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1.
Operative confidence of graduating surgery residents: a training challenge in a changing environment
Annabelle L. Fonseca Vikram ReddyWalter E. Longo M.D. Robert UdelsmanRichard J. Gusberg M.D. 《American journal of surgery》2014
Background
Given the recent changes in general surgical training, this study was undertaken to assess the confidence of graduating general surgery residents in performing open operations and to determine factors that are associated with increased confidence.Methods
A survey was sent to the 5th-year general surgery residents in the Northeast. Respondents were queried regarding demographics, program characteristics and asked to rate their confidence in performing open operations. We compared those who indicated confidence with those who did not.Results
We received 232 responses: 74% male, 70% from university programs, and 50% from programs affiliated with a Veterans Affairs Hospital. Fifty-two percent expressed confidence in their ability to practice independently after residency. Operative confidence varied with sex, type of training program, affiliation to a Veterans Affairs Hospital, and surgical volume.Conclusions
Graduating surgical residents indicated a significant lack of confidence in performing a variety of open surgical procedures. Analyzing and addressing this confidence deficit merits further study. 相似文献2.
Amy L. Halverson Debra A. DaRosa David C. Borgstrom Philip R. Caropreso Tyler G. Hughes David B. Hoyt Ajit K. Sachdeva 《American journal of surgery》2014
Background
Rural surgeons have unique learning needs not easily met by traditional continuing medical education courses.Methods
A multidisciplinary team developed and implemented a skills curriculum focused on leadership and communication, advanced endoscopy, emergency urology, emergency gynecology, facial plastic surgery, ultrasound, and management of fingertip amputations.Results
Twenty-five of 30 (89%) rural surgeons who completed a follow-up course evaluation reported that the knowledge acquired during the course had improved their practice and/or the quality of patient care, particularly by refining commonly used skills and expanding the care options they could offer to their patients. The surgeons reported incorporating changes in their communication and interaction with colleagues.Conclusions
This course was successful, from participants' perspectives, in providing hands-on mentored training for a variety of skills that reflect the broad scope of practice of surgeons in rural areas. Attendees felt that their participation resulted in important behavior and practice changes. 相似文献3.
Shaun C. Daly Rebecca A. Deal Daniel E. Rinewalt Amanda B. Francescatti Minh B. Luu Keith W. Millikan Mary C. Anderson Jonathan A. Myers 《American journal of surgery》2014
Background
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.Methods
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.Results
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).Conclusions
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. 相似文献4.
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5.
Purpose
Both pediatric and general surgeons perform pyloromyotomy. Laparoscopic pyloromyotomy (LAP), and changes in referral patterns have affected the training of pediatric surgery fellows and general surgery residents. We surveyed pediatric surgeons regarding these issues.Methods
We mailed an Institutional Review Board of New Hanover Regional Medical Center-approved survey to 701 members of the American Pediatric Surgical Association within the United States to determine each surgeon's preferred technique for pyloromyotomy (LAP vs Ramstedt or transumbilical procedures [OPEN]), practice setting, involvement with trainees, and opinions regarding pyloromyotomy. Significance was determined using χ2 analyses.Results
A total of 331 (48%) surgeons responded: 197 (60%) performed most or all OPEN, and 85 (26%), most or all LAP. Laparoscopic pyloromyotomy was more likely in academic practices and children's hospitals (P < .05). Residents under surgeons performing LAP were less likely to participate (58% vs 91%; P < .05) or gain competence (22% vs 42%; P < .5). Only 34% of surgeons performing LAP believed that general surgery residents should learn pyloromyotomy, whereas 67% of surgeons performing OPEN believed that residents should learn the procedure (P < .05). A total of 307 (93%) surgeons believed at least 4 OPEN were necessary to become competent, but 126 (44%) reported that their residents performed fewer than 4. Only 104 (31%) surgeons believed that their residents were competent in pyloromyotomy. There were 303 (92%) surgeons who believed that pyloromyotomy should be performed only by pediatric surgeons when possible.Conclusions
Most general surgical residents are not learning pyloromyotomy, in part because of the adoption of laparoscopic technique, limited operative experience, and the opinion of most pediatric surgeons that the procedure should be performed only by pediatric surgeons. 相似文献6.
Nikki Tocco Melissa Brunsvold Loay Kabbani Jules Lin Brent Stansfield Dean Mueller Rebecca M. Minter 《American journal of surgery》2013
Background
An operative anatomy course was developed within the construct of a surgical internship preparatory curriculum. This course provided fourth-year medical students matching into a surgical residency the opportunity to perform intern-level procedures on cadavers under the guidance of surgical faculty members.Methods
Senior medical students performed intern-level procedures on cadavers with the assistance of faculty surgeons. Students' confidence, anxiety, and procedural knowledge were evaluated both preoperatively and postoperatively. Preoperative and postoperative data were compared both collectively and based on individual procedures.Results
Student confidence and procedural knowledge significantly increased and anxiety significantly decreased when preoperative and postoperative data were compared (P < .05). Students reported moderate to significant improvement in their ability to perform a variety of surgical tasks.Conclusions
The consistent improvement in confidence, knowledge, and anxiety justifies further development of an operative anatomy course, with future assessment of the impact on performance in surgical residency. 相似文献7.
Yeon-Jeen Chang 《American journal of surgery》2009,197(3):291-295
Background
Advanced training in hepato-pancreato-biliary (HPB) surgery is available at select centers. No approved fellowships have yet been established.Objective
To determine the level of training in HPB surgery during general surgery residency and to assess the need for additional training.Method
All general surgical residency programs in the United States were surveyed. Resident Review Committee (RRC) and International Hepato-Pancreato-Biliary Association (IHPBA) requirements were compared to Accreditation Council of Graduate Medical Education (ACGME) data.Results
Eighty of 250 general surgical residency programs (32%) responded to the survey. Eighty percent felt their graduating residents had sufficient HPB training. The average number of pancreatic cases per graduating resident was 10.2 ± 7.3. The average number of hepatic resections was 8.6 ± 5.1, and for complex biliary cases, 5.3 ± 1.3.Conclusions
A significant portion of HPB surgery is performed at transplant centers or by HPB surgeons. Guidelines must be established to assure adequate training. When HPB surgery is the main focus of the future practice, residents should seek additional training. 相似文献8.
Background
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.Methods
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.Results
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.Conclusions
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. 相似文献9.
Charity C. Glass Robert D. Acton Patrice G. Blair Andre R. Campbell Ellen S. Deutsch Daniel B. Jones Kathleen R. Liscum Ajit K. Sachdeva Daniel J. Scott Stephen C. Yang 《American journal of surgery》2014
Background
Simulation can enhance learning effectiveness, efficiency, and patient safety and is engaging for learners.Methods
A survey was conducted of surgical clerkship directors nationally and medical students at 5 medical schools to rank and stratify simulation-based educational topics. Students applying to surgery were compared with others using Wilcoxon's rank-sum tests.Results
Seventy-three of 163 clerkship directors (45%) and 231 of 872 students (26.5%) completed the survey. Of students, 28.6% were applying for surgical residency training. Clerkship directors and students generally agreed on the importance and timing of specific educational topics. Clerkship directors tended to rank basic skills, such as examination skills, higher than medical students. Students ranked procedural skills, such as lumbar puncture, more highly than clerkship directors.Conclusions
Surgery clerkship directors and 4th-year medical students agree substantially about the content of a simulation-based curriculum, although 4th-year medical students recommended that some topics be taught earlier than the clerkship directors recommended. Students planning to apply to surgical residencies did not differ significantly in their scoring from students pursuing nonsurgical specialties. 相似文献10.
Amalia Cochran William B. Elder Marie Crandall Karen Brasel Tricia Hauschild Leigh Neumayer 《American journal of surgery》2013
Background
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.Methods
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.Results
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.Conclusions
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. 相似文献11.
Brian C. Drolet Suma Sangisetty Patrick M. Mulvaney Beth A. Ryder William G. Cioffi 《American journal of surgery》2014
Background
The predicted shortage of surgeons is of growing concern with declining medical student interest in surgical careers. We hypothesized that earlier exposure to operative experiences and the establishment of resident mentors through a preclinical elective would enhance student confidence and interest in surgery.Methods
We developed a preclinical elective in surgery, which served as an organized curriculum for junior medical students to experience surgery through a paired resident-mentorship model. We assessed student exposure and confidence with clinical activities before and after the elective (N = 24, 100% response rate). We compared these students with a cohort of peers not enrolled in the elective (N = 147, 67% response rate).Results
We found significantly improved confidence (2.8 vs 4.4) and clinical exposure (2.4 vs 4.3) before versus after the elective, with precourse scores equal to matched peers.Conclusions
This elective incorporates elements that have been shown to positively influence student decision making in surgical career choice. The mentorship model promotes residents as educators, whereas the elective provides a means for early identification of students interested in surgery. 相似文献12.
Sherif Emil Geoffrey Blair Jacob C. Langer Grant Miller Ann Aspirot Guy Brisseau B.J. Hancock 《Journal of pediatric surgery》2014
Background
There is significant lack of information regarding the Canadian pediatric surgery workforce.Methods
An IRB-approved survey aimed at assessing workforce issues was administered to pediatric surgeons and pediatric surgery chiefs in Canada in 2012.Results
The survey was completed by 98% of practicing surgeons and 13 of the 18 division chiefs. Only 6% of surgeons are older than 60 years, and only a fifth anticipate retirement over the next decade. The workforce is stable, with 82% of surgeons unlikely to change current positions. Surgical volume showed essentially no growth during the 5-year period 2006–2010. The majority of surgeons felt they were performing the right number or too few cases and anticipated minimal or no future growth in their individual practices or that of their group. Based on anticipated vacancies, the best estimate is a need for 20 new pediatric surgeons over the next decade. This need is significantly surpassed by the current output from the Canadian training programs.Conclusions
The Canadian pediatric surgery workforce is currently saturated. The mismatch between the number of graduating trainees and the available positions over the next decade has significant repercussions for current surgery and pediatric surgery residents wishing to practice in Canada. 相似文献13.
Ralph C. Quillin III Timothy A. Pritts Amit D. Tevar Dennis J. Hanseman Michael J. Edwards Bradley R. Davis 《The Journal of surgical research》2013
Purpose
The perceptions and expectations of students on the surgery clerkship were evaluated and compared with those of surgical residents and faculty.Methods
A voluntary and anonymous survey was distributed to third year medical students, general surgery residents, and surgery faculty. Statistical analysis was performed using the χ2 and Cochran-Mantel-Haenszel tests (P value <0.05 was significant).Results
Medical students, surgery residents and faculty largely agreed on student responsibilities during morning rounds. However, more students (96.9%) than residents (86.2%) and faculty (77.3%) believed they should be writing progress notes, and fewer students (85%) than residents (100%) and faculty (95.5%) thought they should be taught during morning rounds (P < 0.01 and P = 0.04, respectively). The expected and actual educational experience on the surgical clerkship was similar. The amount of instruction provided each week by residents and faculty was similar to the amount expected by students; each group believed that surgical residents were good educators. Students, residents, and faculty agreed on many essential skills for a student to learn by the clerkship’s end; however, more students (85.8%) than residents (58.6%) and faculty (68.2%) viewed identifying surgical complications as an essential skill (P < 0.01).Conclusions
Overall, the expectations of the medical students, surgical residents, and surgical faculty on the surgery clerkship were well matched. However, there were some instances where the students thought they should be more involved in patient care than did the residents and the faculty. It is important for surgical educators to be aware of these discrepancies to fully maximize the educational experience of medical students. 相似文献14.
Background
Deceased donor organ procurement provides unparalleled opportunity for surgical residents with extensive surgical exposure. We hypothesize that surgical residents regard organ donation positively and organ procurement enhances their education.Methods
We conducted an institutional review board approved anonymous national survey to evaluate organ procurement experiences and attitudes of general surgical residents.Results
Three hundred ninety-seven residents representing all postgraduate years responded, with 97% completion rate. Organ procurement increased with training level (92% seniors vs 53% interns). Over 85% agree organ procurement is a good educational and operative experience, and 73% believe that it will benefit their future surgical career. About 68% agree that organ procurement provided knowledge of anatomy and exposures; under 10% felt organ procurement could be duplicated with simulation. Presence of transplant program did not affect attitudes or experience. Eighty-eight percent women versus77% men plan to donate their own organs.Conclusion
Results indicate that surgical residents value organ procurement, and it remains an essential encounter that applies to general surgery. 相似文献15.
Ira L. Leeds Vjollca Sadiraj James C. Cox Kurt E. Schnier John F. Sweeney 《The Journal of surgical research》2013
Background
It is believed that many postoperative patient readmissions can be curbed via optimization of a patient's discharge from hospital, but little is known about how surgeons make the decision to discharge a patient. This study explored the criteria that surgeons preferentially value in their discharge decision-making process.Materials and methods
All surgical faculty and residents at a U.S. academic medical center were surveyed about the relative importance of specific criteria regularly used to make a discharge decision. Demographic and professional information was collected about each surgeon as well. A Kruskal–Wallis and Fisher's exact test were used to describe one-way analysis of variance between groupings of surgeons. Ordered logit regressions were used to analyze variations across multiple subgroups. Factor analysis was used to further characterize statistically relevant groupings of criteria.Results
In total, 88 (49%) of the invited surgeons responded to the survey. Respondents reported statistically less reliance on common Laboratory tests and Patient demographics when making discharge decisions preferring Vital signs, Perioperative factors, and Functional criteria. Surgeon-specific factors that influenced discharge criteria preferences included years of clinical education and gender. Factor analysis further identified subtle variations in preferences for specific criteria groupings based on clinical education, gender, and race.Conclusions
Surgeons use a wide range of clinical data when making discharge decisions. Typical measures of patient condition also appear to be used heterogeneously with a preference for binary rather than continuous measures. Further understanding the nature of these preferences may suggest novel ways of presenting discharge-relevant information to clinical decision makers to optimize discharge outcomes. 相似文献16.
Lindsey J. Barnes Mitchell Unruh Rachel M. Drake Stephen D. Helmer Alex D. Ammar Jacqueline S. Osland 《American journal of surgery》2014,208(6):1035-1039
Background
In 2006, the Residency Review Committee for Surgery increased the total number of required endoscopy cases for graduating residents. Our goal was to evaluate general surgery resident competency in endoscopy, focusing on quality measures.Methods
A 9-year retrospective review was conducted of 29 residents. Total number of endoscopies performed throughout residency was recorded. Procedures performed as fifth-year residents with indirect supervision were evaluated for quality measures.Results
An average of 76 esophagogastroduodenoscopies and 147 colonoscopies were performed through their first 4 years of residency. Chief residents performed an average of 16 esophagogastroduodenoscopies and 22 colonoscopies. Of colonoscopies performed during their fifth year, 191 were performed while the resident had only indirect supervision. During these cases, cecal intubation was achieved in 90.6% of cases, an average of .48 polyps were identified, and average scope withdrawal time was 13.4 ± 7.1 minutes.Conclusions
Our data indicate that surgery residents achieve competency in colonoscopy before performing 140 colonoscopies, supporting the concept that surgery residencies can function as an excellent training ground for endoscopy. 相似文献17.
18.
Ira L. Leeds Lee A. Hugar Barbara J. Pettitt Jahnavi Srinivasan Viraj A. Master 《American journal of surgery》2013
Background
Concerns about international training experiences in medical school curricula include the effect on student learning. We studied the educational effect of an international elective integrated into a traditional third-year (M3) surgical clerkship.Methods
A 1-week surgical elective in Haiti was available to M3 students during the conventional 8-week surgical clerkship each year for the 4 academic years 2008 to 2011. The authors collected student and surgeon perceptions of the elective using a mixed-methods web-based survey. Statistical analysis compared the academic performance of participating M3s relative to nonparticipating peers.Results
Twenty-eight (100%) students (41 trip weeks) and 3 (75%) surgeons responded. Twenty-five (89%) students believed the elective provided appropriate clinical training. Surgeon responses were consistent with students' reported perceptions.Strengths included unique clinical experiences and close interactions with faculty. Criticisms included recurring overwhelming clinical responsibilities and lack of local provider involvement.Academic performance of participants versus nonparticipants in the same clerkship term were statistically insignificant.Conclusions
This study demonstrates the feasibility of integrating global health experiences into traditional medical student clinical curricula. The effects on less tangible attributes such as leadership skills, fostering teamwork, and cultural competency require future investigation. 相似文献19.