共查询到20条相似文献，搜索用时 31 毫秒
1.
James E. Coverdill Jeff Scott Shelton Adnan Alseidi David C. Borgstrom Daniel L. Dent Russell Dumire Jonathan Fryer Thomas H. Hartranft Steven B. Holsten M. Timothy Nelson Mohsen M. Shabahang Stanley R. Sherman Paula M. Termuhlen Randy J. Woods John D. Mellinger 《American journal of surgery》2018,215(2):222-226
Background
Nurse Practitioners and Physician Assistants – called non-physician practitioners or NPPs – are common, but little is known about their educational promise and problems.Methods
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.Results
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.Conclusions
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. 相似文献2.
Anne-Lise D. D&#x;Angelo Jonathan D. D&#x;Angelo David A. Rogers Carla M. Pugh 《American journal of surgery》2018,215(2):336-340
Background
Residents engaging in dedicated research experiences may return to clinical training with less surgical skill. The study aims were 1) to evaluate faculty perceptions of residents skills decay during dedicated research fellowships, and 2) to compare faculty and resident perceptions of residents skills decay.Methods
Faculty and residents were surveyed on resident research practices and perceptions of resident skills decay.Results
Faculty thought residents returning from research demonstrate less technical skill (Median = 4; 5-point Likert scale, 1 = Strongly disagree, 5 = Strongly agree), demonstrate less confidence (Median = 4), and require more instruction (Median = 4). Both faculty and residents perceived the largest skill reduction in complex procedures, technical surgical skills, and knowledge of procedure steps (p < 0.05).Conclusion
While dedicated research experiences provide valuable academic experience, there is a cost to clinical skills retention and confidence specifically in the areas of complex operative procedures and technical surgical skills. 相似文献3.
John L. Falcone 《American journal of surgery》2018,215(2):341-346
Background
There is a decreasing institutional percentage of surgical resident recipients of The Arnold P. Gold Humanism and Excellence in Teaching Award over time. The hypothesis was that this trend was a national phenomenon.Methods
This was a retrospective study from 2004 - 2015, utilizing data from the Arnold P. Gold Foundation. Multiple regression was performed using the estimated ratio of eligible surgical to non-surgical residents and the year as explanatory variables, utilizing an α = 0.05.Results
The percentage of surgical award winners was lower in the second study half compared to the first half (40.2% vs. 47.2%) (p = 0.02). Multiple regression showed that when controlling for the number of eligible residents, the number of resident awardees decreased over time (p = 0.01).Conclusion
There is a clear national trend that surgical residents are receiving the Arnold P. Gold Humanism and Excellence in Teaching Award less over time. 相似文献4.
5.
Vernissia Tam Waseem Lutfi Stephanie Novak Ahmad Hamad Kenneth K. Lee Amer H. Zureikat Herbert J. Zeh Melissa E. Hogg 《American journal of surgery》2018,215(2):282-287
Background
Adoption of robotics in general surgery has expanded but there is no mandatory national standardized curriculum for general surgery residents (GSR).Methods
A survey was administered to all GSRs in 2014 addressing future practice and robotic experience. A non-mandatory robotic curriculum was available for residents to train. Compliance was assessed. In 2016, the same survey was re-administered. Barriers to completing the curriculum were identified.Results
Interest in improving robotic skills remained high (2014 = 97.8% vs 2016 = 95.9%, p = 0.608), and the majority planned to incorporate robotics into future practice (77.8% vs 69.4%; p = 0.358). Only 11 residents (18%) voluntarily completed the curriculum while 36 (60%) started but did not complete. A trend toward increased procedure participation was seen (60.0%–77.6%, p = 0.066). The perceived barriers to completion of the curriculum were length of time required (80%) and lack of access to a simulator (60%).Conclusions
A structured robotic training curriculum that is non-mandatory is insufficient in helping residents gain fundamental robotic skills. 相似文献6.
Jay N. Nathwani Anna Garren Shlomi Laufer Calvin Kwan Carla M. Pugh 《American journal of surgery》2018,215(6):995-999
Background
This study explores the long-term effectiveness of a newly developed clinical skills curriculum.Methods
Students (N = 40) were exposed to a newly developed, simulation-based, clinical breast exam (CBE) curriculum. The same students returned one year later to perform the CBE and were compared to a convenience sample of medical students (N = 15) attending a national conferences. All students were given a clinical vignette and performed the CBE. CBE techniques were video recorded. Chi-squared tests were used to assess differences in CBE technique.Results
Students exposed to a structured curriculum performed physical examination techniques more consistent with national guidelines than the random, national student sample. Structured curriculum students were more organized, likely to use two hands, a linear search pattern, and include the nipple-areolar complex during the CBE compared to national sample (p < 0.01).Conclusions
Students exposed to a structured skills curriculum more consistently performed the CBE according to national guidelines. The variability in technique compared with the national sample of students calls for major improvements in adoption and implementation of structured skills curricula. 相似文献7.
Mary A. Decoteau Louis Rivera Kristina Umali Arden D. Chan Peter Soballe Romeo C. Ignacio 《American journal of surgery》2018,215(2):315-321
Background
There are several factors that influence ABSITE scores, but the optimal approach for remediation of poor scores is unclear.Methods
A structured academic curriculum and focused remediation program (FRP) were implemented to improve academic performances. Within a 15-year period, ABSITE and American Board of Surgery qualifying exam (ABS QE) results were compared before and after the establishment of the program using a paired T-test. Subgroup analysis was performed for residents who completed the FRP.Results
After establishing the FRP, the mean scores increased from 49.3% to 60% (p = 0.001). The proportion of first-time pass rates for the ABS QE increased from 89.5% to 100% (p = 0.18). With the subgroup analysis of FRP residents, the average improvement on the next ABSITE exam score was 51 percentile points (p = 0.003), raw score increased by 80 (p = 0.01) and percent correct increased by 7 percentage points (p = 0.006).Conclusions
A structured academic curriculum and FRP improves ABSITE scores. Additional strategies utilizing the self-regulated learning method can further assist trainees who remain struggling learners. Further study is required to determine direct correlation to the ABS QE. 相似文献8.
Bruce A. Orkin Jennifer Poirier Areta Kowal-Vern Edie Chan Karen Ohara Brian Mendoza 《American journal of surgery》2018,215(2):322-325
Background
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).Methods
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) (<or >35th percentile as PGY1-2) was also performed.Results
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).Conclusion
Protected research time did not improve residents' ABSITE scores, regardless of initial scores. At Risk residents improved regardless of research group status. 相似文献9.
Nicolas J. Mouawad Stefan W. Leichtle Christodoulos Kaoutzanis Kathleen Welch Suzanne Winter Richard Lampman Matt McCord Kimberly A. Hoskins Robert K. Cleary 《American journal of surgery》2018,215(4):570-576
Objective
To compare continuous infusion preperitoneal wound catheters (CPA) versus continuous epidural analgesia (CEA) after elective colorectal surgery.Methods
An open-label equivalence trial randomizing patients to CPA or CEA. Primary outcomes were postoperative pain as determined by numeric pain scores and supplemental narcotic analgesia requirements. Secondary outcomes included incidence of complications and patient health status measured with the SF-36 Health Survey (Acute Form).Results
98 patients were randomized [CPA (N = 50, 51.0%); CEA (N = 48, 49.0%)]. 90 patients were included [ CPA 46 (51.1%); CEA 44 (48.9%)]. Pain scores were significantly higher in the CPA group in the PACU (p = 0.04) and on the day of surgery (p < 0.01) as well as supplemental narcotic requirements on POD 0 (p = 0.02). No significant differences were noted in postoperative complications between groups, aggregate SF-36 scores and SF-36 subscale scores.Conclusions
Continuous epidural analgesia provided superior pain control following colorectal surgery in the PACU and on the day of surgery. The secondary endpoints of return of bowel function, length of stay, and adjusted SF-36 were not affected by choice of peri-operative pain control. 相似文献10.
Nathan Tanoue Lev N. Korovin Melissa Carton Carlos A. Galvani Iman Ghaderi 《American journal of surgery》2018,215(2):288-292
Background
Surgical training requires development of both technical and cognitive skills. The study analyzed feedback by faculty and residents' self-assessments during a laparoscopic training course to identify structure of feedback in this context and compared the focus of trainees to faculty.Methods
This study collected assessments by surgical residents and faculty during an intensive laparoscopic training course at a single institution. The residents' operative performance was assessed using validated assessment tools including free text feedback. Assessments were completed immediately following procedures. Feedback was analyzed using qualitative method.Results
Eighty (80) residents participated. Three themes were identified: Assessment, instruction and occasion. Faculty provided significantly more feedback than trainees. Moreover, the content of feedback was different. Residents focused on technical performance, while faculty commented on technical and cognitive skills, efficiency and level of independence. Errors were mainly addressed by faculty.Conclusion
This study demonstrated differences in cognitive focus of trainees and faculty. Text feedback is informative in understanding perceived challenges. Faculty provided explicit assessment and instruction for improvement. The effectiveness of self-assessment and feedback should be further studied. 相似文献11.
Arghavan Salles Laurel Milam Geoffrey Cohen Claudia Mueller 《American journal of surgery》2018,215(2):233-237
Background
Physician well-being is a significant problem. Here we explore whether one factor, a resident's concern for being judged by one's gender, influences well-being.Methods
Over two years at one institution, we surveyed surgical residents on validated measures of well-being as well as the extent to which they felt they were judged because of their gender (gender judgment). We used correlations and linear regression to investigate the relationships between gender judgment and well-being.Results
There were 193 unique respondents (87% response rate). Women had significantly more concerns about gender judgment than men (M = 2.39, SD = 0.73 vs. M = 1.46, SD = 0.62, t = ?9.47, p < 0.00001). In regression analyses, gender judgment concerns were significantly associated with all three well-being outcomes (Bs -0.34, 0.50, and 0.39, respectively for well-being, emotional exhaustion, and depersonalization, all p < 0.013).Conclusions
The degree to which residents, both male and female, are concerned about being judged for their gender is significantly associated with worse well-being. 相似文献12.
Adrienne N. Cobb Witawat Daungjaiboon Sarah A. Brownlee Anthony J. Baldea Arthur P. Sanford Michael M. Mosier Paul C. Kuo 《American journal of surgery》2018,215(3):411-416
Background
This study aims to identify predictors of survival for burn patients at the patient and hospital level using machine learning techniques.Methods
The HCUP SID for California, Florida and New York were used to identify patients admitted with a burn diagnosis and merged with hospital data from the AHA Annual Survey. Random forest and stochastic gradient boosting (SGB) were used to identify predictors of survival at the patient and hospital level from the top performing model.Results
We analyzed 31,350 patients from 670 hospitals. SGB (AUC 0.93) and random forest (AUC 0.82) best identified patient factors such as age and absence of renal failure (p < 0.001) and hospital factors such as full time residents (p < 0.001) and nurses (p = 0.004) to be associated with increased survival.Conclusions
Patient and hospital factors are predictive of survival in burn patients. It is difficult to control patient factors, but hospital factors can inform decisions about where burn patients should be treated. 相似文献13.
Nahush A. Mokadam Todd F. Dardas Joshua L. Hermsen Jay D. Pal Michael S. Mulligan L. Myria Jacobs Douglas E. Wood Edward D. Verrier 《The Journal of thoracic and cardiovascular surgery》2017,153(4):987-996.e1
Objective
The 88-week Thoracic Surgery Curriculum is challenging to implement because of the large content in a traditional lecture format. This study investigates flipping the classroom by using a case-based format designed to stimulate resident preparation and engagement.Methods
The didactic conference format was altered. Curricular reading assignments, case review, and conference participation prepared residents for novel formative assessment quizzes. Ten residents participated, and faculty served as controls. Scores were compared with the use of linear regression adjusted for clustering of responses for each person. A survey was administered to determine impressions of this educational technique.Results
A majority of residents completed curricular readings (82%) and reviewed case presentations (79%). Resident performance initially lagged behind faculty but exceeded faculty performance by the conclusion (interaction P = .047). Junior resident overall performance was superior to senior residents over the entire analysis (P = .026); however, both groups improved over time similarly (P = .34) Increased reading from the curriculum (5% increase per level, P = .001) and case presentation review (6% increase per level, P < .0001) were associated with improved quiz performance. Residents presenting cases at their session performed no better than other quiz-takers for the same session (P = .38). The majority of residents viewed this method favorably.Conclusions
This method stimulated increased resident participation and engagement in this pilot study. Assessment scores increased at both resident levels, and resident performance exceeded faculty performance with time. By using experiential learning principles, flipping the classroom in this manner may improve educational culture by enhancing accountability, assessment, and feedback. 相似文献14.
Melike Harfouche Leandra Krowsoski Amy Goldberg Zoe Maher 《American journal of surgery》2018,215(1):200-203
Background
The purpose of this study was to evaluate perceptions regarding the value of global surgical electives (GSEs) and pursuit of a career in global surgery amongst residents and surgeons.Methods
We sent an anonymous questionnaire to all current and former surgical residents of our tertiary-care, university-based institution from the years 2000–2013. Questions addressed the experience and value of practicing surgery in low or middle income countries (LMIC) in residency and as a career.Results
Twenty-three (40%) graduates (G) and 36 (84%) surgical residents (R) completed the survey. Thirteen residents (36%) and 13 (52%) graduates had delivered surgical care in a LMIC. Respondents stated that their experience positively impacted patient care (G = 80% vs R = 75%) and learning (G = 75% vs R = 90%). Of the 4 graduates still working in a LMIC, the majority (75%) were providing less than 2 months of care. Logistical reasons and family obligations were the most common barriers (n = 13).Conclusion
Few graduates are able to incorporate global surgery into their practice despite interest. For enduring participation, logistical and family support is needed. 相似文献15.
Joanna K. Law Parker A. Thome Brenessa Lindeman Daren C. Jackson Anne O. Lidor 《American journal of surgery》2018,215(1):196-199
Background
We examined the types of technology used by medical students in clinical clerkships, and the perception of technology implementation into the curriculum.Methods
An online survey about technology use was completed prior to general surgery clinical clerkship. Types of devices and frequency/comfort of use were recorded. Perceptions of the benefits and barriers to technology use in clerkship learning were elicited.Results
125/131 (95.4%) students responded. Most students owned a smart phone (95.2%), tablet (52.8%), or both (50%); 61.6% spent > 11 h/week learning on a device at the Johns Hopkins School of Medicine for educational purposes. Technology use was seen as beneficial by 97.6% of students. Classes that used technology extensively were preferred by 54% of students, although 47.2% perceived decreased faculty/classmate interaction.Conclusions
Students use mobile technology to improve how they learn new material, and prefer taking classes that incorporate information technology. However, in-person/blended curricula are preferable to completely online courses. 相似文献16.
The correlation between fundamental characteristics and first-time performance in laparoscopic tasks
Cuan M. Harrington Richard Bresler Donncha Ryan Patrick Dicker Oscar Traynor Dara O. Kavanagh 《American journal of surgery》2018,215(4):618-624
Background
The ability of characteristics to predict first time performance in laparoscopic tasks is not well described. Videogame experience predicts positive performance in laparoscopic experiences but its mechanism and confounding-association with aptitude remains to be elucidated. This study sought to evaluate for innate predictors of laparoscopic performance in surgically naive individuals with minimal videogame exposure.Methods
Participants with no prior laparoscopic exposure and minimal videogaming experience were recruited consecutively from preclinical years at a medical university. Participants completed four visuospatial, one psychomotor aptitude test and an electronic survey, followed by four laparoscopic tasks on a validated Virtual Reality simulator (LAP Mentor?).Results
Twenty eligible individuals participated with a mean age of 20.8 (±3.8) years. Significant intra-aptitude performance correlations were present amongst 75% of the visuospatial tests. These visuospatial aptitudes correlated significantly with multiple laparoscopic task metrics: number of movements of a dominant instrument (rs ≥ ?0.46), accuracy rate of clip placement (rs ≥ 0.50) and time taken (rs ≥ ?0.47) (p < 0.05). Musical Instrument experience predicted higher average speed of instruments (rs ≥ 0.47) (p < 0.05). Participant's revised competitive index level predicted lower proficiency in laparoscopic metrics including: pathlength, economy and number of movements of dominant instrument (rs ≥ 0.46) (p < 0.05).Conclusion
Multiple visuospatial aptitudes and innate competitive level influenced baseline laparoscopic performances across several tasks in surgically naïve individuals. 相似文献17.
Cassidy Bommer Sarah Sullivan Krystle Campbell Zachary Ahola Suresh Agarwal Ann O&#x;Rourke Hee Soo Jung Angela Gibson Glen Leverson Amy E. Liepert 《American journal of surgery》2018,215(2):266-271
Background
We assessed the effect of basic orientation to the simulation environment on anxiety, confidence, and clinical decision making.Methods
Twenty-four graduating medical students participated in a two-week surgery preparatory curriculum, including three simulations. Baseline anxiety was assessed pre-course. Scenarios were completed on day 2 and day 9. Prior to the first simulation, participants were randomly divided into two groups. Only one group received a pre-simulation orientation. Before the second simulation, all students received the same orientation. Learner anxiety was reported immediately preceding and following each simulation. Confidence was assessed post-simulation. Performance was evaluated by surgical faculty.Results
The oriented group experienced decreased anxiety following the first simulation (p = 0.003); the control group did not. Compared to the control group, the oriented group reported less anxiety and greater confidence and received higher performance scores following all three simulations (all p < 0.05).Conclusions
Pre-simulation orientation reduces anxiety while increasing confidence and improving performance. 相似文献18.
Nikolaus Johannes Wachter Martin Mentzel Gert D. Krischak Joachim Gülke 《Journal of hand therapy》2018,31(4):524-529
Introduction
In the assessment of hand and upper limb function, grip strength is of the major importance. The measurement by dynamometers has been established.Purpose of the Study
In this study, the effect of a simulated ulnar nerve lesion on different grip force measurements was evaluated.Methods
In 25 healthy volunteers, grip force measurement was done by the JAMAR dynamometer (Fabrication Enterprises Inc, Irvington, NY) for power grip and by a pinch strength dynamometer for tip pinch strength, tripod grip, and key pinch strength.Study Design
A within-subject research design was used in this prospective study. Each subject served as the control by preinjection measurements of grip and pinch strength. Subsequent measurements after ulnar nerve block were used to examine within-subject change.Results
In power grip, there was a significant reduction of maximum grip force of 26.9% with ulnar nerve block compared with grip force without block (P < .0001). Larger reductions in pinch strength were observed with block: 57.5% in tip pinch strength (P < .0001), 61.0% in tripod grip (P < .0001), and 58.3% in key pinch strength (P < .0001).Discussion
The effect of the distal ulnar nerve block on grip and pinch force could be confirmed. However, the assessment of other dimensions of hand strength as tip pinch, tripod pinch and key pinch had more relevance in demonstrating hand strength changes resulting from an distal ulnar nerve lesion.Conclusions
The measurement of tip pinch, tripod grip and key pinch can improve the follow-up in hand rehabilitation.Level of Evidence
II. 相似文献19.
Hee Soo Jung Charles Warner-Hillard Ryan Thompson Krista Haines Brooke Moungey Anne LeGare David Williamson Shaffer Carla Pugh Suresh Agarwal Sarah Sullivan 《American journal of surgery》2018,215(2):250-254
Background
We hypothesized that team communication with unmatched grammatical form and communicative intent (mixed mode communication) would correlate with worse trauma teamwork.Methods
Interdisciplinary trauma simulations were conducted. Team performance was rated using the TEAM tool. Team communication was coded for grammatical form and communicative intent. The rate of mixed mode communication (MMC) was calculated. MMC rates were compared to overall TEAM scores. Statements with advisement intent (attempts to guide behavior) and edification intent (objective information) were specifically examined. The rates of MMC with advisement intent (aMMC) and edification intent (eMMC) were also compared to TEAM scores.Results
TEAM scores did not correlate with MMC or eMMC. However, aMMC rates negatively correlated with total TEAM scores (r = ?0.556, p = 0.025) and with the TEAM task management component scores (r = ?0.513, p = 0.042).Conclusions
Trauma teams with lower rates of mixed mode communication with advisement intent had better non-technical skills as measured by TEAM. 相似文献20.