program directors.

Science.gov (United States)

Edwards, Janet P; Schofield, Adam; Paolucci, Elizabeth Oddone; Schieman, Colin; Kelly, Elizabeth; Servatyari, Ramin; Dixon, Elijah; Ball, Chad G; Grondin, Sean C

2014-01-01

To identify core thoracic surgery procedures that require increased emphasis during thoracic surgery residency for residents to achieve operative independence and to compare the perspectives of residents and program directors in this regard. A modified Delphi process was used to create a survey that was distributed electronically to all Canadian thoracic surgery residents (12) and program directors (8) addressing the residents' ability to perform 19 core thoracic surgery procedures independently after the completion of residency. Residents were also questioned about the adequacy of their operative exposure to these 19 procedures during their residency training. A descriptive summary including calculations of frequencies and proportions was conducted. The perceptions of the 2 groups were then compared using the Fisher exact test employing a Bonferroni correction. The relationship between residents' operative exposure and their perceived operative ability was explored in the same fashion. The response rate was 100% for residents and program directors. No statistical differences were found between residents' and program directors' perceptions of residents' ability to perform the 19 core procedures independently. Both groups identified lung transplantation, first rib resection, and extrapleural pneumonectomy as procedures for which residents were not adequately prepared to perform independently. Residents' subjective ratings of operative exposure were in good agreement with their reported operative ability for 13 of 19 procedures. This study provides new insight into the perceptions of thoracic surgery residents and their program directors regarding operative ability. This study points to good agreement between residents and program directors regarding residents' surgical capabilities. This study provides information regarding potential weaknesses in thoracic surgery training, which may warrant an examination of the curricula of existing programs as well as a

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.

Nontrauma emergency surgery: optimal case mix for general surgery and acute care surgery training.

Science.gov (United States)

Cherry-Bukowiec, Jill R; Miller, Barbra S; Doherty, Gerard M; Brunsvold, Melissa E; Hemmila, Mark R; Park, Pauline K; Raghavendran, Krishnan; Sihler, Kristen C; Wahl, Wendy L; Wang, Stewart C; Napolitano, Lena M

2011-11-01

To examine the case mix and patient characteristics and outcomes of the nontrauma emergency (NTE) service in an academic Division of Acute Care Surgery. An NTE service (attending, chief resident, postgraduate year-3 and postgraduate year-2 residents, and two physician assistants) was created in July 2005 for all urgent and emergent inpatient and emergency department general surgery patient consults and admissions. An NTE database was created with prospective data collection of all NTE admissions initiated from November 1, 2007. Prospective data were collected by a dedicated trauma registrar and Acute Physiology and Chronic Health Evaluation-intensive care unit (ICU) coordinator daily. NTE case mix and ICU characteristics were reviewed for the 2-year time period January 1, 2008, through December 31, 2009. During the same time period, trauma operative cases and procedures were examined and compared with the NTE case mix. Thousand seven hundred eight patients were admitted to the NTE service during this time period (789 in 2008 and 910 in 2009). Surgical intervention was required in 70% of patients admitted to the NTE service. Exploratory laparotomy or laparoscopy was performed in 449 NTE patients, comprising 37% of all surgical procedures. In comparison, only 118 trauma patients (5.9% of admissions) required a major laparotomy or thoracotomy during the same time period. Acuity of illness of NTE patients was high, with a significant portion (13%) of NTE patients requiring ICU admission. NTE patients had higher admission Acute Physiology and Chronic Health Evaluation III scores [61.2 vs. 58.8 (2008); 58.2 vs. 55.8 (2009)], increased mortality [(9.71% vs. 4.89% (2008); 6.78% vs. 5.16% (2009)], and increased readmission rates (15.5% vs. 7.4%) compared with the total surgical ICU (SICU) admissions. In an era of declining operative caseload in trauma, the NTE service provides ample opportunity for complex general surgery decision making and operative procedures for

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 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 train with experienced nurses. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

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.

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.

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. © 2016 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

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.

Correlation of Objective Assessment Data With General Surgery Resident In-Training Evaluation Reports and Operative Volumes.

Science.gov (United States)

Abdelsattar, Jad M; AlJamal, Yazan N; Ruparel, Raaj K; Rowse, Phillip G; Heller, Stephanie F; Farley, David R

2018-05-14

Faculty evaluations, ABSITE scores, and operative case volumes often tell little about true resident performance. We developed an objective structured clinical examination called the Surgical X-Games (5 rooms, 15 minutes each, 12-15 tests total, different for each postgraduate [PGY] level). We hypothesized that performance in X-Games will prove more useful in identifying areas of strength or weakness among general surgery (GS) residents than faculty evaluations, ABSITE scores, or operative cases volumes. PGY 2 to 5 GS residents (n = 35) were tested in a semiannual X-Games assessment using multiple simulation tasks: laparoscopic skills, bowel anastomosis, CT/CXR analysis, chest tube placement, etc. over 1 academic year. Resident scores were compared to their ABSITE, in-training evaluation reports, and operating room case numbers. Academic medical center. PGY-2, 3, 4, and 5 GS residents at Mayo Clinic in Rochester, MN. Results varied greatly within each class except for staff evaluations: in-training evaluation reports medians for PGY-2s were 5.3 (range: 5.0-6.0), PGY-3s 5.9 (5.5-6.3), PGY-4s 5.6 (5.0-6.0), and PGY-5s were 6.1 (5.6-6.9). Although ABSITE and operating room case volumes fluctated greatly with each PGY class, only X-Games scores (median: PGY-2 = 82, PGY-3 = 61, PGY-4 = 76, and PGY-5 = 60) correlated positively (p < 0.05) with operative case volume and negatively (p < 0.05) with staff evaluations. X-Games assessment generated wide differentiation of resident performance quickly, inexpensively, and objectively. Although "Minnesota-nice" surgical staff may feel all GS trainees are "above average," objective assessment tells us otherwise. Copyright © 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

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)

Ferrarese, Alessia; Gentile, Valentina; Bindi, Marco; Rivelli, Matteo; Cumbo, Jacopo; Solej, Mario; Enrico, Stefano; Martino, Valter

2016-01-01

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. 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 skills proportional to the instructor

Incorporating cultural competency into the general surgery residency curriculum: a preliminary assessment.

Science.gov (United States)

Chun, Maria B J; Young, Keane G M; Jackson, David S

2009-08-01

In response to the growing diversity of the United States population and concerns with health disparities, formal training in cross-cultural care has become mandatory for all medical specialties, including surgery. The aim of this study was to assess the readiness of a general surgery residency program to incorporate cultural competency initiatives into its curriculum. Eighteen surgical teaching faculty (at a community-based hospital with a university affiliation) voluntarily participated in a qualitative study to share their views on cultural competency and to discuss ways that it could potentially be incorporated into the curriculum. Reflective of current definitions of cultural competency, faculty viewed the term culture broadly (i.e., beyond race and ethnicity). Suggested instructional methods varied, with some noting that exposure to different cultures was helpful. Others stated the importance of faculty serving as role models. Most faculty in this study appear open to cultural training, but desire a clear understanding of what that would entail and how it can be taught. They also acknowledged the lack of time to address cultural issues. Taking into consideration these and other concerns, planned curricular interventions are also presented.

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 shop compared with at home; P < 0.04), and used active rather than passive study strategies (P < 0.04). Gender, marital status, having children, and debt burden had no correlation with examination success. Backward stepwise multiple regression analysis identified the following independent predictors of ABSITE scores: study location (P < 0.0001), frequency of reading (P = 0.0001), Oldenburg Burnout Inventory exhaustion (P = 0.02), and USMLE step 1 and 2 scores (P = 0.007 and 0

Veterans Affairs general surgery service: the last bastion of integrated specialty care.

Science.gov (United States)

Poteet, Stephen; Tarpley, Margaret; Tarpley, John L; Pearson, A Scott

2011-11-01

In a time of increasing specialization, academic training institutions provide a compartmentalized learning environment that often does not reflect the broad clinical experience of general surgery practice. This study aimed to evaluate the contribution of the Veterans Affairs (VA) general surgery surgical experience to both index Accreditation Council for Graduate Medical Education (ACGME) requirements and as a unique integrated model in which residents provide concurrent care of multiple specialty patients. Institutional review board approval was obtained for retrospective analysis of electronic medical records involving all surgical cases performed by the general surgery service from 2005 to 2009 at the Nashville VA. Over a 5-year span general surgery residents spent an average of 5 months on the VA general surgery service, which includes a postgraduate year (PGY)-5, PGY-3, and 2 PGY-1 residents. Surgeries involved the following specialties: surgical oncology, endocrine, colorectal, hepatobiliary, transplant, gastrointestinal laparoscopy, and elective and emergency general surgery. The surgeries were categorized according to ACGME index requirements. A total of 2,956 surgeries were performed during the 5-year period from 2005 through 2009. Residents participated in an average of 246 surgeries during their experience at the VA; approximately 50 cases are completed during the chief year. On the VA surgery service alone, 100% of the ACGME requirement was met for the following categories: endocrine (8 cases); skin, soft tissue, and breast (33 cases); alimentary tract (78 cases); and abdominal (88 cases). Approximately 50% of the ACGME requirement was met for liver, pancreas, and basic laparoscopic categories. The VA hospital provides an authentic, broad-based, general surgery training experience that integrates complex surgical patients simultaneously. Opportunities for this level of comprehensive care are decreasing or absent in many general surgery training

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

A Time Study of Plastic Surgery Residents.

Science.gov (United States)

Lau, Frank H; Sinha, Indranil; Jiang, Wei; Lipsitz, Stuart R; Eriksson, Elof

2016-05-01

Resident work hours are under scrutiny and have been subject to multiple restrictions. The studies supporting these changes have not included data on surgical residents. We studied the workday of a team of plastic surgery residents to establish prospective time-study data of plastic surgery (PRS) residents at a single tertiary-care academic medical center. Five trained research assistants observed all residents (n = 8) on a PRS service for 10 weeks and produced minute-by-minute activity logs. Data collection began when the team first met in the morning and continued until the resident being followed completed all non-call activities. We analyzed our data from 3 perspectives: 1) time spent in direct patient care (DPC), indirect patient care, and didactic activities; 2) time spent in high education-value activities (HEAs) versus low education-value activities; and 3) resident efficiency. We defined HEAs as activities that surgeons must master; other activities were LEAs. We quantified resident efficiency in terms of time fragmentation and time spent waiting. A total of 642.4 hours of data across 50 workdays were collected. Excluding call, residents worked an average of 64.2 hours per week. Approximately 50.7% of surgical resident time was allotted to DPC, with surgery accounting for the largest segment of this time (34.8%). Time spent on HEAs demonstrated trended upward with higher resident level (P = 0.086). Time in spent in surgery was significantly associated with higher resident levels (P time study of PRS residents, we found that compared with medicine trainees, surgical residents spent 3.23 times more time on DPC. High education-value activities comprised most of our residents' workdays. Surgery was the leading component of both DPC and HEAs. Our residents were highly efficient and fragmented, with the majority of all activities requiring 4 minutes or less. Residents spent a large portion of their time waiting for other services. In light of these data, we

The evolving integrated vascular surgery residency curriculum.

Science.gov (United States)

Smith, Brigitte K; Greenberg, Jacob A; Mitchell, Erica L

2014-10-01

Since their introduction several years ago, integrated (0 + 5) vascular surgery residency programs are being increasingly developed across the country. To date, however, there is no defined "universal" curriculum for these programs and each program is responsible for creating its own curriculum. The aim of this study was to review the experiences of current 0 + 5 program directors (PDs) to determine what factors contributed to the curricular development within their institution. Semistructured interviews were conducted with 0 + 5 PDs to explore their experiences with program development, factors influencing the latter, and rationale for current curricula. The interview script was loosely structured to explore several factors including time of incoming residents' first exposure to the vascular surgical service, timing and rationale behind the timing of core surgical rotations throughout the 5 year program, educational value of nonsurgical rotations, opportunities for leadership and scholarly activity, and influence the general surgery program and institutional climate had on curricular structure. All interviews were conducted by a single interviewer. All interviews were qualitatively analyzed using emergent theme analysis. Twenty-six 0 + 5 PDs participated in the study. A total of 69% believed establishing professional identity early reduces resident attrition and recommend starting incoming trainees on vascular surgical services. Sixty-two percent spread core surgical rotations over the first 3 years to optimize general surgical exposure and most of the programs have eliminated specific rotations, as they were not considered valuable to the goals of training. Factors considered most important by PDs in curricular development include building on existing institutional opportunities (96%), avoiding rotations considered unsuccessful by "experienced" programs (92%), and maintaining a good working relationship with general surgery (77%). Fifty-eight percent of

The role of a preliminary PGY-3 in general surgery training.

Science.gov (United States)

Tarpley, Margaret J; Van Way, Charles; Friedell, Mark; Deveney, Karen; Farley, David; Mellinger, John; Scott, Bradford; Tarpley, John

2014-01-01

Even before the preliminary postgraduate year (PGY)-3 was eliminated from surgical residency, it had become increasingly difficult to fill general surgery PGY-4 vacancies. This ongoing need prompted the Association of Program Directors in Surgery (APDS) leadership to form a task force to study the possibility of requesting the restoration of the preliminary PGY-3 to Accreditation Council for Graduate Medical Education-approved general surgery residency programs. The task force conducted a 10-year review of the APDS list serve to ascertain the number of advertised PGY-4 open positions. Following the review of the list serve, the task force sent IRB-approved electronic REDCap surveys to 249 program directors (PDs) in general surgery. The list serve review revealed more than 230 requests for fourth-year residents, a number that most likely underestimates the need, as such, vacancies are not always advertised through the APDS. A total of 119 PDs (~48%) responded. In the last 10 years, these 119 programs needed an average of 2 PGY-4 residents (range: 0-8), filled 1.3 positions (range: 0-7), and left a position unfilled 1.3 times (range: 0-7). Methods for finding PGY-4 residents included making personal contacts with other PDs (52), posting on the APDS Topica List Serve (47), and using the APDS Web site for interested candidates on residency and fellowship job listings (52). Reasons for needing a PGY-4 resident included residents leaving the program (82), extra laboratory years (39), remediation (31), and approved program expansion (21), as well as other issues. Satisfaction scores for the added PGY-4 residents were more negative (43) than positive (30). Problems ranged from lack of preparation to professionalism. When queried as to an optimal number of preliminary residents needed nationally at the PGY-3 level, responses varied from 0 to 50 (34 suggested 10). The survey of PDs supports the need for the reintroduction of a limited number of Accreditation Council for

Surgical resident involvement is safe for common elective general surgery procedures.

Science.gov (United States)

Tseng, Warren H; Jin, Leah; Canter, Robert J; Martinez, Steve R; Khatri, Vijay P; Gauvin, Jeffrey; Bold, Richard J; Wisner, David; Taylor, Sandra; Chen, Steven L

2011-07-01

Outcomes of surgical resident training are under scrutiny with the changing milieu of surgical education. Few have investigated the effect of surgical resident involvement (SRI) on operative parameters. Examining 7 common general surgery procedures, we evaluated the effect of SRI on perioperative morbidity and mortality and operative time (OpT). The American College of Surgeons National Surgical Quality Improvement Program database (2005 to 2007) was used to identify 7 cases of nonemergent operations. Cases with simultaneous procedures were excluded. Logistic regression was performed across all procedures and within each procedure incorporating SRI, OpT, and risk-stratifying American College of Surgery National Surgical Quality Improvement Program morbidity and mortality probability scores, which incorporate multiple prognostic individual patient factors. Procedure-specific, SRI-stratified OpTs were compared using Wilcoxon rank-sum tests. A total of 71.3% of the 37,907 cases had SRI. Absolute 30-day morbidity for all cases with SRI and without SRI were 3.0% and 1.0%, respectively (p < 0.001); absolute 30-day mortality for all cases with SRI and without SRI were 0.1% and 0.08%, respectively (p < 0.001). After multivariate analysis by specific procedure, SRI was not associated with increased morbidity but was associated with decreased mortality during open right colectomy (odds ratio 0.32; p = 0.01). Across all procedures, SRI was associated with increased morbidity (odds ratio 1.14; p = 0.048) but decreased mortality (odds ratio 0.42; p < 0.001). Mean OpT for all procedures was consistently lower for cases without SRI. SRI has a measurable impact on both 30-day morbidity and mortality and OpT. These data have implications to the impact associated with surgical graduate medical education. Further studies to identify causes of patient morbidity and prevention strategies in surgical teaching environments are warranted. Copyright © 2011 American College of Surgeons

Evaluating Coding Accuracy in General Surgery Residents' Accreditation Council for Graduate Medical Education Procedural Case Logs.

Science.gov (United States)

Balla, Fadi; Garwe, Tabitha; Motghare, Prasenjeet; Stamile, Tessa; Kim, Jennifer; Mahnken, Heidi; Lees, Jason

.0043). The survey response rate was 100%. Survey results indicated that inability to find the precise code within the ACGME search interface and unfamiliarity with available CPT codes were by far the most common perceived barriers to accuracy. Survey results also indicated that most residents (74%) believe that they code accurately most of the time and agree that their case log would accurately represent their operative experience (66.6%). This is the first study to evaluate correctness of residents' ACGME case logs in general surgery. The degree of inaccuracy found here necessitates further investigation into the etiology of these discrepancies. Instruction on coding practices should also benefit the residents after graduation. Optimizing communication among attendings and residents, improving ACGME coding search interface, and implementing consistent coding practices could improve accuracy giving a more realistic view of residents' operative experience. Published by Elsevier Inc.

The role of the nonphysician educator in general surgery residency training: from outcome project and duty-hours restrictions to the next accreditation system and milestones.

Science.gov (United States)

Tarpley, Margaret J; Davidson, Mario A; Tarpley, John L

2014-01-01

In 2002 and 2003 the ACGME Outcome Project (assessing residents based on competencies) and duty-hours restrictions were implemented. One strategy for assisting PDs in the increased workload was to hire nonphysician educators with training and experience in curriculum design, teaching techniques, adult learning theories, and research methods. This study sought to document prevalence and responsibilities of nonphysician educators. IRB approval was received for a two-part study. All 247 general surgery PDs were e-mailed the question, "Do you have a nonphysician educator as a member of your surgery education office?" Those who replied "yes" or volunteered "not currently but in the past" were e-mailed a link to an electronic survey concerning the role of the nonphysician educator. Residency training programs in general surgery. General surgery program directors. Of the 126 PDs who responded to the initial query, 37 said "yes" and 4 replied "not currently but in the past". Thirty-two PDs of the initial 41 respondents completed the survey. Significant findings included: 65% were hired in the last 6 years; faculty rank is held by 69%; and curriculum development was the most common responsibility but teaching, research, and administrative duties were often listed. PDs perceived that faculty, residents, and medical students had mostly positive attitudes towards nonphysician educators. The overall results seem to support the notion that nonphysician educators serve as vital members of the team. Copyright © 2014 Association of Program Directors in Surgery. All rights reserved.

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

2018-06-01

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 .

A virtual reality endoscopic simulator augments general surgery resident cancer education as measured by performance improvement.

Science.gov (United States)

White, Ian; Buchberg, Brian; Tsikitis, V Liana; Herzig, Daniel O; Vetto, John T; Lu, Kim C

2014-06-01

Colorectal cancer is the second most common cause of death in the USA. The need for screening colonoscopies, and thus adequately trained endoscopists, particularly in rural areas, is on the rise. Recent increases in required endoscopic cases for surgical resident graduation by the Surgery Residency Review Committee (RRC) further emphasize the need for more effective endoscopic training during residency to determine if a virtual reality colonoscopy simulator enhances surgical resident endoscopic education by detecting improvement in colonoscopy skills before and after 6 weeks of formal clinical endoscopic training. We conducted a retrospective review of prospectively collected surgery resident data on an endoscopy simulator. Residents performed four different clinical scenarios on the endoscopic simulator before and after a 6-week endoscopic training course. Data were collected over a 5-year period from 94 different residents performing a total of 795 colonoscopic simulation scenarios. Main outcome measures included time to cecal intubation, "red out" time, and severity of simulated patient discomfort (mild, moderate, severe, extreme) during colonoscopy scenarios. Average time to intubation of the cecum was 6.8 min for those residents who had not undergone endoscopic training versus 4.4 min for those who had undergone endoscopic training (p Virtual reality endoscopic simulation is an effective tool for both augmenting surgical resident endoscopy cancer education and measuring improvement in resident performance after formal clinical endoscopic training.

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.

The Surgical Personality: Does Surgery Resident Motivation Predict Attrition?

Science.gov (United States)

Symer, Matthew M; Abelson, Jonathan S; Yeo, Heather L; Sosa, Julie A; Rosenthal, M Zachary

2018-05-01

There is limited understanding of the wide variation in attrition rates among general surgery residencies. We used the validated Behavior Inhibitory System/Behavior Approach System (BIS/BAS) instrument to compare motivational traits among residents who did and not complete surgical training. All US general surgery categorical interns in the class of 2007-2008 were surveyed with a validated motivational trait assessment tool. American Board of Surgery records from 2008-2016 were used to determine who completed training. Motivation, an aspect of personality, was assessed with the BIS/BAS, which correlates with an individual's tendency to approach pleasant stimuli (BAS) or avoid negative stimuli (BIS). Subscale mean scores were compared with regard to the primary end point, attrition. Eight hundred and one (76.5%) interns completed the survey and had matching records. Six hundred and forty-five (80.5%) completed training. Men had lower scores than women in the BAS Drive subscale (12.0 vs 12.5; p scale (19.3 vs 20.9; p academic 17.3 vs community 17.6 vs military 16.6; p motivational personality traits. Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Emotional intelligence in orthopedic surgery residents.

Science.gov (United States)

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.

Do You See What I See? How We Use Video as an Adjunct to General Surgery Resident Education.

Science.gov (United States)

Abdelsattar, Jad M; Pandian, T K; Finnesgard, Eric J; El Khatib, Moustafa M; Rowse, Phillip G; Buckarma, EeeL N H; Gas, Becca L; Heller, Stephanie F; Farley, David R

2015-01-01

Preparation of learners for surgical operations varies by institution, surgeon staff, and the trainees themselves. Often the operative environment is overwhelming for surgical trainees and the educational experience is substandard due to inadequate preparation. We sought to develop a simple, quick, and interactive tool that might assess each individual trainee's knowledge baseline before participating in minimally invasive surgery (MIS). A 4-minute video with 5 separate muted clips from laparoscopic procedures (splenectomy, gastric band removal, cholecystectomy, adrenalectomy, and inguinal hernia repair) was created and shown to medical students (MS), general surgery residents, and staff surgeons. Participants were asked to watch the video and commentate (provide facts) on the operation, body region, instruments, anatomy, pathology, and surgical technique. Comments were scored using a 100-point grading scale (100 facts agreed upon by 8 surgical staff and trainees) with points deducted for incorrect answers. All participants were video recorded. Performance was scored by 2 separate raters. An academic medical center. MS = 10, interns (n = 8), postgraduate year 2 residents (PGY)2s (n = 11), PGY3s (n = 10), PGY4s (n = 9), PGY5s (n = 7), and general surgery staff surgeons (n = 5). Scores ranged from -5 to 76 total facts offered during the 4-minute video examination. MS scored the lowest (mean, range; 5, -5 to 8); interns were better (17, 4-29), followed by PGY2s (31, 21-34), PGY3s (33, 10-44), PGY4s (44, 19-47), PGY5s (48, 28-49), and staff (48, 17-76), p video clip vs 10 of 11 PGY2 residents (p video clip of 5 MIS operations than inexperienced trainees. However, even tenured staff surgeons relayed very few facts on procedures they were unfamiliar with. The potential differentiating capabilities of such a quick and inexpensive effort has pushed us to generate better online learning tools (operative modules) and hands-on simulation resources for our learners. We aim to

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

2018-01-01

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.

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

General surgery workloads and practice patterns in the United States, 2007 to 2009: a 10-year update from the American Board of Surgery.

Science.gov (United States)

Valentine, R James; Jones, Andrew; Biester, Thomas W; Cogbill, Thomas H; Borman, Karen R; Rhodes, Robert S

2011-09-01

To assess changes in general surgery workloads and practice patterns in the past decade. Nearly 80% of graduating general surgery residents pursue additional training in a surgical subspecialty. This has resulted in a shortage of general surgeons, especially in rural areas. The purpose of this study is to characterize the workloads and practice patterns of general surgeons versus certified surgical subspecialists and to compare these data with those from a previous decade. The surgical operative logs of 4968 individuals recertifying in surgery 2007 to 2009 were reviewed. Data from 3362 (68%) certified only in Surgery (GS) were compared with 1606 (32%) with additional American Board of Medical Specialties certificates (GS+). Data from GS surgeons were also compared with data from GS surgeons recertifying 1995 to 1997. Independent variables were compared using factorial ANOVA. GS surgeons performed a mean of 533 ± 365 procedures annually. Women GS performed far more breast operations and fewer abdomen, alimentary tract and laparoscopic procedures compared to men GS (P surgery procedures. GS practice patterns are heterogeneous; gender, age, and practice setting significantly affect operative caseloads. A substantial portion of general surgery procedures currently are performed by GS+ surgeons, whereas GS surgeons continue to perform considerable numbers of specialty operations. Reduced general surgery operative experience in GS+ residencies may negatively impact access to general surgical care. Similarly, narrowing GS residency operative experience may impair specialty operation access.

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

Professionalism: A Core Competency, but What Does it Mean? A Survey of Surgery Residents.

Science.gov (United States)

Dilday, Joshua C; Miller, Elizabeth A; Schmitt, Kyle; Davis, Brian; Davis, Kurt G

2017-10-27

Professionalism is 1 of the 6 core competencies of the Accreditation Council of Graduate Medical Education. Despite its obvious importance, it is poorly defined in the literature and an understanding of its meaning has not been evaluated on surgical trainees. The American College of Surgeons (ACS) has previously published tenets of surgical professionalism. However, surgery residents may not share similar views on professionalism as those of the ACS. Surgical residents of all levels at 2 surgery residencies located in the same city were interviewed regarding their personal definitions, thoughts, and experiences regarding professionalism during their training. They were then queried regarding 20 points of professionalism as outlined by the ACS tenets of professionalism. The study utilized the surgery residencies at William Beaumont Army Medical Center and Texas Tech University Health Science Center in El Paso, Texas. All general surgery residents at each program were invited to participate in the study. Eighteen residents volunteered to take the survey and be interviewed. The definitions of professionalism centered on clinical competence. Surgery residents conveyed experiences with both professional and unprofessional behavior. Seven of the 20 ACS tenets of professionalism were unanimously agreed upon. There were key differences between resident definitions and those as outlined by the ACS. The least agreed upon ACS tenets of professionalism include professionalism education, public education, and public health. Surgical trainees express personal experiences in both professional and unprofessional behavior. Their definitions of professionalism are not as expansive as those of the ACS and seem to focus on patient and colleague interaction. Due to the lack of congruency, a tailored curriculum for professionalism based upon ACS tenets appears warranted. Published by Elsevier Inc.

Higher clinical performance during a surgical clerkship is independently associated with matriculation of medical students into general surgery.

Science.gov (United States)

Daly, Shaun C; Deal, Rebecca A; Rinewalt, Daniel E; Francescatti, Amanda B; Luu, Minh B; Millikan, Keith W; Anderson, Mary C; Myers, Jonathan A

2014-04-01

The purpose of our study was to determine the predictive impact of individual academic measures for the matriculation of senior medical students into a general surgery residency. Academic records were evaluated for third-year medical students (n = 781) at a single institution between 2004 and 2011. Cohorts were defined by student matriculation into either a general surgery residency program (n = 58) or a non-general surgery residency program (n = 723). Multivariate logistic regression was performed to evaluate independently significant academic measures. Clinical evaluation raw scores were predictive of general surgery matriculation (P = .014). In addition, multivariate modeling showed lower United States Medical Licensing Examination Step 1 scores to be independently associated with matriculation into general surgery (P = .007). Superior clinical aptitude is independently associated with general surgical matriculation. This is in contrast to the negative correlation United States Medical Licensing Examination Step 1 scores have on general surgery matriculation. Recognizing this, surgical clerkship directors can offer opportunities for continued surgical education to students showing high clinical aptitude, increasing their likelihood of surgical matriculation. Copyright © 2014 Elsevier Inc. All rights reserved.

Variability in Resident Operative Hand Experience by Specialty.

Science.gov (United States)

Silvestre, Jason; Lin, Ines C; Levin, L Scott; Chang, Benjamin

2018-01-01

Recent attention has sought to standardize hand surgery training in the United States. This study analyzes the variability in operative hand experience for orthopedic and general surgery residents. Case logs for orthopedic and general surgery residency graduates were obtained from the American Council of Graduate Medical Education (2006-2007 to 2014-2015). Plastic surgery case logs were not available for comparison. Hand surgery case volumes were compared between specialties with parametric tests. Intraspecialty variation in orthopedic surgery was assessed between the bottom and top 10th percentiles in procedure categories. Case logs for 9605 general surgery residents and 5911 orthopedic surgery residents were analyzed. Orthopedic surgery residents performed a greater number of hand surgery cases than general surgery residents ( P < .001). Mean total hand experience ranged from 2.5 ± 4 to 2.8 ± 5 procedures for general surgery residents with no reported cases of soft tissue repairs, vascular repairs, and replants. Significant intraspecialty variation existed in orthopedic surgery for all hand procedure categories (range, 3.3-15.0). As the model for hand surgery training evolves, general surgeons may represent an underutilized talent pool to meet the critical demand for hand surgeon specialists. Future research is needed to determine acceptable levels of training variability in hand surgery.

Comparison of Plastic Surgery Residency Training in United States and China.

Science.gov (United States)

Zheng, Jianmin; Zhang, Boheng; Yin, Yiqing; Fang, Taolin; Wei, Ning; Lineaweaver, William C; Zhang, Feng

2015-12-01

Residency training is internationally recognized as the only way for the physicians to be qualified to practice independently. China has instituted a new residency training program for the specialty of plastic surgery. Meanwhile, plastic surgery residency training programs in the United States are presently in a transition because of restricted work hours. The purpose of this study is to compare the current characteristics of plastic surgery residency training in 2 countries. Flow path, structure, curriculum, operative experience, research, and evaluation of training in 2 countries were measured. The number of required cases was compared quantitatively whereas other aspects were compared qualitatively. Plastic surgery residency training programs in 2 countries differ regarding specific characteristics. Requirements to become a plastic surgery resident in the United States are more rigorous. Ownership structure of the regulatory agency for residency training in 2 countries is diverse. Training duration in the United States is more flexible. Clinical and research training is more practical and the method of evaluation of residency training is more reasonable in the United States. The job opportunities after residency differ substantially between 2 countries. Not every resident has a chance to be an independent surgeon and would require much more training time in China than it does in the United States. Plastic surgery residency training programs in the United States and China have their unique characteristics. The training programs in the United States are more standardized. Both the United States and China may complement each other to create training programs that will ultimately provide high-quality care for all people.

Does Residency Selection Criteria Predict Performance in Orthopaedic Surgery Residency?

Science.gov (United States)

Raman, Tina; Alrabaa, Rami George; Sood, Amit; Maloof, Paul; Benevenia, Joseph; Berberian, Wayne

2016-04-01

More than 1000 candidates applied for orthopaedic residency positions in 2014, and the competition is intense; approximately one-third of the candidates failed to secure a position in the match. However, the criteria used in the selection process often are subjective and studies have differed in terms of which criteria predict either objective measures or subjective ratings of resident performance by faculty. Do preresidency selection factors serve as predictors of success in residency? Specifically, we asked which preresidency selection factors are associated or correlated with (1) objective measures of resident knowledge and performance; and (2) subjective ratings by faculty. Charts of 60 orthopaedic residents from our institution were reviewed. Preresidency selection criteria examined included United States Medical Licensing Examination (USMLE) Step 1 and Step 2 scores, Medical College Admission Test (MCAT) scores, number of clinical clerkship honors, number of letters of recommendation, number of away rotations, Alpha Omega Alpha (AOA) honor medical society membership, fourth-year subinternship at our institution, and number of publications. Resident performance was assessed using objective measures including American Board of Orthopaedic Surgery (ABOS) Part I scores and Orthopaedics In-Training Exam (OITE) scores and subjective ratings by faculty including global evaluation scores and faculty rankings of residents. We tested associations between preresidency criteria and the subsequent objective and subjective metrics using linear correlation analysis and Mann-Whitney tests when appropriate. Objective measures of resident performance namely, ABOS Part I scores, had a moderate linear correlation with the USMLE Step 2 scores (r = 0.55, p communication skills" subsection of the global evaluations. We found that USMLE Step 2, number of honors in medical school clerkships, and AOA membership demonstrated the strongest correlations with resident performance. Our

Early experience in establishing and evaluating an ACGME-approved international general surgery rotation.

Science.gov (United States)

Tarpley, Margaret; Hansen, Erik; Tarpley, John L

2013-01-01

In 2011, the Accreditation Council for Graduate Medical Education Surgery Residency Review Committee first provided guidelines for elective international general surgery rotations. The Vanderbilt general surgery residency program received Surgery Residency Review Committee approval for a fourth-year elective in Kenya beginning in the 2011-2012 academic year. Because this rotation would break ground culturally and geographically, and as an educational partnership, a briefing and debriefing process was developed for this ground-breaking year. Our objectives were to prepare residents to maximize the experience without competing for cases with local trainees or overburdening the host institution and to perform continuous quality assessment and improvement as each resident returned back. Briefing included health protection strategies, a procedures manual containing step-by-step preparation activities, and cultural-sensitivity training. Institutional Review Board exemption approval was obtained to administer a questionnaire created for returning residents concerning educational value, relations with local trainees, physical environment, and personal perceptions that would provide the scaffold for the debriefing conference. The questionnaire coupled with the debriefing discussion for the first 9 participants revealed overall satisfaction with the rotation and the briefing process, good health, and no duty hours or days-off issues. Other findings include the following: (1) emotional effect of observing African families weigh cost in medical decision making; (2) satisfactory access to educational resources; (3) significant exposure to specialties such as urology and radiology; and (4) toleration of 4 weeks as a single and expressed need for leisure activity materials such as books, DVDs, or games. The responses triggered adjustments in the briefing sessions and travel preparation. The host institution invited the residents to return for the 2012-2013 year as well as 2013

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.

Impact of the European Working Time Directive (EWTD) on the operative experience of surgery residents.

Science.gov (United States)

Hopmans, Cornelis J; den Hoed, Pieter T; van der Laan, Lijckle; van der Harst, Erwin; van der Elst, Maarten; Mannaerts, Guido H H; Dawson, Imro; Timman, Reinier; Wijnhoven, Bas P L; IJzermans, Jan N M

2015-04-01

In Europe and the United States, work hour restrictions are considered to be particularly burdensome for residents in surgery specialties. The aim of this study was to examine whether reduction of the work week to 48 hours resulting from the implementation of the European Working Time Directive has affected the operative experience of surgery residents. This study was conducted in a general surgery training region in the Netherlands, consisting of 1 university hospital and 6 district training hospitals. Operating records summarizing the surgical procedures performed as "primary surgeon" in the operating theater for different grades of surgeons were retrospectively analyzed for the period 2005-2012 by the use of linear regression models. Operative procedures performed by residents were considered the main outcome measure. In total, 235,357 operative procedures were performed, including 47,458 (20.2%) in the university hospital and 187,899 (79.8%) in the district training hospitals (n = 5). For residents in the university hospital, the mean number of operative procedures performed per 1.0 full-time equivalent increased from 128 operations in 2005 to 204 operations in 2012 (P = .001), whereas for residents in district training hospitals, no substantial differences were found over time. The mean (±SD) operative caseload of 64 residents who completed the 6-year training program between 2005 and 2012 was 1,391 ± 226 (range, 768-1856). A comparison of the operative caseload according to year of board-certification showed no difference. Implementation of the European Working Time Directive has not affected adversely the number of surgical procedures performed by residents within a general surgical training region in the Netherlands. Copyright © 2015 Elsevier Inc. All rights reserved.

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 < 0.05). 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.

A novel cadaver-based educational program in general surgery training.

Science.gov (United States)

Lewis, Catherine E; Peacock, Warwick J; Tillou, Areti; Hines, O Joe; Hiatt, Jonathan R

2012-01-01

To describe the development of a cadaver-based educational program and report our residents' assessment of the new program. An anatomy-based educational program was developed using fresh frozen cadavers to teach surgical anatomy and operative skills to general surgery (GS) trainees. Residents were asked to complete a voluntary, anonymous survey evaluating perceptions of the program (6 questions formulated on a 5-point Likert scale) and comparing cadaver sessions to other types of learning (4 rank order questions). Large university teaching hospital. Medical students, residents, and faculty members were participants in the cadaver programs. Only GS residents were asked to complete the survey. Since its implementation, 150 residents of all levels participated in 13 sessions. A total of 40 surveys were returned for a response rate of 89%. Overall, respondents held a positive view of the cadaver sessions and believed them to be useful for learning anatomy (94% agree or strongly agree), learning the steps of an operation (76% agree or strongly agree), and increasing confidence in doing an operation (53% agree or strongly agree). Trainees wanted to have more sessions (87% agree or strongly agree), and believed they would spend free time in the cadaver laboratory (58% agree or strongly agree). Compared with other learning modalities, cadaver sessions were ranked first for learning surgical anatomy, followed by textbooks, simulators, web sites, animate laboratories, and lectures. Respondents also ranked cadaver sessions first for increasing confidence in performing a procedure and for learning the steps of an operation. Cost of cadavers represented the major expense of the program. Fresh cadaver dissections represent a solution to the challenges of efficient, safe, and effective general surgery education. Residents have a positive attitude toward these teaching sessions and found them to be more effective than other learning modalities. Copyright © 2012 Association of

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 (technology will support a shared vocabulary between residents and faculty to enhance intraoperative education.

Racial and ethnic diversity in orthopaedic surgery residency programs.

Science.gov (United States)

Okike, Kanu; Utuk, Mekeme E; White, Augustus A

2011-09-21

Although the U.S. population is increasingly diverse, the field of orthopaedic surgery has historically been less diverse. The purpose of this study was to quantify the representation of racial and ethnic minorities among orthopaedic surgery residents compared with those in other fields of medicine and to determine how these levels of diversity have changed over time. We determined the representation of minorities among residents in orthopaedic surgery and in other fields by analyzing the Graduate Medical Education reports published annually by the Journal of the American Medical Association (JAMA), which provided data for African-Americans from 1968 to 2008, Hispanics from 1990 to 2008, Asians from 1995 to 2008, and American Indians/Alaskan Natives and Native Hawaiians/Pacific Islanders from 2001 to 2008. During the 1990s and 2000s, representation among orthopaedic residents increased rapidly for Asians (+4.53% per decade, p < 0.0001) and gradually for Hispanics (+1.37% per decade, p < 0.0001) and African-Americans (+0.68% per decade, p = 0.0003). Total minority representation in orthopaedics averaged 20.2% during the most recent years studied (2001 to 2008), including 11.7% for Asians, 4.0% for African-Americans, 3.8% for Hispanics, 0.4% for American Indians/Alaskan Natives, and 0.3% for Native Hawaiians/Pacific Islanders. However, orthopaedic surgery was significantly less diverse than all of the other residencies examined during this time period (p < 0.001). This was due primarily to the lower representation of Hispanics and Asians in orthopaedic surgery than in any of the other fields of medicine. Minority representation in orthopaedic residency programs has increased over time for Asians, Hispanics, and African-Americans. In spite of these gains, orthopaedic surgery has remained the least diverse of the specialty training programs considered in this study. While further efforts are needed to determine the factors underlying this lack of representation, we

Maximizing Technological Resources in Plastic Surgery Resident Education.

Science.gov (United States)

Khansa, Ibrahim; Janis, Jeffrey E

2015-11-01

Modern plastic surgery resident education demands the acquisition of an ever-increasing fund of knowledge and familiarity with more surgical techniques than ever before. This all must take place within the context and boundaries of Accreditation Council for Graduate Medical Education-mandated restrictions on work hours as well as balance of education and service. Technological resources have been developed and can be used to complement the skills that residents acquire while performing their day-to-day activities such as taking care of patients, reading textbooks and journal articles, and assisting or performing surgical procedures. Those complementary resources provide the benefits of portability and accessibility, and can thus be conveniently incorporated into the hectic daily life of a resident. This article presents a summary of the most commonly used currently available advanced technologies in plastic surgery resident education, and suggestions for integration of those technologies into a curriculum.

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; Baron, Adam; Nordquist, Thomas; Moore, Braden; Robinson, Richmond; Reilly, Charles

2018-01-01

Background 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 mid-term outcomes in hallux valgus surgery. Methods Consecutive adults who underwent isolated hallux valgus surgery 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 simple, multiple and logistic regression analyses. Results A total of 102 adult patients (n=102 feet) agreed to participate with a mean age of 46.8 (SD 13.1 years, range 18-71) and average length of follow-up 6.2 years (SD 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% CI 0.98-1.01], p = 0.827) or multivariate analyses (odds ratio 1.00 [95% CI 0.97-1.02], p = 0.907). Conclusions We conclude that podiatry resident level of experience in hallux valgus surgery does not contribute appreciably to postoperative clinical outcomes. PMID:24726058

Functional Status After Colon Cancer Surgery In Elder Nursing Home Residents

Science.gov (United States)

Finlayson, Emily; Zhao, Shoujun; Boscardin, W. John; Fries, Brant E.; Landefeld, C. Seth; Dudley, R. Adams

2015-01-01

Objectives To determine functional status and mortality rates after colon cancer surgery in older nursing home residents. Design Retrospective cohort study. Setting and Participants 6822 nursing home residents age 65 and older who underwent surgery for colon cancer in the United States between 1999 and 2005. Measurements Changes in functional status were assessed before and after surgery using the Minimum Data Set-Activities of Daily Living (MDS-ADL) summary scale, a 28-point scale in which score increases as functional dependence increases. Methods Using the Medicare Inpatient File and the Minimum Data Set for Nursing Homes, we identified the 6822 nursing home residents age 65 and older who underwent surgery for colon cancer. We used regression techniques to identify patient characteristics associated with mortality and functional decline at 1 year after surgery. Results On average, residents who underwent colectomy experienced a 3.9 point worsening in MDS-ADL score at one year. One year after surgery, the rates of mortality and sustained functional decline were 53% and 24%, respectively. In multivariate analysis, older age (age 80+ v. age 65–69, adjusted relative risk (ARR 1.53), 95%CI 1.15–2.04, pppp<0.0001) were associated with functional decline at one year. Conclusion Mortality and sustained functional decline are very common after colon cancer surgery in nursing home residents. Initiatives aimed at improving surgical outcomes are needed in this vulnerable population. PMID:22428583

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

Surgery or general medicine: a study of the reasons underlying the choice of medical specialty

Directory of Open Access Journals (Sweden)

Patrícia Lacerda Bellodi

Full Text Available CONTEXT: The reality of medical services in Brazil points towards expansion and diversification of medical knowledge. However, there are few Brazilian studies on choosing a medical specialty. OBJECTIVE: To investigate and characterize the process of choosing the medical specialty among Brazilian resident doctors, with a comparison of the choice between general medicine and surgery. TYPE OF STUDY: Stratified survey. SETTING: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HC-FMUSP. METHODS: A randomized sample of resident doctors in general medicine (30 and surgery (30 was interviewed. Data on sociodemographic characteristics and the moment, stability and reasons for the choice of specialty were obtained. RESULTS: The moment of choice between the two specialties differed. Surgeons (30% choose the specialty earlier, while general doctors decided progressively, mainly during the internship (43%. Most residents in both fields (73% general medicine, 70% surgery said they had considered another specialty before the current choice. The main reasons for general doctors' choice were contact with patients (50%, intellectual activities (30% and knowledge of the field (27%. For surgeons the main reasons were practical intervention (43%, manual activities (43% and the results obtained (40%. Personality was important in the choice for 20% of general doctors and for 27% of surgeons. DISCUSSION: The reasons found for the choice between general medicine and surgery were consistent with the literature. The concepts of wanting to be a general doctor or a surgeon are similar throughout the world. Personality characteristics were an important influencing factor for all residents, without statistical difference between the specialties, as was lifestyle. Remuneration did not appear as a determinant. CONCLUSION: The results from this group of Brazilian resident doctors corroborated data on choosing a medical specialty from other countries

Top five craniofacial techniques for training in plastic surgery residency.

Science.gov (United States)

Fan, Kenneth; Kawamoto, Henry K; McCarthy, Joseph G; Bartlett, Scott P; Matthews, David C; Wolfe, S Anthony; Tanna, Neil; Vu, Minh-Thien; Bradley, James P

2012-03-01

Despite increasing specialization of craniofacial surgery, certain craniofacial techniques are widely applicable. The authors identified five such craniofacial techniques and queried American Society of Plastic Surgeons members and plastic surgery program directors regarding their comfort level with the procedures and their opinion on resident training for these selected procedures. First, a select group of senior craniofacial surgeons discussed and agreed on the top five procedures. Second, active American Society of Plastic Surgeons were surveyed regarding their opinion on training and their comfort level with each procedure. Third, plastic surgery residency program directors were studied to see which of the top five procedures are taught as part of the plastic surgery residency curriculum. The top five widely applicable craniofacial procedures are technically described and include the following: (1) cranial or iliac bone graft for nasal reconstruction, (2) perialar rim bone graft, (3) lateral canthopexy, (4) osseous genioplasty, and (5) bone graft harvest for orbital floor defects. For practicing plastic surgeons, comfort level in all procedures increased with advancing years in practice (except those with 75 percent), especially those with craniofacial fellowship training, felt competent in all procedures except osseous genioplasty (53 percent). Plastic surgery program directors agreed that all top five procedures should be mastered by graduation. Although program directors felt that all five selected craniofacial procedures should be taught and mastered during residency training, plastic surgeons without craniofacial fellowship training were less comfortable with the techniques. Residency training goals should include competence in core craniofacial techniques.

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.

Essential hand surgery procedures for mastery by graduating plastic surgery residents: a survey of program directors.

Science.gov (United States)

Noland, Shelley S; Fischer, Lauren H; Lee, Gordon K; Friedrich, Jeffrey B; Hentz, Vincent R

2013-12-01

This study was designed to establish the essential hand surgery procedures that should be mastered by graduating plastic surgery residents. This framework can then be used as a guideline for developing Objective Structured Assessment of Technical Skill to teach technical skills in hand surgery. Ten expert hand surgeons were surveyed regarding the essential hand surgery procedures that should be mastered by graduating plastic surgery residents. The top 10 procedures from this survey were then used to survey all 89 Accreditation Council for Graduate Medical Education-approved plastic surgery program directors. There was a 69 percent response rate to the program director survey (n = 61). The top nine hand surgery procedures included open carpal tunnel release, open A1 pulley release, digital nerve repair with microscope, closed reduction and percutaneous pinning of metacarpal fracture, excision of dorsal or volar ganglion, zone II flexor tendon repair with multistrand technique, incision and drainage of the flexor tendon sheath for flexor tenosynovitis, flexor tendon sheath steroid injection, and open cubital tunnel release. Surgical educators need to develop objective methods to teach and document technical skill. The Objective Structured Assessment of Technical Skill is a valid method for accomplishing this task. There has been no consensus regarding which hand surgery procedures should be mastered by graduating plastic surgery residents. The authors have identified nine procedures that are overwhelmingly supported by plastic surgery program directors. These nine procedures can be used as a guideline for developing Objective Structured Assessment of Technical Skill to teach and document technical skills in hand surgery.

Factors Influencing American Plastic Surgery Residents Toward an Academic Career.

Science.gov (United States)

Chetta, Matthew D; Sugg, Kristoffer B; Diaz-Garcia, Rafael J; Kasten, Steven J

2018-02-01

Plastic surgery residency program directors have an interest in recruiting applicants who show an interest in an academic practice. Medical school achievements (ie, United States Medical Licensing Examination® scores, publications, and Alpha Omega Alpha status) are metrics assessed to grade applicants but may not correlate with ultimately choosing an academic career. This study was designed to investigate factors influencing residents' choices for or against academic careers. A 25-item online questionnaire was designed to measure baseline interest in academic plastic surgery and factors that influence decisions to continue on or abandon that career path. This questionnaire was disseminated to the integrated/combined plastic surgery residents during the 2013 to 2014 academic year. One hundred twenty-five respondents indicated that they were currently interested in pursuing academic practice (n = 78) or had lost interest in academic practice (n = 47). Among all respondents, 92.8% (n = 116) stated they were interested in academic careers at the time of residency application, but one-third (n = 41) subsequently lost interest. Those residents who retained interest in academic careers indicated resident/medical student educational opportunities (57%) and complexity of patients (52%) as reasons. Those who lost interest cited a lack of autonomy (43%), publishing requirements (32%), and income discrepancy (26%) as reasons. Many residents report losing interest in academics during residency. Traditional metrics valued in the recruitment process may not serve as positive predictors of an academic career path. Reasons why residents lose interest are not easily correctable, but mentorship, adequate career counseling, and research opportunities during training remain factors that can be addressed across all residency programs.

Geographic Diffusion and Implementation of Acute Care Surgery: An Uneven Solution to the National Emergency General Surgery Crisis.

Science.gov (United States)

Khubchandani, Jasmine A; Ingraham, Angela M; Daniel, Vijaya T; Ayturk, Didem; Kiefe, Catarina I; Santry, Heena P

2018-02-01

Owing to lack of adequate emergency care infrastructure and decline in general surgery workforce, the United States faces a crisis in access to emergency general surgery (EGS) care. Acute care surgery (ACS), an organized system of trauma, general surgery, and critical care, is a proposed solution; however, ACS diffusion remains poorly understood. To investigate geographic diffusion of ACS models of care and characterize the communities in which ACS implementation is lagging. A national survey on EGS practices was developed, tested, and administered at all 2811 US acute care hospitals providing EGS to adults between August 2015 and October 2015. Surgeons responsible for EGS coverage at these hospitals were approached. If these surgeons failed to respond to the initial survey implementation, secondary surgeons or chief medical officers at hospitals with only 1 general surgeon were approached. Survey responses on ACS implementation were linked with geocoded hospital data and national census data to determine geographic diffusion of and access to ACS. We measured the distribution of hospitals with ACS models of care vs those without over time (diffusion) and by US counties characterized by sociodemographic characteristics of county residents (access). Survey response rate was 60% (n = 1690); 272 responding hospitals had implemented ACS by 2015, steadily increasing from 34 in 2001 to 125 in 2010. Acute care surgery implementation has not been uniform. Rural regions have limited ACS access, with hospitals in counties with greater than the 75th percentile population having 5.4 times higher odds (95% CI, 1.66-7.35) of implementing ACS than hospitals in counties with less than 25th percentile population. Communities with greater percentages of adults without a college degree also have limited ACS access (OR, 3.43; 95% CI, 1.81-6.48). However, incorporating EGS into ACS models may be a potential equalizer for poor, black, and Hispanic communities. Understanding and

Goals and Methodology for a Surgery Residency Program: A Committee Approach.

Science.gov (United States)

Knecht, Charles D.; And Others

1979-01-01

Written goals of a small animal residency program established by Purdue University are identified and an elaborate list of methodology for goals is provided. Tables include: summary of required activities of residents, checklist of residency progress, and comparable effort for surgery residency and masters program. (Author/MLW)

Supplementing Resident Research Funding Through a Partnership With Local Industry.

Science.gov (United States)

Skube, Steven J; Arsoniadis, Elliot G; Jahansouz, Cyrus; Novitsky, Sherri; Chipman, Jeffrey G

2018-01-17

To develop a model for the supplementation of resident research funding through a resident-hosted clinical immersion with local industry. Designated research residents hosted multiple groups of engineers and business professionals from local industry in general surgery-focused clinical immersion weeks. The participants in these week-long programs are educated about general surgery and brought to the operating room to observe a variety of surgeries. This study was performed at the University of Minnesota, in Minneapolis, Minnesota, at a tertiary medical center. Ten designated research residents hosted general surgery immersion programs. Fifty-seven engineers and business professionals from 5 different local biomedical firms have participated in this program. General surgery research residents (in collaboration with the University of Minnesota's Institute for Engineering in Medicine) have hosted 9 clinical immersion programs since starting the collaborative in 2015. Immersion participant response to the experiences was very positive. Two full-time resident research positions can be funded annually through participation in this program. With decreasing funding available for surgical research, particularly resident research, innovative ways to fund resident research are needed. The general surgery clinical immersion program at the University of Minnesota has proven its value as a supplement for resident research funding and may be a sustainable model for the future. Copyright © 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Current robotic curricula for surgery residents: A need for additional cognitive and psychomotor focus.

Science.gov (United States)

Green, Courtney A; Chern, Hueylan; O'Sullivan, Patricia S

2018-02-01

Current robot surgery curricula developed by industry were designed for expert surgeons. We sought to identify the robotic curricula that currently exist in general surgery residencies and describe their components. We identified 12 residency programs with robotic curricula. Using a structured coding form to identify themes including sequence, duration, emphasis and assessment, we generated a descriptive summary. Curricula followed a similar sequence: learners started with online modules and simulation exercises, followed by bedside experience during R2-R3 training years, and then operative opportunities on the console in the final years of training. Consistent portions of the curricula reflect a device-dependent training paradigm; they defined the sequence of instruction. Most curricula lacked specifics on duration and content of training activities. None clearly described cognitive or psychomotor skills needed by residents and none required a proficiency assessment before graduation. Resident-specific robotic curricula remain grounded in initial industrial efforts to train experienced surgeons, are non-specific regarding the type and nature of hands on experience, and do not include discussion of operative technique and surgical concepts. Copyright © 2017 Elsevier Inc. All rights reserved.

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.

Declining Otolaryngology Resident Training Experience in Tracheostomies: Case Log Trends from 2005 to 2015.

Science.gov (United States)

Lesko, David; Showmaker, Jason; Ukatu, Ceisha; Wu, Qiwei; Chang, C W David

2017-06-01

Objective To evaluate recent tracheostomy surgical experience among otolaryngology residents and general surgery residents. Study Design Retrospective database review. Setting Accreditation Council for Graduate Medical Education otolaryngology and general surgery programs. Subjects and Methods Accreditation Council for Graduate Medical Education case log data from 2005 to 2015 for resident graduates in otolaryngology and general surgery were used to obtain mean graduate tracheostomy numbers, mean graduate composite case numbers, and number of graduating residents. Market share for each specialty was estimated through the derived metric of nationwide total tracheostomy graduate experience, calculated by multiplying the number of graduating residents by the mean number of graduate tracheostomies. Linear regression analysis was used to calculate trends. Multiple linear regression analysis was used for pairwise comparison of trends. Results From 2005 to 2015, mean graduate tracheostomy numbers for otolaryngology residents declined 2.3% per year, while those for general surgery residents increased 1.8% per year. Accounting for changes in number of resident graduates, market share of tracheostomy decreased 1.0% per year for otolaryngology and increased 3.0% per year for general surgery. Mean graduate composite case numbers increased significantly by 1.8% and 1.0% per year for otolaryngology and general surgery residents, respectively. Conclusion Tracheostomy case volume in otolaryngology residency has decreased steadily in comparison with general surgery residency. However, current otolaryngology graduates have more experience in tracheostomy when compared with general surgery graduates. While otolaryngology residents have excellent exposure to tracheostomy, otolaryngology programs should be made aware of this declining trend as well as changing procedural trends, which may affect training needs.

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...... 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...... 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...

Implementing a robotics curriculum at an academic general surgery training program: our initial experience.

Science.gov (United States)

Winder, Joshua S; Juza, Ryan M; Sasaki, Jennifer; Rogers, Ann M; Pauli, Eric M; Haluck, Randy S; Estes, Stephanie J; Lyn-Sue, Jerome R

2016-09-01

The robotic surgical platform is being utilized by a growing number of hospitals across the country, including academic medical centers. Training programs are tasked with teaching their residents how to utilize this technology. To this end, we have developed and implemented a robotic surgical curriculum, and share our initial experience here. Our curriculum was implemented for all General Surgical residents for the academic year 2014-2015. The curriculum consisted of online training, readings, bedside training, console simulation, participating in ten cases as bedside first assistant, and operating at the console. 20 surgical residents were included. Residents were provided the curriculum and notified the department upon completion. Bedside assistance and operative console training were completed in the operating room through a mix of biliary, foregut, and colorectal cases. During the fiscal years of 2014 and 2015, there were 164 and 263 robot-assisted surgeries performed within the General Surgery Department, respectively. All 20 residents completed the online and bedside instruction portions of the curriculum. Of the 20 residents trained, 13/20 (65 %) sat at the Surgeon console during at least one case. Utilizing this curriculum, we have trained and incorporated residents into robot-assisted cases in an efficient manner. A successful curriculum must be based on didactic learning, reading, bedside training, simulation, and training in the operating room. Each program must examine their caseload and resident class to ensure proper exposure to this platform.

Stapes surgery in residency: the UFPR clinical hospital experience.

Science.gov (United States)

Caldart, Adriano Ulisses; Terruel, Igor; Enge, Dair Jocely; Kurogi, Adriana Sayuri; Buschle, Maurício; Mocellin, Marcos

2007-01-01

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. To evaluate the experience of the otorhinolaryngology unit, Parana University, relative to stapes surgery done in the residency training program. A retrospective study of 114 stapes surgeries done in the past 9 years in 96 patients. Audiometric results were analysed according to the Committee on Hearing and Equilibrium guidelines and the Amsterdam Hearing Evaluation Plots. The improvement of the airway postoperative gap and thresholds were taken into account. 96 patients were included, most of them female adults (67.7%) and white (93.7%). Stapedectomy was done in 50.9% of cases, mostly under local anesthesia and sedation (96.5%), using mostly the Teflon prosthesis (37.7%). The surgical success rate was 50.88%, there was an 11.4% complication rate. Postoperative hearing gains considered as surgical success were inferior to published results in the literature, done by experienced surgeons.

A model for a career in a specialty of general surgery: One surgeon's opinion.

Science.gov (United States)

Ko, Bona; McHenry, Christopher R

2018-01-01

The integration of general and endocrine surgery was studied as a potential career model for fellowship trained general surgeons. Case logs collected from 1991-2016 and academic milestones were examined for a single general surgeon with a focused interest in endocrine surgery. Operations were categorized using CPT codes and the 2017 ACGME "Major Case Categories" and there frequencies were determined. 10,324 operations were performed on 8209 patients. 412.9 ± 84.9 operations were performed yearly including 279.3 ± 42.7 general and 133.7 ± 65.5 endocrine operations. A high-volume endocrine surgery practice and a rank of tenured professor were achieved by years 11 and 13, respectively. At year 25, the frequency of endocrine operations exceeded general surgery operations. Maintaining a foundation in broad-based general surgery with a specialty focus is a sustainable career model. Residents and fellows can use the model to help plan their careers with realistic expectations. Copyright © 2017. Published by Elsevier Inc.

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

Science.gov (United States)

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

2017-11-01

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. Questionnaires were sent to lead surgeons from all 19 bariatric centers in the Netherlands. At least two residents or fellows were surveyed for each center. Dutch residents are required to collect at least 20 electronic Objective Standard Assessment of Technical Skills (OSATS) observations per year, which include the level of supervision needed for specific procedures. Centers without resident accreditation were excluded. All 19 surgeons responded (100%). Answers from respondents who worked at teaching hospitals with residency accreditation (12/19, 63%) were analyzed. The average number of trained residents or fellows was 14 (range 3-33). Preferred procedures were LRYGB (n = 10), laparoscopic gastric sleeve (LGS) resection (n = 1), or no preference (n = 1). Three groups could be discerned for the order in which procedural steps were trained: unstructured, in order of increasing difficulty, or in order of chronology. Questionnaire response was 79% (19/24) for residents and 73% (8/11) for fellows. On average, residents started training in bariatric surgery in postgraduate year (PGY) 4 (range 0-5). The median number of bariatric procedures performed was 40 for residents (range 0-148) and 220 during fellowships (range 5-306). Training in bariatric surgery differs considerably among centers. A structured program incorporating background knowledge, step-wise technical skills training, and life-long learning should enhance efficient training in bariatric teaching centers without affecting quality or patient safety.

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.

Variability of Arthroscopy Case Volume in Orthopaedic Surgery Residency.

Science.gov (United States)

Gil, Joseph A; Waryasz, Gregory R; Owens, Brett D; Daniels, Alan H

2016-05-01

To examine orthopaedic surgery case logs for arthroscopy case volume during residency training and to evaluate trends in case volume and variability over time. Publicly available Accreditation Council for Graduate Medical Education surgical case logs from 2007 to 2013 for orthopaedic surgery residency were assessed for variability and case volume trends in shoulder, elbow, wrist, hip, knee, and ankle arthroscopy. The national average number of procedures performed in each arthroscopy category reported was directly compared from 2009 to 2013. The 10th and 90th percentile arthroscopy case volume was compared between 2007 and 2013 for shoulder and knee arthroscopy procedures. Subsequently, the difference between the 10th and 90th percentile arthroscopy case volume in each category in 2007 was compared with the difference between the 10th and 90th percentile arthroscopy case volume in each category in 2013. From 2007 to 2013, shoulder arthroscopy procedures performed per resident increased by 43.1% (P = .0001); elbow arthroscopy procedures increased by 28.0% (P = .00612); wrist arthroscopy procedures increased by 8.6% (P = .05); hip arthroscopy procedures, which were first reported in 2012, increased by 588.9%; knee arthroscopy procedures increased by 8.5% (P = .0435); ankle arthroscopy increased by 27.6% (P = .00149). The difference in knee and shoulder arthroscopy volume between residents in the 10th and 90th percentile in 2007 and residents in the 10th and 90th percentile in 2013 was not significant (P > .05). There was a 3.66-fold difference in knee arthroscopy volume between residents in the 10th and 90th percentile in 2007, whereas the difference was 3.36-fold in 2013 (P = .70). There was a 5.86-fold difference in shoulder arthroscopy case volume between residents in the 10th and 90th percentile in 2007, whereas the difference was 4.96-fold in 2013 (P = .29). The volume of arthroscopy cases performed by graduating orthopaedic surgery residents has

Current approaches to journal club by general surgery programs within the Southwestern surgical congress.

Science.gov (United States)

Shifflette, Vanessa; Mitchell, Chris; Mangram, Alicia; Dunn, Ernest

2012-01-01

Journal club (JC) is a well-recognized education tool for many postgraduate medical education programs. Journal club helps residents learn critical analytic skills and keep up to date with current medical practices. To our knowledge, there is minimal evidence in the current literature detailing modern JC practices of general surgery training programs. Our study attempts to define how general surgery residency programs are implementing JC in their training process. We distributed by mail a 14-question survey to general surgery program directors within the Southwestern Surgical Congress. These surveys were redistributed 1 month after the initial attempt. The responses were collected and analyzed. Survey questions aimed to define JC practice characteristics, such as where JC is held, when JC is held, who directs JC, what journals are used, the perceived importance of JC, and average attendance. The surveys were sent to 32 program directors (PDs), which included 26 university and 6 community-based programs. We received responses from 26 (81%) PDs. Ninety-two percent of the programs have a consistent journal club (JC). Most JCs meet monthly (64%) or weekly (16%). The meeting places ranged from conference rooms (60%), faculty homes (20%), restaurants (8%), or in the hospital (12%). The meeting times were divided between morning (29%), midday (29%), and evening (42%). Most JCs lasted between 1 and 2 hours (88%), reviewed 1-4 articles (88%), and are attended by more than 60% of residents routinely (75%). Half of the programs (50%) had 3-4 faculty members present during discussion; 29% of the programs had only 1-2 faculty present. The articles were selected from more than 10 different journals. Seventy-five percent of the programs used the American Journal of Surgery and Annals of Surgery to find articles; only 13% of the programs used evidence-based reviews in surgery. PDs believe JC is very beneficial (42%), moderately beneficial (42%), or only fairly beneficial (16

The pregnant female surgical resident

Directory of Open Access Journals (Sweden)

Shifflette V

2018-05-01

Full Text Available Vanessa Shifflette,1 Susannah Hambright,2 Joseph Darryl Amos,1 Ernest Dunn,3 Maria Allo4 1Associates in Surgical Acute Care, Methodist Dallas Medical Center, Dallas, TX, USA; 2Methodist Surgical Associates, Methodist Dallas Medical Center, Dallas, TX, USA; 3Graduate Medical Education - General Surgery, Methodist Dallas Medical Center, Dallas, TX, USA; 4Santa Clara Valley Medical Center, San Jose, CA, USA Background: Surgery continues to be an intense, time-consuming residency. Many medical students decide against surgery as a profession due to the long work hours and family strain. The pregnant female surgical resident has an added stress factor compared to her male counterpart. Methods: We distributed an electronic, online 26-question survey to 32 general surgery programs in the southwestern region of the United States. Each program distributed our survey to the female surgical residents who had been pregnant during residency in the last 5 years. Each program was re-contacted 6 weeks after the initial contact. Most questions were in a 5-point Likert scale format. The responses were collected and analyzed using the Survey Monkey website. Results: An unvalidated survey was sent to 32 general surgery programs and 26 programs responded (81%. Each program was asked for the total number of possible responses from female residents that met our criteria (60 female residents. Seven of the programs (27% stated that they have had zero residents pregnant. We had 22 residents respond (37%. Over half of the residents (55% were pregnant during their 2nd or 3rd year of residency, with only 18% pregnant during a research year. Thirty-one percent had a lower American Board of Surgery In-Training Exam (ABSITE score. Ninety percent of the residents were able to take 4 weeks or more for maternity leave. Most of the residents (95% stated that they would do this again during residency given the opportunity, but many of the residents felt that returning back to work

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

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.

GENERAL SURGERY

African Journals Online (AJOL)

in the endoscopy room. GENERAL SURGERY. T du Toit, O C Buchel, S J A Smit. Department of Surgery, University of the Free State, Bloemfontein, ... The lack of video instrumentation in developing countries: Redundant fibre-optic instruments (the old. “eye scope”) are still being used. This instrument brings endoscopists ...

Navigating the pathway to robotic competency in general thoracic surgery.

Science.gov (United States)

Seder, Christopher W; Cassivi, Stephen D; Wigle, Dennis A

2013-01-01

Although robotic technology has addressed many of the limitations of traditional videoscopic surgery, robotic surgery has not gained widespread acceptance in the general thoracic community. We report our initial robotic surgery experience and propose a structured, competency-based pathway for the development of robotic skills. Between December 2008 and February 2012, a total of 79 robot-assisted pulmonary, mediastinal, benign esophageal, or diaphragmatic procedures were performed. Data on patient characteristics and perioperative outcomes were retrospectively collected and analyzed. During the study period, one surgeon and three residents participated in a triphasic, competency-based pathway designed to teach robotic skills. The pathway consisted of individual preclinical learning followed by mentored preclinical exercises and progressive clinical responsibility. The robot-assisted procedures performed included lung resection (n = 38), mediastinal mass resection (n = 19), hiatal or paraesophageal hernia repair (n = 12), and Heller myotomy (n = 7), among others (n = 3). There were no perioperative mortalities, with a 20% complication rate and a 3% readmission rate. Conversion to a thoracoscopic or open approach was required in eight pulmonary resections to facilitate dissection (six) or to control hemorrhage (two). Fewer major perioperative complications were observed in the later half of the experience. All residents who participated in the thoracic surgery robotic pathway perform robot-assisted procedures as part of their clinical practice. Robot-assisted thoracic surgery can be safely learned when skill acquisition is guided by a structured, competency-based pathway.

Training surgical residents for a career in academic global surgery: a novel training model.

Science.gov (United States)

Swain, JaBaris D; Matousek, Alexi C; Scott, John W; Cooper, Zara; Smink, Douglas S; Bolman, Ralph Morton; Finlayson, Samuel R G; Zinner, Michael J; Riviello, Robert

2015-01-01

Academic global surgery is a nascent field focused on improving surgical care in resource-poor settings through a broad-based scholarship agenda. Although there is increasing momentum to expand training opportunities in low-resource settings among academic surgical programs, most focus solely on establishing short-term elective rotations rather than fostering research or career development. Given the complex nature of surgical care delivery and programmatic capacity building in the resource-poor settings, many challenges remain before global surgery is accepted as an academic discipline and an established career path. Brigham and Women's Hospital has established a specialized global surgery track within the general surgery residency program to develop academic leaders in this growing area of need and opportunity. Here we describe our experience with the design and development of the program followed by practical applications and lessons learned from our early experiences. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Barriers to advancement in academic surgery: views of senior residents and early career faculty.

Science.gov (United States)

Cochran, Amalia; Elder, William B; Crandall, Marie; Brasel, Karen; Hauschild, Tricia; Neumayer, Leigh

2013-11-01

A significant faculty attrition rate exists in academic surgery. The authors hypothesized that senior residents and early-career faculty members have different perceptions of advancement barriers in academic surgery. A modified version of the Career Barriers Inventory-Revised was administered electronically to surgical residents and early-career surgical faculty members at 8 academic medical centers. Residents identified a lack of mentorship as a career barrier about half as often as faculty members. Residents were twice as likely as faculty members to view childbearing as a career barrier. Many early-career faculty members cite a lack of mentors as a limitation to their career development in academic surgery. Childbearing remains a complex perceived influence for female faculty members in particular. Female faculty members commonly perceive differential treatment and barriers on the basis of their sex. Faculty development programs should address both systemic and sex-specific obstacles if academic surgery is to remain a vibrant field. Copyright © 2013 Elsevier Inc. All rights reserved.

Laparoscopic pyloromyotomy: effect of resident training on complications.

Science.gov (United States)

Haricharan, Ramanath N; Aprahamian, Charles J; Celik, Ahmet; Harmon, Carroll M; Georgeson, Keith E; Barnhart, Douglas C

2008-01-01

The purpose of this study was to characterize the safety of laparoscopic pyloromyotomy and examine the effect of resident training on the occurrence of complications. Five hundred consecutive infants who underwent laparoscopic pyloromyotomy between January 1997 and December 2005 were reviewed and analyzed. Laparoscopic pyloromyotomy was successfully completed in 489 patients (97.8%). Four hundred seventeen patients were boys (83%). Intraoperative complication occurred in 8 (1.6%) patients (mucosal perforation, 7; serosal injury to the duodenum, 1). All were immediately recognized and uneventfully repaired. Six patients (1.2%) required revision pyloromyotomy for persistent or recurrent gastric outlet obstruction. There were 7 wound complications (1.4%) and no deaths. Pediatric surgery residents performed 81% of the operations, whereas 16% were done by general surgery residents (postgraduate years 3-4). There was a 5.4-fold increased risk of mucosal perforation or incomplete pyloromyotomy when a general surgery resident rather than a pediatric surgery resident performed the operation (95% confidence interval, 1.8-15.8; P = .003). These effects persisted even after controlling for weight, age, and attending experience. The laparoscopic pyloromyotomy has an excellent success rate with low morbidity. The occurrence of complications is increased when the operation is performed by a general surgery resident, even when directly supervised by pediatric surgical faculty.

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

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

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 residents (post-graduate year 3 and beyond reported being able to perform simple procedures such as circumcision and transurethral resections but not complex procedures such as radical and laparoscopic procedures. A total of 41% of non-junior residents practice at a urology clinic. A total of 62% of residents from centers with no robotics replied its absence harmed their training, and 85% replied they would benefit from a robotics rotation. A total of 61% of residents from centers with robotics replied its presence harmed their training, and 72% replied they would benefit from an open surgery rotation. A total of 82% of the residents participated in post-graduate courses, and 81% replied they would engage in a clinical fellowship. Conclusion Given the survey results we propose some changes to be considered in the residency program. These include changes in the general surgery rotation and exam, better surgical training, possible exchange rotations to expose residents to robotic and open surgery (depending on the availability of robotics in their center, greater out-patient urology clinic exposure, and possible changes in the basic science

Vascular Trauma Operative Experience is Inadequate in General Surgery Programs.

Science.gov (United States)

Yan, Huan; Maximus, Steven; Koopmann, Matthew; Keeley, Jessica; Smith, Brian; Virgilio, Christian de; Kim, Dennis Y

2016-05-01

Vascular injuries may be challenging, particularly for surgeons who have not received formal vascular surgery fellowship training. Lack of experience and improper technique can result in significant complications. The objective of this study was to examine changes in resident experience with operative vascular trauma over time. A retrospective review was performed using Accreditation Council for Graduate Medical Education (ACGME) case logs of general surgery residents graduating between 2004 and 2014 at 2 academic, university-affiliated institutions associated with level 1 trauma centers. The primary outcome was number of reported vascular trauma operations, stratified by year of graduation and institution. A total of 112 residents graduated in the study period with a median 7 (interquartile range 4.5-13.5) vascular trauma cases per resident. Fasciotomy and exposure and/or repair of peripheral vessels constituted the bulk of the operative volume. Linear regression showed no significant trend in cases with respect to year of graduation (P = 0.266). Residents from program A (n = 53) reported a significantly higher number of vascular trauma cases when compared with program B (n = 59): 12.0 vs. 5.0 cases, respectively (P < 0.001). Level 1 trauma center verification does not guarantee sufficient exposure to vascular trauma. The operative exposure in program B is reflective of the national average of 4.0 cases per resident as reported by the ACGME, and this trend is unlikely to change in the near future. Fellowship training may be critical for surgeons who plan to work in a trauma setting, particularly in areas lacking vascular surgeons. Copyright © 2016 Elsevier Inc. All rights reserved.

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

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.

General surgery 2.0: the emergence of acute care surgery in Canada

Science.gov (United States)

Hameed, S. Morad; Brenneman, Frederick D.; Ball, Chad G.; Pagliarello, Joe; Razek, Tarek; Parry, Neil; Widder, Sandy; Minor, Sam; Buczkowski, Andrzej; MacPherson, Cailan; Johner, Amanda; Jenkin, Dan; Wood, Leanne; McLoughlin, Karen; Anderson, Ian; Davey, Doug; Zabolotny, Brent; Saadia, Roger; Bracken, John; Nathens, Avery; Ahmed, Najma; Panton, Ormond; Warnock, Garth L.

2010-01-01

Over the past 5 years, there has been a groundswell of support in Canada for the development of organized, focused and multidisciplinary approaches to caring for acutely ill general surgical patients. Newly forged acute care surgery (ACS) services are beginning to provide prompt, evidence-based and goal-directed care to acutely ill general surgical patients who often present with a diverse range of complex pathologies and little or no pre- or postoperative planning. Through a team-based structure with attention to processes of care and information sharing, ACS services are well positioned to improve outcomes, while finding and developing efficiencies and reducing costs of surgical and emergency health care delivery. The ACS model also offers enhanced opportunities for surgical education for students, residents and practicing surgeons, and it will provide avenues to strengthen clinical and academic bonds between the community and academic surgical centres. In the near future, cooperation of ACS services from community and academic hospitals across the country will lead to the formation of systems of acute surgical care whose development will be informed by rigorous data collection and research and evidence-based quality-improvement initiatives. In an era of increasing subspecialization, ACS is a strong unifying force in general surgery and a platform for collective advocacy for an important patient population. PMID:20334738

Association Between American Board of Surgery In-Training Examination Scores and Resident Performance.

Science.gov (United States)

Ray, Juliet J; Sznol, Joshua A; Teisch, Laura F; Meizoso, Jonathan P; Allen, Casey J; Namias, Nicholas; Pizano, Louis R; Sleeman, Danny; Spector, Seth A; Schulman, Carl I

2016-01-01

The American Board of Surgery In-Training Examination (ABSITE) is designed to measure progress, applied medical knowledge, and clinical management; results may determine promotion and fellowship candidacy for general surgery residents. Evaluations are mandated by the Accreditation Council for Graduate Medical Education but are administered at the discretion of individual institutions and are not standardized. It is unclear whether the ABSITE and evaluations form a reasonable assessment of resident performance. To determine whether favorable evaluations are associated with ABSITE performance. Cross-sectional analysis of preliminary and categorical residents in postgraduate years (PGYs) 1 through 5 training in a single university-based general surgery program from July 1, 2011, through June 30, 2014, who took the ABSITE. Evaluation overall performance and subset evaluation performance in the following categories: patient care, technical skills, problem-based learning, interpersonal and communication skills, professionalism, systems-based practice, and medical knowledge. Passing the ABSITE (≥30th percentile) and ranking in the top 30% of scores at our institution. The study population comprised residents in PGY 1 (n = 44), PGY 2 (n = 31), PGY 3 (n = 26), PGY 4 (n = 25), and PGY 5 (n = 24) during the 4-year study period (N = 150). Evaluations had less variation than the ABSITE percentile (SD = 5.06 vs 28.82, respectively). Neither annual nor subset evaluation scores were significantly associated with passing the ABSITE (n = 102; for annual evaluation, odds ratio = 0.949; 95% CI, 0.884-1.019; P = .15) or receiving a top 30% score (n = 45; for annual evaluation, odds ratio = 1.036; 95% CI, 0.964-1.113; P = .33). There was no difference in mean evaluation score between those who passed vs failed the ABSITE (mean [SD] evaluation score, 91.77 [5.10] vs 93.04 [4.80], respectively; P = .14) or between those who

The evolution of robotic general surgery.

Science.gov (United States)

Wilson, E B

2009-01-01

Surgical robotics in general surgery has a relatively short but very interesting evolution. Just as minimally invasive and laparoscopic techniques have radically changed general surgery and fractionated it into subspecialization, robotic technology is likely to repeat the process of fractionation even further. Though it appears that robotics is growing more quickly in other specialties, the changes digital platforms are causing in the general surgical arena are likely to permanently alter general surgery. This review examines the evolution of robotics in minimally invasive general surgery looking forward to a time where robotics platforms will be fundamental to elective general surgery. Learning curves and adoption techniques are explored. Foregut, hepatobiliary, endocrine, colorectal, and bariatric surgery will be examined as growth areas for robotics, as well as revealing the current uses of this technology.

Template for success: using a resident-designed sign-out template in the handover of patient care.

Science.gov (United States)

Clark, Clancy J; Sindell, Sarah L; Koehler, Richard P

2011-01-01

Report our implementation of a standardized handover process in a general surgery residency program. The standardized handover process, sign-out template, method of implementation, and continuous quality improvement process were designed by general surgery residents with support of faculty and senior hospital administration using standard work principles and business models of the Virginia Mason Production System and the Toyota Production System. Nonprofit, tertiary referral teaching hospital. General surgery residents, residency faculty, patient care providers, and hospital administration. After instruction in quality improvement initiatives, a team of general surgery residents designed a sign-out process using an electronic template and standard procedures. The initial implementation phase resulted in 73% compliance. Using resident-driven continuous quality improvement processes, real-time feedback enabled residents to modify and improve this process, eventually attaining 100% compliance and acceptance by residents. The creation of a standardized template and protocol for patient handovers might eliminate communication failures. Encouraging residents to participate in this process can establish the groundwork for successful implementation of a standardized handover process. Integrating a continuous quality-improvement process into such an initiative can promote active participation of busy general surgery residents and lead to successful implementation of standard procedures. Copyright © 2011 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

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.

The effect of the Accreditation Council for Graduate Medical Education Duty Hours Policy on plastic surgery resident education and patient care: an outcomes study.

Science.gov (United States)

Basu, Chandrasekhar Bob; Chen, Li-Mei; Hollier, Larry H; Shenaq, Saleh M

2004-12-01

deviation, the highest levels of consensus among the residents were found in positive statements addressing resident alertness (both in and out of the operative environment), time to read/prepare for cases/conferences, efficacy of the didactic curriculum, and overall satisfaction with this policy for surgery resident education. Residents also felt that their patients favored this work hours policy. In addition, there was high consensus that this policy improved overall patient care. The majority of residents identified a negative effect of this policy through an increase in cross-coverage responsibilities, however, and half of the residents perceived that faculty negatively viewed their unavailability postcall. In addition, no consensus among the residents was achieved regarding perceptions on overall weekly operative experience. Plastic surgery residents perceived that the reduction of resident work hours through adherence to the ACGME guidelines has beneficial effects on patient care and clinical/operative duties, academic duties, and resident quality of life. Residents felt, however, that these benefits may increase cross-coverage workloads. Furthermore, residents were concerned about faculty perception of their changes in postcall duties. In contrast to previously published findings in the general surgery literature, the current results indicate that residents do not believe that this policy negatively affects continuity of patient care. In fact, the current findings suggest that adherence to this policy improves patient care on multiple levels. The effect on the operative experience remains to be elucidated. Further large-scale and longitudinal research design and analysis is warranted to better assess the results of the ACGME resident duty work-hours policy in plastic surgery resident education.

Building a Sustainable Global Surgical Program in an Academic Department of Surgery.

Science.gov (United States)

Zhang, Linda P; Silverberg, Daniel; Divino, Celia M; Marin, Michael

Global surgery and volunteerism in surgery has gained significant interest in recent years for general surgery residents across the country. However, there are few well-established long-term surgical programs affiliated with academic institutions. The present report discusses the implementation process and challenges facing an academic institution in building a long-term sustainable global surgery program. As one of the pioneer programs in global surgery for residents, the Icahn School of Medicine at Mount Sinai global surgery rotation has been successfully running for the last 10 years in a small public hospital in the Dominican Republic. The present report details many key components of implementing a sustainable global surgery program and the evolution of this program over time. Since 2005, 80 general surgery residents have rotated through Juan Pablo Pina Hospital in the Dominican Republic. They have performed a total of 1239 major operations and 740 minor operations. They have also participated in 328 emergency cases. More importantly, this rotation helped shape residents' sense of social responsibility and ownership in their surgical training. Residents have also contributed to the training of local residents in laparoscopic skills and through cultural exchange. As interest in global surgery grows among general surgery residents, it is essential that supporting academic institutions create sustainable and capacity-building rotations for their residents. These programs must address many of the barriers that can hinder maintenance of a sustainable global surgery experience for residents. After 10 years of sending our residents to the Dominican Republic, we have found that it is possible and valuable to incorporate a formal global surgery rotation into a general surgery residency. Copyright © 2016. Published by Elsevier Inc.

Balancing Privacy and Professionalism: A Survey of General Surgery Program Directors on Social Media and Surgical Education.

Science.gov (United States)

Langenfeld, Sean J; Vargo, Daniel J; Schenarts, Paul J

Unprofessional behavior is common among surgical residents and faculty surgeons on Facebook. Usage of social media outlets such as Facebook and Twitter is growing at exponential rates, so it is imperative that surgery program directors (PDs) focus on professionalism within social media, and develop guidelines for their trainees and surgical colleagues. Our study focuses on the surgery PDs current approach to online professionalism within surgical education. An online survey of general surgery PDs was conducted in October 2015 through the Association for Program Directors in Surgery listserv. Baseline PD demographics, usage and approach to popular social media outlets, existing institutional policies, and formal curricula were assessed. A total of 110 PDs responded to the survey (110/259, 42.5% response rate). Social media usage was high among PDs (Facebook 68% and Twitter 40%). PDs frequently viewed the social media profiles of students, residents, and faculty. Overall, 11% of PDs reported lowering the rank or completely removing a residency applicant from the rank order list because of online behavior, and 10% reported formal disciplinary action against a surgical resident because of online behavior. Overall, 68% of respondents agreed that online professionalism is important, and that residents should receive instruction on the safe use of social media. However, most programs did not have formal didactics or known institutional policies in place. Use of social media is high among PDs, and they often view the online behavior of residency applicants, surgical residents, and faculty surgeons. Within surgical education, there needs to be an increased focus on institutional policies and standardized curricula to help educate physicians on social media and online professionalism. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Teaching Forensic Psychiatry to General Psychiatry Residents

Science.gov (United States)

Lewis, Catherine F.

2004-01-01

Objective: The Accreditation Council on Graduate Medical Education (ACGME) requires that general psychiatry residency training programs provide trainees with exposure to forensic psychiatry. Limited information is available on how to develop a core curriculum in forensic psychiatry for general psychiatry residents and few articles have been…

Surgical specialty procedures in rural surgery practices: implications for rural surgery training.

Science.gov (United States)

Sticca, Robert P; Mullin, Brady C; Harris, Joel D; Hosford, Clint C

2012-12-01

Specialty procedures constitute one eighth of rural surgery practice. Currently, general surgeons intending to practice in rural hospitals may not get adequate training for specialty procedures, which they will be expected to perform. Better definition of these procedures will help guide rural surgery training. Current Procedural Terminology codes for all surgical procedures for 81% of North Dakota and South Dakota rural surgeons were entered into the Dakota Database for Rural Surgery. Specialty procedures were analyzed and compared with the Surgical Council on Resident Education curriculum to determine whether general surgery training is adequate preparation for rural surgery practice. The Dakota Database for Rural Surgery included 46,052 procedures, of which 5,666 (12.3%) were specialty procedures. Highest volume specialty categories included vascular, obstetrics and gynecology, orthopedics, cardiothoracic, urology, and otolaryngology. Common procedures in cardiothoracic and vascular surgery are taught in general surgical residency, while common procedures in obstetrics and gynecology, orthopedics, urology, and otolaryngology are usually not taught in general surgery training. Optimal training for rural surgery practice should include experience in specialty procedures in obstetrics and gynecology, orthopedics, urology, and otolaryngology. Copyright © 2012 Elsevier Inc. All rights reserved.

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.

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.

[Residency in plastic surgery: comparison between the French and the Canadian Royal College programs].

Science.gov (United States)

Sinna, R; Harris, P G; Danino, A M

2010-02-01

Learning plastic surgery in Montreal is different from learning plastic surgery in a French university. In Canada, all residency programs are accredited by a national structure: the Royal College of Physicians and Surgeons. We tried to highlight the differences that exist between the French and a North American academic system. With the different rules and law that governs academic education in both countries, we analyzed the following elements: the residency selection, the program of plastic surgery (content and organisation), the system of evaluation and the diplomas. The training of a Canadian plastic surgeon is very controlled. The recommendations of the Royal College guarantee to the resident who enters a program to have the means to acquire a complete training in quantity and in quality. On the four studied items, none is completely similar between both countries. Each having advantages and inconveniences as, for example, the selection of residency by interview or by the classifying national exam. Actually, few French plastic surgery programs could satisfy the requirements of the Royal College on several points, however without failing the training of French plastic surgeons. Nevertheless, we could be inspired by several elements (rotation in private practice,grouping together several academic hospitals. . .) to improve our system of training.

Welcome to cultural competency: surgery's efforts to acknowledge diversity in residency training.

Science.gov (United States)

Ly, Catherine L; Chun, Maria B J

2013-01-01

Although cultural competency is not a new concept in healthcare, it has only recently been formally embraced as important in the field of surgery. All physicians, including and especially surgeons, must acknowledge the potential influence of culture in order to provide effective and equitable care for patients of all backgrounds. The Accreditation Council for Graduate Medical Education (ACGME) recognizes cultural competency as a component of "patient care," "professionalism," and "interpersonal and communication skills." A systematic literature search was conducted using the MEDLINE, EBSCOhost, Web of Science, and Google Scholar databases. All publications focusing on surgical residents and the assessment of patient care, professionalism, interpersonal and communication skills, or specifically cultural competency and/or were considered. This initial search resulted in 12 articles. To further refine the review, publications discussing curricula in residencies other than surgery, the assessment of technical, or clinical skills and/or without any explicit focus on cultural competency were excluded. Based on the specified inclusion and exclusion criteria, 5 articles were selected. These studies utilized various methods to improve surgical residents' cultural competency, including lectures, Objective Structural Clinical Examinations (OSCE), and written exercises and evaluations. A number of surgical residency programs have made promising strides in training culturally competent surgeons. Ultimately, in order to maximize our collective efforts to improve the quality of health care, the development of cultural competency curricula must be made a priority and such training should be a requirement for all trainees in surgical residency programs. Copyright © 2013 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Choosing academia versus private practice: factors affecting oral maxillofacial surgery residents' career choices.

Science.gov (United States)

Lanzon, Jesse; Edwards, Sean P; Inglehart, Marita R

2012-07-01

This study explored how residents who intend to enter private practice versus academic careers differ in their background and educational characteristics, engagement in different professional activities, professional values, and satisfaction. Survey data were collected from 257 residents in oral and maxillofacial surgery programs in the United States. The responses of the respondents who planned a career in private practice (65%) and who considered academia (35%) were compared with χ(2) and independent-sample t tests. Residents who considered academia were more likely to be women (29% vs 8%; P career compared with residents interested in private practice. Future clinicians placed a higher value on having manageable hours and more time performing outpatient procedures than future educators. These findings showed, first, that the characteristics at the beginning of residency programs that are likely to indicate an increased interest in academic careers are being a woman, from a non-European American background, and having an interest in research. Second, once residents are admitted, different types of surgeries and different types of professional activities tend to appeal to residents who want to practice in private practice settings versus work in academia. Third, residents interested in academia have a relatively lower level of satisfaction compared with residents interested in practicing outside of academia. Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Attrition from surgical residency training: perspectives from those who left.

Science.gov (United States)

Bongiovanni, Tasce; Yeo, Heather; Sosa, Julie A; Yoo, Peter S; Long, Theodore; Rosenthal, Marjorie; Berg, David; Curry, Leslie; Nunez-Smith, Marcella

2015-10-01

High rates of attrition from general surgery residency may threaten the surgical workforce. We sought to gain further insight regarding resident motivations for leaving general surgery residency. We conducted in-depth interviews to generate rich narrative data that explored individual experiences. An interdisciplinary team used the constant comparative method to analyze the data. Four themes characterized experiences of our 19 interviewees who left their residency program. Participants (1) felt an informal contract was breached when clinical duties were prioritized over education, (2) characterized a culture in which there was no safe space to share personal and programmatic concerns, (3) expressed a scarcity of role models who demonstrated better work-life balance, and (4) reported negative interactions with authority resulting in a profound loss of commitment. As general surgery graduate education continues to evolve, our findings may inform interventions and policies regarding programmatic changes to boost retention in surgical residency. Copyright © 2015 Elsevier Inc. All rights reserved.

Local and national trends in general surgery residents' operative experience: do work hour limitations negatively affect case volume in small community-based programs?

Science.gov (United States)

Markelov, Alexey; Sakharpe, Aniket; Kohli, Harjeet; Livert, David

2011-12-01

The goals of this study were to analyze the impact of work hour restrictions on the operative case volume at a small community-based general surgery residency training program and compare changes with the national level. Annual national resident case log data from Accreditation Council for Graduate Medical Education (ACGME) website and case logs of graduating Easton Hospital residents (years 2002-2009) were used for analysis. Weighted average change in total number of cases in our institution was -1.20 (P = 0.52) vs 1.78 (P = 0.07) for the national program average with statistically significant difference on comparison (P = 0.027). We also found significant difference in case volume changes at the national level compared with our institution for the following ACGME defined subcategories: alimentary tract [8.19 (P < 0.01) vs -1.08 (P = 0.54)], abdomen [8.48 (P < 0.01) vs -6.29 (P < 0.01)], breast [1.91 (P = 0.89) vs -3.6 (P = 0.02)], and vascular [4.03 (P = 0.02) vs -3.98 (P = 0.01)]. Comparing the national trend to the community hospital we see that there is total increase in cases at the national level whereas there is a decrease in case volume at the community hospital. These trends can also be followed in ACGME defined subcategories which form the major case load for a general surgical training such as alimentary tract, abdominal, breast, and vascular procedures. We hypothesize that work hour restrictions have been favorable for the larger programs, as these programs were able to better integrate the night float system, restructure their call schedule, and implement institutional modifications which are too resource demanding for smaller training programs.

A systematic approach to developing a global surgery elective.

Science.gov (United States)

Hoehn, Richard S; Davis, Bradley R; Huber, Nathan L; Edwards, Michael J; Lungu, Douglas; Logan, Jocelyn M

2015-01-01

Interest in global health has been increasing for years among American residents and medical students. Many residency programs have developed global health tracks or electives in response to this need. Our goal was to create a global surgery elective based on a synergistic partnership between our institution and a hospital in the developing world. We created a business plan and 1-year schedule for researching potential sites and completing a pilot rotation at our selected hospital. We administered a survey to general surgery residents at the University of Cincinnati and visited medical facilities in Sierra Leone, Cameroon, and Malawi. The survey was given to all general surgery residents. A resident and a faculty member executed the fact-finding trip as well as the pilot rotation. Our general surgery residents view an international elective as integral to residency training and would participate in such an elective. After investigating 6 hospitals in sub-Saharan Africa, we conducted a pilot rotation at our selected hospital and gained the necessary information to organize a curriculum. We will begin sending senior residents for 8-week rotations in the coming academic year. By systematically approaching the process of creating a global surgery elective, we were able to gain considerable insight into choosing a location and organizing the elective. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Comparison of private versus academic practice for general surgeons: a guide for medical students and residents.

Science.gov (United States)

Schroen, Anneke T; Brownstein, Michelle R; Sheldon, George F

2003-12-01

Medical students and residents often make specialty and practice choices with limited exposure to aspects of professional and personal life in general surgery. The purpose of this study was to portray practice composition, career choices, professional experiences, job satisfaction, and personal life characteristics specific to practicing general surgeons in the United States. A 131-question survey was mailed to all female members (n = 1,076) and a random 2:1 sample of male members (n = 2,152) of the American College of Surgeons in three mailings between September 1998 and March 1999. Respondents who were not actively practicing general surgery in the United States and both trainees and surgeons who did not fit the definition of private or academic practice were excluded. Detailed questions regarding practice attributes, surgical training, professional choices, harassment, malpractice, career satisfaction, and personal life characteristics were included. Separate five-point Likert scales were designed to measure influences on career choices and satisfaction with professional and personal matters. Univariate analyses were used to analyze responses by surgeon age, gender, and practice type. A response rate of 57% resulted in 1,532 eligible responses. Significant differences between private and academic practice were noted in case composition, practice structure, and income potential; no major differences were seen in malpractice experience. Propensity for marriage and parenthood differed significantly between men and women surgeons. Overall career satisfaction was very high regardless of practice type. Some differences by surgeon gender in perceptions of equal career advancement opportunities and of professional isolation were noted. This study offers a comprehensive view of general surgery to enable more informed decisions among medical students and residents regarding specialty choice or practice opportunities.

Structured assessment format for evaluating operative reports in general surgery.

Science.gov (United States)

Vergis, Ashley; Gillman, Lawrence; Minor, Samuel; Taylor, Mark; Park, Jason

2008-01-01

Despite its multifaceted importance, no validated or reliable tools assess the quality of the dictated operative note. This study determined the construct validity, interrater reliability, and internal consistency of a Structured Assessment Format for Evaluating Operative Reports (SAFE-OR) in general surgery. SAFE-OR was developed by using consensus criteria set forth by the Canadian Association of General Surgeons. This instrument includes a structured assessment and a global quality rating scale. Residents divided into novice and experienced groups viewed and dictated a videotaped laparoscopic sigmoid colectomy. Blinded, independent faculty evaluators graded the transcribed reports using SAFE-OR. Twenty-one residents participated in the study. Mean structured assessment scores (out of 44) were significantly lower for novice versus experienced residents (23.3 +/- 5.2 vs 34.1 +/- 6.0, t = .001). Mean global quality scores (out of 45) were similarly lower for novice residents (25.6 +/- 4.7 vs 35.9 +/- 7.6, t = .006). Interclass correlation coefficients were .98 (95% confidence interval, .96-.99) for structured assessment and .93 (95% confidence interval, .83-.97) for global quality scales. Cronbach alpha coefficients for internal consistency were .85 for structured assessment and .96 for global quality assessment scales. SAFE-OR shows significant construct validity, excellent interrater reliability, and high internal consistency. This tool will allow educators to objectively evaluate the quality of trainee operative reports and provide a mechanism for implementing, monitoring, and refining curriculum for dictation skills.

GENERAL SURGERY

African Journals Online (AJOL)

Department of Surgery, University of Cape Town Health Sciences Faculty, Groote Schuur Hospital, Observatory, Cape Town,. South Africa ... included all district, regional and tertiary hospitals in the nine provinces. Clinics and so-called ..... large contingency of senior general surgeons from countries such as Cuba, who have ...

Characterizing the Relationship Between Surgical Resident and Faculty Perceptions of Autonomy in the Operating Room.

Science.gov (United States)

Young, Katelyn A; Lane, Samantha M; Widger, John E; Neuhaus, Nina M; Dove, James T; Fluck, Marcus; Hunsinger, Marie A; Blansfield, Joseph A; Shabahang, Mohsen M

Characterize the concordance among faculty and resident perceptions of surgical case complexity, resident technical performance, and autonomy in a diverse sample of general surgery procedures using case-specific evaluations. A prospective study was conducted in which a faculty surgeon and surgical resident independently completed a postoperative assessment examining case complexity, resident operative performance (Milestone assessment) and autonomy (Zwisch model). Pearson correlation coefficients (r) reaching statistical significance (p autonomy demonstrated a moderate correlation (r = 0.56, p autonomy and operative performance, respectively. General surgery residents generally demonstrated high correlations with faculty perceptions of case complexity, technical performance, and operative autonomy. This generalized accord supports the use of the Milestone and Zwisch assessments in residency programs. However, discordance among perceptions of midlevel resident autonomy and chief resident operative performance suggests that these trainees may need more direct communication from the faculty. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Does resident ranking during recruitment accurately predict subsequent performance as a surgical resident?

Science.gov (United States)

Fryer, Jonathan P; Corcoran, Noreen; George, Brian; Wang, Ed; Darosa, Debra

2012-01-01

While the primary goal of ranking applicants for surgical residency training positions is to identify the candidates who will subsequently perform best as surgical residents, the effectiveness of the ranking process has not been adequately studied. We evaluated our general surgery resident recruitment process between 2001 and 2011 inclusive, to determine if our recruitment ranking parameters effectively predicted subsequent resident performance. We identified 3 candidate ranking parameters (United States Medical Licensing Examination [USMLE] Step 1 score, unadjusted ranking score [URS], and final adjusted ranking [FAR]), and 4 resident performance parameters (American Board of Surgery In-Training Examination [ABSITE] score, PGY1 resident evaluation grade [REG], overall REG, and independent faculty rating ranking [IFRR]), and assessed whether the former were predictive of the latter. Analyses utilized Spearman correlation coefficient. We found that the URS, which is based on objective and criterion based parameters, was a better predictor of subsequent performance than the FAR, which is a modification of the URS based on subsequent determinations of the resident selection committee. USMLE score was a reliable predictor of ABSITE scores only. However, when we compared our worst residence performances with the performances of the other residents in this evaluation, the data did not produce convincing evidence that poor resident performances could be reliably predicted by any of the recruitment ranking parameters. Finally, stratifying candidates based on their rank range did not effectively define a ranking cut-off beyond which resident performance would drop off. Based on these findings, we recommend surgery programs may be better served by utilizing a more structured resident ranking process and that subsequent adjustments to the rank list generated by this process should be undertaken with caution. Copyright © 2012 Association of Program Directors in Surgery

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

Can Future Academic Surgeons be Identified in the Residency Ranking Process?

Science.gov (United States)

Beninato, Toni; Kleiman, David A; Zarnegar, Rasa; Fahey, Thomas J

2016-01-01

The goal of surgical residency training programs is to train competent surgeons. Academic surgical training programs also have as a mission training future academicians-surgical scientists, teachers, and leaders. However, selection of surgical residents is dependent on a relatively unscientific process. Here we sought to determine how well the residency selection process is able to identify future academicians in surgery. Rank lists from an academic surgical residency program from 1992 to 1997 were examined. All ranked candidates׳ career paths after residency were reviewed to determine whether they stayed in academics, were university affiliated, or in private practice. The study was performed at New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY. A total of 663 applicants for general surgery residency participated in this study. In total 6 rank lists were evaluated, which included 663 candidates. Overall 76% remained in a general surgery subspecialty. Of those who remained in general surgery, 49% were in private practice, 20% were university affiliated, and 31% had academic careers. Approximately 47% of candidates that were ranked in the top 20 had ≥20 publications, with decreasing percentages as rank number increased. There was a strong correlation between the candidates׳ rank position and pursuing an academic career (p career. The residency selection process can identify candidates likely to be future academicians. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

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 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. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Utility of 3D Reconstruction of 2D Liver Computed Tomography/Magnetic Resonance Images as a Surgical Planning Tool for Residents in Liver Resection Surgery.

Science.gov (United States)

Yeo, Caitlin T; MacDonald, Andrew; Ungi, Tamas; Lasso, Andras; Jalink, Diederick; Zevin, Boris; Fichtinger, Gabor; Nanji, Sulaiman

A fundamental aspect of surgical planning in liver resections is the identification of key vessel tributaries to preserve healthy liver tissue while fully resecting the tumor(s). Current surgical planning relies primarily on the surgeon's ability to mentally reconstruct 2D computed tomography/magnetic resonance (CT/MR) images into 3D and plan resection margins. This creates significant cognitive load, especially for trainees, as it relies on image interpretation, anatomical and surgical knowledge, experience, and spatial sense. The purpose of this study is to determine if 3D reconstruction of preoperative CT/MR images will assist resident-level trainees in making appropriate operative plans for liver resection surgery. Ten preoperative patient CT/MR images were selected. Images were case-matched, 5 to 2D planning and 5 to 3D planning. Images from the 3D group were segmented to create interactive digital models that the resident can manipulate to view the tumor(s) in relation to landmark hepatic structures. Residents were asked to evaluate the images and devise a surgical resection plan for each image. The resident alternated between 2D and 3D planning, in a randomly generated order. The primary outcome was the accuracy of resident's plan compared to expert opinion. Time to devise each surgical plan was the secondary outcome. Residents completed a prestudy and poststudy questionnaire regarding their experience with liver surgery and the 3D planning software. Senior level surgical residents from the Queen's University General Surgery residency program were recruited to participate. A total of 14 residents participated in the study. The median correct response rate was 2 of 5 (40%; range: 0-4) for the 2D group, and 3 of 5 (60%; range: 1-5) for the 3D group (p surgery planning increases accuracy of resident surgical planning and decreases amount of time required. 3D reconstruction would be a useful model for improving trainee understanding of liver anatomy and surgical

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 ...

The electronic residency application service application can predict accreditation council for graduate medical education competency-based surgical resident performance.

Science.gov (United States)

Tolan, Amy M; Kaji, Amy H; Quach, Chi; Hines, O Joe; de Virgilio, Christian

2010-01-01

Program directors often struggle to determine which factors in the Electronic Residency Application Service (ERAS) application are important in the residency selection process. With the establishment of the Accreditation Council for Graduate Medical Education (ACGME) competencies, it would be important to know whether information available in the ERAS application can predict subsequent competency-based performance of general surgery residents. This study is a retrospective correlation of data points found in the ERAS application with core competency-based clinical rotation evaluations. ACGME competency-based evaluations as well as technical skills assessment from all rotations during residency were collected. The overall competency score was defined as an average of all 6 competencies and technical skills. A total of77 residents from two (one university and one community based university-affiliate) general surgery residency programs were included in the analysis. Receiving honors for many of the third year clerkships and AOA membership were associated with a number of the individual competencies. USMLE scores were predictive only of Medical Knowledge (p = 0.004). Factors associated with higher overall competency were female gender (p = 0.02), AOA (p = 0.06), overall number of honors received (p = 0.04), and honors in Ob/Gyn (p = 0.03) and Pediatrics (p = 0.05). Multivariable analysis showed honors in Ob/Gyn, female gender, older age, and total number of honors to be predictive of a number of individual core competencies. USMLE scores were only predictive of Medical Knowledge. The ERAS application is useful for predicting subsequent competency based performance in surgical residents. Receiving honors in the surgery clerkship, which has traditionally carried weight when evaluating a potential surgery resident, may not be as strong a predictor of future success. Copyright © 2010 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights

Effect of Process Changes in Surgical Training on Quantitative Outcomes From Surgery Residency Programs.

Science.gov (United States)

Dietl, Charles A; Russell, John C

2016-01-01

The purpose of this article is to review the literature on process changes in surgical training programs and to evaluate their effect on the Accreditation Council of Graduate Medical Education (ACGME) Core Competencies, American Board of Surgery In-Training Examination (ABSITE) scores, and American Board of Surgery (ABS) certification. A literature search was obtained from MEDLINE via PubMed.gov, ScienceDirect.com, Google Scholar on all peer-reviewed studies published since 2003 using the following search queries: surgery residency training, surgical education, competency-based surgical education, ACGME core competencies, ABSITE scores, and ABS pass rate. Our initial search list included 990 articles on surgery residency training models, 539 on competency-based surgical education, 78 on ABSITE scores, and 33 on ABS pass rate. Overall, 31 articles met inclusion criteria based on their effect on ACGME Core Competencies, ABSITE scores, and ABS certification. Systematic review showed that 5/31, 19/31, and 6/31 articles on process changes in surgical training programs had a positive effect on patient care, medical knowledge, and ABSITE scores, respectively. ABS certification was not analyzed. The other ACGME core competencies were addressed in only 6 studies. Several publications on process changes in surgical training programs have shown a positive effect on patient care, medical knowledge, and ABSITE scores. However, the effect on ABS certification, and other quantitative outcomes from residency programs, have not been addressed. Studies on education strategies showing evidence that residency program objectives are being achieved are still needed. This article addresses the 6 ACGME Core Competencies. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

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

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.

[Thymus surgery in a general surgery department].

Science.gov (United States)

Mega, Raquel; Coelho, Fátima; Pimentel, Teresa; Ribero, Rui; Matos, Novo de; Araújo, António

2005-01-01

Evaluation of thymectomy cases between 1990-2003, in a General Surgery Department. Evaluation of the therapeutic efficacy in Miastenia Gravis patients. Retrospective study based on evaluation of data from Serviço de Cirurgia, Neurologia and Consult de Neurology processes, between 1990-2003, of 15 patients submitted to total thymectomy. 15 patients, aged 17 to 72, 11 female and 4 male. Miastenia Gravis was the main indication for surgery, for uncontrollable symptoms or suspicion of thymoma. In patients with myasthenia, surgery was accomplish after compensation of symptoms. There weren't post-surgery complications. Pathology were divided in thymic hyperplasia and thymoma. Miastenia patients have there symptoms diminished or stable with reduction or cessation of medical therapy. Miastenia was the most frequent indication for thymectomy. Surgery was good results, with low morbimortality, as long as the protocols are respected.

Surgical resident learning styles have changed with work hours.

Science.gov (United States)

Quillin, Ralph C; Cortez, Alexander R; Pritts, Timothy A; Hanseman, Dennis J; Edwards, Michael J; Davis, Bradley R

2016-01-01

The Accreditation Council for Graduate Medical Education instituted the 80-h workweek for residency programs in 2003. This presented a unique challenge for surgery residents who must acquire a medical and technical knowledge base during training. Therefore, learning should be delivered in an environment congruent with an individual's learning style. In this study, we evaluated the learning styles of general surgery residents to determine how learning styles changed after the implementation to the 80-h workweek. Kolb learning style inventory was taken by general surgery residents at the University of Cincinnati's Department of Surgery, and results from 1999-2012 were analyzed. Statistical analysis was performed using the chi-squared, logistic regression and Wilcoxon rank-sum test. Significance was defined as a P value of learning styles after the institution of the 80-h workweek to converging (43.9%) and accommodating (40.4%, P learning. This change paralleled the transition to a more team-based approach to patient care with the implementation of the 80-h workweek. These findings are important for surgical educators to consider in the development of surgical resident curriculum. Copyright © 2016 Elsevier Inc. All rights reserved.

Oral and maxillofacial surgery residents have poor understanding of biostatistics.

Science.gov (United States)

Best, Al M; Laskin, Daniel M

2013-01-01

The purpose of this study was to evaluate residents' understanding of biostatistics and interpretation of research results. A questionnaire previously used in internal medicine residents was modified to include oral and maxillofacial surgery (OMS) examples. The survey included sections to identify demographic and educational characteristics of residents, attitudes and confidence, and the primary outcome-knowledge of biostatistics. In 2009 an invitation to the Internet survey was sent to all 106 program directors in the United States, who were requested to forward it to their residents. One hundred twelve residents responded. The percentage of residents who had taken a course in epidemiology was 53%; biostatistics, 49%; and evidence-based dentistry, 65%. Conversely, 10% of OMS residents had taken none of these classes. Across the 6-item test of knowledge of statistical methods, the mean percentage of correct answers was 38% (SD, 22%). Nearly half of the residents (42%) could not correctly identify continuous, ordinal, or nominal variables. Only 21% correctly identified a case-control study, but 79% correctly identified that the purpose of blinding was to reduce bias. Only 46% correctly interpreted a clinically unimportant and statistically nonsignificant result. None of the demographic or experience factors of OMS residents were related to statistical knowledge. Overall, OMS resident knowledge was below that of internal medicine residents (Pbiostatistics and the interpretation of research and are thus unprepared to interpret the results of published clinical research. Residency programs should include effective biostatistical training in their curricula to prepare residents in evidence-based dentistry. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Implications of current resident work-hour guidelines on the future practice of surgery in Canada.

Science.gov (United States)

Maruscak, Adam A; VanderBeek, Laura; Ott, Michael C; Kelly, Stephen; Forbes, Thomas L

2012-01-01

Work-hour restrictions have had a profound impact on surgical training. However, little is known of how work-hour restrictions may affect the future practice patterns of current surgical residents. The purpose of this study is to compare the anticipated career practice patterns of surgical residents who are training within an environment of work-hour restrictions with the current practice of faculty surgeons. An electronic survey was sent to all surgery residents and faculty at 2 Canadian university-affiliated medical centers. The survey consisted of questions regarding expected (residents) or current (faculty) practice patterns. A total of 149 residents and 125 faculty members completed the survey (50.3% and 52.3% response rates, respectively). A greater proportion of males were in the faculty cohort than in the resident group (77.6% vs 62.4%, p = 0.0003). More faculty than residents believed that work-hour restrictions have a negative impact on both residency education (40.8% vs 20.8%, p = 0.008) and preparation for a surgical career (56.8% vs 19.5%, p implications and might require larger surgical groups and reconsideration of resource allocation. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

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.

Repaying in Kind: Examination of the Reciprocity Effect in Faculty and Resident Evaluations.

Science.gov (United States)

Gardner, Aimee K; Scott, Daniel J

Although the reciprocity hypothesis (that trainees have a tendency to modify evaluations based on the grades they receive from instructors) has been documented in other fields, very little work has examined this phenomenon in the surgical residency environment. The purpose of this study was to investigate the extent to which lenient-grading faculty receive higher evaluations from surgery residents. Evaluation data from 2 consecutive academic years were collected retrospectively at a large university-based General Surgery residency program. Monthly faculty evaluations of residents (15 items) and resident evaluations of faculty (8 items; 1 = never demonstrates, 10 = always demonstrates) were included. Correlation and regression analyses were conducted with SPSS version 22 (IBM; Chicago, IL). A total of 2274 faculty assessments and 1480 resident assessments were included in this study, representing 2 years of evaluations for 32 core faculty members responsible for completing all resident evaluations and 68 PGY1-5 general surgery residents. Faculty (63% men, 13.5 ± 9.8 years out of training) represented 5 different divisions (general surgery, surgical oncology, transplant, trauma critical care, and vascular) within the general surgery department. Faculty received an average of 71.1 ± 33.9 evaluations from residents over the course of 2 years. The average rating of faculty teaching by residents was 9.5 ± 0.4. Residents received an average of 21.8 ± 0.5 evaluations with average ratings of 4.2 ± 0.4. Correlation analyses indicated a positive relationship between the average rating received from residents and the number of years since faculty completed training (r = 0.44, p = 0.01). Additionally, a significant relationship emerged between ratings received from residents and ratings given to residents (r = 0.40, p = 0.04). Regression analyses indicated that when both variables (years since training, ratings given to residents) were included in the model, only ratings

Robotics in General Surgery

OpenAIRE

Wall, James; Chandra, Venita; Krummel, Thomas

2008-01-01

In summary, robotics has made a significant contribution to General Surgery in the past 20 years. In its infancy, surgical robotics has seen a shift from early systems that assisted the surgeon to current teleoperator systems that can enhance surgical skills. Telepresence and augmented reality surgery are being realized, while research and development into miniaturization and automation is rapidly moving forward. The future of surgical robotics is bright. Researchers are working to address th...

Away Rotations and Matching in Integrated Plastic Surgery Residency: Applicant and Program Director Perspectives.

Science.gov (United States)

Drolet, Brian C; Brower, Jonathan P; Lifchez, Scott D; Janis, Jeffrey E; Liu, Paul Y

2016-04-01

Although nearly all medical students pursuing integrated plastic surgery residency participate in elective rotations away from their home medical school, the value and costs of these "away" rotations have not been well studied. The authors surveyed all integrated plastic surgery program directors and all applicants in the 2015 National Residency Matching Program. Forty-two program directors and 149 applicants (64 percent and 70 percent response rate, respectively) completed the survey. Applicants reported 13.7 weeks spent on plastic surgery rotations during medical school, including a mean of 9.2 weeks on away rotations. Average reported cost for away rotations was $3591 per applicant. Both applicants and program directors most commonly reported "making a good impression" (44.6 percent and 36.6 percent, respectively) or finding a "good-fit" program (27.7 percent and 48.8 percent, respectively) as the primary goal for away rotations. Almost all applicants (91.1 percent) believed an away rotation made them more competitive for matching to a program at which they rotated. Program directors ranked a strong away rotation performance as the most important residency selection criterion. Twenty-seven percent of postgraduate year-1 positions were filled by an away rotatorm and an additional 17 percent were filled by a home medical student. Away rotations appear to be mutually beneficial for applicants and programs in helping to establish a good fit between students and training programs through an extended interaction with the students, residents, and faculty. In addition, making a good impression on a senior elective rotation (home or away) may improve an applicant's chance of matching to a residency program.

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

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

Canadian Orthopaedic Residents Perception of Their Needs in Elbow Surgery Teaching

Science.gov (United States)

Carroll, Michael; Drosdovech, Darren; Faber, Kenneth J.; Hildebrand, Kevin A.; King, Graham; Pollock, J.; Rouleau, Dominique M.; Sandman, Emilie

2018-01-01

Introduction: The aim of this paper is to guide training program and review course curriculum planning in elbow disorders. To this end, a nationwide email survey was administered to residents' in orthopaedic surgery training programs. Material and Methods: The survey had 12 items that examined learning needs in several domains: assessment of acute…

Resident-Specific Morbidity Reduced Following ACS NSQIP Data-Driven Quality Program.

Science.gov (United States)

Turrentine, Florence E; Hanks, John B; Tracci, Megan C; Jones, R Scott; Schirmer, Bruce D; Smith, Philip W

2018-04-16

The Accreditation Council for Graduate Medical Education Milestone Project for general surgery provided a more robust method for developing and tracking residents' competence. This framework enhanced systematic and progressive development of residents' competencies in surgical quality improvement. A 22-month interactive, educational program based on resident-specific surgical outcomes data culminated in a quality improvement project for postgraduate year 4 surgery residents. Self- assessment, quality knowledge test, and resident-specific American College of Surgeons National Surgical Quality Improvement Program Quality In-Training Initiative morbidity were compared before and after the intervention. Quality in-training initiative morbidity decreased from 25% (82/325) to 18% (93/517), p = 0.015 despite residents performing more complex cases. All participants achieved level 4 competency (4/4) within the general surgery milestones improvement of care, practice-based learning and improvement competency. Institutional American College of Surgeons National Surgical Quality Improvement Program general surgery morbidity improved from the ninth to the sixth decile. Quality assessment and improvement self-assessment postintervention scores (M = 23.80, SD = 4.97) were not significantly higher than preintervention scores (M = 19.20, SD = 5.26), p = 0.061. Quality Improvement Knowledge Application Tool postintervention test scores (M = 17.4, SD = 4.88), were not significantly higher than pretest scores (M = 13.2, SD = 1.92), p = 0.12. Sharing validated resident-specific clinical data with participants was associated with improved surgical outcomes. Participating fourth year surgical residents achieved the highest score, a level 4, in the practice based learning and improvement competency of the improvement of care practice domain and observed significantly reduced surgical morbidity for cases in which they participated. Copyright © 2018. Published by Elsevier Inc.

An evaluation of the availability, accessibility, and quality of online content of vascular surgery training program websites for residency and fellowship applicants.

Science.gov (United States)

Huang, Bryant Y; Hicks, Taylor D; Haidar, Georges M; Pounds, Lori L; Davies, Mark G

2017-12-01

Vascular surgery residency and fellowship applicants commonly seek information about programs from the Internet. Lack of an effective web presence curtails the ability of programs to attract applicants, and in turn applicants may be unable to ascertain which programs are the best fit for their career aspirations. This study was designed to evaluate the presence, accessibility, comprehensiveness, and quality of vascular surgery training websites (VSTW). A list of accredited vascular surgery training programs (integrated residencies and fellowships) was obtained from four databases for vascular surgery education: the Accreditation Council for Graduate Medical Education, Electronic Residency Application Service, Fellowship and Residency Electronic Interactive Database, and Society for Vascular Surgery. Programs participating in the 2016 National Resident Matching Program were eligible for study inclusion. Accessibility of VSTW was determined by surveying the Accreditation Council for Graduate Medical Education, Electronic Residency Application Service, and Fellowship and Residency Electronic Interactive Database for the total number of programs listed and for the presence or absence of website links. VSTW were analyzed for the availability of recruitment and education content items. The quality of VSTW was determined as a composite of four dimensions: content, design, organization, and user friendliness. Percent agreements and kappa statistics were calculated for inter-rater reliability. Eighty-nine of the 94 fellowship (95%) and 45 of the 48 integrated residencies (94%) programs participating in the 2016 Match had a VSTW. For program recruitment, evaluators found an average of 12 of 32 content items (35.0%) for fellowship programs and an average of 12 of 32 (37%) for integrated residencies. Only 47.1% of fellowship programs (53% integrated residencies) specified the number of positions available for the 2016 Match, 20% (13% integrated residencies) indicated alumni

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

Increased ICU resource needs for an academic emergency general surgery service*.

Science.gov (United States)

Lissauer, Matthew E; Galvagno, Samuel M; Rock, Peter; Narayan, Mayur; Shah, Paulesh; Spencer, Heather; Hong, Caron; Diaz, Jose J

2014-04-01

ICU needs of nontrauma emergency general surgery patients are poorly described. This study was designed to compare ICU utilization of emergency general surgery patients admitted to an acute care emergency surgery service with other general surgery patients. Our hypothesis is that tertiary care emergency general surgery patients utilize more ICU resources than other general surgical patients. Retrospective database review. Academic, tertiary care, nontrauma surgical ICU. All patients admitted to the surgical ICU over age 18 between March 2004 and June 2012. None. Six thousand ninety-eight patients were evaluated: 1,053 acute care emergency surgery, 1,964 general surgery, 1,491 transplant surgery, 995 facial surgery/otolaryngology, and 595 neurosurgery. Acute care emergency surgery patients had statistically significantly longer ICU lengths of stay than other groups: acute care emergency surgery (13.5 ± 17.4 d) versus general surgery (8.7 ± 12.9), transplant (7.8 ± 11.6), oral-maxillofacial surgery (5.5 ± 4.2), and neurosurgery (4.47 ± 9.8) (all psurgery patients: acute care emergency surgery 73.4% versus general surgery 64.9%, transplant 63.3%, oral-maxillofacial surgery 58.4%, and neurosurgery 53.1% (all p surgery patients: acute care emergency surgery 10.8% versus general surgery 4.3%, transplant 6.6%, oral-maxillofacial surgery 0%, and neurosurgery 0.5% (all p surgery patients were more likely interhospital transfers for tertiary care services than general surgery or transplant (24.5% vs 15.5% and 8.3% respectively, p surgery (13.7% vs 6.7% and 3.5%, all p surgery and general surgery, whereas transplant had fewer. Emergency general surgery patients have increased ICU needs in terms of length of stay, ventilator usage, and continuous renal replacement therapy usage compared with other services, perhaps due to the higher percentage of transfers and emergent surgery required. These patients represent a distinct population. Understanding their resource needs

How much guidance is given in the operating room? Factors influencing faculty self-reports, resident perceptions, and faculty/resident agreement.

Science.gov (United States)

Torbeck, Laura; Williams, Reed G; Choi, Jennifer; Schmitz, Connie C; Chipman, Jeffrey G; Dunnington, Gary L

2014-10-01

Guidance in the operating room impacts resident confidence and ability to function independently. The purpose of this study was to explore attending surgeon guidance practices in the operating room as reported by faculty members themselves and by junior and senior residents. This was an exploratory, cross-sectional survey research study involving 91 categorical residents and 82 clinical faculty members at two academic general surgery training programs. A series of analyses of variance along with descriptive statistics were performed to understand the impact of resident training year, program, and surgeon characteristics (sex and type of surgery performed routinely) on guidance practices. Resident level (junior versus senior) significantly impacted the amount of guidance given as reported by faculty and as perceived by residents. Within each program, junior residents perceived less guidance than faculty reported giving. For senior guidance practices, however, the differences between faculty and resident practices varied by program. In terms of the effects of surgeon practice type (mostly general versus mostly complex cases), residents at both institutions felt they were more supervised closely by the faculty who perform mostly complex cases. More autonomy is given to senior than to junior residents. Additionally, faculty report a greater amount of change in their guidance practices over the training period than residents perceive. Faculty and resident agreement about the need for guidance and for autonomy are important for achieving the goals of residency training. Copyright © 2014 Elsevier Inc. All rights reserved.

Generation Y and the Integrated Plastic Surgery Residency Match: A Cross-sectional Study of the 2011 Match Outcomes

Science.gov (United States)

Narayan, Deepak

2013-01-01

Background: Plastic surgery is the most competitive specialty in medicine. We sought to identify factors associated with the successful match of generation Y applicants into integrated plastic surgery residency. Methods: We utilized the most recent data from the Charting Outcomes in the Match published by the National Resident Matching Program in 2011. We had data on US senior or independent applicant status, Alpha Omega Alpha (AOA) status, attendance of top 40 medical schools, advanced degree status, and number of contiguous ranks within plastic surgery. Our main outcome measure was match status. Results: A total of 81 out of 197 applicants (41.1%) successfully matched into integrated plastic surgery in the 2011 main match. US seniors matched at a significantly higher rate compared to independent applicants (44.0% vs 24.1%, P = 0.044). Matched US seniors were more likely to have AOA membership compared to unmatched US seniors (45.9% vs 27.7%, P = 0.014) and attend a top 40 medical school (52.7% vs 35.1%, P = 0.022). There were no differences in terms of advanced degrees between matched and unmatched US seniors. Unmatched US seniors were more likely to have 3 or fewer contiguous ranks of plastic surgery residency programs than matched US seniors (86.2% vs 68.9%, P = 0.007). Conclusions: US senior status, AOA membership, and attendance at a top 40 medical school are predictors of matching into integrated plastic surgery. Program directors need to be aware of the background of the millennial applicants to recruit and maintain top residents. PMID:25289227

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

Learning style preferences of surgical residency applicants.

Science.gov (United States)

Kim, Roger H; Gilbert, Timothy

2015-09-01

The learning style preferences of general surgery residents have been previously reported; there is evidence that residents who prefer read/write learning styles perform better on the American Board of Surgery In-Training Examination (ABSITE). However, little is known regarding the learning style preferences of applicants to general surgery residency and their impact on educational outcomes. In this study, the preferred learning styles of surgical residency applicants were determined. We hypothesized that applicant rank data are associated with specific learning style preferences. The Fleming VARK learning styles inventory was offered to all general surgery residency applicants that were interviewed at a university hospital-based program. The VARK model categorizes learners as visual (V), aural (A), read/write (R), kinesthetic (K), or multimodal (MM). Responses on the inventory were scored to determine the preferred learning style for each applicant. Applicant data, including United States Medical Licensing Examination (USMLE) scores, class rank, interview score, and overall final applicant ranking, were examined for association with preferred learning styles. Sixty-seven applicants were interviewed. Five applicants were excluded due to not completing the VARK inventory or having incomplete applicant data. The remaining 62 applicants (92%) were included for analysis. Most applicants (57%) had a multimodal preference. Sixty-nine percent of all applicants had some degree of preference for kinesthetic learning. There were statistically significant differences between applicants of different learning styles in terms of USMLE step 1 scores (P = 0.001) and USMLE step 2 clinical knowledge scores (P = 0.01), but not for class ranks (P = 0.27), interview scores (P = 0.20), or final ranks (P = 0.14). Multiple comparison analysis demonstrated that applicants with aural preferences had higher USMLE 1 scores (233.2) than those with kinesthetic (211.8, P = 0.005) or multimodal

Training in breast surgery in Spain.

Science.gov (United States)

Miguelena, José M; Domínguez Cunchillos, Fernando

2016-01-01

Breast surgery is a key part of training and competency in general surgery in Spain and is a "frontier area" that can be efficiently managed by general surgeons and gynecologists. The main objective of the training process consists of the surgical treatment of breast cancer, including conservative surgery, oncoplastic and reconstructive techniques. This article analyses the current status of breast surgery training in Spain and schematically proposes potential targets of the different training programs, to improve access and training for surgeons and residents in this area, taking into account the RD 639/2014 and European regulation. The priority is to specify the level of training that should be achieved, in relation to the group of professionals involved, considering their area of competency: surgery resident, educational programs, and surgeons with special dedication to this area. Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

General medicine vs subspecialty career plans among internal medicine residents.

Science.gov (United States)

West, Colin P; Dupras, Denise M

2012-12-05

Current medical training models in the United States are unlikely to produce sufficient numbers of general internists and primary care physicians. Differences in general internal medicine (GIM) career plans between internal medicine residency program types and across resident demographics are not well understood. To evaluate the general medicine career plans of internal medicine residents and how career plans evolve during training. A study of US internal medicine residents using an annual survey linked to the Internal Medicine In-Training Examination taken in October of 2009-2011 to evaluate career plans by training program, sex, and medical school location. Of 67,207 US eligible categorical and primary care internal medicine residents, 57,087 (84.9%) completed and returned the survey. Demographic data provided by the National Board of Medical Examiners were available for 52,035 (77.4%) of these residents, of whom 51,390 (76.5%) responded to all survey items and an additional 645 (1.0%) responded to at least 1 survey item. Data were analyzed from the 16,781 third-year residents (32.2%) in this sample. Self-reported ultimate career plans of internal medicine residents. A GIM career plan was reported by 3605 graduating residents (21.5%). A total of 562 primary care program (39.6%) and 3043 categorical (19.9%) residents reported GIM as their ultimate career plan (adjusted odds ratio [AOR], 2.76; 99% CI, 2.35-3.23; P international medical graduates (22.0% vs 21.1%, respectively; AOR, 1.76; 99% CI, 1.50-2.06; P international medical graduates (57.3% vs 27.3%, respectively; AOR, 3.48; 99% CI, 2.58-4.70; P internal medicine residents, including those in primary care training programs, and differed according to resident sex, medical school location, and program type.

Emergency general surgery in the geriatric patient.

Science.gov (United States)

Desserud, K F; Veen, T; Søreide, K

2016-01-01

Emergency general surgery in the elderly is a particular challenge to the surgeon in charge of their care. The aim was to review contemporary aspects of managing elderly patients needing emergency general surgery and possible alterations to their pathways of care. This was a narrative review based on a PubMed/MEDLINE literature search up until 15 September 2015 for publications relevant to emergency general surgery in the geriatric patient. The number of patients presenting as an emergency with a general surgical condition increases with age. Up to one-quarter of all emergency admissions to hospital may be for general surgical conditions. Elderly patients are a particular challenge owing to added co-morbidity, use of drugs and risk of poor outcome. Frailty is an important potential risk factor, but difficult to monitor or manage in the emergency setting. Risk scores are not available universally. Outcomes are usually severalfold worse than after elective surgery, in terms of both higher morbidity and increased mortality. A care bundle including early diagnosis, resuscitation and organ system monitoring may benefit the elderly in particular. Communication with the patient and relatives throughout the care pathway is essential, as indications for surgery, level of care and likely outcomes may evolve. Ethical issues should also be addressed at every step on the pathway of care. Emergency general surgery in the geriatric patient needs a tailored approach to improve outcomes and avoid futile care. Although some high-quality studies exist in related fields, the overall evidence base informing perioperative acute care for the elderly remains limited. © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.

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.

Are there gender differences in the emotional intelligence of resident physicians?

Science.gov (United States)

McKinley, Sophia K; Petrusa, Emil R; Fiedeldey-Van Dijk, Carina; Mullen, John T; Smink, Douglas S; Scott-Vernaglia, Shannon E; Kent, Tara S; Black-Schaffer, W Stephen; Phitayakorn, Roy

2014-01-01

Because academic literature indicates that emotional intelligence (EI) is tied to work performance, job satisfaction, burnout, and client satisfaction, there is great interest in understanding physician EI. To determine whether gender differences in resident EI profiles mirror EI gender differences in the general population. A total of 325 residents in 3 types of residency programs (pathology, pediatrics, and general surgery) at 3 large academic institutions were invited electronically to complete the validated Trait Emotional Intelligence Questionnaire (TEIQue), a tool consisting of 153 items that cluster to 15 independent facets, 4 composite factors, and 1 global EI score. The response rate was 42.8% (n = 139, women = 84). Global EI was not significantly different between men and women resident physicians (p = 0.74). Women scored higher than men in the TEIQue facets impulse control (p = 0.004) and relationships (p = 0.004). Men scored higher than women in 2 facets, stress management (p = 0.008) and emotion management (p = 0.023). Within surgery (n = 85, women = 46), women scored higher than men in impulse control (p = 0.006), whereas men scored higher in stress management (p = 0.008). Men and women residents across 3 specialties demonstrated near-identical global EI scores. However, gender differences in specific TEIQue facets suggest that similar to the general population, men and women residents may benefit from specific training of different EI domains to enhance well-rounded development. The lack of significant gender differences within surgery may indicate that surgery attracts individuals with particular EI profiles regardless of gender. Future research should focus on the functional relationship between educational interventions that promote targeted EI development and enhanced clinical performance. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Robot-assisted general surgery.

Science.gov (United States)

Hazey, Jeffrey W; Melvin, W Scott

2004-06-01

With the initiation of laparoscopic techniques in general surgery, we have seen a significant expansion of minimally invasive techniques in the last 16 years. More recently, robotic-assisted laparoscopy has moved into the general surgeon's armamentarium to address some of the shortcomings of laparoscopic surgery. AESOP (Computer Motion, Goleta, CA) addressed the issue of visualization as a robotic camera holder. With the introduction of the ZEUS robotic surgical system (Computer Motion), the ability to remotely operate laparoscopic instruments became a reality. US Food and Drug Administration approval in July 2000 of the da Vinci robotic surgical system (Intuitive Surgical, Sunnyvale, CA) further defined the ability of a robotic-assist device to address limitations in laparoscopy. This includes a significant improvement in instrument dexterity, dampening of natural hand tremors, three-dimensional visualization, ergonomics, and camera stability. As experience with robotic technology increased and its applications to advanced laparoscopic procedures have become more understood, more procedures have been performed with robotic assistance. Numerous studies have shown equivalent or improved patient outcomes when robotic-assist devices are used. Initially, robotic-assisted laparoscopic cholecystectomy was deemed safe, and now robotics has been shown to be safe in foregut procedures, including Nissen fundoplication, Heller myotomy, gastric banding procedures, and Roux-en-Y gastric bypass. These techniques have been extrapolated to solid-organ procedures (splenectomy, adrenalectomy, and pancreatic surgery) as well as robotic-assisted laparoscopic colectomy. In this chapter, we review the evolution of robotic technology and its applications in general surgical procedures.

Prioritizing quality improvement in general surgery.

Science.gov (United States)

Schilling, Peter L; Dimick, Justin B; Birkmeyer, John D

2008-11-01

Despite growing interest in quality improvement, uncertainty remains about which procedures offer the most room for improvement in general surgery. In this context, we sought to describe the relative contribution of different procedures to overall morbidity, mortality, and excess length of stay in general surgery. Using data from the American College of Surgeons' National Surgery Quality Improvement Program (ACS-NSQIP), we identified all patients undergoing a general surgery procedure in 2005 and 2006 (n=129,233). Patients were placed in 36 distinct procedure groups based on Current Procedural Terminology codes. We first examined procedure groups according to their relative contribution to overall morbidity and mortality. We then assessed procedure groups according to their contribution to overall excess length of stay. Ten procedure groups alone accounted for 62% of complications and 54% of excess hospital days. Colectomy accounted for the greatest share of adverse events, followed by small intestine resection, inpatient cholecystectomy, and ventral hernia repair. In contrast, several common procedures contributed little to overall morbidity and mortality. For example, outpatient cholecystectomy, breast procedures, thyroidectomy, parathyroidectomy, and outpatient inguinal hernia repair together accounted for 34% of procedures, but only 6% of complications (and only 4% of major complications). These same procedures accounted for surgery. Focusing quality improvement efforts on these procedures may be an effective strategy for improving patient care and reducing cost.

Are surgery training programs ready for virtual reality? A survey of program directors in general surgery.

Science.gov (United States)

Haluck, R S; Marshall, R L; Krummel, T M; Melkonian, M G

2001-12-01

The use of advanced technology, such as virtual environments and computer-based simulators (VR/CBS), in training has been well established by both industry and the military. In contrast the medical profession, including surgery, has been slow to incorporate such technology in its training. In an attempt to identify factors limiting the regular incorporation of this technology into surgical training programs, a survey was developed and distributed to all general surgery program directors in the United States. A 22-question survey was sent to 254 general surgery program directors. The survey was designed to reflect attitudes of the program directors regarding the use of computer-based simulation in surgical training. Questions were scaled from 1 to 5 with 1 = strongly disagree and 5 = strongly agree. A total of 139 responses (55%) were returned. The majority of respondents (58%) had seen VR/CBS, but only 19% had "hands-on" experience with these systems. Respondents strongly agreed that there is a need for learning opportunities outside of the operating room and a role for VR/CBS in surgical training. Respondents believed both staff and residents would support this type of training. Concerns included VR/CBS' lack of validation and potential requirements for frequent system upgrades. Virtual environments and computer-based simulators, although well established training tools in other fields, have not been widely incorporated into surgical education. Our results suggest that program directors believe this type of technology would be beneficial in surgical education, but they lack adequate information regarding VR/CBS. Developers of this technology may need to focus on educating potential users and addressing their concerns.

Racial and Ethnic Diversity of U.S. Plastic Surgery Trainees.

Science.gov (United States)

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

Increased diversity of U.S. physicians can improve patient communication and mitigate health disparities for racial minorities. This study analyzes trends in racial and ethnic diversity of plastic surgery residents. Demographic data of surgical residents, medical students, and integrated plastic surgery residency applicants were obtained from the Association of American Medical Colleges. Data for college students and the general population were obtained from the U.S. Census for comparison with plastic surgery. Interspecialty differences and temporal trends in racial composition were analyzed with chi-square tests. From 1995 to 2014, Asian and Hispanic plastic surgery residents increased nearly 3-fold (7.4%-21.7%, p < 0.001) and 2-fold (4.6%-7.9%, p < 0.001), respectively. African American plastic surgery residents did not increase significantly (3.0%-3.5%, p = 0.129). Relative to the U.S. population, Hispanics (range: 0.1-0.5-fold) and African Americans (range: 0.1-0.4-fold) were underrepresented, whereas Asians (range: 2.2-5.3-fold) were overrepresented in plastic surgery. A "bottleneck" existed in the pipeline of African American and Hispanic plastic surgery residents. Significant differences in racial composition existed between plastic surgery and other surgical disciplines, which varied over time. The percentage of Hispanic (10.6% vs 7.0%, p = 0.402) and African American (6.4% vs 2.1%, p < 0.001) plastic surgery residency applicants exceeded those in residency. Hispanics and African Americans are underrepresented in plastic surgery residency relative to whites and Asians. This study underscores the need for greater initiatives to increase diversity in plastic surgery residency. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Performance goals on simulators boost resident motivation and skills laboratory attendance.

Science.gov (United States)

Stefanidis, Dimitrios; Acker, Christina E; Greene, Frederick L

2010-01-01

To assess the impact of setting simulator training goals on resident motivation and skills laboratory attendance. Residents followed a proficiency-based laparoscopic curriculum on the 5 Fundamentals of Laparoscopic Surgery and 9 virtual reality tasks. Training goals consisted of the average expert performance on each task + 2 SD (mandatory) and best expert performance (optional). Residents rated the impact of the training goals on their motivation on a 20-point visual analog scale. Performance and attendance data were analyzed and correlated (Spearman's). Data are reported as medians (range). General Surgery residency program at a regional referral Academic Medical Center. General surgery residents (n = 15). During the first 5 months of the curriculum, weekly attendance rate was 51% (range, 8-96). After 153 (range, 21-412) repetitions, resident speed improved by 97% (range, 18-230), errors improved by 17% (range, 0-24), and motion efficiency by 59% (range, 26-114) compared with their baseline. Nine (60%) residents achieved proficiency in 7 (range, 3-14) and the best goals in 3.5 (range, 1-9) tasks; the other 6 residents had attendance rates motivation as 15 (range, 1-18) and setting a best goal as 13 (range, 1-18). Motivation ratings correlated positively with attendance rates, number of repetitions, performance improvement, and achievement of proficiency and best goals (r = 0.59-0.75; p motivation to participate in a simulator curriculum. While more stringent goals may potentiate this effect, they have a limited impact on senior residents. Further research is needed to investigate ways to improve skills laboratory attendance. Copyright 2010 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Impact of an Event Reporting System on Resident Complication Reporting in Plastic Surgery Training: Addressing an ACGME and Plastic Surgery Milestone Project Core Competency.

Science.gov (United States)

Parikh, Rajiv P; Snyder-Warwick, Alison; Naidoo, Sybill; Skolnick, Gary B; Patel, Kamlesh B

2017-11-01

The Accreditation Council for Graduate Medical Education and Plastic Surgery Milestone Project has identified practice-based learning and improvement, which involves systematically analyzing current practices and implementing changes, as a core competency in residency education. In surgical care, complication reporting is an essential component of practice-based learning and improvement as complications are analyzed in morbidity and mortality conference for quality improvement. Unfortunately, current methods for capturing a comprehensive profile of complications may significantly underestimate the true occurrence of complications. Therefore, the objectives of this study are to evaluate an intervention for complication reporting and compare this to current practice, in a plastic surgery training program. This is a preintervention and postintervention study evaluating resident reporting of complications on a plastic surgery service. The intervention was an online event reporting system developed by department leadership and patient safety experts. The cohorts consisted of all patients undergoing surgery during two separate 3-month blocks bridged by an implementation period. A trained reviewer recorded complications, and this served as the reference standard. Fisher's exact test was used for binary comparisons. There were 32 complications detected in 219 patients from June to August of 2015 and 35 complications in 202 patients from October to December of 2015. The proportion of complications reported in the preintervention group was nine of 32 (28.1 percent). After the intervention, this significantly increased to 32 of 35 (91.4 percent) (p < 0.001). An intervention using an event reporting system, supported by departmental leadership, led to significant improvements in complication reporting by plastic surgery residents.

The use of standardized patients in the plastic surgery residency curriculum: teaching core competencies with objective structured clinical examinations.

Science.gov (United States)

Davis, Drew; Lee, Gordon

2011-07-01

As of 2006, the Accreditation Council for Graduate Medical Education had defined six "core competencies" of residency education: interpersonal communication skills, medical knowledge, patient care, professionalism, practice-based learning and improvement, and systems-based practice. Objective structured clinical examinations using standardized patients are becoming effective educational tools, and the authors developed a novel use of the examinations in plastic surgery residency education that assesses all six competencies. Six plastic surgery residents, two each from postgraduate years 4, 5, and 6, participated in the plastic surgery-specific objective structured clinical examination that focused on melanoma. The examination included a 30-minute videotaped encounter with a standardized patient actor and a postencounter written exercise. The residents were scored on their performance in all six core competencies by the standardized patients and faculty experts on a three-point scale (1 = novice, 2 = moderately skilled, and 3 = proficient). Resident performance was averaged for each postgraduate year, stratified according to core competency, and scored from a total of 100 percent. Residents overall scored well in interpersonal communications skills (84 percent), patient care (83 percent), professionalism (86 percent), and practice-based learning (84 percent). Scores in medical knowledge showed a positive correlation with level of training (86 percent). All residents scored comparatively lower in systems-based practice (65 percent). The residents reported unanimously that the objective structured clinical examination was realistic and educational. The objective structured clinical examination provided comprehensive and meaningful feedback and identified areas of strengths and weakness for the residents and for the teaching program. The examination is an effective assessment tool for the core competencies and a valuable adjunct to residency training.

Robotic general surgery: current practice, evidence, and perspective.

Science.gov (United States)

Jung, M; Morel, P; Buehler, L; Buchs, N C; Hagen, M E

2015-04-01

Robotic technology commenced to be adopted for the field of general surgery in the 1990s. Since then, the da Vinci surgical system (Intuitive Surgical Inc, Sunnyvale, CA, USA) has remained by far the most commonly used system in this domain. The da Vinci surgical system is a master-slave machine that offers three-dimensional vision, articulated instruments with seven degrees of freedom, and additional software features such as motion scaling and tremor filtration. The specific design allows hand-eye alignment with intuitive control of the minimally invasive instruments. As such, robotic surgery appears technologically superior when compared with laparoscopy by overcoming some of the technical limitations that are imposed on the surgeon by the conventional approach. This article reviews the current literature and the perspective of robotic general surgery. While robotics has been applied to a wide range of general surgery procedures, its precise role in this field remains a subject of further research. Until now, only limited clinical evidence that could establish the use of robotics as the gold standard for procedures of general surgery has been created. While surgical robotics is still in its infancy with multiple novel systems currently under development and clinical trials in progress, the opportunities for this technology appear endless, and robotics should have a lasting impact to the field of general surgery.

Robotics in general surgery: an evidence-based review.

Science.gov (United States)

Baek, Se-Jin; Kim, Seon-Hahn

2014-05-01

Since its introduction, robotic surgery has been rapidly adopted to the extent that it has already assumed an important position in the field of general surgery. This rapid progress is quantitative as well as qualitative. In this review, we focus on the relatively common procedures to which robotic surgery has been applied in several fields of general surgery, including gastric, colorectal, hepato-biliary-pancreatic, and endocrine surgery, and we discuss the results to date and future possibilities. In addition, the advantages and limitations of the current robotic system are reviewed, and the advanced technologies and instruments to be applied in the near future are introduced. Such progress is expected to facilitate the widespread introduction of robotic surgery in additional fields and to solve existing problems.

Fellowship and career path preferences in residents of otolaryngology-head and neck surgery.

Science.gov (United States)

Golub, Justin S; Ossoff, Robert H; Johns, Michael M

2011-04-01

Assess fellowship and academic/private practice career track preferences in residents of otolaryngology-head and neck surgery. Cross-sectional survey. A total of 1,364 U.S. otolaryngology residents were surveyed. Questions addressed demographics, work hours and sleep, fellowship preference, and career track preference (academic/private practice). Trends in fellowship and career track preference were analyzed by year of clinical otolaryngology training. Data were additionally analyzed after stratification by sex. The response rate was 50%. The desire to complete a fellowship declined from 62% (year 2) to 58% (year 5), whereas the desire to not complete a fellowship increased from 31% (year 2) to 41% (year 5). Fellowship interest increased for rhinology and head and neck surgery by training year, whereas interest declined for neurotology and facial plastics. Expectation of an academic path increased from 29% (year 2) to 38% (year 5), whereas expectation of private practice declined slightly from 59% (year 2) to 57% (year 5). Women were initially more interested in both completing a fellowship (69% women, 60% men) and academics (40% women, 27% men). At the end of training, these sex differences were eliminated or reversed (59% men, 54% women for fellowship; 39% men, 35% women for academics). Residents interested in pursuing fellowship or academics reported working 2 hr/week more than those interested in no fellowship or private practice, respectively (P career track preferences suggest trends that may be useful to residency/fellowship program directors and residents making career choices. Inequalities producing differences according to sex should be addressed. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

Orthognathic surgery: general considerations.

Science.gov (United States)

Khechoyan, David Y

2013-08-01

a patient's appearance and occlusal function can be improved significantly, impacting the patient's sense of self and well-being. Successful outcomes in modern orthognathic surgery rely on close collaboration between the surgeon and the orthodontist across all stages of treatment, from preoperative planning to finalization of occlusion. Virtual computer planning promotes a more accurate analysis of dentofacial deformity and preoperative planning. It is also an invaluable aid in providing comprehensive patient education. In this article, the author describes the general surgical principles that underlie orthognathic surgery, highlighting the sequence of treatment, preoperative analysis of dentofacial deformity, surgical execution of the treatment plan, and possible complications.

Qualitative and quantitative outcomes of audience response systems as an educational tool in a plastic surgery residency program.

Science.gov (United States)

Arneja, Jugpal S; Narasimhan, Kailash; Bouwman, David; Bridge, Patrick D

2009-12-01

In-training evaluations in graduate medical education have typically been challenging. Although the majority of standardized examination delivery methods have become computer-based, in-training examinations generally remain pencil-paper-based, if they are performed at all. Audience response systems present a novel way to stimulate and evaluate the resident-learner. The purpose of this study was to assess the outcomes of audience response systems testing as compared with traditional testing in a plastic surgery residency program. A prospective 1-year pilot study of 10 plastic surgery residents was performed using audience response systems-delivered testing for the first half of the academic year and traditional pencil-paper testing for the second half. Examination content was based on monthly "Core Quest" curriculum conferences. Quantitative outcome measures included comparison of pretest and posttest and cumulative test scores of both formats. Qualitative outcomes from the individual participants were obtained by questionnaire. When using the audience response systems format, pretest and posttest mean scores were 67.5 and 82.5 percent, respectively; using traditional pencil-paper format, scores were 56.5 percent and 79.5 percent. A comparison of the cumulative mean audience response systems score (85.0 percent) and traditional pencil-paper score (75.0 percent) revealed statistically significantly higher scores with audience response systems (p = 0.01). Qualitative outcomes revealed increased conference enthusiasm, greater enjoyment of testing, and no user difficulties with the audience response systems technology. The audience response systems modality of in-training evaluation captures participant interest and reinforces material more effectively than traditional pencil-paper testing does. The advantages include a more interactive learning environment, stimulation of class participation, immediate feedback to residents, and immediate tabulation of results for the

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

Understanding the Multidimensional Effects of Resident Duty Hours Restrictions: A Thematic Analysis of Published Viewpoints in Surgery.

Science.gov (United States)

Devitt, Katharine S; Kim, Michael J; Gotlib Conn, Lesley; Wright, Frances C; Moulton, Carol-Anne; Keshet, Itay; Ahmed, Najma

2018-02-01

Individuals representing various surgical disciplines have expressed concerns with the impact of resident duty hours (RDH) restrictions on resident education and patient outcomes. This thematic review of published viewpoints aimed to describe the effects of these restrictions in surgery. The authors conducted a qualitative systematic review of non-research-based literature published between 2003 and 2015. Articles were included if they focused on the RDH restrictions in surgery and resident wellness, health promotion, resident safety, resident education and/or training, patient safety, medical errors, and/or heterogeneity regarding training or disciplines. A thematic analysis approach guided data extraction. Contextual data were abstracted from the included articles to aid in framing the identified themes. Of 1,482 identified articles, 214 were included in the review. Most were from authors in the United States (144; 67%) and focused on the 80-hour workweek (164; 77%). The emerging themes were organized into three overarching categories: (1) impact of the RDH restrictions, (2) surgery has its own unique culture, and (3) strategies going forward. Published opinions suggested that RDH restrictions alone are insufficient to achieve the desired outcomes and that careful consideration of the surgical training model is needed to maintain the integrity of educational outcomes. Opinions from the surgical community highlight the complexity of issues surrounding the RDH restrictions and suggest that recent changes are not achieving all the desired outcomes and have resulted in unintended outcomes. From the perceptions of the various stakeholders in surgical education studied, areas for new policies were identified.

Robotics in general surgery: A systematic cost assessment

OpenAIRE

Gkegkes, Ioannis D.; Mamais, Ioannis A.; Iavazzo, Christos

2017-01-01

The utilisation of robotic-assisted techniques is a novelty in the field of general surgery. Our intention was to examine the up to date available literature on the cost assessment of robotic surgery of diverse operations in general surgery. PubMed and Scopus databases were searched in a systematic way to retrieve the included studies in our review. Thirty-one studies were retrieved, referring on a vast range of surgical operations. The mean cost for robotic, open and laparoscopic ranged from...

Resident Wellness and Social Support: Development and Cognitive Validation of a Resident Social Capital Assessment Tool.

Science.gov (United States)

Kaplan, Stephen J; Seabott, Heather M; Cunningham, Erika B; Helman, James D; Calderon, Alvin; Thirlby, Richard C; Schenarts, Kimberly D

The purpose of this study is to develop and generate validity evidence for an instrument to measure social capital in residents. Mixed-methods, phased approach utilizing a modified Delphi technique, focus groups, and cognitive interviews. Four residency training institutions in Washington state between February 2016 and March 2017. General surgery, anesthesia, and internal medicine residents ranging from PGY-1 to PGY-6. The initial resident-focused instrument underwent revision via Delphi process with 6 experts; 100% expert consensus was achieved after 4 cycles. Three focus groups were conducted with 19 total residents. Focus groups identified 6 of 11 instrument items with mean quality ratings ≤4.0 on a 1-5 scale. The composite instrument rating of the draft version was 4.1 ± 0.5. After refining the instrument, cognitive interviews with the final version were completed with 22 residents. All items in the final version had quality ratings >4.0; the composite instrument rating was 4.8 ± 0.1. Social capital may be an important factor in resident wellness as residents rely upon each other and external social support to withstand fatigue, burnout, and other negative sequelae of rigorous training. This instrument for assessment of social capital in residents may provide an avenue for data collection and potentially, identification of residents at-risk for wellness degradation. Copyright © 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

The History of the Department of Cardiovascular and Thoracic Surgery at Rush.

Science.gov (United States)

Faber, L Penfield; Liptay, Michael J; Seder, Christopher W

2016-01-01

The Rush Department of Cardiovascular and Thoracic Surgery received certification by the American Board of Thoracic Surgery (ABTS) to train thoracic surgical residents in 1962. The outstanding clinical faculty, with nationally recognized technical expertise, was eager to provide resident education. The hallmark of the program has been clinical excellence, dedication to patient care, and outstanding results in complex cardiac, vascular, and general thoracic surgical procedures. A strong commitment to resident education has been carried to the present time. Development of the sternotomy incision, thoracic and abdominal aneurysm repair, carotid endarterectomy, along with valve replacement, have been the hallmark of the section of cardiovascular surgery. Innovation in bronchoplastic lung resection, aggressive approach to thoracic malignancy, and segmental resection for lung cancer identify the section of general thoracic surgery. A total of 131 thoracic residents have been trained by the Rush Thoracic Surgery program, and many achieved their vascular certificate, as well. Their training has been vigorous and, at times, difficult. They carry the Rush thoracic surgical commitment of excellence in clinical surgery and patient care throughout the country, both in practice groups and academic centers. Copyright © 2016 Elsevier Inc. All rights reserved.

Disparities in access to emergency general surgery care in the United States.

Science.gov (United States)

Khubchandani, Jasmine A; Shen, Connie; Ayturk, Didem; Kiefe, Catarina I; Santry, Heena P

2018-02-01

As fewer surgeons take emergency general surgery call and hospitals decrease emergency services, a crisis in access looms in the United States. We examined national emergency general surgery capacity and county-level determinants of access to emergency general surgery care with special attention to disparities. To identify potential emergency general surgery hospitals, we queried the database of the American Hospital Association for "acute care general hospital," with "surgical services," and "emergency department," and ≥1 "operating room." Internet search and direct contact confirmed emergency general surgery services that covered the emergency room 7 days a week, 24 hours a day. Geographic and population-level emergency general surgery access was derived from Geographic Information Systems and US Census. Of the 6,356 hospitals in the 2013 American Hospital Association database, only 2,811 were emergency general surgery hospitals. Counties with greater percentages of black, Hispanic, uninsured, and low-education individuals and rural counties disproportionately lacked access to emergency general surgery care. For example, counties above the 75th percentile of African American population (10.2%) had >80% odds of not having an emergency general surgery hospital compared with counties below the 25th percentile of African American population (0.6%). Gaps in access to emergency general surgery services exist across the United States, disproportionately affecting underserved, rural communities. Policy initiatives need to increase emergency general surgery capacity nationwide. Copyright © 2017 Elsevier Inc. All rights reserved.

A 360 degrees evaluation of a night-float system for general surgery: a response to mandated work-hours reduction.

Science.gov (United States)

Goldstein, Michael J; Kim, Eugene; Widmann, Warren D; Hardy, Mark A

2004-01-01

New York State Code 405 and societal/political pressure have led the RRC and ACGME to mandate strict limitations on resident work hours. In an attempt to meet these limitations, we have switched from the previous Q3 call schedule to a specialized night float (NF) system, the continuity-care system (CCS). The purpose of this CCS is to maximize resident duty time spent on direct patient care, operative experience, and outpatient clinics, while reducing duty hours spent on performing routine tasks and call coverage. The implementation of the CCS is the fundamental step in the restructuring of our residency program. In addition to a change in the call system, we added physician assistants to aid in performing some service tasks. We performed a 360 degrees evaluation of this work in progress. In May 2002, the standard Q3 call system was abolished on the general surgery services at the New York Presbyterian Hospital, Columbia campus. Two dedicated teams were created to provide day and night coverage, a day continuity-care team (DCT) and a night continuity-care team (NCT). The DCTs, consisting of PGY1-5 residents, provide daily in-house coverage from 6 AM to 5 PM with no regular weekday night-call responsibilities. The DCT residents provide Friday night, Saturday, and daytime Sunday call coverage 3 to 4 days per month. The NCT, consisting of 5 PGY1-5 residents, provides nightly continuous care, 5 PM to 6 AM, Sunday through Thursday, with no other weekend call responsibilities. This system creates a schedule with less than 80 duty hours per week, on average, with one 24-hour period off a week, one complete weekend off per month, and no more than 24 hours of consecutive duty time. After 1 year of use, the system was evaluated by a 360 degrees method in which residents, residents' spouses, nurses, and faculty were surveyed using a Likert-type scale. Statistical significance was calculated using the Student t-test. Patient satisfaction was measured both by internal review of

The promise and problems of non-physician practitioners in general surgery education: Results of a multi-center, mixed-methods study of faculty.

Science.gov (United States)

Coverdill, James E; Shelton, Jeff Scott; Alseidi, Adnan; Borgstrom, David C; Dent, Daniel L; Dumire, Russell; Fryer, Jonathan; Hartranft, Thomas H; Holsten, Steven B; Nelson, M Timothy; Shabahang, Mohsen M; Sherman, Stanley R; Termuhlen, Paula M; Woods, Randy J; Mellinger, John D

2018-02-01

Nurse Practitioners and Physician Assistants - called non-physician practitioners or NPPs - are common, but little is known about their educational promise and problems. General surgery faculty in 13 residency programs were surveyed (N = 279 with a 71% response rate) and interviewed (N = 43) about experiences with NPPs. The survey documents overall patterns and differences by program type and primary service; interviews point to deeper rationales and concerns. NPPs reduce faculty and resident workloads and teach residents. NPPs also reduce resident exposure to educationally valuable activities, and faculty sometimes round, make decisions, and operate with NPPs instead of residents. Interviews indicate that NPPs can overly reduce resident involvement in patient care, diminish resident responsibility and decision making, disrupt team dynamics, and compete for procedures. NPPs both enhance and hinder surgical education and highlight the need to more clearly articulate learning outcomes for residents and activities necessary to achieve those outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

Critical differences between elective and emergency surgery: identifying domains for quality improvement in emergency general surgery.

Science.gov (United States)

Columbus, Alexandra B; Morris, Megan A; Lilley, Elizabeth J; Harlow, Alyssa F; Haider, Adil H; Salim, Ali; Havens, Joaquim M

2018-04-01

The objective of our study was to characterize providers' impressions of factors contributing to disproportionate rates of morbidity and mortality in emergency general surgery to identify targets for care quality improvement. Emergency general surgery is characterized by a high-cost burden and disproportionate morbidity and mortality. Factors contributing to these observed disparities are not comprehensively understood and targets for quality improvement have not been formally developed. Using a grounded theory approach, emergency general surgery providers were recruited through purposive-criterion-based sampling to participate in semi-structured interviews and focus groups. Participants were asked to identify contributors to emergency general surgery outcomes, to define effective care for EGS patients, and to describe operating room team structure. Interviews were performed to thematic saturation. Transcripts were iteratively coded and analyzed within and across cases to identify emergent themes. Member checking was performed to establish credibility of the findings. A total of 40 participants from 5 academic hospitals participated in either individual interviews (n = 25 [9 anesthesia, 12 surgery, 4 nursing]) or focus groups (n = 2 [15 nursing]). Emergency general surgery was characterized by an exceptionally high level of variability, which can be subcategorized as patient-variability (acute physiology and comorbidities) and system-variability (operating room resources and workforce). Multidisciplinary communication is identified as a modifier to variability in emergency general surgery; however, nursing is often left out of early communication exchanges. Critical variability in emergency general surgery may impact outcomes. Patient-variability and system-variability, with focus on multidisciplinary communication, represent potential domains for quality improvement in this field. Copyright © 2017 Elsevier Inc. All rights reserved.

Surgical resident education: what is the department's price for commitment?

Science.gov (United States)

Meara, Michael P; Schlitzkus, Lisa L; Witherington, Mitzi; Haisch, Carl; Rotondo, Michael F; Schenarts, Paul J

2010-01-01

The current recession has impacted all aspects of our economy. Some residency programs have experienced faculty salary cuts, furlough days, and cessation of funding for travel to academic meetings. This milieu forced many residency programs to reevaluate their commitment to resident education, particularly for those expenses not provided for by Direct Medical Education (DME) and Indirect Medical Education (IME) funds. The purpose of this study was to determine what price a Department of Surgery pays to fulfill its commitment to resident education. A financial analysis of 1 academic year was performed for all expenses not covered by DME or IME funds and is paid for by the faculty practice plan. These expenses were categorized and further analyzed to determine the funds required for resident-related scholarly activity. A university-based general surgery residency program. Twenty-eight surgical residents and a program coordinator. The departmental faculty provided $153,141 during 1 academic year to support the educational mission of the residency. This amount is in addition to the $1.6 million in faculty time, $850,000 provided by the federal government in terms of DME funds, and $14 million of IME funds, which are distributed on an institutional basis. Resident presentations at scientific meetings accounted for $49,672, and program coordinator costs of $44,190 accounted for nearly two-thirds of this funding. The departmental faculty committed $6400 per categorical resident. In addition to DME and IME funds, a department of surgery must commit significant additional monies to meet the educational goals of surgical residency. Copyright © 2010 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

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

Science.gov (United States)

Maluf, Miguel Angel; Gomes, Walter José; Bras, Ademir Massarico; Araújo, Thiago Cavalcante Vila Nova de; Mota, André Lupp; Cardoso, Caio Cesar; Coutinho, Rafael Viana dos S

2015-01-01

Engage the UNIFESP Cardiovascular Surgery residents in coronary anastomosis, assess their skills and certify results, using the Arroyo Anastomosis Simulator and UNIFESP surgical models. 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. 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. 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.

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

Abolishment of 24-hour continuous medical call duty in quebec: a quality of life survey of general surgical residents following implementation of the new work-hour restrictions.

Science.gov (United States)

Hamadani, Fadi T; Deckelbaum, Dan; Sauve, Alexandre; Khwaja, Kosar; Razek, Tarek; Fata, Paola

2013-01-01

The implementation of work hour restrictions across North America have resulted in decreased levels of self injury and medical errors for Residents. An arbitration ruling in Quebec has led to further curtailment of work hours beyond that proposed by the ACGME. This may threaten Resident quality of life and in turn decrease the educational quality of surgical residency training. We administered a quality of life questionnaire with an integrated education quality assessment tool to all General Surgery residents training at McGill 6 months after the work hour restrictions. Across several strata respondents reveal a decreased sense of educational quality and quality of life. The arbitration argued that work- hour restrictions would be necessary to improve quality of life for trainees and hence improve patient safety. Results from this study demonstrate the exact opposite in a large majority of respondents, who report a poorer quality of life and a self-reported inability on their part to provide continuous and safe patient care. Copyright © 2013 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Outcomes of cataract surgery with residents as primary surgeons in the Veterans Affairs Healthcare System.

Science.gov (United States)

Payal, Abhishek R; Gonzalez-Gonzalez, Luis A; Chen, Xi; Cakiner-Egilmez, Tulay; Chomsky, Amy; Baze, Elizabeth; Vollman, David; Lawrence, Mary G; Daly, Mary K

2016-03-01

To explore visual outcomes, functional visual improvement, and events in resident-operated cataract surgery cases. Veterans Affairs Ophthalmic Surgery Outcomes Database Project across 5 Veterans Affairs Medical Centers. Retrospective data analysis of deidentified data. Cataract surgery cases with residents as primary surgeons were analyzed for logMAR corrected distance visual acuity (CDVA) and vision-related quality of life (VRQL) measured by the modified National Eye Institute Vision Function Questionnaire and 30 intraoperative and postoperative events. In some analyses, cases without events (Group A) were compared with cases with events (Group B). The study included 4221 cataract surgery cases. Preoperative to postoperative CDVA improved significantly in both groups (P < .0001), although the level of improvement was less in Group B (P = .03). A CDVA of 20/40 or better was achieved in 96.64% in Group A and 88.25% in Group B (P < .0001); however, Group B had a higher prevalence of preoperative ocular comorbidities (P < .0001). Cases with 1 or more events were associated with a higher likelihood of a postoperative CDVA worse than 20/40 (odds ratio, 3.82; 95% confidence interval, 2.92-5.05; P < .0001) than those who did not experience an event. Both groups had a significant increase in VRQL from preoperative levels (both P < .0001); however, the level of preoperative to postoperative VRQL improvement was significantly less in Group B (P < .0001). Resident-operated cases with and without events had an overall significant improvement in visual acuity and visual function compared with preoperatively, although this improvement was less marked in those that had an event. None of the authors has a financial or proprietary interest in any material or method mentioned. Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

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.

The effect of general surgery clerkship rotation on the attitude of medical students towards general surgery as a future career.

Science.gov (United States)

Al-Heeti, Khalaf N M; Nassar, Aussama K; Decorby, Kara; Winch, Joanne; Reid, Susan

2012-01-01

Literature suggests declining interest in General Surgery (GS) and other surgical specialties, with fewer Canadian medical residency applicants identifying a surgical specialty as their first choice. Although perceptions of surgical careers may begin before enrollment in clerkship, clerkship itself provides the most concentrated environment for perceptions to evolve. Most students develop perceptions about specialties during their clinical clerkships. This study examines the immediate impact of GS clerkship on student attitudes toward GS as a career, and on preferences towards GS compared with other specialties. A pre-post design involved 61 McMaster clinical clerks. Two instruments were used to collect data from students over the course of clerkship (2008-2009). Paired comparison (PC) compared ranking of career choices before and after clerkship. Semantic differential (SD) measured attitudes toward GS and variables that may have affected attitudes before and after clerkship. Analyses used SPSS 16.0 (SPSS Inc., Chicago, IL). Clerks ranked preferences for GS changed substantially after clerkship, moving from the 10th to the 5th position compared with other specialties. Ranks of surgical subspecialties also changed, though GS demonstrated the largest improvement. SD results were consistent with PC, showing improved attitudes after rotation, with differences both statistically and practically significant (t = 3.81, p staff (including attending surgeons and nurses), ensure that teaching hospital staff provide a positive experience for clerks, and should provide opportunities to learn basic technical skills during GS clerkship. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Risk factors for postoperative complications in robotic general surgery.

Science.gov (United States)

Fantola, Giovanni; Brunaud, Laurent; Nguyen-Thi, Phi-Linh; Germain, Adeline; Ayav, Ahmet; Bresler, Laurent

2017-03-01

The feasibility and safety of robotically assisted procedures in general surgery have been reported from various groups worldwide. Because postoperative complications may lead to longer hospital stays and higher costs overall, analysis of risk factors for postoperative surgical complications in this subset of patients is clinically relevant. The goal of this study was to identify risk factors for postoperative morbidity after robotic surgical procedures in general surgery. We performed an observational monocentric retrospective study. All consecutive robotic surgical procedures from November 2001 to December 2013 were included. One thousand consecutive general surgery patients met the inclusion criteria. The mean overall postoperative morbidity and major postoperative morbidity (Clavien >III) rates were 20.4 and 6 %, respectively. This included a conversion rate of 4.4 %, reoperation rate of 4.5 %, and mortality rate of 0.2 %. Multivariate analysis showed that ASA score >3 [OR 1.7; 95 % CI (1.2-2.4)], hematocrit value surgery [OR 1.5; 95 % CI (1-2)], advanced dissection [OR 5.8; 95 % CI (3.1-10.6)], and multiquadrant surgery [OR 2.5; 95 % CI (1.7-3.8)] remained independent risk factors for overall postoperative morbidity. It also showed that advanced dissection [OR 4.4; 95 % CI (1.9-9.6)] and multiquadrant surgery [OR 4.4; 95 % CI (2.3-8.5)] remained independent risk factors for major postoperative morbidity (Clavien >III). This study identifies independent risk factors for postoperative overall and major morbidity in robotic general surgery. Because these factors independently impacted postoperative complications, we believe they could be taken into account in future studies comparing conventional versus robot-assisted laparoscopic procedures in general surgery.

Resident simulation training in endoscopic endonasal surgery utilizing haptic feedback technology.

Science.gov (United States)

Thawani, Jayesh P; Ramayya, Ashwin G; Abdullah, Kalil G; Hudgins, Eric; Vaughan, Kerry; Piazza, Matthew; Madsen, Peter J; Buch, Vivek; Sean Grady, M

2016-12-01

Simulated practice may improve resident performance in endoscopic endonasal surgery. Using the NeuroTouch haptic simulation platform, we evaluated resident performance and assessed the effect of simulation training on performance in the operating room. First- (N=3) and second- (N=3) year residents were assessed using six measures of proficiency. Using a visual analog scale, the senior author scored subjects. After the first session, subjects with lower scores were provided with simulation training. A second simulation served as a task-learning control. Residents were evaluated in the operating room over six months by the senior author-who was blinded to the trained/untrained identities-using the same parameters. A nonparametric bootstrap testing method was used for the analysis (Matlab v. 2014a). Simulation training was associated with an increase in performance scores in the operating room averaged over all measures (p=0.0045). This is the first study to evaluate the training utility of an endoscopic endonasal surgical task using a virtual reality haptic simulator. The data suggest that haptic simulation training in endoscopic neurosurgery may contribute to improvements in operative performance. Limitations include a small number of subjects and adjudication bias-although the trained/untrained identity of subjects was blinded. Further study using the proposed methods may better describe the relationship between simulated training and operative performance in endoscopic Neurosurgery. Copyright © 2016 Elsevier Ltd. All rights reserved.

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

Construction of a Urologic Robotic Surgery Training Curriculum: How Many Simulator Sessions Are Required for Residents to Achieve Proficiency?

Science.gov (United States)

Wiener, Scott; Haddock, Peter; Shichman, Steven; Dorin, Ryan

2015-11-01

To define the time needed by urology residents to attain proficiency in computer-aided robotic surgery to aid in the refinement of a robotic surgery simulation curriculum. We undertook a retrospective review of robotic skills training data acquired during January 2012 to December 2014 from junior (postgraduate year [PGY] 2-3) and senior (PGY4-5) urology residents using the da Vinci Skills Simulator. We determined the number of training sessions attended and the level of proficiency achieved by junior and senior residents in attempting 11 basic or 6 advanced tasks, respectively. Junior residents successfully completed 9.9 ± 1.8 tasks, with 62.5% completing all 11 basic tasks. The maximal cumulative success rate of junior residents completing basic tasks was 89.8%, which was achieved within 7.0 ± 1.5 hours of training. Of senior residents, 75% successfully completed all six advanced tasks. Senior residents attended 6.3 ± 3.5 hours of training during which 5.1 ± 1.6 tasks were completed. The maximal cumulative success rate of senior residents completing advanced tasks was 85.4%. When designing and implementing an effective robotic surgical training curriculum, an allocation of 10 hours of training may be optimal to allow junior and senior residents to achieve an acceptable level of surgical proficiency in basic and advanced robotic surgical skills, respectively. These data help guide the design and scheduling of a residents training curriculum within the time constraints of a resident's workload.

Burnout is Associated With Emotional Intelligence but not Traditional Job Performance Measurements in Surgical Residents.

Science.gov (United States)

Cofer, Kevin D; Hollis, Robert H; Goss, Lauren; Morris, Melanie S; Porterfield, John R; Chu, Daniel I

2018-02-23

To evaluate whether burnout was associated with emotional intelligence and job performance in surgical residents. General surgery residents at a single institution were surveyed using the Maslach Burnout Inventory (MBI) and trait EI questionnaire (TEIQ-SF). Burnout was defined as scoring in 2 of the 3 following domains; Emotional Exhaustion (high), Depersonalization (high), and Personal Accomplishment (low). Job performance was evaluated using faculty evaluations of clinical competency-based surgical milestones and standardized test scores including the American Board of Surgery In-Training Exam (ABSITE) and the United States Medical Licensing Examination (USMLE) Step 3. USMLE Step 1 and USMLE Step 2, which were taken prior to residency training, were included to examine possible associations of burnout with USMLE examinations. Statistical comparison was made using Pearson correlation and simple linear regression adjusting for PGY level. This study was conducted at the University of Alabama at Birmingham (UAB) general surgery residency program. All current and incoming general surgery residents at UAB were invited to participate in this study. Forty residents participated in the survey (response rate 77%). Ten residents, evenly distributed from incoming residents to PGY-4, had burnout (25%). Mean global EI was lower in residents with burnout versus those without burnout (3.71 vs 3.9, p = 0.02). Of the 4 facets of EI, mean self-control values were lower in residents with burnout versus those without burnout (3.3 vs 4.06, p burnout was associated with global EI, with the strongest correlation being with personal accomplishment (r = 0.64; p burnout did not have significantly different mean scores for USMLE Step 1 (229 vs 237, p = 0.12), Step 2 (248 vs 251, p = 0.56), Step 3 (223 vs 222, p = 0.97), or ABSITE percentile (44.6 vs 58, p = 0.33) compared to residents without burnout. Personal accomplishment was associated with ABSITE percentile scores (r = 0.35; p = 0

[Robotic general surgery: where do we stand in 2013?].

Science.gov (United States)

Buchs, Nicolas C; Pugin, François; Ris, Frédéric; Jung, Minoa; Hagen, Monika E; Volonté, Francesco; Azagury, Dan; Morel, Philippe

2013-06-19

While the number of publications concerning robotic surgery is increasing, the level of evidence remains to be improved. The safety of robotic approach has been largely demonstrated, even for complex procedures. Yet, the objective advantages of this technology are still lacking in several fields, notably in comparison to laparoscopy. On the other hand, the development of robotic surgery is on its way, as the enthusiasm of the public and the surgical community can testify. Still, clear clinical indications remain to be determined in the field of general surgery. The study aim is to review the current literature on robotic general surgery and to give the reader an overview in 2013.

The surgical residency interview: a candidate-centered, working approach.

Science.gov (United States)

Seabott, Heather; Smith, Ryan K; Alseidi, Adnan; Thirlby, Richard C

2012-01-01

The interview process is a pivotal, differentiating component of the residency match. Our bias is toward a working interview, producing better fulfillment of the needs of both parties, and a more informed match selection for the candidates and program. We describe a "candidate-centered" approach for integrating applicant interviews into our daily work schedule. Applicants are informed upon accepting the interview of the working interview model. Our program offers 33 interview days over a 12-week period. A maximum of 5 applicants are hosted per day. Applicants are assigned to 1 of our general, thoracic, vascular, or plastic surgery teams. The interview day begins with the applicant changing into scrubs, attending a morning conference, and taking part in a program overview by a Chief Resident. Applicants join their host team where 4-8 hours are spent observing the operative team, on rounds and sharing lunch. The faculty and senior residents are responsible for interviewing and evaluating applicants though the Electronic Residency Application Service. A total of 13 surgeons are involved in the interview process resulting in broad-based evaluations. Each surgeon interviewed between 3 and 12 applicants. Faculty rate this interview approach highly because it allows them to maintain a rigorous operative schedule while interacting with applicants. Current residents are engaged in welcoming applicants to view the program. Faculty and residents believe cooperating in a real world manner aids their assessment of the applicant. Applicants routinely provide positive feedback, relaying this approach is informative, transparent, and should be the "standard." Applicants believe they are presented a realistic view of the program. Ultimately, this candidate-centered process may be attributable to our resident cohort who exhibit high satisfaction, excellent resident morale, and very low dropout rate. We present a candidate-centered, working interview approach used in the selection of

Is nighttime laparoscopic general surgery under general anesthesia safe?

Science.gov (United States)

Koltka, Ahmet Kemalettin; İlhan, Mehmet; Ali, Achmet; Gök, Ali Fuat Kaan; Sivrikoz, Nükhet; Yanar, Teoman Hakan; Günay, Mustafa Kayıhan; Ertekin, Cemalettin

2018-01-01

Fatigue and sleep deprivation can affect rational decision-making and motor skills, which can decrease medical performance and quality of patient care. The aim of the present study was to investigate the association between times of the day when laparoscopic general surgery under general anesthesia was performed and their adverse outcomes. All laparoscopic cholecystectomies and appendectomies performed at the emergency surgery department of a tertiary university hospital from 01. 01. 2016 to 12. 31. 2016 were included. Operation times were divided into three groups: 08.01-17.00 (G1: daytime), 17.01-23.00 (G2: early after-hours), and 23.01-08.00 (G3: nighttime). The files of the included patients were evaluated for intraoperative and postoperative surgery and anesthesia-related complications. We used multiple regression analyses of variance with the occurrence of intraoperative complications as a dependent variable and comorbidities, age, gender, body mass index (BMI), ASA score, and operation time group as independent variables. This revealed that nighttime operation (p<0.001; OR, 6.7; CI, 2.6-16.9) and older age (p=0.004; OR, 1.04; CI, 1.01-1.08) were the risk factor for intraoperative complications. The same analysis was performed for determining a risk factor for postoperative complications, and none of the dependent variables were found to be associated with the occurrence of postoperative complications. Nighttime surgery and older patient age increased the risk of intraoperative complications without serious morbidity or mortality, but no association was observed between the independent variables and the occurrence of postoperative complications.

Mentor-guided self-directed learning affects resident practice.

Science.gov (United States)

Aho, Johnathon M; Ruparel, Raaj K; Graham, Elaina; Zendejas-Mummert, Benjamin; Heller, Stephanie F; Farley, David R; Bingener, Juliane

2015-01-01

Self-directed learning (SDL) can be as effective as instructor-led training. It employs less instructional resources and is potentially a more efficient educational approach. Although SDL is encouraged among residents in our surgical training program via 24-hour access to surgical task trainers and online modules, residents report that they seldom practice. We hypothesized that a mentor-guided SDL approach would improve practice habits among our residents. From 2011 to 2013, 12 postgraduate year (PGY)-2 general surgery residents participated in a 6-week minimally invasive surgery (MIS) rotation. At the start of the rotation, residents were asked to practice laparoscopic skills until they reached peak performance in at least 3 consecutive attempts at a task (individual proficiency). Trainees met with the staff surgeon at weeks 3 and 6 to evaluate progress and review a graph of their individual learning curve. All trainees subsequently completed a survey addressing their practice habits and suggestions for improvement of the curriculum. By the end of the rotation, 100% of participants improved in all practiced tasks (p mentor-guided SDL. Additionally, 6 (50%) residents reported that their skill level had improved relative to their peers. Some residents (n = 3) felt that the curriculum could be improved by including task-specific goals and additional practice sessions with the staff surgeon. Mentor-guided SDL stimulated surgical residents to practice with greater frequency. This repeated deliberate practice led to significantly improved MIS skills without significantly increasing the need for faculty-led instruction. Some residents preferred more discrete goal setting and increased mentor guidance. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Reduction Mammoplasty: A Comparison Between Operations Performed by Plastic Surgery and General Surgery.

Science.gov (United States)

Kordahi, Anthony M; Hoppe, Ian C; Lee, Edward S

2015-01-01

Reduction mammoplasty is an often-performed procedure by plastic surgeons and increasingly by general surgeons. The question has been posed in both general surgical literature and plastic surgical literature as to whether this procedure should remain the domain of surgical specialists. Some general surgeons are trained in breast reductions, whereas all plastic surgeons receive training in this procedure. The National Surgical Quality Improvement Project provides a unique opportunity to compare the 2 surgical specialties in an unbiased manner in terms of preoperative comorbidities and 30-day postoperative complications. The National Surgical Quality Improvement Project database was queried for the years 2005-2012. Patients were identified as having undergone a reduction mammoplasty by Current Procedural Terminology codes. RESULTS were refined to include only females with an International Classification of Diseases, Ninth Revision, code of 611.1 (hypertrophy of breasts). Information was collected regarding age, surgical specialty performing procedure, body mass index, and other preoperative variables. The outcomes utilized were presence of superficial surgical site infection, presence of deep surgical site infection, presence of wound dehiscence, postoperative respiratory compromise, pulmonary embolism, deep vein thrombosis, perioperative transfusion, operative time, reintubation, reoperation, and length of hospital stay. During this time period, there were 6239 reduction mammaplasties performed within the National Surgical Quality Improvement Project database: 339 by general surgery and 5900 by plastic surgery. No statistical differences were detected between the 2 groups with regard to superficial wound infections, deep wound infections, organ space infections, or wound dehiscence. There were no significant differences noted between within groups with regard to systemic postoperative complications. Patients undergoing a procedure by general surgery were more likely

Stress and coping among orthopaedic surgery residents and faculty.

Science.gov (United States)

Sargent, M Catherine; Sotile, Wayne; Sotile, Mary O; Rubash, Harry; Barrack, Robert L

2004-07-01

Evaluations of physicians and residents have revealed concerning levels of psychosocial dysfunction. The purposes of this study were to determine the quality of life of orthopaedic residents and faculty and to identify the risk factors for decompensation. Twenty-one orthopaedic residents and twenty-five full-time orthopaedic faculty completed a 102-question voluntary, anonymous survey. The survey consisted of three validated instruments, i.e., the Maslach Burnout Inventory, the General Health Questionnaire-12, and the Revised Dyadic Adjustment Scale; and three novel question sets addressing background and demographic information, stress reaction and management, and the balance between work and home life. Descriptive statistics, pairwise correlations, simple t tests, and Pearson and nonparametric Spearman correlations were calculated. The simple correlation coefficient was used to assess bivariate relationships. The mean overall quality-of-life score, on a scale of 0 to 4 points, was 2.5 points for residents compared with 3.6 points for faculty members. Residents reported considerable burnout, showing a high level of emotional exhaustion and depersonalization and an average level of personal achievement, whereas faculty reported minimal burnout, showing a low level of emotional exhaustion (p burnout and psychiatric morbidity correlated with weekly work hours; conflict between the commitments of work and home life; discord with faculty, nursing staff, and senior residents; debt load; and work-related stress. Protective factors included being a parent, spending time with a spouse, having a physician father, and deriving satisfaction from discussing concerns with colleagues, friends, and family. In pursuit of our goal of determining the quality of life of orthopaedic residents and faculty, we identified a large disparity between the two groups. The resident group reported much greater levels of dysfunction particularly with regard to burnout and psychiatric morbidity

Understanding the "Weekend Effect" for Emergency General Surgery.

Science.gov (United States)

Hoehn, Richard S; Go, Derek E; Dhar, Vikrom K; Kim, Young; Hanseman, Dennis J; Wima, Koffi; Shah, Shimul A

2018-02-01

Several studies have identified a "weekend effect" for surgical outcomes, but definitions vary and the cause is unclear. Our aim was to better characterize the weekend effect for emergency general surgery using mortality as a primary endpoint. Using data from the University HealthSystem Consortium from 2009 to 2013, we identified urgent/emergent hospital admissions for seven procedures representing 80% of the national burden of emergency general surgery. Patient characteristics and surgical outcomes were compared between cases that were performed on weekdays vs weekends. Hospitals varied widely in the proportion of procedures performed on the weekend. Of the procedures examined, four had higher mortality for weekend cases (laparotomy, lysis of adhesions, partial colectomy, and small bowel resection; p < 0.01), while three did not (appendectomy, cholecystectomy, and peptic ulcer disease repair). Among the four procedures with increased weekend mortality, patients undergoing weekend procedures also had increased severity of illness and shorter time from admission to surgery (p < 0.01). Multivariate analysis adjusting for patient characteristics demonstrated independently higher mortality on weekends for these same four procedures (p < 0.01). For the first time, we have identified specific emergency general surgery procedures that incur higher mortality when performed on weekends. This may be due to acute changes in patient status that require weekend surgery or indications for urgent procedures (ischemia, obstruction) compared to those without a weekend mortality difference (infection). Hospitals that perform weekend surgery must acknowledge and identify ways to manage this increased risk.

Validation of a model of intensive training in digestive laparoscopic surgery.

Science.gov (United States)

Enciso, Silvia; Díaz-Güemes, Idoia; Usón, Jesús; Sánchez-Margallo, Francisco Miguel

2016-02-01

Our objective was to assess a laparoscopic training model for general surgery residents. Twelve general surgery residents carried out a training program, consisting of a theoretical session (one hour) and a hands-on session on simulator (7 h) and on animal model (13 h). For the first and last repetitions of simulator tasks and the Nissen fundoplication technique, time and scores from the global rating scale objective structured assessment of technical skills (OSATS) were registered. Before and after the course, participants performed 4 tasks on the virtual reality simulator LAPMentor™: 1) hand-eye coordination, 2) hand-hand coordination, 3) transference of objects and 4) cholecystectomy task, registering time and movement metrics. Moreover, the residents completed a questionnaire related to the training components on a 5-point rating scale. The last repetition of the tasks and the Nissen fundoplication technique were performed faster and with a higher OSATS score. After the course, the participants performed all LAPMentor™ tasks faster, increasing the speed of movements in all tasks. Number of movements decreased in tasks 2, 3 and 4; as well as path length in tasks 2 and 4. Training components were positively rated by residents, being the suture task the aspect best rated (4.90 ± 0.32). This training model in digestive laparoscopic surgery has demonstrated to be valid for the improvement of basic and advanced skills of general surgery residents. Intracorporeal suturing and the animal model were the best rated training elements. Copyright © 2015 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

Operative time and cost of resident surgical experience: effect of instituting an otolaryngology residency program.

Science.gov (United States)

Pollei, Taylor R; Barrs, David M; Hinni, Michael L; Bansberg, Stephen F; Walter, Logan C

2013-06-01

Describe the procedure length difference between surgeries performed by an attending surgeon alone compared with the resident surgeon supervised by the same attending surgeon. Case series with chart review. Tertiary care center and residency program. Six common otolaryngologic procedures performed between August 1994 and May 2012 were divided into 2 cohorts: attending surgeon alone or resident surgeon. This division coincided with our July 2006 initiation of an otolaryngology-head and neck surgery residency program. Operative duration was compared between cohorts with confounding factors controlled. In addition, the direct result of increased surgical length on operating room cost was calculated and applied to departmental and published resident case log report data. Five of the 6 procedures evaluated showed a statistically significant increase in surgery length with resident involvement. Operative time increased 6.8 minutes for a cricopharyngeal myotomy (P = .0097), 11.3 minutes for a tonsillectomy (P operative time difference. Cost of increased surgical time was calculated per surgery and ranged from $286 (cricopharyngeal myotomy) to $2142 (mastoidectomy). When applied to reported national case log averages for graduating residents, this resulted in a significant increase of direct training-related costs. Resident participation in the operating room results in increased surgical length and additional system cost. Although residency is a necessary part of surgical training, associated costs need to be acknowledged.

Accounting for graduate medical education production of primary care physicians and general surgeons: timing of measurement matters.

Science.gov (United States)

Petterson, Stephen; Burke, Matthew; Phillips, Robert; Teevan, Bridget

2011-05-01

Legislation proposed in 2009 to expand GME set institutional primary care and general surgery production eligibility thresholds at 25% at entry into training. The authors measured institutions' production of primary care physicians and general surgeons on completion of first residency versus two to four years after graduation to inform debate and explore residency expansion and physician workforce implications. Production of primary care physicians and general surgeons was assessed by retrospective analysis of the 2009 American Medical Association Masterfile, which includes physicians' training institution, residency specialty, and year of completion for up to six training experiences. The authors measured production rates for each institution based on physicians completing their first residency during 2005-2007 in family or internal medicine, pediatrics, or general surgery. They then reassessed rates to account for those who completed additional training. They compared these rates with proposed expansion eligibility thresholds and current workforce needs. Of 116,004 physicians completing their first residency, 54,245 (46.8%) were in primary care and general surgery. Of 683 training institutions, 586 met the 25% threshold for expansion eligibility. At two to four years out, only 29,963 physicians (25.8%) remained in primary care or general surgery, and 135 institutions lost eligibility. A 35% threshold eliminated 314 institutions collectively training 93,774 residents (80.8%). Residency expansion thresholds that do not account for production at least two to four years after completion of first residency overestimate eligibility. The overall primary care production rate from GME will not sustain the current physician workforce composition. Copyright © by the Association of American medical Colleges.

Robot-assisted laparoscopic (RAL) procedures in general surgery.

Science.gov (United States)

Alimoglu, Orhan; Sagiroglu, Julide; Atak, Ibrahim; Kilic, Ali; Eren, Tunc; Caliskan, Mujgan; Bas, Gurhan

2016-09-01

Robotics was introduced in clinical practice more than two decades ago, and it has gained remarkable popularity for a wide variety of laparoscopic procedures. We report our results of robot-assisted laparoscopic surgery (RALS) in the most commonly applied general surgical procedures. Ninety seven patients underwent RALS from 2009 to 2012. Indications for RALS were cholelithiasis, gastric carcinoma, splenic tumors, colorectal carcinoma, benign colorectal diseases, non-toxic nodular goiter and incisional hernia. Records of patients were analyzed for demographic features, intraoperative and postoperative complications and conversion to open surgery. Forty six female and 51 male patients were operated and mean age was 58,4 (range: 25-88). Ninety three out of 97 procedures (96%) were completed robotically, 4 were converted to open surgery and there were 15 postoperative complications. There was no mortality. Wide variety of procedures of general surgery can be managed safely and effectively by RALS. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

A Systematic Review of the Effects of Resident Duty Hour Restrictions in Surgery

Science.gov (United States)

Devitt, Katharine S.; Keshet, Itay; Spicer, Jonathan; Imrie, Kevin; Feldman, Liane; Cools-Lartigue, Jonathan; Kayssi, Ahmed; Lipsman, Nir; Elmi, Maryam; Kulkarni, Abhaya V.; Parshuram, Chris; Mainprize, Todd; Warren, Richard J.; Fata, Paola; Gorman, M. Sean; Feinberg, Stan; Rutka, James

2014-01-01

Background: In 2003, the Accreditation Council for Graduate Medical Education (ACGME) mandated 80-hour resident duty limits. In 2011 the ACGME mandated 16-hour duty maximums for PGY1 (post graduate year) residents. The stated goals were to improve patient safety, resident well-being, and education. A systematic review and meta-analysis were performed to evaluate the impact of resident duty hours (RDH) on clinical and educational outcomes in surgery. Methods: A systematic review (1980–2013) was executed on CINAHL, Cochrane Database, Embase, Medline, and Scopus. Quality of articles was assessed using the GRADE guidelines. Sixteen-hour shifts and night float systems were analyzed separately. Articles that examined mortality data were combined in a random-effects meta-analysis to evaluate the impact of RDH on patient mortality. Results: A total of 135 articles met the inclusion criteria. Among these, 42% (N = 57) were considered moderate-high quality. There was no overall improvement in patient outcomes as a result of RDH; however, some studies suggest increased complication rates in high-acuity patients. There was no improvement in education related to RDH restrictions, and performance on certification examinations has declined in some specialties. Survey studies revealed a perception of worsened education and patient safety. There were improvements in resident wellness after the 80-hour workweek, but there was little improvement or negative effects on wellness after 16-hour duty maximums were implemented. Conclusions: Recent RDH changes are not consistently associated with improvements in resident well-being, and have negative impacts on patient outcomes and performance on certification examinations. Greater flexibility to accommodate resident training needs is required. Further erosion of training time should be considered with great caution. PMID:24662409

Robotics and general surgery.

Science.gov (United States)

Jacob, Brian P; Gagner, Michel

2003-12-01

Robotics are now being used in all surgical fields, including general surgery. By increasing intra-abdominal articulations while operating through small incisions, robotics are increasingly being used for a large number of visceral and solid organ operations, including those for the gallbladder, esophagus, stomach, intestines, colon, and rectum, as well as for the endocrine organs. Robotics and general surgery are blending for the first time in history and as a specialty field should continue to grow for many years to come. We continuously demand solutions to questions and limitations that are experienced in our daily work. Laparoscopy is laden with limitations such as fixed axis points at the trocar insertion sites, two-dimensional video monitors, limited dexterity at the instrument tips, lack of haptic sensation, and in some cases poor ergonomics. The creation of a surgical robot system with 3D visual capacity seems to deal with most of these limitations. Although some in the surgical community continue to test the feasibility of these surgical robots and to question the necessity of such an expensive venture, others are already postulating how to improve the next generation of telemanipulators, and in so doing are looking beyond today's horizon to find simpler solutions. As the robotic era enters the world of the general surgeon, more and more complex procedures will be able to be approached through small incisions. As technology catches up with our imaginations, robotic instruments (as opposed to robots) and 3D monitoring will become routine and continue to improve patient care by providing surgeons with the most precise, least traumatic ways of treating surgical disease.

The hospital educational environment and performance of residents in the General Medicine In-Training Examination: a multicenter study in Japan

Directory of Open Access Journals (Sweden)

Shimizu T

2013-07-01

Full Text Available Taro Shimizu,1 Yusuke Tsugawa,2,3 Yusuke Tanoue,4 Ryota Konishi,5 Yuji Nishizaki,6 Mitsumasa Kishimoto,7 Toshiaki Shiojiri,8 Yasuharu Tokuda9 1Hospitalist Division, Department of Medicine, Nerima Hikarigaoka Hospital, Tokyo, Japan; 2Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA; 3Center for Clinical Epidemiology, St Luke's Life Science Institute, 4Department of Vascular and Oncological Surgery, Hospital of Tokyo University, 5Department of General Internal Medicine, Kanto Rousai Hospital, 6Department of Cardiology, Juntendo University School of Medicine, 7Division of Rheumatology, St Luke's International Hospital, Tokyo, Japan; 8Asahi Chuo Hospital, Chiba, Japan; 9Department of Medicine, Tsukuba University Mito Kyodo General Hospital, Mito City, Ibaraki, Japan Background: It is believed that the type of educational environment in teaching hospitals may affect the performance of medical knowledge base among residents, but this has not yet been proven. Objective: We aimed to investigate the association between the hospital educational environment and the performance of the medical knowledge base among resident physicians in Japanese teaching hospitals. Methods: To assess the knowledge base of medicine, we conducted the General Medicine In-Training Examination (GM-ITE for second-year residents in the last month of their residency. The items of the exam were developed based on the outcomes designated by the Japanese Ministry of Health, Labor, and Welfare. The educational environment was evaluated using the Postgraduate Hospital Educational Environment Measure (PHEEM score, which was assessed by a mailed survey 2 years prior to the exam. A mixed-effects linear regression model was employed for the analysis of variables associated with a higher score. Results: Twenty-one teaching hospitals participated in the study and a total of 206 residents (67 women participated and

GENERAL SURGERY

African Journals Online (AJOL)

mean time to first surgery post burn was 11.5 days with a median volume of 0.73 mls/kg/% ..... Mode. Mean (SD). Upper limit. 95% CI. Lower limit. 95% CI. Mode. Elective surgery .... evaluating single-unit red blood cell transfusions in reducing.

Identification of Best Practices for Resident Aesthetic Clinics in Plastic Surgery Training: The ACAPS National Survey

Directory of Open Access Journals (Sweden)

C. Scott Hultman, MD, MBA, FACS

2015-03-01

Conclusions: RACs are an important component of plastic surgery education. Most clinics are financially viable but carry high malpractice risk and consume significant resources. Best practices, to maximize patient safety and optimize resident education, include use of accredited procedural rooms and direct faculty supervision of all components of care.

[Robotics in general surgery: personal experience, critical analysis and prospectives].

Science.gov (United States)

Fracastoro, Gerolamo; Borzellino, Giuseppe; Castelli, Annalisa; Fiorini, Paolo

2005-01-01

Today mini invasive surgery has the chance to be enhanced with sophisticated informative systems (Computer Assisted Surgery, CAS) like robotics, tele-mentoring and tele-presence. ZEUS and da Vinci, present in more than 120 Centres in the world, have been used in many fields of surgery and have been tested in some general surgical procedures. Since the end of 2003, we have performed 70 experimental procedures and 24 operations of general surgery with ZEUS robotic system, after having properly trained 3 surgeons and the operating room staff. Apart from the robot set-up, the mean operative time of the robotic operations was similar to the laparoscopic ones; no complications due to robotic technique occurred. The Authors report benefits and disadvantages related to robots' utilization, problems still to be solved and the possibility to make use of them with tele-surgery, training and virtual surgery.

Main Educational Stressors and theirs Relationship with General Health of Medical Residents

Directory of Open Access Journals (Sweden)

Nahid Khajehmougahi

2009-03-01

Full Text Available Background: In the age of information and technology application, troublesome regulations and traditional  procedures for medical education may cause serious stresses and be a threat to the general health (GH of the students of medicine.Purpose: To determine the relationship between educational stressors and the general health of residents studying at the Ahwaz Jundishapour  University of Medical Sciences (Alums.Method: In this cross sectional study, the study group was consisted  of  ll4 cooperative residents (69% of all residents in the hospital, who were being trained in a variety of different specialties.  The instruments used were the Educational Stressors Questionnaire, including 45 four-choice items and a General  Health Questionnaire. When the questionnaires were completed, the results were analyzed through Pierson Correlation Coefficient using the SPSS.Results: The residents mentioned their educational stressors as follows: lack of an arranged curriculum, troublesome educational regulations, deficient educational instruments, and inadequate clinical instruction. of all the subjects, 43 ( 37.6% appeared to have problems in GH,and significantly positive correlation (pgeneral health, medical residents, medical  education

Do patients fear undergoing general anesthesia for oral surgery?

Science.gov (United States)

Elmore, Jasmine R; Priest, James H; Laskin, Daniel M

2014-01-01

Many patients undergoing major surgery have more fear of the general anesthesia than the procedure. This appears to be reversed with oral surgery. Therefore, patients need to be as well informed about this aspect as the surgical operation.

Putting residents in the office: an effective method to teach the systems-based practice competency.

Science.gov (United States)

Pulcrano, Marisa; Chahine, A Alfred; Saratsis, Amanda; Divine-Cadavid, Jamie; Narra, Vinod; Evans, Stephen R T

2015-01-01

Systems-based practice (SBP) was 1 of 6 core competencies established by the Accreditation Council for Graduate Medical Education and has proven to be one of the most difficult to effectively implement. This pilot study presents an immersion workshop as an effective tool to teach the SBP competency in a way that could easily be integrated into a residency curriculum. In 2006, 16 surgical residents rotated through 3 stations for 30 minutes each: coding and billing, scheduling operations and return appointments, and patient check-in. Participants were administered a pretest and posttest questionnaire evaluating their knowledge of SBP, and were asked to evaluate the workshop. Outpatient clinic at MedStar Georgetown University Hospital, Washington, DC. Residents in the general surgery residency training program at MedStar Georgetown University Hospital. Most residents (62.5%) improved their score after the workshop, whereas 31.25% showed no change and 6.25% demonstrated a decrease in score. Overall within their training levels, all groups demonstrated an increase in mean test score. Postgraduate year-2 residents demonstrated the greatest change in mean score (20%), whereas postgraduate year-4 residents demonstrated the smallest change in mean score (3.3%). An immersion workshop where general surgery residents gained direct exposure to SBP concepts in situ was an effective and practical method of integrating this core competency into the residency curriculum. Such a workshop could complement more formal didactic teaching and be easily incorporated into the curriculum. For example, this workshop could be integrated into the ambulatory care requirement that each resident must fulfill as part of their clinical training. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Perceptions of society for vascular surgery members and surgery department chairs of the integrated 0 + 5 vascular surgery training paradigm.

Science.gov (United States)

Kiguchi, Misaki; Leake, Andrew; Switzer, Galen; Mitchell, Erica; Makaroun, Michel; Chaer, Rabih A

2014-01-01

As the first generation of integrated (0 + 5) vascular surgery (VS) residents enter the job market, this survey sought to understand how the surgical community perceives this training paradigm. An anonymous online survey was e-mailed to surgery chairpersons (n = 193) and Society for Vascular Surgery (SVS) members (n = 2193) in the United States/Canada with 26% (n = 38) and 14% (n = 309) response rates, respectively. Respondents were asked about their practice background, residency program, hiring patterns, and perceptions of the 0 + 5 training. Response rates were 26% (n = 38) and 14% (n = 309) for surgery chairpersons and SVS members, respectively. SVS respondents were from academic (62%) and private (38%) practices and included staff surgeons (62%), program directors (15%), and division chiefs (22%). Only 33% had a 0 + 5 program, and 57% had a VS fellowship. Overall, 94% were likely to hire a new vascular surgeon in the next 5 years. In some categories, SVS respondents believed 0 + 5 residents would be less prepared than 5 + 2 residents. Only 32% thought that 0 + 5 residents have the same level of surgical maturity, and 36% thought that they have the same level of open operative skills as 5 + 2 trainees. Another 34% thought 0 + 5 residents will need additional fellowship training in open surgery. However, there was also a general perception from SVS respondents that 0 + 5 residents would be prepared for clinical practice (67%) and would have equal endovascular skills to 5 + 2 trainees (92%). The chairpersons had similar perceptions as SVS members. Both SVS members (88%) and chairpersons (86%) would consider interviewing a 0 + 5 graduate for faculty position; 83% and 72%, respectively, would consider hiring. Moreover, 93% of SVS respondents who currently have a 0 + 5 program and 86% of SVS respondents who do not would consider hiring a 0 + 5 graduate. Both SVS members (62%) and chairpersons (50%) believed the 0 + 5 paradigm is essential for the advancement of VS

An appraisal of the learning curve in robotic general surgery.

Science.gov (United States)

Pernar, Luise I M; Robertson, Faith C; Tavakkoli, Ali; Sheu, Eric G; Brooks, David C; Smink, Douglas S

2017-11-01

Robotic-assisted surgery is used with increasing frequency in general surgery for a variety of applications. In spite of this increase in usage, the learning curve is not yet defined. This study reviews the literature on the learning curve in robotic general surgery to inform adopters of the technology. PubMed and EMBASE searches yielded 3690 abstracts published between July 1986 and March 2016. The abstracts were evaluated based on the following inclusion criteria: written in English, reporting original work, focus on general surgery operations, and with explicit statistical methods. Twenty-six full-length articles were included in final analysis. The articles described the learning curves in colorectal (9 articles, 35%), foregut/bariatric (8, 31%), biliary (5, 19%), and solid organ (4, 15%) surgery. Eighteen of 26 (69%) articles report single-surgeon experiences. Time was used as a measure of the learning curve in all studies (100%); outcomes were examined in 10 (38%). In 12 studies (46%), the authors identified three phases of the learning curve. Numbers of cases needed to achieve plateau performance were wide-ranging but overlapping for different kinds of operations: 19-128 cases for colorectal, 8-95 for foregut/bariatric, 20-48 for biliary, and 10-80 for solid organ surgery. Although robotic surgery is increasingly utilized in general surgery, the literature provides few guidelines on the learning curve for adoption. In this heterogeneous sample of reviewed articles, the number of cases needed to achieve plateau performance varies by case type and the learning curve may have multiple phases as surgeons add more complex cases to their case mix with growing experience. Time is the most common determinant for the learning curve. The literature lacks a uniform assessment of outcomes and complications, which would arguably reflect expertise in a more meaningful way than time to perform the operation alone.

Orthopedic resident work-shift analysis: are we making the best use of resident work hours?

Science.gov (United States)

Hamid, Kamran S; Nwachukwu, Benedict U; Hsu, Eugene; Edgerton, Colston A; Hobson, David R; Lang, Jason E

2014-01-01

Surgery programs have been tasked to meet rising demands in patient surgical care while simultaneously providing adequate resident training in the midst of increasing resident work-hour restrictions. The purpose of this study was to quantify orthopedic surgery resident workflow and identify areas needing improved resident efficiency. We hypothesize that residents spend a disproportionate amount of time involved in activities that do not relate directly to patient care or maximize resident education. We observed 4 orthopedic surgery residents on the orthopedic consult service at a major tertiary care center for 72 consecutive hours (6 consecutive shifts). We collected minute-by-minute data using predefined work-task criteria: direct new patient contact, direct existing patient contact, communications with other providers, documentation/administrative time, transit time, and basic human needs. A seventh category comprised remaining less-productive work was termed as standby. In a 720-minute shift, residents spent on an average: 191 minutes (26.5%) performing documentation/administrative duties, 167.0 minutes (23.2%) in direct contact with new patient consults, 129.6 minutes (17.1%) in communication with other providers regarding patients, 116.2 (16.1%) minutes in standby, 63.7 minutes (8.8%) in transit, 32.6 minutes (4.5%) with existing patients, and 20 minutes (2.7%) attending to basic human needs. Residents performed an additional 130 minutes of administrative work off duty. Secondary analysis revealed residents were more likely to perform administrative work rather than directly interact with existing patients (p = 0.006) or attend to basic human needs (p = 0.003). Orthopedic surgery residents spend a large proportion of their time performing documentation/administrative-type work and their workday can be operationally optimized to minimize nonvalue-adding tasks. Formal workflow analysis may aid program directors in systematic process improvements to better align

Surgery and Medicine Residents' Perspectives of Morbidity and Mortality Conference: An Interdisciplinary Approach to Improve ACGME Core Competency Compliance.

Science.gov (United States)

Flynn-O'Brien, Katherine T; Mandell, Samuel P; Eaton, Erik Van; Schleyer, Anneliese M; McIntyre, Lisa K

2015-01-01

Morbidity and mortality conferences (MMCs) are often used to fulfill the Accreditation Council for Graduate Medical Education practice-based learning and improvement (PBLI) competency, but there is variation among institutions and disciplines in their approach to MMCs. The objective of this study is to examine the trainees' perspective and experience with MMCs and adverse patient event (APE) reporting across disciplines to help guide the future implementation of an institution-wide, workflow-embedded, quality improvement (QI) program for PBLI. Between April 1, 2013, and May 8, 2013, surgical and medical residents were given a confidential survey about APE reporting practices and experience with and attitudes toward MMCs and other QI/patient safety initiatives. Descriptive statistics and univariate analyses using the chi-square test for independence were calculated for all variables. Logistic regression and ordered logistic regression were used for nominal and ordinal categorical dependent variables, respectively, to calculate odds of reporting APEs. Qualitative content analysis was used to code free-text responses. A large, multihospital, tertiary academic training program in the Pacific Northwest. Residents in all years of training from the Accreditation Council for Graduate Medical Education-accredited programs in surgery and internal medicine. Survey response rate was 46.2% (126/273). Although most respondents agreed or strongly agreed that knowledge of and involvement in QI/patient safety activities was important to their training (88.1%) and future career (91.3%), only 10.3% regularly or frequently reported APEs to the institution's established electronic incident reporting system. Senior-level residents in both surgery and medicine were more likely to report APEs than more junior-level residents were (odds ratio = 4.8, 95% CI: 3.1-7.5). Surgery residents had a 4.9 (95% CI: 2.3-10.5) times higher odds than medicine residents had to have reported an APE to

Nationwide survey of US integrated 6-year cardiothoracic surgical residents.

Science.gov (United States)

Lebastchi, Amir H; Yuh, David D

2014-08-01

Integrated 6-year cardiothoracic surgical residency programs have recently been implemented in the United States. We report the results of the first published nationwide survey assessing the motivations, satisfaction, and ambitions of integrated 6-year residents. A 63-question web-based survey was distributed to 83 residents enrolled in 21 Accreditation Council for Graduate Medical Education-accredited integrated 6-year programs in November 2013. There was an outstanding 69% response rate. The median age of integrated 6-year residents was 29 years with women comprising 24%. A clear majority had faculty mentorship (95%) and significant clinical exposure in medical school. Focused (100%) and abbreviated (74%) training curricula were identified as the top advantages of integrated 6-year programs; the format itself was a significant factor (46%) in career choice. Most integrated 6-year residents (95%) were satisfied with their program; 80.7% were satisfied with their operative experience thus far. Career plans skewed toward adult cardiac surgery (67%), followed by pediatric cardiac (24%) and general thoracic (9%) surgery; 49% were not particularly concerned about future employment, with 65% foreseeing an increase in opportunities. Specialized training (eg, aortic, heart failure, minimally invasive, congenital) was anticipated by 77%. Most integrated 6-year residents envision an academic career (94.7%). This survey takes an important snapshot of the nascent integrated 6-year format. Mentorship and intense clinical exposure are critical in attracting applicants. Purported advantages of the format are holding true among integrated 6-year residents, with the majority satisfied with their programs. These early data indicate that this format holds significant promise in attracting and retaining highly qualified trainees to academic cardiothoracic surgery. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Plastic surgery residency graduate outcomes: a 43-year experience at a single institution and the first "integrated" training program in the United States.

Science.gov (United States)

Noland, Shelley S; Lee, Gordon K

2012-04-01

The Accreditation Council for Graduate Medical Education emphasizes outcome-based residency education. This project is an outcomes study on graduates of the Stanford University Integrated Plastic Surgery Residency. A survey assessing various outcomes, including practice profile, financial, personal, and educational issues, was electronically distributed to all 130 graduates between 1966 and 2009. There was a 65% response rate. Nearly all respondents are currently in practice. Popular fellowships included hand and microsurgery. Most respondents participated in research and held leadership roles. Adequate residency education was noted in areas of patient care, board preparation, and ethical and legal issues. Inadequate residency education was noted in areas of managing a practice, coding, and cost-effective medicine. This is the first long-term outcomes study of plastic surgery graduates. Most are in active, successful practice. We have incorporated educational content related to running a small business, contract negotiating, and marketing to better prepare our residents for future practice.

Bilateral corneal denting after surgery under general anesthesia: A case report

Directory of Open Access Journals (Sweden)

Satsuki Obata

2018-06-01

Full Text Available Purpose: To report a case of temporary bilateral corneal denting in a patient who underwent cardiovascular surgery under general anesthesia. Observations: A 71-year-old male with no history of ophthalmological disease experienced bilateral corneal denting immediately after undergoing surgery for aneurysm of the thoracic aorta under general anesthesia. Anesthesia was induced with propofol and maintained with rocuronium bromide and remifentanil hydrochloride. The initial examination revealed significant denting on the surface of both the corneas and ocular hypotension. Visual evaluation could not be performed due to the patient's low level of consciousness resulting from delayed emergence from anesthesia. After applying tropicamide and phenylephrine ophthalmic solution for fundus examination, the ocular morphology improved. Ocular pressure was normal on the day after surgery, and creasing on the surface of the corneas had disappeared. Conclusions: and Importance: We experienced a patient with bilateral corneal denting following a cardiovascular surgery under general anesthesia. The dents could be attributed to augmentation of ocular hypotension using several types of anesthesia at relatively high doses. Keywords: General anesthesia, Cornea denting, Complication, Cardiovascular surgery

Work-related health complaints in surgical residents and the influence of social support and job-related autonomy.

Science.gov (United States)

Boerjan, Martine; Bluyssen, Simone J M; Bleichrodt, Robert P; van Weel-Baumgarten, Evelyn M; van Goor, Harry

2010-08-01

The aim of this cross-sectional study was to investigate the influence of job-related autonomy and social support provided by consultants and colleagues on the stress-related health complaints of surgical residents in the Netherlands. All (n = 400) Dutch residents in training in general surgery were sent validated self-report questionnaires. Odds ratios were calculated predicting health and exposure to long-term stress for gender, number of working hours, type of hospital, level of social support, job-related autonomy and training phase. The interactions between job-related autonomy and level of social support provided by consultants and colleagues, and all variables, were analysed. A total of 254 of 400 (64%) residents returned questionnaires that were eligible for analysis. Residents experienced more health complaints than the average member of the Dutch working population (4.0 versus 2.5; p = 0.000). Male and senior residents were significantly 'healthier' than female and junior residents, respectively. Social support by consultants was a strong predictor of health and social support by colleagues showed a significant interaction with gender. Women and residents in university hospitals experienced less social support by consultants than men and residents in general teaching hospitals. Residents working in university hospitals experienced lower levels of job-related autonomy and less support from colleagues in comparison with those working in general teaching hospitals. A working week of > 60 hours adversely affected health and job-related autonomy. Social support provided by consultants and colleagues, and job control, are important factors that interact with the work-associated, stress-related health of residents in training in general surgery. Residents report a greater number of health complaints than the average member of the working population, especially female and junior residents. General teaching hospitals seem to provide better support at work than

Women in academic general surgery.

Science.gov (United States)

Schroen, Anneke T; Brownstein, Michelle R; Sheldon, George F

2004-04-01

To portray the professional experiences of men and women in academic general surgery with specific attention to factors associated with differing academic productivity and with leaving academia. A 131-question survey was mailed to all female (1,076) and a random 2:1 sample of male (2,152) members of the American College of Surgeons in three mailings between September 1998 and March 1999. Detailed questions regarding academic rank, career aspirations, publication rate, grant funding, workload, harassment, income, marriage and parenthood were asked. A five-point Likert scale measured influences on career satisfaction. Responses from strictly academic and tenure-track surgeons were analyzed and interpreted by gender, age, and rank. Overall, 317 surgeons in academic practice (168 men, 149 women) responded, of which 150 were in tenure-track positions (86 men, 64 women). Men and women differed in academic rank, tenure status, career aspirations, and income. Women surgeons had published a median of ten articles compared with 25 articles for men (p career satisfaction was high, but women reported feeling career advancement opportunities were not equally available to them as to their male colleagues and feeling isolation from surgical peers. Ten percent to 20% of surgeons considered leaving academia, with women assistant professors (29%) contemplating this most commonly. Addressing the differences between men and women academic general surgeons is critical in fostering career development and in recruiting competitive candidates of both sexes to general surgery.

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.

Perceptions, training experiences, and preferences of surgical residents toward laparoscopic simulation training: a resident survey.

Science.gov (United States)

Shetty, Shohan; Zevin, Boris; Grantcharov, Teodor P; Roberts, Kurt E; Duffy, Andrew J

2014-01-01

Simulation training for surgical residents can shorten learning curves, improve technical skills, and expedite competency. Several studies have shown that skills learned in the simulated environment are transferable to the operating room. Residency programs are trying to incorporate simulation into the resident training curriculum to supplement the hands-on experience gained in the operating room. Despite the availability and proven utility of surgical simulators and simulation laboratories, they are still widely underutilized by surgical trainees. Studies have shown that voluntary use leads to minimal participation in a training curriculum. Although there are several simulation tools, there is no clear evidence of the superiority of one tool over the other in skill acquisition. The purpose of this study was to explore resident perceptions, training experiences, and preferences regarding laparoscopic simulation training. Our goal was to profile resident participation in surgical skills simulation, recognize potential barriers to voluntary simulator use, and identify simulation tools and tasks preferred by residents. Furthermore, this study may help to inform whether mandatory/protected training time, as part of the residents' curriculum is essential to enhance participation in the simulation laboratory. A cross-sectional study on general surgery residents (postgraduate years 1-5) at Yale University School of Medicine and the University of Toronto via an online questionnaire was conducted. Overall, 67 residents completed the survey. The institutional review board approved the methods of the study. Overall, 95.5% of the participants believed that simulation training improved their laparoscopic skills. Most respondents (92.5%) perceived that skills learned during simulation training were transferrable to the operating room. Overall, 56.7% of participants agreed that proficiency in a simulation curriculum should be mandatory before operating room experience. The

Assessing knowledge and attitudes towards addictions in medical residents of a general hospital

OpenAIRE

Barral, Carmen; Eiroa-Orosa, Francisco Jose; Navarro-Marfisis, Maria Cecilia; Roncero, Carlos; Casas, Miguel

2014-01-01

Addiction treatment training has been recognized to be an essential part of the curriculum in psychiatry and general medicine. Our objective in this study was to measure the knowledge and attitudes towards addictions among medical residents of a general hospital in Catalonia, Spain.\\ud \\ud Method\\ud Within a sample of medical residents, we administered a questionnaire based on previous literature including attitudes towards patients with drug use problems, evaluation of knowledge and beliefs ...

Maintaining the Fire but Avoiding Burnout: Implementation and Evaluation of a Resident Well-Being Program.

Science.gov (United States)

Riall, Taylor S; Teiman, Joshua; Chang, Michelle; Cole, Denzel; Leighn, Tambre; McClafferty, Hilary; Nfonsam, Valentine N

2018-04-01

There have been few programs designed to improve surgical resident well-being, and such efforts often lack formal evaluation. General surgery residents participated in the Energy Leadership Well-Being and Resiliency Program. They were assessed at baseline and 1 year after implementation using the Energy Leadership Index (measures emotional intelligence), Maslach Burnout Inventory General Survey, Perceived Stress Scale, the Beck Depression Inventory, and the annual required ACGME resident survey. Scores before and after implementation were compared using paired t-tests for continuous variables and chi-square tests for categorical variables. Forty-nine general surgery residents participate in the program. One year after implementation, resident score on the Energy Leadership Index improved (from 3.16 ± 0.24 to 3.24 ± 0.32; p = 0.03). Resident perceived stress decreased from baseline (Perceived Stress Scale score, from 17.0 ± 7.2 to 15.7 ± 6.2; p = 0.05). Scores on the emotional exhaustion scale of the Maslach Burnout Inventory decreased (from 16.8 ± 8.4 to 14.4 ± 8.5; p = 0.04). Resident-reported satisfaction improved in many areas; satisfaction with leadership skills, work relationships, communication skills, productivity, time management, personal freedom, and work-life balance, increased during the 1-year intervention (p = NS). On the annual ACGME resident survey, residents' evaluation of the program as positive or very positive increased from 80% to 96%. This study demonstrates that formal implementation of a program to improve resident well-being positively impacted residents' perceived stress, emotional exhaustion, emotional intelligence, life satisfaction, and their perception of the residency program. Formal evaluation and reporting of such efforts allow for reproducibility and scalability, with the potential for widespread impact on resident well-being. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Impact of robotic general surgery course on participants' surgical practice.

Science.gov (United States)

Buchs, Nicolas C; Pugin, François; Volonté, Francesco; Hagen, Monika E; Morel, Philippe

2013-06-01

Courses, including lectures, live surgery, and hands-on session, are part of the recommended curriculum for robotic surgery. However, for general surgery, this approach is poorly reported. The study purpose was to evaluate the impact of robotic general surgery course on the practice of participants. Between 2007 and 2011, 101 participants attended the Geneva International Robotic Surgery Course, held at the University Hospital of Geneva, Switzerland. This 2-day course included theory lectures, dry lab, live surgery, and hands-on session on cadavers. After a mean of 30.1 months (range, 2-48), a retrospective review of the participants' surgical practice was performed using online research and surveys. Among the 101 participants, there was a majority of general (58.4 %) and colorectal surgeons (10.9 %). Other specialties included urologists (7.9 %), gynecologists (6.9 %), pediatric surgeons (2 %), surgical oncologists (1 %), engineers (6.9 %), and others (5.9 %). Data were fully recorded in 99 % of cases; 46 % of participants started to perform robotic procedures after the course, whereas only 6.9 % were already familiar with the system before the course. In addition, 53 % of the attendees worked at an institution where a robotic system was already available. All (100 %) of participants who started a robotic program after the course had an available robotic system at their institution. A course that includes lectures, live surgery, and hands-on session with cadavers is an effective educational method for spreading robotic skills. However, this is especially true for participants whose institution already has a robotic system available.

Work-hour restrictions as an ethical dilemma for residents.

Science.gov (United States)

Carpenter, Robert O; Austin, Mary T; Tarpley, John L; Griffin, Marie R; Lomis, Kimberly D

2006-04-01

We propose that the standardized work-hour limitations have created an ethical dilemma for residents. A survey tool was designed to assess factors that influence the number of hours residents work and report. The program directors of pediatrics, internal medicine, and general surgery at our institution supported their residents' participation. A voluntary, anonymous survey of these residents was performed. One hundred seventy of 265 eligible residents were surveyed. Eighty-one percent of residents surveyed responded. Eighty percent of respondents reported exceeding work-hour restrictions at least once within the past 6 months. The factor of greatest influence measured was concern for patient care (80%). Forty-nine percent of respondents admitted underreporting their work hours. The Accreditation Council for Graduate Medical Education work-hour restrictions have created an ethical dilemma for residents. Our data show that a significant number of residents feel compelled to exceed work-hour regulations and report those hours falsely.

Position Paper: Dental General Practice Residency Programs: Financing and Operations.

Science.gov (United States)

Hanson, Paul W.

1983-01-01

A discussion of changeable economic issues that can affect dental general practice residency program planning includes costs and resource allocation, maximizing efficiency and productivity, ambulatory and inpatient revenue sources, management functions, faculty as practitioners, faculty appointments, and marketing. (MSE)

Training needs for general dentistry residents to place and restore two-implant-retained mandibular overdentures.

Science.gov (United States)

Malmstrom, Hans; Xiao, Jin; Romanos, Georgios E; Ren, Yan-Fang

2015-01-01

Implant therapy is rapidly becoming a standard of care for replacing missing dentition. Predoctoral dental curricula include some training in the implant restorative phase but offer limited exposure to the surgical phase, so it is important for postdoctoral general dentistry residency programs to provide competency training in all phases of implant therapy. The aim of this study was to determine the training needed for general dentistry residents to achieve competence in this area, specifically by defining the number of clinical experiences necessary in both the surgical and prosthetic phases of implant-retained mandibular overdenture construction (IRMOD). Fifteen Advanced Education in General Dentistry (AEGD) residents at one academic dental institution placed two implants in a total of 50 patients with edentulous mandibles and subsequently restored them with IRMOD. The supervising faculty member and the residents evaluated the competency level on a five-point scale after each implant placement and prosthetic case completion. According to the faculty evaluations, the residents achieved surgical competence after placing two implants in four to six cases and prosthetic management competence after restoring two to four cases of IRMOD. All 50 patients were satisfied with the treatment outcomes of IRMOD. This study concluded that general dentistry residents could potentially achieve competence in both the surgical and prosthetic phases of implant therapy while enrolled in an AEGD program.

Development and evaluation of standardized narrative cases depicting the general surgery professionalism milestones.

Science.gov (United States)

Rawlings, Arthur; Knox, Aaron D C; Park, Yoon Soo; Reddy, Shalini; Williams, Sarah R; Issa, Nabil; Jameel, Abid; Tekian, Ara

2015-08-01

Residency programs now are required to use educational milestones, which has led to the need for new methods of assessment. The literature suggests that narrative cases are a promising tool to track residents' progress. This study demonstrates the process for developing and evaluating narrative cases representing the five levels of the professionalism milestones. In 2013, the authors identified 28 behaviors in the Accreditation Council for Graduate Medical Education general surgery professionalism milestones. They modified previously published narrative cases to fit these behaviors. To evaluate the quality of these cases, the authors developed a 28-item, five-point scale instrument, which 29 interdisciplinary faculty completed. The authors compared the faculty ratings by narrative case and specialty with the authors' initial rankings of the cases by milestone level. They used t tests and analysis of variance to compare mean scores across specialties. The authors developed 10 narrative cases, 2 for each of the 5 milestone levels. Each case contained at least 20 of the 28 behaviors identified in the milestones. Mean faculty ratings matched the milestone levels. Reliability was good (G coefficient = 0.86, phi coefficient = 0.85), indicating consistency in raters' ability to determine the proper milestone level for each case. The authors demonstrate a process for using specialty-specific milestones to develop narrative cases that map to a spectrum of professionalism behaviors. This process can be applied to other competencies and specialties to facilitate faculty awareness of resident performance descriptors and provide a frame of reference for milestones assessment.

Blood transfusion knowledge of surgical residents: is an educational intervention effective?

Science.gov (United States)

Champion, Caitlin; Saidenberg, Elianna; Lampron, Jacinthe; Pugh, Debra

2017-04-01

Evidence-based transfusion education for surgical residents is crucial to improving practice. A pilot study was undertaken to assess the effectiveness of an education module for improving transfusion knowledge among surgical residents. Modules were developed and delivered by experts in surgery and transfusion medicine. They were delivered to residents in their first 2 years of training (Surgical Foundations), and to General Surgery residents across all years of training. Premodule and postmodule and retention knowledge assessments were used to assess efficacy. Median assessment scores for each group were compared using a two-sample Wilcoxon rank-sum analysis. Chi-square tests were used to compare each group's correct response rates for each question across the three tests. Median assessment scores of residents in the Surgical Foundations program improved from a mean of 60% premodule to 80% postmodule and remained at 80% in the retention assessment (p transfusion dose, preoperative blood management, management of reactions, and informed consent (p Transfusion knowledge of surgical residents was improved by a collaborative educational initiative. This could serve as a model for other training programs to improve resident knowledge of evidence-based transfusion practices. The efficacy of such interventions in changing practice remains untested. © 2017 AABB.

Pricing strategy for aesthetic surgery: economic analysis of a resident clinic's change in fees.

Science.gov (United States)

Krieger, L M; Shaw, W W

1999-02-01

The laws of microeconomics explain how prices affect consumer purchasing decisions and thus overall revenues and profits. These principles can easily be applied to the behavior aesthetic plastic surgery patients. The UCLA Division of Plastic Surgery resident aesthetics clinic recently offered a radical price change for its services. The effects of this change on demand for services and revenue were tracked. Economic analysis was applied to see if this price change resulted in the maximization of total revenues, or if additional price changes could further optimize them. Economic analysis of pricing involves several steps. The first step is to assess demand. The number of procedures performed by a given practice at different price levels can be plotted to create a demand curve. From this curve, price sensitivities of consumers can be calculated (price elasticity of demand). This information can then be used to determine the pricing level that creates demand for the exact number of procedures that yield optimal revenues. In economic parlance, revenues are maximized by pricing services such that elasticity is equal to 1 (the point of unit elasticity). At the UCLA resident clinic, average total fees per procedure were reduced by 40 percent. This resulted in a 250-percent increase in procedures performed for representative 4-month periods before and after the price change. Net revenues increased by 52 percent. Economic analysis showed that the price elasticity of demand before the price change was 6.2. After the price change it was 1. We conclude that the magnitude of the price change resulted in a fee schedule that yielded the highest possible revenues from the resident clinic. These results show that changes in price do affect total revenue and that the nature of these effects can be understood, predicted, and maximized using the tools of microeconomics.

The outcomes of the elderly in acute care general surgery.

Science.gov (United States)

St-Louis, E; Sudarshan, M; Al-Habboubi, M; El-Husseini Hassan, M; Deckelbaum, D L; Razek, T S; Feldman, L S; Khwaja, K

2016-02-01

Elderly patients form a growing subset of the acute care surgery (ACS) population. Older age may be associated with poorer outcomes for some elective procedures, but there are few studies focusing on outcomes for the elderly ACS population. Our objective is to characterize differences in mortality and morbidity for acute care surgery patients >80 years old. A retrospective review of all ACS admissions at a large teaching hospital over 1 year was conducted. Patients were classified into non-elderly (4 days) hospital stay (p = 0.05), increased postoperative complications (p = 0.002), admission to the ICU (p = 0.002), and were more likely to receive a non-operative procedure (p = 0.003). No difference was found (p = NS) for patient flow factors such as time to consult general surgery, time to see consult by general surgery, and time to operative management and disposition. Compared to younger patients admitted to an acute care surgery service, patients over 80 years old have a higher risk of complications, are more likely to require ICU admission, and stay longer in the hospital.

Efficacy of neurosurgery resident education in the new millennium: the 2008 Council of State Neurosurgical Societies post-residency survey results.

Science.gov (United States)

Mazzola, Catherine A; Lobel, Darlene A; Krishnamurthy, Satish; Bloomgarden, Gary M; Benzil, Deborah L

2010-08-01

Neurosurgical residency training paradigms have changed in response to Accreditation Council for Graduate Medical Education mandates and demands for quality patient care. Little has been done to assess resident education from the perspective of readiness to practice. To assess the efficacy of resident training in preparing young neurosurgeons for practice. In response to Resolution V-2007F of the Council of State Neurosurgical Societies, a survey was developed for neurosurgeons who applied for oral examination, Part II of the American Board of Neurological Surgery boards, in 2002 through 2007 (N = 800). The survey was constructed in "survey monkey" format and sent to 775 of 800 (97%) neurosurgeons for whom e-mail addresses were available. The response rate was 30% (233/775). Most neurosurgeons were board certified (n = 226, 97%). General neurosurgical training was judged as adequate by a large majority (n = 188, 80%). Sixty-percent chose to pursue at least 1 additional year of fellowship training (n = 138, 60%). Surgical skills training was acceptable, but 6 skill-technique areas were reported to be inadequate (endovascular techniques, neurosurgical treatment of pain, stereotactic radiosurgery, epilepsy surgery, cranial base surgery, and stereotactic neurosurgery). Respondents also noted inadequate education in contract negotiation, practice evaluation, and management. The study suggests that neurosurgeons believed that they were well trained in their surgical skills except for some areas of subspecialization. However, there is a significant need for improvement of resident training in the areas of socioeconomic and medicolegal education. Continued evaluation of the efficacy of neurosurgical education is important.

"Is general surgery still relevant to the subspecialised trainee?" A 10 year comparison of general versus specialty surgical practice.

Science.gov (United States)

Fleming, C A; Khan, Z; Andrews, E J; Fulton, G J; Redmond, H P; Corrigan, M A

2015-02-01

The splintering of general surgery into subspecialties in the past decade has brought into question the relevance of a continued emphasis on traditional general surgical training. With the majority of trainees now expressing a preference to subspecialise early, this study sought to identify if the requirement for proficiency in managing general surgical conditions has reduced over the past decade through comparison of general and specialty surgical admissions at a tertiary referral center. A cross-sectional review of all surgical admissions at Cork University Hospital was performed at three individual time points: 2002, 2007 & 2012. Basic demographic details of both elective & emergency admissions were tabulated & analysed. Categorisation of admissions into specialty relevant or general surgery was made using International guidelines. 11,288 surgical admissions were recorded (2002:2773, 2007:3498 & 2012:5017), showing an increase of 81 % over the 10-year period. While growth in overall service provision was seen, the practice of general versus specialty relevant emergency surgery showed no statistically significant change in practice from 2002 to 2012 (p = 0.87). General surgery was mostly practiced in the emergency setting (84 % of all emergency admissions in 2012) with only 28 % elective admissions for general surgery. A reduction in length of stay was seen in both elective (3.62-2.58 bed days, p = 0.342) & emergency admissions (7.36-5.65, p = 0.026). General surgical emergency work continues to constitute a major part of the specialists practice. These results emphasize the importance of general surgical training even for those trainees committed to sub-specialisation.

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

Emotional Intelligence as a Predictor of Resident Well-Being.

Science.gov (United States)

Lin, Dana T; Liebert, Cara A; Tran, Jennifer; Lau, James N; Salles, Arghavan

2016-08-01

There is increasing recognition that physician wellness is critical; it not only benefits the provider, but also influences quality and patient care outcomes. Despite this, resident physicians suffer from a high rate of burnout and personal distress. Individuals with higher emotional intelligence (EI) are thought to perceive, process, and regulate emotions more effectively, which can lead to enhanced well-being and less emotional disturbance. This study sought to understand the relationship between EI and wellness among surgical residents. Residents in a single general surgery residency program were surveyed on a voluntary basis. Emotional intelligence was measured using the Trait Emotional Intelligence Questionnaire-Short Form. Resident wellness was assessed with the Dupuy Psychological General Well-Being Index, Maslach Burnout Inventory, and Beck Depression Inventory-Short Form. Emotional intelligence and wellness parameters were correlated using Pearson coefficients. Multivariate analysis was performed to identify factors predictive of well-being. Seventy-three residents participated in the survey (response rate 63%). Emotional intelligence scores correlated positively with psychological well-being (r = 0.74; p emotional exhaustion (r = -0.69; p emotional exhaustion (β = -0.63; p Emotional intelligence is a strong predictor of resident well-being. Prospectively measuring EI can identify those who are most likely to thrive in surgical residency. Interventions to increase EI can be effective at optimizing the wellness of residents. Copyright © 2016. Published by Elsevier Inc.

Money matters: a resident curriculum for financial management.

Science.gov (United States)

Mizell, Jason S; Berry, Katherine S; Kimbrough, Mary Katherine; Bentley, Frederick R; Clardy, James A; Turnage, Richard H

2014-12-01

A 2005 survey reported 87% of surgery program directors believed practice management training should occur during residency. However, only 8% of program directors believed residents received adequate training in practice management [1]. In addition to the gap in practice financial management knowledge, we recognized the need for training in personal finance among residents. A literature review and needs assessment led to the development of a novel curriculum for surgery residents combining principles of practice management and personal finance. An 18-h curriculum was administered over the 2012 academic year to 28 post graduate year 1-5 surgery residents and faculty. A self-assessment survey was given at the onset and conclusion of the curriculum [2]. Pre-tests and post-tests were given to objectively evaluate each twice monthly session's content. Self-perception of learning, interest, and acquired knowledge were analyzed using the Wilcoxon signed ranks test. Initial self-assessment data revealed high interest in practice management and personal finance principles but a deficiency in knowledge of and exposure to these topics. Throughout the curriculum, interest increased. Residents believed their knowledge of these topics increased after completing the curriculum, and objective data revealed various impacts on knowledge. Although surgery residents receive less exposure to these topics than residents in other specialties, their need to know is no less. We developed, implemented, and evaluated a curriculum that bridged this gap in surgery education. After the curriculum, residents reported an increase in interest, knowledge, and responsible behavior relating to personal and practice financial management. Copyright © 2014 Elsevier Inc. All rights reserved.

Hospital costs associated with surgical site infections in general and vascular surgery patients.

Science.gov (United States)

Boltz, Melissa M; Hollenbeak, Christopher S; Julian, Kathleen G; Ortenzi, Gail; Dillon, Peter W

2011-11-01

Although much has been written about excess cost and duration of stay (DOS) associated with surgical site infections (SSIs) after cardiothoracic surgery, less has been reported after vascular and general surgery. We used data from the National Surgical Quality Improvement Program (NSQIP) to estimate the total cost and DOS associated with SSIs in patients undergoing general and vascular surgery. Using standard NSQIP practices, data were collected on patients undergoing general and vascular surgery at a single academic center between 2007 and 2009 and were merged with fully loaded operating costs obtained from the hospital accounting database. Logistic regression was used to determine which patient and preoperative variables influenced the occurrence of SSIs. After adjusting for patient characteristics, costs and DOS were fit to linear regression models to determine the effect of SSIs. Of the 2,250 general and vascular surgery patients sampled, SSIs were observed in 186 inpatients. Predisposing factors of SSIs were male sex, insulin-dependent diabetes, steroid use, wound classification, and operative time (P surgery. Although the excess costs and DOS associated with SSIs after general and vascular surgery are somewhat less, they still represent substantial financial and opportunity costs to hospitals and suggest, along with the implications for patient care, a continuing need for cost-effective quality improvement and programs of infection prevention. Copyright © 2011 Mosby, Inc. All rights reserved.

Application of robotics in general surgery: initial experience.

Science.gov (United States)

Nguyen, Ninh T; Hinojosa, Marcelo W; Finley, David; Stevens, Melinda; Paya, Mahbod

2004-10-01

Robotic surgery was recently approved for clinical use in general abdominal surgery. The aim of this study was to review our experience with the da Vinci surgical system during laparoscopic general surgical procedures. Eighteen patients underwent robotically assisted laparoscopic abdominal surgery between June 2002 and March 2003. Main outcome measures were operative time, room setup time, robotic arm-positioning and surgical time, blood loss, conversion to laparoscopy, length of stay, and morbidity. The types of robotically assisted laparoscopic procedures were excision of gastric leiomyoma (n = 1), Heller myotomy (n = 1), cholecystectomy (n = 2), gastric banding (n = 2), Nissen fundoplication (n = 4), and gastric bypass (n = 8). The mean room setup time was 63 +/- 14 minutes, and the mean robotic arm-positioning time was 16 +/- 7 minutes. Conversion to laparoscopy occurred in two (11%) of 18 cases because of equipment difficulty (n = 1) and technical difficulty (n = 1). Estimated blood loss was 91 +/- 71 mL. The mean operative time was 156 +/- 42 minutes, and the robotic operative time was 27% of the total operative time. The mean length of hospital stay was 2.2 +/- 1.5 days. There was one postoperative wound infection and one anastomotic stricture. Robotically assisted laparoscopic abdominal surgery is feasible and safe; however, the theoretical advantages of the da Vinci surgical system were not clinically apparent.

"Taking Training to the Next Level": The American College of Surgeons Committee on Residency Training Survey.

Science.gov (United States)

Damewood, Richard B; Blair, Patrice Gabler; Park, Yoon Soo; Lupi, Linda K; Newman, Rachel Williams; Sachdeva, Ajit K

The American College of Surgeons (ACS) appointed a committee of leaders from the ACS, Association of Program Directors in Surgery, Accreditation Council for Graduate Medical Education, and American Board of Surgery to define key challenges facing surgery resident training programs and to explore solutions. The committee wanted to solicit the perspectives of surgery resident program directors (PDs) given their pivotal role in residency training. Two surveys were developed, pilot tested, and administered to PDs following Institutional Review Board approval. PDs from 247 Accreditation Council for Graduate Medical Education-accredited general surgery programs were randomized to receive 1 of the 2 surveys. Bias analyses were conducted, and adjusted Pearson χ 2 tests were used to test for differences in response patterns by program type and size. All accredited general surgery programs in the United States were included in the sampling frame of the survey; 10 programs with initial or withdrawn accreditation were excluded from the sampling frame. A total of 135 PDs responded, resulting in a 54.7% response rate (Survey A: n = 67 and Survey B: n = 68). The respondent sample was determined to be representative of program type and size. Nearly 52% of PD responses were from university-based programs, and 41% had over 6 residents per graduating cohort. More than 61% of PDs reported that, compared to 10 years ago, both entering and graduating residents are less prepared in technical skills. PDs expressed significant concerns regarding the effect of duty-hour restrictions on the overall preparation of graduating residents (61%) and quality of patient care (57%). The current 5-year training structure was viewed as needing a significant or extensive increase in opportunities for resident autonomy (63%), and the greatest barriers to resident autonomy were viewed to be patient preferences not to be cared for by residents (68%), liability concerns (68%), and Centers for Medicare and

Transforming Patient Value: Comparison of Hospital, Surgical, and General Surgery Patients.

Science.gov (United States)

Pitt, Henry A; Tsypenyuk, Ella; Freeman, Susan L; Carson, Steven R; Shinefeld, Jonathan A; Hinkle, Sally M; Powers, Benjamin D; Goldberg, Amy J; DiSesa, Verdi J; Kaiser, Larry R

2016-04-01

Patient value (V) is enhanced when quality (Q) is increased and cost (C) is diminished (V = Q/C). However, calculating value has been inhibited by a lack of risk-adjusted cost data. The aim of this analysis was to measure patient value before and after implementation of quality improvement and cost reduction programs. Multidisciplinary efforts to improve patient value were initiated at a safety-net hospital in 2012. Quality improvement focused on adoption of multiple best practices, and minimizing practice variation was the strategy to control cost. University HealthSystem Consortium (UHC) risk-adjusted quality (patient mortality + safety + satisfaction + effectiveness) and cost (length of stay + direct cost) data were used to calculate patient value over 3 fiscal years. Normalized ranks in the UHC Quality and Accountability Scorecard were used in the value equation. For all hospital patients, quality scores improved from 50.3 to 66.5, with most of the change occurring in decreased mortality. Similar trends were observed for all surgery patients (42.6 to 48.4) and for general surgery patients (30.9 to 64.6). For all hospital patients, cost scores improved from 71.0 to 2.9. Similar changes were noted for all surgical (71.6 to 27.1) and general surgery (85.7 to 23.0) patients. Therefore, value increased more than 30-fold for all patients, 3-fold for all surgical patients, and almost 8-fold for general surgery patients. Multidisciplinary quality and cost efforts resulted in significant improvements in value for all hospitalized patients as well as general surgery patients. Mortality improved the most in general surgery patients, and satisfaction was highest among surgical patients. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Understanding Surgical Resident and Fellow Perspectives on Their Operative Performance Feedback Needs: A Qualitative Study.

Science.gov (United States)

Bello, Ricardo J; Sarmiento, Samuel; Meyer, Meredith L; Rosson, Gedge D; Cooney, Damon S; Lifchez, Scott D; Cooney, Carisa M

2018-04-20

Operative performance feedback is essential for surgical training. We aimed to understand surgical trainees' views on their operative performance feedback needs and to characterize feedback to elucidate factors affecting its value from the resident perspective. Using a qualitative research approach, 2 research fellows conducted semistructured, one-on-one interviews with surgical trainees. We analyzed recurring themes generated during interviews related to feedback characteristics, as well as the extent to which performance rating tools can help meet trainees' operative feedback needs. Departments or divisions of general or plastic surgery at 9 US academic institutions. Surgical residents and clinical fellows in general or plastic surgery. We conducted 30 interviews with 9 junior residents, 14 senior residents, and 7 clinical fellows. Eighteen (60%) participants were in plastic and 12 (40%) were in general surgery. Twenty-four participants (80%) reported feedback as very or extremely important during surgical training. All trainees stated that verbal, face-to-face feedback is the most valuable, especially if occurring during (92%) or immediately after (65%) cases. Of those trainees using performance rating tools (74%), most (57%) expressed positive views about them but wanted the tools to complement and not replace verbal feedback in surgical education. Trainees value feedback more if received within 1 week or the case. Verbal, face-to-face feedback is very or extremely important to surgical trainees. Residents and fellows prefer to receive feedback during or immediately after a case and continue to value feedback if received within 1 week of the event. Performance rating tools can be useful for providing formative feedback and documentation but should not replace verbal, face-to-face feedback. Considering trainee views on feedback may help reduce perceived gaps in feedback demand-versus-supply in surgical training, which may be essential to overcoming current

Emergency general surgery: definition and estimated burden of disease.

Science.gov (United States)

Shafi, Shahid; Aboutanos, Michel B; Agarwal, Suresh; Brown, Carlos V R; Crandall, Marie; Feliciano, David V; Guillamondegui, Oscar; Haider, Adil; Inaba, Kenji; Osler, Turner M; Ross, Steven; Rozycki, Grace S; Tominaga, Gail T

2013-04-01

Acute care surgery encompasses trauma, surgical critical care, and emergency general surgery (EGS). While the first two components are well defined, the scope of EGS practice remains unclear. This article describes the work of the American Association for the Surgery of Trauma to define EGS. A total of 621 unique International Classification of Diseases-9th Rev. (ICD-9) diagnosis codes were identified using billing data (calendar year 2011) from seven large academic medical centers that practice EGS. A modified Delphi methodology was used by the American Association for the Surgery of Trauma Committee on Severity Assessment and Patient Outcomes to review these codes and achieve consensus on the definition of primary EGS diagnosis codes. National Inpatient Sample data from 2009 were used to develop a national estimate of EGS burden of disease. Several unique ICD-9 codes were identified as primary EGS diagnoses. These encompass a wide spectrum of general surgery practice, including upper and lower gastrointestinal tract, hepatobiliary and pancreatic disease, soft tissue infections, and hernias. National Inpatient Sample estimates revealed over 4 million inpatient encounters nationally in 2009 for EGS diseases. This article provides the first list of ICD-9 diagnoses codes that define the scope of EGS based on current clinical practices. These findings have wide implications for EGS workforce training, access to care, and research.

First 101 Robotic General Surgery Cases in a Community Hospital

Science.gov (United States)

Robertson, Jarrod C.; Alrajhi, Sharifah

2016-01-01

Background and Objectives: The general surgeon's robotic learning curve may improve if the experience is classified into categories based on the complexity of the procedures in a small community hospital. The intraoperative time should decrease and the incidence of complications should be comparable to conventional laparoscopy. The learning curve of a single robotic general surgeon in a small community hospital using the da Vinci S platform was analyzed. Methods: Measured parameters were operative time, console time, conversion rates, complications, surgical site infections (SSIs), surgical site occurrences (SSOs), length of stay, and patient demographics. Results: Between March 2014 and August 2015, 101 robotic general surgery cases were performed by a single surgeon in a 266-bed community hospital, including laparoscopic cholecystectomies, inguinal hernia repairs; ventral, incisional, and umbilical hernia repairs; and colorectal, foregut, bariatric, and miscellaneous procedures. Ninety-nine of the cases were completed robotically. Seven patients were readmitted within 30 days. There were 8 complications (7.92%). There were no mortalities and all complications were resolved with good outcomes. The mean operative time was 233.0 minutes. The mean console operative time was 117.6 minutes. Conclusion: A robotic general surgery program can be safely implemented in a small community hospital with extensive training of the surgical team through basic robotic skills courses as well as supplemental educational experiences. Although the use of the robotic platform in general surgery could be limited to complex procedures such as foregut and colorectal surgery, it can also be safely used in a large variety of operations with results similar to those of conventional laparoscopy. PMID:27667913

Reliability and Validity of 3 Methods of Assessing Orthopedic Resident Skill in Shoulder Surgery.

Science.gov (United States)

Bernard, Johnathan A; Dattilo, Jonathan R; Srikumaran, Uma; Zikria, Bashir A; Jain, Amit; LaPorte, Dawn M

Traditional measures for evaluating resident surgical technical skills (e.g., case logs) assess operative volume but not level of surgical proficiency. Our goal was to compare the reliability and validity of 3 tools for measuring surgical skill among orthopedic residents when performing 3 open surgical approaches to the shoulder. A total of 23 residents at different stages of their surgical training were tested for technical skill pertaining to 3 shoulder surgical approaches using the following measures: Objective Structured Assessment of Technical Skills (OSATS) checklists, the Global Rating Scale (GRS), and a final pass/fail assessment determined by 3 upper extremity surgeons. Adverse events were recorded. The Cronbach α coefficient was used to assess reliability of the OSATS checklists and GRS scores. Interrater reliability was calculated with intraclass correlation coefficients. Correlations among OSATS checklist scores, GRS scores, and pass/fail assessment were calculated with Spearman ρ. Validity of OSATS checklists was determined using analysis of variance with postgraduate year (PGY) as a between-subjects factor. Significance was set at p shoulder approaches. Checklist scores showed superior interrater reliability compared with GRS and subjective pass/fail measurements. GRS scores were positively correlated across training years. The incidence of adverse events was significantly higher among PGY-1 and PGY-2 residents compared with more experienced residents. OSATS checklists are a valid and reliable assessment of technical skills across 3 surgical shoulder approaches. However, checklist scores do not measure quality of technique. Documenting adverse events is necessary to assess quality of technique and ultimate pass/fail status. Multiple methods of assessing surgical skill should be considered when evaluating orthopedic resident surgical performance. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights

General anesthesia in cardiac surgery: a review of drugs and practices.

Science.gov (United States)

Alwardt, Cory M; Redford, Daniel; Larson, Douglas F

2005-06-01

General anesthesia is defined as complete anesthesia affecting the entire body with loss of consciousness, analgesia, amnesia, and muscle relaxation. There is a wide spectrum of agents able to partially or completely induce general anesthesia. Presently, there is not a single universally accepted technique for anesthetic management during cardiac surgery. Instead, the drugs and combinations of drugs used are derived from the pathophysiologic state of the patient and individual preference and experience of the anesthesiologist. According to the definition of general anesthesia, current practices consist of four main components: hypnosis, analgesia, amnesia, and muscle relaxation. Although many of the agents highlighted in this review are capable of producing more than one of these effects, it is logical that drugs producing these effects are given in combination to achieve the most beneficial effect. This review features a discussion of currently used anesthetic drugs and clinical practices of general anesthesia during cardiac surgery. The information in this particular review is derived from textbooks, current literature, and personal experience, and is designed as a general overview of anesthesia during cardiac surgery.

The Effect of Gender on Resident Autonomy in the Operating room.

Science.gov (United States)

Meyerson, Shari L; Sternbach, Joel M; Zwischenberger, Joseph B; Bender, Edward M

Discrimination against women training in medicine and surgery has been subjectively described for decades. This study objectively documents gender differences in the degree of autonomy given to thoracic surgery trainees in the operating room. Thoracic surgery residents and faculty underwent frame of reference training on the use of the 4-point Zwisch scale to measure operative autonomy. Residents and faculty then submitted evaluations of their perception of autonomy granted for individual operations as well as operative difficulty on a real-time basis using the "Zwisch Me!!" mobile application. Differences in autonomy given to male and female residents were elucidated using chi-square analysis and ordered logistic regression. Seven academic medical centers with thoracic surgery training programs. Volunteer thoracic surgery residents in both integrated and traditional training pathways and their affiliated cardiothoracic faculty. Residents (n = 33, female 18%) submitted a total of 596 evaluations to faculty (n = 48, female 12%). Faculty gave less autonomy to female residents with only 56 of 184 evaluations (30.3%) showing meaningful autonomy (passive help or supervision only) compared to 107 of 292 evaluations (36.7%) at those levels for male residents (p = 0.02). Resident perceptions of autonomy showed even more pronounced differences with female residents receiving only 38 of 197 evaluations (19.3%) with meaningful autonomy compared to 133 of 399 evaluations (33.3%) for male residents (p autonomy granted to residents. Evaluations of operative autonomy reveal a significant bias against female residents. Faculty education is needed to encourage allowing female residents more operative autonomy. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Effects of duty hour restrictions on core competencies, education, quality of life, and burnout among general surgery interns.

Science.gov (United States)

Antiel, Ryan M; Reed, Darcy A; Van Arendonk, Kyle J; Wightman, Sean C; Hall, Daniel E; Porterfield, John R; Horvath, Karen D; Terhune, Kyla P; Tarpley, John L; Farley, David R

2013-05-01

To measure the implications of the new Accreditation Council for Graduate Medical Education duty hour regulations for education, well-being, and burnout. Longitudinal study. Eleven university-based general surgery residency programs from July 2011 to May 2012. Two hundred thirteen surgical interns. Perceptions of the impact of the new duty hours on various aspects of surgical training, including the 6 Accreditation Council for Graduate Medical Education core competencies, were measured on 3-point scales. Quality of life, burnout, balance between personal and professional life, and career satisfaction were measured using validated instruments. Half of all interns felt that the duty hour changes have decreased the coordination of patient care (53%), their ability to achieve continuity with hospitalized patients (70%), and their time spent in the operating room (57%). Less than half (44%) of interns believed that the new standards have decreased resident fatigue. In longitudinal analysis, residents' beliefs had significantly changed in 2 categories: less likely to believe that practice-based learning and improvement had improved and more likely to report no change to resident fatigue (P life. Compared with the normal US population, 50 interns (32%) were 0.5 SD less than the mean on the 8-item Short Form Health Survey mental quality of life score. Approximately one-third of interns demonstrated weekly symptoms of emotional exhaustion (28%) or depersonalization (28%) or reported that their personal-professional balance was either "very poor" or "not great" (32%). Although many interns (67%) reported that they daily or weekly reflect on their satisfaction from being a surgeon, 1 in 7 considered giving up their career as a surgeon on at least a weekly basis. The first cohort of surgical interns to train under the new regulations report decreased continuity with patients, coordination of patient care, and time spent in the operating room. Furthermore, suboptimal quality of

Robotics in general surgery: A systematic cost assessment.

Science.gov (United States)

Gkegkes, Ioannis D; Mamais, Ioannis A; Iavazzo, Christos

2017-01-01

The utilisation of robotic-assisted techniques is a novelty in the field of general surgery. Our intention was to examine the up to date available literature on the cost assessment of robotic surgery of diverse operations in general surgery. PubMed and Scopus databases were searched in a systematic way to retrieve the included studies in our review. Thirty-one studies were retrieved, referring on a vast range of surgical operations. The mean cost for robotic, open and laparoscopic ranged from 2539 to 57,002, 7888 to 16,851 and 1799 to 50,408 Euros, respectively. The mean operative charges ranged from 273.74 to 13,670 Euros. More specifically, for the robotic and laparoscopic gastric fundoplication, the cost ranged from 1534 to 2257 and 657 to 763 Euros, respectively. For the robotic and laparoscopic colectomy, it ranged from 3739 to 17,080 and 3109 to 33,865 Euros, respectively. For the robotic and laparoscopic cholecystectomy, ranged from 1163.75 to 1291 and from 273.74 to 1223 Euros, respectively. The mean non-operative costs ranged from 900 to 48,796 from 8347 to 8800 and from 870 to 42,055 Euros, for robotic, open and laparoscopic technique, respectively. Conversions to laparotomy were present in 34/18,620 (0.18%) cases of laparoscopic and in 22/1488 (1.5%) cases of robotic technique. Duration of surgery robotic, open and laparoscopic ranged from 54.6 to 328.7, 129 to 234, and from 50.2 to 260 min, respectively. The present evidence reveals that robotic surgery, under specific conditions, has the potential to become cost-effective. Large number of cases, presence of industry competition and multidisciplinary team utilisation are some of the factors that could make more reasonable and cost-effective the robotic-assisted technique.

Trends in Accreditation Council for Graduate Medical Education Accreditation for Subspecialty Fellowship Training in Plastic Surgery.

Science.gov (United States)

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

2018-05-01

The purposes of this study were to (1) determine the proportion of plastic surgery residents pursuing subspecialty training relative to other surgical specialties, and (2) analyze trends in Accreditation Council for Graduate Medical Education accreditation of plastic surgery subspecialty fellowship programs. The American Medical Association provided data on career intentions of surgical chief residents graduating from 2014 to 2016. The percentage of residents pursuing fellowship training was compared by specialty. Trends in the proportion of accredited fellowship programs in craniofacial surgery, hand surgery, and microsurgery were analyzed. The percentage of accredited programs was compared between subspecialties with added-certification options (hand surgery) and subspecialties without added-certification options (craniofacial surgery and microsurgery). Most integrated and independent plastic surgery residents pursued fellowship training (61.8 percent versus 49.6 percent; p = 0.014). Differences existed by specialty from a high in orthopedic surgery (90.8 percent) to a low in colon and rectal surgery (3.2 percent). From 2005 to 2015, the percentage of accredited craniofacial fellowship programs increased, but was not significant (from 27.8 percent to 33.3 percent; p = 0.386). For hand surgery, the proportion of accredited programs that were plastic surgery (p = 0.755) and orthopedic surgery (p = 0.253) was stable, whereas general surgery decreased (p = 0.010). Subspecialty areas with added-certification options had more accredited fellowships than those without (100 percent versus 19.2 percent; p < 0.001). There has been slow adoption of accreditation among plastic surgery subspecialty fellowships, but added-certification options appear to be highly correlated.

A New Era of Minimally Invasive Surgery: Progress and Development of Major Technical Innovations in General Surgery Over the Last Decade.

Science.gov (United States)

Siddaiah-Subramanya, Manjunath; Tiang, Kor Woi; Nyandowe, Masimba

2017-10-01

Minimally invasive surgery (MIS) continues to play an important role in general surgery as an alternative to traditional open surgery as well as traditional laparoscopic techniques. Since the 1980s, technological advancement and innovation have seen surgical techniques in MIS rapidly grow as it is viewed as more desirable. MIS, which includes natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopic surgery (SILS), is less invasive and has better cosmetic results. The technological growth and adoption of NOTES and SILS by clinicians in the last decade has however not been uniform. We look at the differences in new developments and advancement in the different techniques in the last 10 years. We also aim to explain these differences as well as the implications in general surgery for the future.

The effects of power, leadership and psychological safety on resident event reporting.

Science.gov (United States)

Appelbaum, Nital P; Dow, Alan; Mazmanian, Paul E; Jundt, Dustin K; Appelbaum, Eric N

2016-03-01

Although the reporting of adverse events is a necessary first step in identifying and addressing lapses in patient safety, such events are under-reported, especially by frontline providers such as resident physicians. This study describes and tests relationships between power distance and leader inclusiveness on psychological safety and the willingness of residents to report adverse events. A total of 106 resident physicians from the departments of neurosurgery, orthopaedic surgery, emergency medicine, otolaryngology, neurology, obstetrics and gynaecology, paediatrics and general surgery in a mid-Atlantic teaching hospital were asked to complete a survey on psychological safety, perceived power distance, leader inclusiveness and intention to report adverse events. Perceived power distance (β = -0.26, standard error [SE] 0.06, 95% confidence interval [CI] -0.37 to 0.15; p leadership practices build psychological safety and minimise power distance between low- and high-status members in order to support greater reporting of adverse events. © 2016 John Wiley & Sons Ltd.

GENERAL SURGERY

African Journals Online (AJOL)

influence medical students in pursuing a career in surgery. ... training, females reported significantly higher levels of agreement that surgical training would be better overseas when ..... mentoring surgical research or educational lectures and.

Day surgery: Results after restructuration of a university public general surgery unit.

Science.gov (United States)

Gaucher, S; Cappiello, F; Bouam, S; Damardji, I; Aissat, A; Boutron, I; Béthoux, J P

2013-06-01

Nowadays, in France, development of the ambulatory surgery has stalled. This is probably related to the fact that ambulatory surgery is restricted by the law to the "day surgery" in 12 hours, and only 17 procedures are referenced for this surgery. Thus, conventional hospitalization remained the rule after surgery. In January 2010, our university general surgery unit was restructured. It evolved from a conventional unit to a predominantly ambulatory unit. Otherwise, our unit adjoins a hotel, even inside our institution, which accommodates patients, patient visitors and tourists. The aim of this retrospective study was to compare the postoperative accommodation modalities between two groups of patients. The first group consisted of patients admitted before January 2010, at the time of conventional activity, whereas the second group consisted of patients admitted after January 2010 in a restructured unit. Inclusion of patients admitted from April 1, 2008 to March 31, 2009 (conventional hospitalization period) and from April 1, 2010 to March 31, 2011 (ambulatory management period), scheduled for one single surgical procedure excluding emergency. A total of 360 patients were retained: 229 for the conventional period and 131 for the ambulatory period, with a median age of 55 (range 15-87). No statistically significant difference was noted between the two groups as concerned median age, gender or ASA status. The number of postoperative nights varied significantly between the two groups with a mean of 3.8 nights (median three nights, range 0-32) for the conventional period versus 0.4 nights (median 0 night, range 0-10) for the ambulatory period (Plegal period of 12 hours to 24 hours in order to expand the list of the referenced procedures. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

The Value of a Resident Aesthetic Clinic: A 7-Year Institutional Review and Survey of the Chief Resident Experience.

Science.gov (United States)

Weissler, Jason M; Carney, Martin J; Yan, Chen; Percec, Ivona

2017-10-16

With the evolving plastic surgery training paradigm, there is an increasing emphasis on aesthetic surgery education during residency. In an effort to improve aesthetic education and to encourage preparation for independent practice, our institution has supported a resident-run aesthetic clinic for over two decades. To provide insight into the educational benefits of a resident-run cosmetic clinic through longitudinal resident follow up and institutional experiential review. A retrospective review was conducted to identify all clinic-based aesthetic operations performed between 2009 and 2016. To capture residents' perspectives on the cosmetic resident clinic, questionnaires were distributed to the cohort. Primary outcome measures included: volume and types of cases performed, impact of clinic experience on training, confidence level performing cosmetic procedures, and satisfaction with chief clinic. Unpaired t tests were calculated to compare case volume/type with level of confidence and degree of preparedness to perform cosmetic procedures independently. Overall, 264 operations performed by 18 graduated chief residents were reviewed. Surveys were distributed to 28 chief residents (71.4% completion rate). Performing twenty or more clinic-based procedures was associated with higher levels of preparedness to perform cosmetic procedures independently (P = 0.037). Residents reported the highest confidence when performing cosmetic breast procedures when compared to face/neck (P = 0.005), body/trunk procedures (P = 0.39), and noninvasive facial procedures (P = 0.85). The continued growth of aesthetic surgery highlights the need for comprehensive training and preparation for the new generation of plastic surgeons. Performing cosmetic procedures in clinic is a valuable adjunct to the traditional educational curriculum and increases preparedness and confidence for independent practice. © 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission

Exchange of letters between the Resident Representative of Mexico and the Director General

International Nuclear Information System (INIS)

1987-11-01

The document reproduces the text of a letter (dated 23 November 1987) to the Director General of the IAEA from the Resident Representative of Mexico and the Director General's reply (dated 24 November 1987) in connection with the military attack of the Bushehr Nuclear Power Plant

Cited Brazilian papers in general surgery between 1970 and 2009

Directory of Open Access Journals (Sweden)

Flavio L. Heldwein

2010-01-01

Full Text Available OBJECTIVES: To identify the most cited articles in general surgery published by Brazilian authors. INTRODUCTION: There are several ways for the international community to recognize the quality of a scientific article. Although controversial, the most widely used and reliable methodology to identify the importance of an article is citation analysis. METHODS: A search using the Institute for Scientific Information citation database (Science Citation Index Expanded was performed to identify highly cited Brazilian papers published in twenty-six highly cited general surgery journals, selected based on their elevated impact factors, from 1970 to 2009. Further analysis was done on the 65 most-cited papers. RESULTS: We identified 1,713 Brazilian articles, from which nine papers emerged as classics (more than 100 citations received. For the Brazilian contributions, a total increase of about 21-fold was evident between 1970 and 2009. Although several topics were covered, articles covering trauma, oncology and organ transplantation were the most cited. The majority of classic studies were done with international cooperation. CONCLUSIONS: This study identified the most influential Brazilian articles published in internationally renowned general surgery journals.

Do resident's leadership skills relate to ratings of technical skill?

Science.gov (United States)

Gannon, Samantha J; Law, Katherine E; Ray, Rebecca D; Nathwani, Jay N; DiMarco, Shannon M; D'Angelo, Anne-Lise D; Pugh, Carla M

2016-12-01

This study sought to compare general surgery research residents' survey information regarding self-efficacy ratings to their observed performance during a simulated small bowel repair. Their observed performance ratings were based on their leadership skills in directing their assistant. Participants were given 15 min to perform a bowel repair using bovine intestines with standardized injuries. Operative assistants were assigned to help assist with the repair. Before the procedure, participants were asked to rate their expected skills decay, task difficulty, and confidence in addressing the small bowel injury. Interactions were coded to identify the number of instructions given by the participants to the assistant during the repair. Statistical analyses assessed the relationship between the number of directional instructions and participants' perceptions self-efficacy measures. Directional instructions were defined as any dialog by the participant who guided the assistant to perform an action. Thirty-six residents (58.3% female) participated in the study. Participants who rated lower levels of decay in their intraoperative decision-making and small bowel repair skills were noted to use their assistant more by giving more instructions. Similarly, a higher number of instructions correlated with lower perceived difficulty in selecting the correct suture, suture pattern, and completing the entire surgical task. General surgery research residents' intraoperative leadership skills showed significant correlations to their perceptions of skill decay and task difficulty during a bowel repair. Evaluating resident's directional instructions may provide an additional individualized intraoperative assessment metric. Further evaluation relating to operative performance outcomes is warranted. Copyright © 2016 Elsevier Inc. All rights reserved.

[Legendary Hwa Tuo's surgery under general anesthesia in the second century China].

Science.gov (United States)

Chu, Nai-Shin

2004-12-01

In traditional Chinese medicine, Hwa Tuo (110 ? - 208 A.D.) is one of the most famous doctors. He used only few herbs in drug treatment or applied few points in acupuncture, and achieved excellent results. His ultimate fame came from his remarkable surgical skills and his discovery of general anesthesia. According to the Chronicle of the Three Kingdoms (ca. 270 A.D.) and the Annals of the Later Han Dynasty (ca. 430 A.D.), Hwa Tuo performed operations under general anesthesia and the operations even included major ones such as dissection of gangrenous intestines. Before the surgery, he gave patient an anesthetic to drink to become drunk, numb and insensible. The anesthetic was called " foamy narcotic powder" and probably dissolved in wine. Because Confucian teachings regarded the body sacred, surgery as a form of body mutilation was not encouraged, or even became a taboo. Despite his great achievement, practice of surgery could hardly take off and the death of Hwa Tuo marked the end of Chinese surgery. Unfortunately, the composition of the anesthetic powder was not mentioned in those two books or other Chinese medical writings. The herb has been thought to be datura flower, aconite root, rhododendron flower, or jasmine root. Furthermore, Hwa Tuo's operations under general anesthesia were not described in details. Therefore, his remarkable achievement needs to be further documented. In Western medicine, the first operation under general anesthesia occurred at the Massachusetts General Hospital in 1846 when William Morton demonstrated the effectiveness of ether. How could Hwa Tuo accomplish such scientific achievement in the second century has remained a mystery. Even so, it seems quite remarkable that Hwa Tuo had come up with the idea of performing surgery under general anesthesia using the "foamy narcotic powder".

Psychosomatic Medicine for Non-Psychiatric Residents: Video Education and Incorporation of Technology.

Science.gov (United States)

Saunders, J; Gopalan, P; Puri, N; Azzam, P N; Zhou, L; Ghinassi, F; Jain, A; Travis, M; Ryan, N D

2015-12-01

Psychiatric education for non-psychiatric residents varies between training programs, and may affect resident comfort with psychiatric topics. This study's goals were to identify non-psychiatric residents' comfort with psychiatric topics and to test the effectiveness of a video intervention. Residents in various departments were given a survey. They were asked to rank their comfort level with multiple psychiatric topics, answer questions about medical decision making capacity (MDMC), watch a 15-min video about MDMC, and answer a post-test section. In total, 91 Internal Medicine, General Surgery, and Obstetrics and Gynecology residents responded to the study. Of the 91 residents, 55 completed the pre- and post-test assessments. There was no significant difference in correct responses. Residents' comfort levels were assessed, and a significant improvement in comfort level with MDMC was found. This study highlights potential opportunities for psychiatric education, and suggests brief video interventions can increase resident physicians' comfort with a psychiatric topic.

Evaluating Surgical Residents' Patient-Centered Communication Skills: Practical Alternatives to the "Apprenticeship Model".

Science.gov (United States)

Newcomb, Anna; Trickey, Amber W; Lita, Elena; Dort, Jonathan

2017-10-06

The Accreditation Council for Graduate Medical Education (ACGME) requires residency programs to assess communication skills and provide feedback to residents. We aimed to develop a feasible data collection process that generates objective clinical performance information to guide training activities, inform ACGME milestone evaluations, and validate assessment instruments. Residents care for patients in the surgical clinic and in the hospital, and participate in a communication curriculum providing practice with standardized patients (SPs). We measured perception of resident communication using the 14-item Communication Assessment Tool (CAT), collecting data from patients at the surgery clinic and surgical wards in the hospital, and from SP encounters during simulated training scenarios. We developed a handout of CAT example behaviors to guide patients completing the communication assessment. Independent academic medical center. General surgery residents. The primary outcome is the percentage of total items patients rated "excellent;" we collected data on 24 of 25 residents. Outpatient evaluations resulted in significantly higher scores (mean 84.5% vs. 68.6%, p communication assessments in their concurrent patient population (p = 0.017), and (2) receiving CAT example instructions was associated with a lower percentage of excellent ratings by 9.3% (p = 0.047). Our data collection process provides a model for obtaining meaningful information about resident communication proficiency. CAT evaluations of surgical residents by the inpatient population had not previously been described in the literature; our results provide important insight into relationships between the evaluations provided by inpatients, clinic patients, and SPs in simulation. Our example behaviors guide shows promise for addressing a common concern, minimizing ceiling effects when measuring physician-patient communication. Copyright © 2017 Association of Program Directors in Surgery. Published by

GENERAL SURGERY

African Journals Online (AJOL)

1 Department of Surgery, Nelson R Mandela School of Medicine, University of ... in 51 reports. Four reports were illegible; one was conducted by a junior consultant, two by a fourth year trainee specialist ... The study period was 12 months from.

Training, Research, and Working Conditions for Urology Residents in Germany: A Contemporary Survey.

Science.gov (United States)

Borgmann, Hendrik; Arnold, Hannah K; Meyer, Christian P; Bründl, Johannes; König, Justus; Nestler, Tim; Ruf, Christian; Struck, Julian; Salem, Johannes

2016-12-16

Excellent uniform training of urology residents is crucial to secure both high-quality patient care and the future of our specialty. Residency training has come under scrutiny following the demands of subspecialized care, economical aspects, and working hour regulations. To comprehensively assess the surgical training, research opportunities, and working conditions among urology residents in Germany. We sent a 29-item online survey via email to 721 members of the German Society of Residents in Urology. Descriptive analyses were conducted to describe the surveys' four domains: (1) baseline characteristics, (2) surgical training (cumulative completed case volume for all minor-, medium-, and major-complexity surgeries), (3) research opportunities, and (4) working conditions. Four hundred and seventy-two residents completed the online survey (response rate 65%). Surgical training: the median number of cumulative completed cases for postgraduate yr (PGY)-5 residents was 113 (interquartile range: 76-178). Minor surgeries comprised 57% of all surgeries and were performed by residents in all PGYs. Medium-complexity surgeries comprised 39% of all surgeries and were mostly performed by residents in PGYs 2-5. Major surgeries comprised 4% of all surgeries and were occasionally performed by residents in PGYs 3-5. Research opportunities: some 44% have attained a medical thesis (Dr. med.), and 39% are currently pursuing research. Working conditions: psychosocial work-related stress was high and for 82% of residents their effort exceeded their rewards. Some 44% were satisfied, 32% were undecided, and 24% were dissatisfied with their current working situation. Limitations include self-reported survey answers and a lack of validated assessment tools. Surgical exposure among German urology residents is low and comprises minor and medium-complex surgeries. Psychosocial work-related stress is high for the vast majority of residents indicating the need for structural improvements in

History of Cardiovascular Surgery at Toronto General Hospital.

Science.gov (United States)

Lee, Myunghyun M; Alvarez, Juglans; Rao, Vivek

2016-01-01

The Division of Cardiovascular Surgery at Toronto General Hospital has enjoyed an enviable history of academic achievement and clinical success. The foundations of this success are innovation, creativity and excellence in patient care, which continue to influence the current members of the division. Copyright © 2016 Elsevier Inc. All rights reserved.

Sepsis in general surgery: the 2005-2007 national surgical quality improvement program perspective.

Science.gov (United States)

Moore, Laura J; Moore, Frederick A; Todd, S Rob; Jones, Stephen L; Turner, Krista L; Bass, Barbara L

2010-07-01

To document the incidence, mortality rate, and risk factors for sepsis and septic shock compared with pulmonary embolism and myocardial infarction in the general-surgery population. Retrospective review. American College of Surgeons National Surgical Quality Improvement Program institutions. General-surgery patients in the 2005-2007 National Surgical Quality Improvement Program data set. Incidence, mortality rate, and risk factors for sepsis and septic shock. Of 363 897 general-surgery patients, sepsis occurred in 8350 (2.3%), septic shock in 5977 (1.6%), pulmonary embolism in 1078 (0.3%), and myocardial infarction in 615 (0.2%). Thirty-day mortality rates for each of the groups were as follows: 5.4% for sepsis, 33.7% for septic shock, 9.1% for pulmonary embolism, and 32.0% for myocardial infarction. The septic-shock group had a greater percentage of patients older than 60 years (no sepsis, 40.2%; sepsis, 51.7%; and septic shock, 70.3%; P surgery resulted in more cases of sepsis (4.5%) and septic shock (4.9%) than did elective surgery (sepsis, 2.0%; septic shock, 1.2%) (P surgery, and the presence of any comorbidity. This study emphasizes the need for early recognition of patients at risk via aggressive screening and the rapid implementation of evidence-based guidelines.

17 CFR 279.4 - Form ADV-NR, appointment of agent for service of process by non-resident general partner and non...

Science.gov (United States)

2010-04-01

... 17 Commodity and Securities Exchanges 3 2010-04-01 2010-04-01 false Form ADV-NR, appointment of agent for service of process by non-resident general partner and non-resident managing agent of an... agent for service of process by non-resident general partner and non-resident managing agent of an...

Program Director Perceptions of Surgical Resident Training and Patient Care under Flexible Duty Hour Requirements.

Science.gov (United States)

Saadat, Lily V; Dahlke, Allison R; Rajaram, Ravi; Kreutzer, Lindsey; Love, Remi; Odell, David D; Bilimoria, Karl Y; Yang, Anthony D

2016-06-01

The Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) trial was a national, cluster-randomized, pragmatic, noninferiority trial of 117 general surgery programs, comparing standard ACGME resident duty hour requirements ("Standard Policy") to flexible, less-restrictive policies ("Flexible Policy"). Participating program directors (PDs) were surveyed to assess their perceptions of patient care, resident education, and resident well-being during the study period. A survey was sent to all PDs of the general surgery residency programs participating in the FIRST trial (N = 117 [100% response rate]) in June and July 2015. The survey compared PDs' perceptions of the duty hour requirements in their arm of the FIRST trial during the study period from July 1, 2014 to June 30, 2015. One hundred percent of PDs in the Flexible Policy arm indicated that residents used their additional flexibility in duty hours to complete operations they started or to stabilize a critically ill patient. Compared with the Standard Policy arm, PDs in the Flexible Policy arm perceived a more positive effect of duty hours on the safety of patient care (68.9% vs 0%; p care (98.3% vs 0%; p care (71.8%), continuity of care (94.0%), quality of resident education (83.8%), and resident well-being (55.6%) would be improved with a hypothetical permanent adoption of more flexible duty hours. Program directors involved in the FIRST trial perceived improvements in patient safety, continuity of care, and multiple aspects of resident education and well-being with flexible duty hours. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Virtual surgery simulation versus traditional approaches in training of residents in cervical pedicle screw placement.

Science.gov (United States)

Hou, Yang; Shi, Jiangang; Lin, Yanping; Chen, Huajiang; Yuan, Wen

2018-06-01

The cervical screw placement is one of the most difficult procedures in spine surgery, which often needs a long period of repeated practices and could cause screw placement-related complications. We performed this cadaver study to investigate the effectiveness of virtual surgical training system (VSTS) on cervical pedicle screw instrumentation for residents. A total of ten novice residents were randomly assigned to two groups: the simulation training (ST) group (n = 5) and control group (n = 5). The ST group received a surgical training of cervical pedicle screw placement on VSTS and the control group was given an introductory teaching session before cadaver test. Ten fresh adult spine specimens including 6 males and 4 females were collected, and were randomly allocated to the two groups. The bilateral C3-C6 pedicle screw instrumentation was performed in the specimens of the two groups, respectively. After instrumentation, screw positions of the two groups were evaluated by image examinations. There was significantly statistical difference in screw penetration rates between the ST (10%) and control group (62.5%, P VSTS as an advanced training tool exhibited promising effects on improving performance of novice residents in cervical pedicle screw placement compared with the traditional teaching methods.

A review of teaching methods and outcomes of resident phacoemulsification.

Science.gov (United States)

Kaplowitz, Kevin; Yazdanie, Mohammad; Abazari, Azin

Cataract surgery with phacoemulsification is a challenging procedure for surgeons in training to learn to perform safely, efficiently, and effectively. We review the auxiliary learning tools outside the operating room that residency programs have incorporated into their curriculum to improve surgical skills, including wet laboratory and surgical simulators. We then discuss different methods of teaching cataract surgery in the operating room. Our goal is to define a learning curve for cataract surgery. We demonstrate that complication rates decline significantly after a resident performs an average of 70 cases. We summarize the reported incidence and risk factors for complications in resident-performed cataract surgery to help identify cases that require a higher level of skill to improve visual outcomes. We suggest that future studies include details on preoperative comorbidities, risk stratification, resident skill level, and frequency of takeover by attending. Published by Elsevier Inc.

Assessing Readmission After General, Vascular, and Thoracic Surgery Using ACS-NSQIP

Science.gov (United States)

Lucas, Donald J.; Haider, Adil; Haut, Elliot; Dodson, Rebecca; Wolfgang, Christopher L.; Ahuja, Nita; Sweeney, John; Pawlik, Timothy M.

2015-01-01

Objective In 2012, Medicare began cutting reimbursement for hospitals with high readmission rates. We sought to define the incidence and risk factors associated with readmission after surgery. Methods A total of 230,864 patients discharged after general, upper gastrointestinal (GI), small and large intestine, hepatopancreatobiliary (HPB), vascular, and thoracic surgery were identified using the 2011 American College of Surgeons National Surgical Quality Improvement Program. Readmission rates and patient characteristics were analyzed. A predictive model for readmission was developed among patients with length of stay (LOS) 10 days or fewer and then validated using separate samples. Results Median patient age was 56 years; 43% were male, and median American Society of Anesthesiologists (ASA) class was 2 (general surgery: 2; upper GI: 3; small and large intestine: 2; HPB: 3; vascular: 3; thoracic: 3; P readmission was 7.8% (general surgery: 5.0%; upper GI: 6.9%; small and large intestine: 12.6%; HPB: 15.8%; vascular: 11.9%; thoracic: 11.1%; P readmission included ASA class, albumin less than 3.5, diabetes, inpatient complications, nonelective surgery, discharge to a facility, and the LOS (all P readmission. A simple integer-based score using ASA class and the LOS predicted risk of readmission (area under the receiver operator curve 0.702). Conclusions Readmission among patients with the LOS 10 days or fewer occurs at an incidence of at least 5% to 16% across surgical subspecialties. A scoring system on the basis of ASA class and the LOS may help stratify readmission risk to target interventions. PMID:24022435

A comprehensive review of telementoring applications in laparoscopic general surgery.

Science.gov (United States)