Impact of a novel education curriculum on surgical training within an academic training program

BACKGROUND: The training of the 21st century surgeon has become increasingly complex with the Accreditation Council for Graduate Medical Education (ACGME) core competency requirements and work-hour restrictions. Herein we report the two-year results of a novel problem-based learning education module at a large academic surgery program. METHODS: All data were prospectively collected from 2004 to 2006 on all categorical residents in the department of surgery (n = 42). Analysis was performed to identify any correlation between class attendance and American Board of Surgery In-Service Training Exam (ABSITE) score performance (percentile change). All data were reported as a mean with a standard error of the mean. Categorical variables were analyzed using a paired Student's t-test. A bivariate correlation was calculated using Spearman's rho correlation. RESULTS: When comparing the 2004 scores (pre-program) to 2006 scores, there was significant score improvement (P 相似文献   

Preliminary assessment of a scientific curriculum in a surgical residency program.

A structured, basic science curriculum was instituted for surgical residents of the University of Connecticut (Farmington) Integrated Residency Program during the 1990-1991 academic year in concordance with American Board of Surgery guidelines. The impact of the new program was measured by comparing performance on monthly basic science examinations, the in-training examination, and "mock" oral examinations for the 1990-1991 academic year with that of the preceding academic year. While monthly examination scores improved for the entire group of residents (67.7 vs 64.6), in-training and oral examination scores did not change significantly. Categorical residents generally demonstrated superior performance and greater improvement than did preliminary residents. Data analysis suggested that the new curriculum was an effective educational device and that university-designed monthly examinations were valid testing instruments, but there was an apparent incongruity between the goals of the curriculum and the American Board of Surgery In-Training Examination.     

泌尿外科腹腔镜技能培训模式的初步探索

目的 初步探索合理的泌尿外科腹腔镜技能培训模式. 方法利用模拟训练箱开展腹腔镜基本技能培训.选择20～30 kg的小猪建立腹腔镜下肾部分切除术、肾盂成形术和输尿管再植术3种动物模型,然后开展有针对性的专项手术模拟训练.33名泌尿外科研究生参与培训,其中博士16名、硕士17名.初学者从基本技能培训开始,腹腔镜基本技能达剑合格水平后在动物模型上进行模拟手术培训. 结果 参与2期基本技能培训后,33名学员腹腔镜基本操作技能均达到合格水平.33名学员在完成8次肾部分切除术专项手术训练后,手术时间从(64.0±18.4)min降为(30.9±3.8)min(P<0.01),学员均熟练掌握肾肿瘤切除和肾实质腔内缝合等技术;完成8次肾盂成形术的模拟训练后,平均完成时间由(127.5±17.5)min降为(65.2±7.5)min(P<0.01),学员均能熟练完成无张力的肾盂输尿管吻合并掌握了顺行放置双J管的技巧;完成8次输尿管膀胱再植术的模拟训练后,平均手术时间从(75.8±11.6)min降为(37.7±7.2)min(P<0.01),学员均能熟练完成输尿管的分离、裁剪、缝合等操作.接受系统培训后,15名(45.5%)学员已完成了从模拟训练到临床手术的过渡,在临床开展腹腔镜手术. 结论 腹腔镜基本技能训练设备简单,成本较低,适合于初学者的培养;动物模拟手术可以全真地模拟手术过程,在动物模型上进行专项手术训练町以帮助学员更快掌握腹腔镜手术方法和技巧.基本技能培训与动物模拟手术相结合的模式较适合于腹腔镜技能的培训,有一定的临床推广价值.     

The impact of a resident-directed survey on the education curriculum of a university surgical training program

Surgical training programs use various objective and subjective means to evaluate housestaff performance. However it is less clear how to assess the quality of the educational experience the program itself provides. This study examines the use of a resident-directed survey as a means of identifying and rectifying weakness in a surgical training curriculum. Multiple choice questionnaires covering each of 14 senior rotations were prepared by chief residents and distributed to all senior surgical residents in April 1989 (year I). The survey covered factors considered vital to resident education, including operative experience, input into preoperative and postoperative decisions, autonomy, and time demands, and an overall rating (OR) of the educational quality of the rotations. Responses were numerically graded: 1, appropriate; 0, fair; -1, inadequate (or "excessive" for the variable "time demands"). The results, which were presented and discussed at a departmental retreat that spring, prompted specific curriculum changes for the 1989-1990 academic year. An identical survey was conducted the next spring (year II). Major reorganizational changes were made in three of the four negatively rated rotations from year I. The OR for each of the rotations improved dramatically in year II (average increase of 0.64/rotation; p less than 0.05). None of the eight favorably rated rotations in year I suffered a reduction in OR as a result of the changes. Case load, intraoperative involvement, and input in both preoperative and postoperative decisions correlated most frequently with favorable ORs in both years. This study shows that a resident survey is an effective tool for critically assessing the education curriculum of a surgical training program.     

Incorporation of laparoscopy into a surgical endoscopy training program.

The impact of introducing laparoscopy as part of the overall gastrointestinal endoscopy case load performed by residents was reviewed. During 1990, there was a significant increase (56.9%) in the number of flexible diagnostic endoscopic procedures performed compared with 1989. When the total number of laparoscopic procedures was considered, the increase was 117%. Residents participated in the "surgeon's" position in 59% of the therapeutic laparoscopic procedures and as either surgeon or "first assistant" in 86% of all therapeutic laparoscopic procedures and 94% of all diagnostic laparoscopic procedures. Complication rates for diagnostic laparoscopic procedures were low in 1989 (0.03%) and 1990 (0.2%). Complication rates for therapeutic laparoscopic procedures were also low (4%). There was no difference in the complication rate for cases in which residents were in the surgeon's position (4%) versus cases in which they were not (4%). Introduction of laparoscopic procedures into a surgical residency program can be done safely, especially in cases in which an established program in endoscopy exists.     

Parietal cell vagotomy in a surgical training program

Parietal cell vagotomy was performed in 48 patients at the Parkland Memorial Hospital and the Dallas Veterans Administration Hospital between April 1977 and January 1981. The maximum follow-up time was 50 months and the average was 28 months. Seventy-five percent of the patients were followed for more than 1 year. There were no operative deaths. Four patients (8.3 percent) had persistent postoperative side effects including two documented ulcer recurrences (4.2 percent). Acid secretion studies were reviewed to characterize the longterm effect of parietal cell vagotomy. These studies demonstrated marked postoperative reductions in gastric acid secretion. The results of this study suggest that with the simplified technique described in this paper, parietal cell vagotomy can be performed with minimal mortality and morbidity by surgical residents under direct staff supervision.     

International education: 20 years after implementation of a training program

Medical care in developing countries may be improved by various means. Advances in the medical education and training of specialists play an important role in improving health care systems. The results of the efforts of a neurosurgeon from North America who helped establish neurosurgical training in Taiwan are reported after a follow-up period of 20 years.     

Beyond surgical care improvement program compliance: antibiotic prophylaxis implementation gaps

Background

Despite increased compliance with Surgical Care Improvement Project infection measures, surgical-site infections are not decreasing. The aim of this study was to test the hypothesis that documented compliance with antibiotic prophylaxis guidelines on a pediatric surgery service does not reflect implementation fidelity or adherence to guidelines as intended.

Methods

A 7-week observational study of elective pediatric surgical cases was conducted. Adherence was evaluated for appropriate administration, type, timing, weight-based dosing, and redosing of antibiotics.

Results

Prophylactic antibiotics were administered appropriately in 141 of 143 cases (99%). Of 100 cases (70%) in which antibiotic prophylaxis was indicated, compliance was documented in 100% cases in the electronic medical record, but only 48% of cases adhered to all 5 guidelines. Lack of adherence was due primarily to dosing or timing errors.

Conclusions

Lack of implementation fidelity in antibiotic prophylaxis guidelines may partly explain the lack of expected reduction in surgical-site infections. Future studies of Surgical Care Improvement Project effectiveness should measure adherence and implementation fidelity rather than just documented compliance.     

Reducing medication errors in a surgical residency training program

Medication errors contribute to in-hospital morbidity and mortality. Teaching hospitals and the surgical residency training programs they support should take proactive steps to reduce error frequency. In order to accomplish meaningful error reduction, we must first define the scope and nature of the problem. Pharmacists at the Monmouth Medical Center prospectively recorded medication prescribing errors made by surgical residents during 2 years. These data were reviewed to determine the types of medication errors made most frequently by surgical house officers. Seventy-five medication-prescribing errors were made by surgical house staff in the years 2001 and 2002. Thirty-three of these errors involved orders for antibiotic therapy. Errors that could not be directly attributed to knowledge deficits were responsible for 36 of the 75 errors (48%), whereas specific knowledge deficits were responsible for 39 of the 75 errors (52%). Twentyeight of the 36 errors not directly attributable to knowledge deficits (78%) were made at the postgraduate year one level, whereas only 15 of the 39 knowledge deficit errors (38%) were made at the postgraduate year one level. Though targeted education to address specific knowledge deficits may substantially reduce the occurrence of "knowledge deficit" medication errors within surgical residency training programs, more costly measures such as the implementation of physician computerized order entry will likely be needed to reduce maximally the frequency of medication ordering errors. Many prescribing errors cannot be attributed to specific knowledge deficits.     

Design and implementation of a neuromuscular training program following anterior cruciate ligament reconstruction.

Neuromuscular training programs are increasingly integrated into clinical practice for lower extremity rehabilitation. A few rehabilitation programs have been evaluated for patients with anterior cruciate ligament (ACL) deficiency and for injury prevention, but there is limited scientific evidence of the effect of neuromuscular training following ACL reconstruction. Therefore, a neuromuscular training program was developed for patients after ACL reconstruction. The objective of the neuromuscular training was to improve the ability to generate a fast and optimal muscle firing pattern, to increase dynamic joint stability, and to relearn movement patterns and skills necessary during activities of daily living and sports activities. The main areas considered when designing the postoperative rehabilitation program after ACL reconstruction were: ACL graft healing and ACL strain values during exercises, proprioception and neuromuscular control, and clinical studies on the effect of neuromuscular training programs. The rehabilitation program consists of balance exercises, dynamic joint stability exercises, jump training/plyometric exercises, agility drills, and sport-specific exercise. The patients exercise 3 times a week for 6 months. The scientific and clinical evidence for the rehabilitation program are described and the main exercises in the program are outlined.