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1.
Derek M. Freitas James Munthali Joseph Musowoya Hebah Ismail Allyson Herbst Laston Chikoya Shubhada Dhage Mary Ann Hopkins 《American journal of surgery》2018,215(4):744-751
Background
Surgery is a vital component of a comprehensive health system, but there are often personnel limitations in resource constrained areas. Zambia provides post graduate surgical training through two systems to help address this shortage. However, no studies have analyzed surgical trainees' perceptions of these programs.Methods
Surgical registrars at COSECSA affiliated hospitals in Zambia were surveyed about their programs. Responses were analyzed to identify key strengths and challenges across several categories including: operative training, clinical training, educational experiences, and career plans.Results
Registrars report having significant independence and receiving broad and high quality operative training. They note specific challenges including limitations in specialty training, resources, and infrastructure.Conclusions
Zambian training programs have the potential to increase number of surgeons in Zambia by a significant amount in the coming years. These programs have many strengths but also face challenges in their goal to expand surgical access in the country. 相似文献2.
Introduction
The positive effect of feedback has long been recognized in surgical education. Surgical educators convey feedback to improve the performance of the surgical trainees. We aimed to review the scientific classification and application of feedback in surgical education, and to propose possible future directions for research.Methods
A literature search was performed using Pubmed, OVID, CINAHL, Web of science, EMBASE, ERIC database and Google Scholar. The following search terms were used: ‘feedback’, ‘feedback in medical education’, ‘feedback in medical training’ and ‘feedback in surgery’. The search was limited to articles in English.Results
From 1157 citations, 12 books and 43 articles met the inclusion criteria and were selected for this review.Conclusion
Feedback comes in a variety of types and is an essential tool for learning and developing performance in surgical education. Different methods of feedback application are evolving and future work needs to concentrate on the value of each method as well as the role of new technologies in surgical education. 相似文献3.
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4.
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5.
Benjamin R. Veenstra Aleksandra Wojtowicz Nathan Walsh Jose M. Velasco 《American journal of surgery》2019,217(3):562-565
Background
Emergency surgical airway is a low frequency, high risk clinical scenario. Implementing a simulation-based curriculum may bridge the gap in surgical training and address quality assurance/performance improvement (QAPI) needs.Methods
We designed and implemented an Advanced Surgical Airway Curriculum (ASAC) modeled after proficiency-based training. General Surgery residents and student nurse anesthetists were enrolled. Evaluation consisted of cognitive tests, procedure checklists and questionnaire.Results
In total, 78 participants successfully completed the ASAC. Trainees agreed that the curriculum provided the cognitive and psychomotor skills necessary to perform both an open and needle cricothyroidotomy.Conclusions
In the age of increased patient safety concerns, QAPI initiatives can serve as a driver for simulation-based training curricula, with particular focus on individualized, active learning. This may be particularly useful in high risk, low frequency scenarios in which the traditional method of “See one, Do one, Teach one,” is not feasible. 相似文献6.
Lauren Wallace Nicholas Raison Faisal Ghumman Aidan Moran Prokar Dasgupta Kamran Ahmed 《The surgeon》2017,15(4):231-239
Background
There is a need for new approaches to surgical training in order to cope with the increasing time pressures, ethical constraints, and legal limitations being placed on trainees. One of the most interesting of these new approaches is “cognitive training” or the use of psychological processes to enhance performance of skilled behaviour. Its ability to effectively improve motor skills in sport has raised the question as to whether it could also be used to improve surgical performance. The aim of this review is to provide an overview of the current evidence on the use of cognitive training within surgery, and evaluate the potential role it can play in surgical education.Methods
Scientific database searches were conducted to identify studies that investigated the use of cognitive training in surgery. The key studies were selected and grouped according to the type of cognitive training they examined.Results
Available research demonstrated that cognitive training interventions resulted in greater performance benefits when compared to control training. In particular, cognitive training was found to improve surgical motor skills, as well as a number of non-technical outcomes. Unfortunately, key limitations restricting the generalizability of these findings include small sample size and conceptual issues arising from differing definitions of the term ‘cognitive training’.Conclusions
When used appropriately, cognitive training can be a highly effective supplementary training tool in the development of technical skills in surgery. Although further studies are needed to refine our understanding, cognitive training should certainly play an important role in future surgical education. 相似文献7.
Background
Surgeons who work with trainees must address their learning needs without compromising patient safety.Methods
We used a constructivist grounded theory approach to examine videos of five teaching surgeries. Attending surgeons were interviewed afterward while watching cued videos of their cases. Codes were iteratively refined into major themes, and then constructed into a larger framework.Results
We present a novel framework, Intelligent Cooperation, which accounts for the highly adaptive, iterative features of surgical teaching in the operating room. Specifically, we define Intelligent Cooperation as a sequence of coordinated exchanges between attending and trainee that accomplishes small surgical steps while simultaneously uncovering the trainee's learning needs.Conclusions
Intelligent Cooperation requires the attending to accurately determine learning needs, perform real-time needs assessment, provide critical scaffolding, and work with the learner to accomplish the next step in the surgery. This is achieved through intense, coordinated verbal and physical cooperation. 相似文献8.
9.
N.E. Anton J. Beane A.M. Yurco L.D. Howley E. Bean E.M. Myers D. Stefanidis 《American journal of surgery》2018,215(2):214-221
Background
Stress can negatively impact surgical performance, but mental skills may help. We hypothesized that a comprehensive mental skills curriculum (MSC) would minimize resident performance deterioration under stress.Methods
Twenty-four residents were stratified then randomized to receive mental skills and FLS training (MSC group), or only FLS training (control group). Laparoscopic suturing skill was assessed on a live porcine model with and without external stressors. Outcomes were compared with t-tests.Results
Twenty-three residents completed the study. The groups were similar at baseline. There were no differences in suturing at posttest or transfer test under normal conditions. Both groups experienced significantly decreased performance when stress was applied, but the MSC group significantly outperformed controls under stress.Conclusions
This MSC enabled residents to perform significantly better than controls in the simulated OR under unexpected stressful conditions. These findings support the use of psychological skills as an integral part of a surgical resident training. 相似文献10.
Tara M. Veasey James N. Fleming Sara E. Strout Ryan Miller Nicole A. Pilch Holly B. Meadows Caitlin R. Mardis Benjamin A. Mardis Sunil Shenvi John McGillicuddy Kenneth D. Chavin Prabhakar Baliga David J. Taber 《American journal of surgery》2018,215(4):663-668
Background
This study evaluated the impact of body mass index (BMI) and patient functional status on the risk for surgical complications after kidney transplant.Methods
This retrospective cohort study of adult kidney transplant recipients grouped patients by baseline Karnofsky status (low function ≤ 70%) and further stratified by morbid obesity (BMI ≥ 35 kg/m2) to assess surgical complication risk.Results
736 patients were included with surgical complications occurring in 25%. Logistic regression analysis with interaction terms demonstrated that morbid obesity and low functional status conditionally impact risk with an OR of 2.8 [95% CI (1.1–7.3)]. Within the functional status cohort, BMI ≥35 kg/m2 was associated with increased risk of surgical complication, superficial wound infection, and DGF. Independent predictors for surgical complications included diabetes and morbid obesity with low functional status. There was no significant difference in graft loss or death across the cohorts.Conclusions
While neither morbid obesity nor poor functional status alone predicts increased complications, the combined presence is associated with significant increase in risk for surgical complications after renal transplantation. 相似文献11.
Konstantinos Georgiou Andreas Larentzakis Athanasios G. Papavassiliou 《The surgeon》2017,15(6):355-365
Background and purpose
Acute stress in surgery is ubiquitous and has an immediate impact on surgical performance and patient safety. Surgeons react with several coping strategies; however, they recognise the necessity of formal stress management training. Thus, stress assessment is a direct need. Surgical simulation is a validated standardised training milieu designed to replicate real-life situations. It replicates stress, prevents biases, and provides objective metrics. The complexity of stress mechanisms makes stress measurement difficult to quantify and interpret. This systematic review aims to identify studies that have used acute stress estimation measurements in surgeons or surgical trainees during real operations or surgical simulation, and to collectively present the rationale of these tools, with special emphasis in salivary markers.Methods
A search strategy was implemented to retrieve relevant articles from MEDLINE and SCOPUS databases. The 738 articles retrieved were reviewed for further evaluation according to the predetermined inclusion/exclusion criteria.Results
Thirty-three studies were included in this systematic review. The methods for acute stress assessment varied greatly among studies with the non-invasive techniques being the most commonly used. Subjective and objective tests for surgeons' acute stress assessment are being presented.Conclusion
There is a broad spectrum of acute mental stress assessment tools in the surgical field and simulation and salivary biomarkers have recently gained popularity. There is a need to maintain a consistent methodology in future research, towards a deeper understanding of acute stress in the surgical field. 相似文献12.
Ji Wan Kim Yongkoo Lee Joonho Seo Jai Hyung Park Yong Min Seo Sung Soo Kim Hyun Chul Shon 《Journal of orthopaedic science》2018,23(2):383-388
Background
To report our experiences with the use of three-dimensional (3D) printing in the field of orthopedic trauma.Methods
This retrospective study enrolled 24 patients from three university teaching hospitals in whom 3D printing technique was applied: 14 patients with acetabular fractures and 10 patients with clavicular shaft fractures. We summarized our experiences with 3D printed bone models.Results
Three-dimensional printed acetabular models improved understanding of complex acetabular anatomy and fracture pattern to plan the optimal positioning of a reduction clamp and the trajectory of screws. Pre-bending of a reconstruction plate could reduce operative time. We also recorded fluoroscopic images of a simulated surgery for percutaneous screw fixation of the acetabular posterior column, with the optimal positioning of the guide wire determined during the simulation used as a reference during the actual operation. This surgical simulation was performed by a resident and served as a helpful training method. For fractures of the clavicle, we identified the optimal position of anatomical plates using 3D printed clavicle models.Conclusion
In our experience, 3D printing technique provided surgeons with improved understanding of the fracture pattern and anatomy and was effectively used for preoperative planning, education of surgical trainees, and performing simulations to improve intra-operative technical outcomes. 相似文献13.
Background
The global rise in infectious disease has led the Center for Disease Control and Prevention and the World Health Organization to release new guidelines for the prevention of surgical site infection.Methods
In this article, we summarize current recommendations based on level of evidence, review unresolved and unaddressed issues, and supplement them with new literature.Results
Although the guidelines discuss major issues in reducing surgical site infection, many questions remain unanswered.Conclusion
These guidelines will hopefully help in setting a standard of care based on best evidence available and focus investigators on areas where evidence is lacking. 相似文献14.
D.Z. Khan M.E. Kelly J. O&#x;Reilly W. Khan R. Waldron K. Barry I.Z. Khan 《The surgeon》2017,15(4):206-210
Introduction
Diverticulitis is a common surgical admission that presents with a wide range of symptoms and severity. Overall there has been a shift to conservative management practices, including the consideration of non-antibiotic treatment approaches in select cases.Methods
A national survey of all consultant surgeons evaluating their practices was performed. Reasons for changes in management, use of radiological imaging, role of non-antibiotic treatment approaches and indications for elective surgical management were evaluated.Results
Response rate for this survey was 67.7% (n = 67/99). An overwhelming 92.5% stated that computed tomography imaging was routinely used to investigate acute presentations. Interestingly, 22.4% stated they would consider a non-antibiotic treatment approach in uncomplicated diverticulitis. Main reasons for adopting this approach was low inflammatory markers with short duration of symptoms. Co-amoxiclav was the most common antibiotic used for acute diverticulitis, with considerable variability in duration of treatment. Additionally, there was considerable heterogeneity regarding how many recurrences were necessary before surgical management was required.Conclusion
This review highlights substantial variation in the management of diverticulitis across Ireland. Shifts to non-antibiotic treatment approaches for uncomplicated cases are observed, but less so than in Northern Europe. National guidelines are required to establish uniform treatment protocols including indications for surgical resection. 相似文献15.
Background
Prior studies indicate that one factor that may contribute to total hip arthroplasty failure due to mechanically assisted crevice corrosion at the femoral head-trunnion junction is the method of femoral head fixation.Methods
Up-to-date on-line surgical technique guides describing fixation of the prosthetic femoral head of common implants of the 4 largest manufacturers as well as 2 minor manufacturers were identified. The information given regarding preparation and fixation of the femoral head was evaluated and compared.Results
A total of 24 surgical technique guides were evaluated. Most guides (22/24) addressed fixation technique; of these, 19 of 22 suggested cleaning and 20 of 22 suggested drying the trunnion prior to affixing the femoral head. The manner of fixation, however, varied widely and there was no single technique advocated.Conclusion
The majority of surgeon education materials do not specify a single technique for assembly of the head femoral component in total hip arthroplasty. If the method of fixation is indeed important, efforts should be made to identify the best technique, and improve and unify the surgical technique instructions. 相似文献16.
Stephen Haggerty Tomokazu Kishiki Michael Ujiki Chi Wang Nancy Schindler 《American journal of surgery》2018,215(2):272-276
Purpose
Using simulation can help surgical trainees acquire surgical skills but at the expense of clinical learning time. We postulate an in-rotation skills curriculum is feasible and minimizes time away from clinical experiences.Methods
Surgical residents (PGY2-5) were allotted two hours of weekly protected time for rotation specific simulation modules that included assessment, mentoring, and practice. Between September 2015 and February 2016 performance data was collected and participants were surveyed.Results
Completion rates of 87–100% were achieved and post-test scores improved significantly, indicating improved performance. The survey (29/30 RR) revealed that 81.5% felt 2 hours a week was ‘just right’ and 79.3% agreed or strongly agreed the in-rotation aspect was a benefit. Improved confidence in the OR was reported by 86.2% of residents Intra-operative skill was self-assessed as improved in 79.3%.Conclusion
In-rotation skills curriculum with high completion rates is feasible and allows training in close proximity to clinical application. Performance in the simulated environment significantly improved with corresponding improvements in confidence and self-assessed skill in the operating room. 相似文献17.
James E. Coverdill 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):326-330
Background
The study explores how residents and faculty assess the ACGME's 16-h limit on intern shifts.Methods
Questionnaire response rates were 76% for residents (N = 291) and 71% for faculty (N = 279) in 13 general surgery residency programs. Results include means, percentage in agreement, and statistical tests for 15 questionnaire items. Semi-structured interviews conducted with 39 residents and 43 faculty were analyzed for main themes.Results
Few view the intern shift limit as a positive change. Views differ (P < 0.01) for residents and faculty on 12 of 15 item means and across PGY levels on all 15 items. Interviews indicate concerns about losses with respect to education and professional development, difficulties when interns transition to their second year, and how intern shifts may be more fatiguing than expected.Conclusions
The 16-h limit on intern shifts has remained a source of concern and an educational challenge for residents and faculty. 相似文献18.
Background
Average costs associated with common procedures can vary by surgeon without a corresponding variation in outcome or case complexity.Methods
De-identified cost and equipment utilization data were collected from our hospital for elective laparoscopic cholecystectomy performed by 17 different surgeons over a 6-month period. A group of surgeons used this data to design a standardized equipment pick list that became optional (not mandated) for laparoscopic cholecystectomy. Cost and consumable surgical supply utilization data were collected for six months prior to and following the creation of the standardized pick-list.Results
280 elective laparoscopic cholecystectomies were performed during the study interval. In the 6 months after standardized pick list creation, the cost of disposable supplies utilized per case decreased by 32%.Conclusions
Surgical cost savings can be achieved with standardized procedure pick lists and attention to the cost of consumable surgical supplies. 相似文献19.
Edin Mujagic Walter R. Marti Michael Coslovsky Jasmin Zeindler Sebastian Staubli Regula Marti Robert Mechera Savas D. Soysal Lorenz Gürke Walter P. Weber 《American journal of surgery》2018,215(4):651-657
Background
Routine preoperative blood work is not recommended but selected biochemical markers may predict the risk of surgical site infection (SSI). This study examines the association between preoperative biochemical markers and the risk of SSI.Methods
This observational cohort study, nested in a randomized controlled trial, was conducted at two tertiary referral centers in Switzerland.Results
122 (5.8%) of 2093 patients experienced SSI. Preoperative increasing levels of albumin (OR 0.93), CRP (OR 1.34), hemoglobin (OR 0.87) and eGFR (OR 0.90) were significantly associated with the odds of SSI. The same accounts for categorized parameters. The highest area under the curve from ROC curves was 0.62 for albumin. Positive predictive values ranged from 6.4% to 9.5% and negative predictive values from 94.8% to 95.7%. The association of CRP, mildly and moderately decreased eGFR and hemoglobin with the odds of SSI remained significant on multivariate analysis.Conclusions
Our results do not support generally delaying elective surgery based on preoperative blood results. However, it may be considered in situations with potentially severe sequelae of SSI. 相似文献20.
Muhammad Zeb Apram Jyot Eduardo Abbott Miguel Gomez Mohamed Baloul David Farley 《American journal of surgery》2018,215(3):395-398