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Autonomy general surgery residents

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https://www.readbyqxmd.com/read/27886972/the-resident-run-minor-surgery-clinic-a-pilot-study-to-safely-increase-operative-autonomy
#1
REVIEW
Brandon M Wojcik, Zhi Ven Fong, Madhukar S Patel, David C Chang, Emil Petrusa, John T Mullen, Roy Phitayakorn
OBJECTIVE: 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...
November 2016: Journal of Surgical Education
https://www.readbyqxmd.com/read/27865597/expert-consensus-of-general-surgery-residents-proficiency-with-common-endocrine-operations
#2
Roy Phitayakorn, Rachel R Kelz, Emil Petrusa, Rebecca S Sippel, Cord Sturgeon, Kepal N Patel, Nancy D Perrier
BACKGROUND: Proficiency with common endocrine operations is expected of graduating, general surgery residents. However, no expert consensus guidelines exist about these expectations. METHODS: Members of the American Association of Endocrine Surgeons were surveyed about their opinions on resident proficiency with common endocrine operations. RESULTS: Overall response rate was 38%. A total of 92% of the respondents operate with residents. On average, they believed that the steps of a total thyroidectomy for benign disease and a well-localized parathyroidectomy could be performed by a postgraduate year 4 surgery resident...
November 16, 2016: Surgery
https://www.readbyqxmd.com/read/27743124/don-t-fix-it-if-it-isn-t-broken-a-survey-of-preparedness-for-practice-among-graduates-of-fellowship-council-accredited-fellowships
#3
Yusuke Watanabe, Amin Madani, Elif Bilgic, Katherine M McKendy, Gada Enani, Iman Ghaderi, Gerald M Fried, Liane S Feldman, Melina C Vassiliou
BACKGROUND: General surgery residency may not adequately prepare residents for independent practice. It is unclear; however, if non-ACGME-accredited fellowships are better meeting training needs. The purpose of this mixed-method study was to determine perceived preparedness for practice and to identify gaps in fellowship training. METHODS: A survey was developed using an iterative qualitative methodology based on interviews and focus groups of graduated fellows and program directors...
October 14, 2016: Surgical Endoscopy
https://www.readbyqxmd.com/read/27603429/confidence-crisis-among-general-surgery-residents-a-systematic-review-and-qualitative-discourse-analysis
#4
Dawn M Elfenbein
Importance: In the surgical community, there is concern that general surgery residents are choosing subspecialty training in large numbers because of a crisis in confidence at the end of training. Confidence is an essential quality of surgeons, and recent studies have attempted to quantify and measure it in graduating general surgery residents. Objectives: To systematically review the quality of evidence provided and to critically analyze the language used to describe the findings using quantitative methods...
September 7, 2016: JAMA Surgery
https://www.readbyqxmd.com/read/27163961/progressive-entrustment-to-achieve-resident-autonomy-in-the-operating-room-a-national-qualitative-study-with-general-surgery-faculty-and-residents
#5
Gurjit Sandhu, Christopher P Magas, Adina B Robinson, Christopher P Scally, Rebecca M Minter
OBJECTIVE: The purpose of this study was to identify behaviors that faculty and residents exhibit during intraoperative interactions, which support or inhibit progressive entrustment leading to operative autonomy. BACKGROUND: In the operating room, a critical balance is sought between direct faculty supervision and appropriate increase in resident autonomy with indirect faculty supervision. Little is known regarding perspectives of faculty and residents about how attendings increasingly step back and safely delegate autonomy to trainees...
May 9, 2016: Annals of Surgery
https://www.readbyqxmd.com/read/26818129/benchmarking-the-wilmer-general-eye-services-clinics-baseline-metrics-for-surgical-and-outpatient-clinic-volume-in-an-educational-environment
#6
Eric Singman, Divya Srikumaran, Kathy Hackett, Brian Kaplan, Albert Jun, Derek Preece, Pradeep Ramulu
BACKGROUND: The Wilmer General Eye Services (GES) at the Johns Hopkins Hospital is the clinic where residents provide supervised comprehensive medical and surgical care to ophthalmology patients. The clinic schedule and supervision structure allows for a progressive increase in trainee responsibility, with graduated autonomy and longitudinal continuity of care over the three years of ophthalmology residency training. This study sought to determine the number of cases the GES contributes to the resident surgical experiences...
2016: BMC Medical Education
https://www.readbyqxmd.com/read/26487226/what-do-residents-need-to-be-competent-laparoscopic-and-endoscopic-surgeons
#7
Aimee K Gardner, Ross E Willis, Brian J Dunkin, Kent R Van Sickle, Kimberly M Brown, Michael S Truitt, John M Uecker, Lonnie Gentry, Daniel J Scott
BACKGROUND: Despite numerous efforts to ensure that surgery residents are adequately trained in the areas of laparoscopy and flexible endoscopy, there remain significant concerns that graduates are not comfortable performing many of these procedures. METHODS: Online surveys were sent to surgery residents (98 items, PGY1-5 Categorical) and faculty (78 items, general surgery, and gastrointestinal specialties) at seven institutions. De-identified data were analyzed under an IRB-approved protocol...
July 2016: Surgical Endoscopy
https://www.readbyqxmd.com/read/26258313/factors-influencing-the-decision-of-surgery-residency-graduates-to-pursue-general-surgery-practice-versus-fellowship
#8
COMPARATIVE STUDY
Mary E Klingensmith, Thomas H Cogbill, Frederick Luchette, Thomas Biester, Kelli Samonte, Andrew Jones, Frank R Lewis, Mark A Malangoni
OBJECTIVES: Surgery residency serves 2 purposes-prepare graduates for general surgery (GS) practice or postresidency surgical fellowship, leading to specialty surgical practice (SS). This study was undertaken to elucidate factors influencing career choice for these 2 groups. METHODS: All US allopathic surgery residency graduates from 2009 to 2013 (n = 5512) were surveyed by the American Board of Surgery regarding confidence, autonomy, and reasons for career selection between GS and SS...
September 2015: Annals of Surgery
https://www.readbyqxmd.com/read/26215240/present-status-of-autonomy-in-surgical-residency-a-program-director-s-perspective
#9
Mitesh Patel, Jasneet S Bhullar, Gokulakkrishna Subhas, Vijay Mittal
As surgery residents graduate and begin their careers as junior attending surgeons, the question of whether a surgeon can complete a case alone still lingers. Allowing autonomy during residency answers this question. The purpose of this study was to gather input from general surgery residency program directors on how they achieve autonomy for residents in their programs. An online survey of 18 questions was sent to all general surgery residency program directors in the United States between April and June of 2013 via e-mail...
August 2015: American Surgeon
https://www.readbyqxmd.com/read/26209569/identification-of-behaviors-and-techniques-for-promoting-autonomy-in-the-operating-room
#10
Laura Torbeck, Adam Wilson, Jennifer Choi, Gary L Dunnington
BACKGROUND: To further understand how faculty promote resident autonomy in the operating room (OR), we explored their perceptions, and those of senior residents, on the behaviors and techniques they employ to foster independence. METHODS: Twenty postgraduate year PGY4 and PGY5 residents were asked to list 3 general surgery faculty who give the most and least autonomy to residents in the OR. Two focus groups were conducted with residents to identify behaviors and techniques for promoting autonomy from the resident perspective...
October 2015: Surgery
https://www.readbyqxmd.com/read/26160132/how-do-perceptions-of-autonomy-differ-in-general-surgery-training-between-faculty-senior-residents-hospital-administrators-and-the-general-public-a-multi-institutional-study
#11
MULTICENTER STUDY
Jason W Kempenich, Ross E Willis, Robert Rakosi, John Wiersch, Paul Joseph Schenarts
OBJECTIVE: 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. DESIGN: 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...
November 2015: Journal of Surgical Education
https://www.readbyqxmd.com/read/26119098/early-results-from-the-flexibility-in-surgical-training-research-consortium-resident-and-program-director-attitudes-toward-flexible-rotations-in-senior-residency
#12
Mary E Klingensmith, Michael Awad, Keith A Delman, Karen Deveney, Thomas J Fahey, Jason S Lees, Pamela Lipsett, John T Mullen, Douglas S Smink, Jeffrey Wayne
OBJECTIVE: To assess the attitudes of residents and program directors (PDs) involved in flexible training to gauge satisfaction with this training paradigm and elicit limitations. DESIGN: Anonymous surveys were sent to residents and PDs in participant programs. Respondents were asked to rate responses on a 5-point Likert scale (1 = strongly disagree and 5 = strongly agree). SETTING: A total of 9 residency programs that are collaborating to prospectively study the effect of flexible tracks on resident performance and outcome...
November 2015: Journal of Surgical Education
https://www.readbyqxmd.com/read/25980826/accreditation-council-for-graduate-medical-education-compliance-and-resident-competence-in-hepatopancreaticobiliary-surgery-during-general-surgery-residency-a-program-director-review
#13
Lauren Smithson, Khortnal Delvecchio, Vijay K Mittal
OBJECTIVE: A survey of general surgery (GS) program directors (PD) was performed to determine how Accreditation Council for Graduate Medical Education (ACGME) hepatopancreatobiliary (HPB) requirements are met and compare the findings with previous national averages. The objectives were to establish whether GS residencies are in compliance with ACGME recommendations. Secondary objectives aimed to determine if fellowship affects residency training. METHODS: A 30-question survey was sent out to GS PDs registered with Association of Program Directors in Surgery...
September 2015: Journal of Surgical Education
https://www.readbyqxmd.com/read/25966713/obstetrics-and-gynaecology-residents-knowledge-of-the-informed-consent-process-and-its-practice-in-their-training-institutions
#14
P I Okonta
INTRODUCTION: The ethical principle of autonomy as expressed in the practice of informed consent is a core tenet of clinical practice and good patient physician relationship. AIM: The aim was to identify specific gaps in the knowledge of trainee obstetricians and gynecologists in Nigeria about the informed consent process and its content. It also sought to describe the practice of informed consent in their respective institutions. MATERIALS AND METHODS: A survey of Residents in obstetrics and gynecology attending the revision course of the Faculty of obstetrics and gynecology of the national postgraduate medical college was done to determine their knowledge of the informed consent process and its practice in their institutions...
July 2015: Nigerian Journal of Clinical Practice
https://www.readbyqxmd.com/read/25799086/the-making-of-a-surgeon-10-000-hours
#15
REVIEW
Ronald B Hirschl
There have been many changes in the "making of a surgeon". Some of the key aspects that have altered residency/fellow training include work hour restrictions; a decrease in autonomy; and the explosion in knowledge, the change in technology, and the movement of complex cases away from General Surgery. There are a number of opportunities for enhancing current surgical training which include the following: 1) returning to reasonable work hour limits; 2) improving the efficiency of resident/fellow training by promoting early development of operative skills and starting down the path toward competency-based education; 3) increasing autonomy in the General and Pediatric Surgery residencies by developing and implementing structured processes for graded autonomy, further promoting the teaching assistant role, and even incorporating time as an attending into the period of training; and 4) developing a paradigm of uniform core surgery training followed by additional qualifications and training in both General Surgery and the surgical specialties...
May 2015: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/25796268/recovery-of-activities-of-daily-living-among-older-people-one-year-after-hip-fracture
#16
María Pilar Córcoles-Jiménez, Ascensión Villada-Munera, María Ángeles Del Egido-Fernández, Eduardo Candel-Parra, Mónica Moreno-Moreno, María Delirio Jiménez-Sánchez, Antonio Piña-Martínez
This article aims to determine the functional recovery of older people, who were previously independent in activities of daily living (ADLs) and without cognitive impairment, in the year following a fall-related hip fracture. A cohort study was carried out among patients admitted to University General Hospital of Albacete (Spain). Consecutive sampling was performed. Variables included demographic, habitual residence, type of hip fracture, mental status (Short Portable Mental Status Questionnaire [SPMSQ] Pfeiffer), and independence in ADLs (according to the Barthel Index [BI]) prior to the fall and after the fracture...
December 2015: Clinical Nursing Research
https://www.readbyqxmd.com/read/25703163/see-one-do-one-and-teach-none-resident-experience-as-a-teaching-assistant
#17
Teviah E Sachs, Timothy M Pawlik
BACKGROUND: Training of surgical residents depends on graduated autonomy in and out of the operating room. We sought to define trends in operative volume and number of teaching cases in graduating surgical residents over time. METHODS: We queried the Accreditation Council for Graduate Medical Education general surgery case log (1999-2012) for all case categories in which graduating chief residents performed a median of 20 or more cases during their training. Median (10th and 90th percentiles) number of cases performed as surgeon chief, surgeon junior and teaching assistant (TA) were analyzed using R(2) for all trends...
May 1, 2015: Journal of Surgical Research
https://www.readbyqxmd.com/read/25387852/are-general-surgery-residents-adequately-prepared-for-hepatopancreatobiliary-fellowships-a-questionnaire-based-study
#18
Houssam Osman, Janak Parikh, Shirali Patel, D Rohan Jeyarajah
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)...
March 2015: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
https://www.readbyqxmd.com/read/25239321/how-much-guidance-is-given-in-the-operating-room-factors-influencing-faculty-self-reports-resident-perceptions-and-faculty-resident-agreement
#19
Laura Torbeck, Reed G Williams, Jennifer Choi, Connie C Schmitz, Jeffrey G Chipman, Gary L Dunnington
BACKGROUND: 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. METHODS: 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...
October 2014: Surgery
https://www.readbyqxmd.com/read/25192794/reliability-validity-and-feasibility-of-the-zwisch-scale-for-the-assessment-of-intraoperative-performance
#20
Brian C George, Ezra N Teitelbaum, Shari L Meyerson, Mary C Schuller, Debra A DaRosa, Emil R Petrusa, Lucia C Petito, Jonathan P Fryer
PURPOSE: The existing methods for evaluating resident operative performance interrupt the workflow of the attending physician, are resource intensive, and are often completed well after the end of the procedure in question. These limitations lead to low faculty compliance and potential significant recall bias. In this study, we deployed a smartphone-based system, the Procedural Autonomy and Supervisions System, to facilitate assessment of resident performance according to the Zwisch scale with minimal workflow disruption...
November 2014: Journal of Surgical Education
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